Anesthesia Online
Med Students Meet Virtual Patient

Dr. Fleming, M.D., Associate Professor in the department of Anesthesiology, leads his students through an online anesthesia administration to their virtual patient, "Stan". Photo by Jeff van de Pol

"Uh oh. I think we killed Stan," said a worried medical student to her classmate as she searched for visible signs of life in the seemingly still patient. A quick review of the vital signs monitor ensued, showing that all was well. After a closer look at the patient, the procedure continued, and Stan's 100 doctors, who were all 20 miles away, collectively breathed a sigh of relief.

In a preview of the possible future of medical education, a large group of students in Dr. Fleming's Anesthesiology class used a high-speed video network link between the campus and the UC Davis Medical Center (UCDMC) to remotely decide upon a course of anesthesia, direct the process on "Stan"--an advanced human patient simulator mannequin--and view the effects in real time.

Previous Issues Nutrition and Animation: Students Can't Get Enough Corporation for Education Network Initiatives in California IET Mediaworks

The result of extensive collaboration between the School of Medicine, UCDMC, and Information and Educational Technology (IET), the remote human patient simulation proved extremely popular among students.

Breaking New Ground
Mindful of the significant distance students must routinely travel between UCDMC (in Sacramento) and the campus, the School of Medicine began searching for innovative ways to allow for easier collaboration. Space for these kinds of demonstrations at the Medical Center is another challenge that school officials were eager to overcome.

"In the past, sessions like these have been limited to 5-10 people who could manage to squeeze into the demonstration space," shared Paul Ver Wey, head of the IET Mediaworks Video Group involved in the project. "Instructional videos were helpful, but did not allow for any real-time interaction between the viewers and those involved in the procedure."

To overcome these challenges, the School of Medicine worked extensively with the UC Davis Health System (UCDHS) Network Operations Group and two IET departments, Communications Resources (CR) and Mediaworks. Collectively, they developed a two-way real-time video link between the campus and the Medical Center.

This type of link between the two facilities had never before been attempted over an IP network. "We never have done a large video stream to and from campus, so we had to continually monitor bandwidth usage to ensure a smooth image and sound," said Daniel Keister, a Senior Network Engineer with UCDHS Network Operations. "I worked with the video encoder/decoders to compress video and audio and sent it across our IP network to the other encoder/decoder on campus."

At the Medical Center, an IET Mediaworks video crew provided three different views of the remote operating room: side and overhead views of Stan, along with a full-screen view of the machine hooked up to Stan that displayed his vital signs. An IET Mediaworks video crew also set up cameras in Dr. Fleming's classroom in Tupper Hall, where two projector screens displayed Dr. Fleming's PowerPoint lecture and the live images of Stan.

"With everything in place, Dr. Fleming and his students were able to switch between the views as needed, and converse with Dr. Wong, who oversaw the anesthesia administration on-site," shared Ver Wey.

Students Like Their Virtual Patient
The students as a whole seemed to enjoy the interactive aspects of the two-way video link. "This is a good way to see the practical use of the material we're learning," said Ravjeet Kullar, a second-year medical student. "We're more likely to remember when we're taught in an interactive way."

The class members were also big fans of the advanced human patient mannequin (nicknamed 'Stan'), which accurately simulated the effects the students' anesthetic choices would have on a live patient. "It was nice seeing the connection between what we were learning and real medicine," said Kullar. "We felt more engaged since we could immediately see the results of our anesthetic choice." The students watched on as Stan's vital signs changed, his breathing rate fluctuated, or his muscles twitched in response to the anesthetic the students chose to administer to him.

The Future Looks Bright
Future plans bode well for collaborative projects like this, as Communications Resources, working with CENIC (Corporation for Education Network Initiatives in California, http://www.cenic.org/), is now installing equipment for the Optical Network Infrastructure (ONI) initiative, a project that will greatly enhance the networking speed available to higher education on the West Coast. Once completed (the second phase will take approximately one year), both the Medical Center and UC Davis will have direct access to each other and to the high speed ONI infrastructure. "This will enable the campus and the UC Davis Health System to use HDTV (High Definition TV) and other advanced technologies between us without impacting the IP data network," shared Keister. "I think it has great potential, as it gives students the ability to see and hear real world medical procedures without having to travel."

One other suggestion for future distance learning medical education is an unexpected but enlightening one: the students actually want longer classes. "I would've appreciated having a two-hour lecture rather than just one hour," said Kullar.

Send us your comments on this story.