Driving the Education Revolution
Novel Technologies and Big Data Enhance Medical Practice and Education
A second-year medical student in virtual reality (VR) goggles immerses himself in wraparound high-resolution graphics that make him feel as though he is standing inside a larger-than-life healthy lung. His classmates follow what he’s doing on a computer monitor. With the click of a controller, he gives the lung chronic obstructive pulmonary disease (COPD). A collective gasp rises in the room, as students can see in vivid, almost living, detail the disease’s effects on the lung. “Swiss cheese,” the student murmurs. “Don’t smoke,” another says.
“Virtual reality is used by doctors to plan surgeries at NYU Langone Health,” says Marc Triola ’98, Res. ’02, associate dean for educational informatics and founding director of the Institute for Innovations in Medical Education (IIME). “It’s used by researchers to visualize data and enables us to look inside the human body in ways that used to be physically impossible. We introduce our students to it early in their education, because it will be such a big part of their world view.”
Innovations in technology and information systems have revolutionized healthcare delivery and biomedical research. But U.S. medical schools, says Dr. Triola, have typically lagged behind in using these innovations to augment the essential—and unwavering—patient learning. NYU Grossman School of Medicine is leading the way forward through the work of the IIME, which applies technology and the science of education and informatics to transform teaching, learning, evaluation, and assessment. With 28 full-time staff and more than 30 affiliate faculty, the IIME is one of the largest medical education innovation groups in the country and represents a multidisciplinary team of faculty educators, education scientists, informaticians (data experts), and multimedia developers.
In programs and initiatives across undergraduate and graduate medical education, and in close conjunction with the health system, the IIME aims to close the gap between how doctors practice medicine and how medical students and trainees learn in the classroom and clinical settings.
The institute curates and develops education technology for the School, including using augmented and virtual reality to immerse students in highly experiential learning; apps such as in-the-moment evaluation tools and clinical resources for students and educators; and multimedia e-learning modules that supplement and enrich in-class learning.
“It’s never technology for technology’s sake,” says Crystal Mainiero, MPA, IIME’s executive director. “Technology in medical education is meant to support active, integrated, personalized learning. It’s always an enabler to [help students] do some really amazing things.”
The institute, which grew out of the Division of Educational Informatics, also avidly collects and leverages a wide range of data and evidence to inform and improve the education experience, making use of the rich data already available across the health system. “We are a science-driven medical center. Gaining insight from data is a theme that has transformed our clinical mission and our research mission. Now we’re working to make sure it’s transforming our education mission,” says Dr. Triola, emphasizing that data does not replace human decision-making but rather positions decision making to be more successful because it is more informed.
New Insights Pinpoint New Opportunities
Using data from a wide set of sources—including the learning management system; evaluation and assessment tools; simulation checklists; student information system; and electronic medical record, EPIC—IIME built an education data warehouse that enables educators to visualize and act nimbly on education-related data. “We’re leveraging all this data that we collect about our learners, about the curriculum, and about the healthcare system to inform our educational programs,” says Dr. Triola. “It makes perfect sense, but it’s not an approach that’s used by most medical schools.” The IIME recently received an award from the Association of American Medical Colleges’ Group on Information Resources for making “significant contributions to academic medicine information technology.”
The data warehouse, combined with enterprise analytics, gives educators a deeper understanding—in real time—of what students are learning, how they are performing, what they will need in future practice, and what changes can be made today to better prepare them for that future. The same can be said for faculty members, who gain actionable insights, again in real time, into their performance and the effectiveness of their teaching and evaluating. “With the infrastructure and ability to collect, analyze, and summarize all of this data, it gives us the ability to create a continuous quality improvement approach to medical education,” says Dr. Triola. “It’s moved us away from education driven by anecdotes to education driven by an epidemiologic approach.”
The NYU Grossman School of Medicine will use such a data-driven approach—combined, importantly, with human input—to inform and improve the transition from undergraduate to graduate medical education (UME/GME). The School collects a vast array of data on its undergraduate medical students—on their strengths and weaknesses, educational goals and trajectory, assessments and competencies—but little of that information makes it across the UME/GME divide. Now, with a $1.8 million grant from the American Medical Association’s (AMA’s) Reimagining Residency initiative, five residency programs will have access to that data right after a student matches to that program. Each student will connect with a residency coach, and, together with the resident’s mentor from NYU Grossman School of Medicine’s undergraduate coaching/advising Violet Society Program, they will use the data at hand to create a road map ensuring curricular continuity and relevance, and, ultimately, enhancing readiness for practice.
NYU Langone is uniquely positioned to develop and benefit from the five-year project, Transition to Residency Advantage, Dr. Triola notes, because a higher-than-average percentage of the School’s graduates continue on through residency: 40 percent, compared with a national average of 24 percent.
Active Learning Through Technology
Back in the classroom, the next student who wears the VR goggles becomes immersed in her selected organ, the pancreas. She first rotates a healthy 3D pancreas 360 degrees, then elects to view the pancreas with diabetes—to see the devastating effects of the chronic illness on the organ.
The class is part of an emergency medicine clerkship designed to give students firsthand experience with the specialty. Elsewhere in the conference room, fellow second-year students in VR goggles are immersed in a simulation to save a baby having a seizure. The immersive nature of the VR technology enables each student to check the baby’s vitals, clear the airway, give oxygen, and select lifesaving IV medications. The simulation increases in difficulty by medically complicating the situation and by introducing the baby’s virtual mother and a series of cascading distractions.
“The simulation allows students to put their knowledge and skills into practice and make ‘real-life’ decisions without compromising a real patient’s safety,” says Carol DerSarkissian, MD, Res. ’02, clinical assistant professor in the Ronald O. Perelman Department of Emergency Medicine. She developed the VR segment of the class with Gregory Dorsainville, MPS, IIME’s senior multimedia developer, after she took the Virtual Reality in Medical Education certification course he teaches for faculty.
“This is active, experiential learning, as opposed to passive learning, and students will remember more because they are learning from experience,” says Dr. DerSarkissian. “That gives them a more solid memory and a deeper understanding of that clinical situation and of that disease state.”
Novel technologies are driving profound advances in surgeries, research, and imaging. The School of Medicine is infusing technology into the curriculum both to ensure that students have a fluency with the tools of their future and to capitalize on what these technologies enable students to learn and do. This kind of enriched learning brings medical students deep inside a human body to experience systems, organs, and structures, as well as various states of disease and wellness, up close and remarkably intact.
“The overall concept is that it’s difficult to visualize in one’s mind what these structures actually look like, where they’re positioned, and what they’re doing. Immersive 3D tech does that,” notes Dorsainville, who is the developer behind many of the learning experiences that integrate existing and emerging technologies at NYU Grossman School of Medicine.
He narrates the immersive learning that is possible in a VR session: “Look at the heart. You can see different layers, the circulation, and the process of beating. You can see the nerves firing across all the muscles, which you can’t do with a cadaver. You can play with the values to manipulate how fast the heart is beating. There, that’s what it looks and sounds like at 75 beats per minute. Now speed it up, or slow it down.”
Starting this fall, students will be using virtual and augmented reality, 3D cinematic renderings of CT and MRI scans, and a new collection of plastinations, which are human cadavers preserved with plastic resins. In its leadership role as an innovator in medical education, the School continues to seek out the optimal way to combine technology and patient-based learning to best prepare the next generation of physicians and scientists.
“Conventional 2D clinical imaging—such as CT, MRI, and radiography—will be infused into the anatomy curriculum, so the students learn living human anatomy in the way they will be seeing it in the future,” explains Kira Melamud ’10, assistant professor of radiology. “Strategic use of advanced 3D rendering techniques will further enhance the students’ understanding of critical spatial relationships.”
New technologies that are being developed and used across the School and health system—including the point-of-care ultrasound—are only as good as the problems they solve and the benefits they deliver to people. “Technology is the enabler, not the driver, of the human changes that we want to realize in our education and clinical systems,” says Dr. Triola. “We’re not casting around for something to do with iPhones because we have them. Rather, because we know we have to have certain conversations at the bedside, we might investigate how an iPhone could help.”
Collaborate to Innovate
Ruth M. Crowe ’86, PhD (GSAS ’86), associate professor of medicine and director of integrated clinical skills, has collaborated with IIME to develop apps that provide standardized, real-time feedback for OSCEs (Objective Structured Clinical Examinations) as well as for workplace-based assessments, such as oral presentations and patient handovers. “Technologic innovations such as the I-PASS app enable standardized assessments that can be measured and followed longitudinally,” says Dr. Crowe.
“We’re gamifying around it: We can motivate learners to collect authentic clinical performance assessments in their electronic portfolio data with the realization that it can enhance their grades. This benefit drives behavior change in the form of practice and feedback, and leads to better patient outcomes.”
She emphasizes the importance of collaboration with clinical teaching faculty, ensuring that the assessment tasks and technology support their teaching goals, enhance communication with learners, and do not require undue time or attention from learners or instructors. “The major lift is not in creating the tool itself,” she says. “The hard part lies in getting buy-in for using the tool.”
IIME developed the NYU Grossman School of Medicine’s Educator Community to inspire and support faculty development in education innovations, including how to use data, novel technology, and e-learning modules to meet teaching and learning demands. In addition to holding regular workshops and providing resources to help faculty members remain current on the latest tools and techniques, the Educator Community holds an annual Medical Education Innovations and Scholarship Day to honor faculty who embrace technology and take it to the next level.
Dr. Crowe’s goal is to support instructors and learners through change. “As we move toward competency-based medical education, these innovations can help sustain a major culture shift,” she says.
Written by Deborah Schupack