THE COLLEGE HILL INDEPENDENT


Simulated Bodies

How virtual physicalities are changing the landscape of medical education

by Parisa Thepmankorn

Illustration by Eve O’Shea

published December 7, 2018


Medicine is intimate. Beginning from our very first breath, most likely taken inside a hospital room under the watchful eye of an OB/GYN doctor, medical professionals are the recurring characters who oversee the bodily changes, conditions, and diseases we experience throughout our lives. The doctor-patient relationship is intrinsic to the practice of medicine, as doctors must simultaneously communicate and interact with their patients while they evaluate, diagnose, and treat.

Effective physician-patient communication has been found to correlate with improved health outcomes, according to a 1995 literature review published in the Canadian Medical Association Journal. Since patients who trust their doctors are more likely to adhere to treatment plans, traits like empathy are critical in a doctor to build trust, effective communication, and high-quality patient care. Empathy is also a major contributing factor to physicians’ “heightened understanding and appreciation of the social context of the patient,” as described by Cheryl Kodojo in a paper published in Pediatrics in Review. Given the diversity of most patient populations, more empathetic physicians are able to better understand the influence of different races, backgrounds, cultures, religions, and socio-economic statuses on health. This helps them navigate sensitive conversations, recognize social determinants of health, and provide more individualized care. By viewing patients as people rather than vessels for diseases, physicians can help improve people’s health beyond simply treating symptoms.

The question, then, is how can we train our physicians and other healthcare professionals to empathize, especially when working with diverse patient populations? Surely, it cannot be taught the same way one might teach human anatomy in a classroom. In fact, a 2008 paper published in Academic Medicine correlated attending medical school with a decrease in students’ empathy for patients. Perhaps one of the contributing factors to that finding is medical schools’ emphasis on the technical aspects of medicine and their lack of focus on its actual practice. To improve medical professionals’ understanding of various patient populations, some innovators have turned to simulations.

 

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Life-like flesh, sculpted out of PVC. Entire organs with detailed anatomical parts, manufactured from plastic. Currently, hospitals and medical schools rely on physical simulators to educate and train staff in technical aspects of medicine. Mannequins and specific task trainers are used to teach clinicians how to react in different scenarios or perform certain procedures. Using these tools, practical skills can be taught and mistakes can be made without any of the ethical qualms that come with learning through firsthand patient experiences.

Unlike the clothing mannequins one might see in storefronts, the realistic details in these generic, plastic bodies are often revealed only after closer examination. Low fidelity mannequins, which lack most life-like features, are often used to teach basic skills such as CPR, while the more expensive high fidelity mannequins come closer to mimicking living patients. At over four thousand dollars, the high fidelity Noelle Maternal Care Patient Simulator simulates various obstetric care situations and includes features such a dilating cervix, a realistic uterus that can be massaged to lessen bleeding, and a placenta with detachable fragments. Due to the abundance of simulated bodies available for practice, the often-repeated mantra in medical education, “see one, do one, teach one,” has essentially evolved into “see one, practice many, do one.”

However, the high cost of physical mannequins effectively eliminates the possibility for a diverse representation of patients. Because each one is generally used to practice specific scenarios, most simulation centers prioritize the purchase of mannequins of different types or of higher fidelity over diverse ones. In fact, normative physical presentations are often the only option. For example, the Noelle Maternal Care Simulator is a thin, white, blonde woman, with no other ethnicities, races, or body types offered as options. If the goal of using medical mannequins is to mimic “real” patient care scenarios, how real can they actually be when they do not reflect diverse patient populations? The Noelle Simulator is not useful for teaching physicians effective communication techniques, nor how to handle nontraditional medical care scenarios. Even a technically successful delivery of a baby could be marred by poor communication, leaving the patient unhappy, frightened, and confused.

 

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Luckily, new developments in technology have begun to advance simulation-based learning in order to provide more well-rounded medical training through no-risk simulations. Where physical mannequins fall short, virtual reality (VR) can be used to compensate––at least in part. Simulated reality startup SimX is one such technology that offers users advanced levels of customizability. The company’s website boasts that “if it can be done in a modern video game, it can be done in the SimX case system.” Any imaginable scenario can be created, such as helping a pregnant African-American woman who goes into labor while on a bus, or examining an elderly below-the-knee amputee during a check-up. After putting on the appropriate equipment, SimX users are immersed in an entirely different, entirely virtual world. They can ask questions aloud to learn about the patient’s medical history and receive actual audio responses, perform basic physical exams and diagnostic tests like ultrasounds, and analyze medically accurate results.

VR reduces the inhibitory effects of monetary cost—besides the initial investment in software and equipment, the only cost is case development time. Now, educators can use software like SimX to affordably develop multiple medical patients and scenarios that reflect reality and help professionals improve their understanding of the effects of race, age, and other facets of a person’s identity on health. For example, scenarios could be written so users could learn to communicate with patients who are resistant to certain treatment plans for religious or cultural reasons.

However, SimX is not a complete solution. Though it allows for the simultaneous training of both medical and patient care skills, it is still only a platform to begin addressing the need for diversity and communication training in medical education. As a new startup, SimX software has only just begun distribution among select institutions. There is no guarantee that this technology will result in anything but the simulation of normative virtual bodies in medically-focused scenarios, as the decision to integrate patient diversity is dependent on the scenario developers. How thoroughly those patient care skills might be taught and developed, however, still remains up in the air.

 

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Physicians, nursing home staffers, and family members of patients alike can also learn understanding and empathy about specific patient experiences through virtually walking in a patient’s shoes via startup company Embodied Labs’ “Embodied VR Experiences.” Unlike SimX, Embodied Labs immerses users in videos taken from real life, involving scenes and people captured on film. Instead of immersive medical simulation, these experiences instead focus on immersive medical storytelling.

The Beatriz Lab is one narrative experience among a small selection offered by the startup. By donning a headset, the user virtually embodies Beatriz, a middle-aged Latina woman, and follows her progression through different stages of Alzheimer’s Disease. Looking at the world through her “eyes,” the user experiences her growing disorientation, family discussions about her future, and nursing care. Through physical hand controls and voice recognition, users are able to interact with the simulation prompts as needed.

Such simulations move beyond the boundaries of mannequins and clinical settings. For Embodied Labs, the question is not how close technology can come to mimicking human bodies; rather, it is how close technology can bring us to mimicking the human condition. If empathy is the ability to understand and share other people’s feelings, then according to Embodied Labs, the best way to cultivate it is to simply experience them yourself.

Of course, this immersive experience does not come without qualms. As a new company, Embodied Labs lacks scientific research that validates the effectiveness of their technology in cultivating understanding or empathy. And despite technological advances, these experiences might lull users into a false sense of understanding and overconfidence about their ability to empathize. After all, it is impossible to actually embody someone else’s identity, experiences, or perspectives and truly walk in a patient’s actual shoes––only their virtual ones.

 

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The innovative work of SimX, Embodied Labs, and similar companies allow healthcare education to expand past its earlier confines. But how useful are these simulations, really? While much anecdotal evidence exists lauding VR technology, little quantitative research has been completed as to the actual efficacy of VR-based simulation training in medicine.

Simulated bodies are not flesh and blood, and their usefulness in enabling skill acquisition varies. In an age of digitally-driven medical education, it is critical to approach technology with a degree of caution. A 2002 study published in Annals of Surgery found that VR-based training of a gallbladder excision procedure helped residents perform it with less errors than those who underwent conventional training. However, it is one of few studies on the the technology’s efficacy, and not all surgical procedures will benefit from the switch to VR-based training. There is also little existing research about its effects on non-surgical forms of healthcare and physicians’ communication skills. Further examination of the widespread effects of VR-based medical simulation training is still necessary.

But it is worth acknowledging that, despite its novelty and potential limitations, simulation technologies are beginning to transform the landscape of medical education. By challenging gaps in diversity, empathy, and humanistic care, they remind us of the roots of medicine: the people, the intimacy, the ability of doctors to fundamentally change and improve people’s lives. In the face of scientifically advanced medicine, we must not forget that real bodies are more than their biology. More than vessels for disease and disorder, illness and disability. They contain what it truly means to be human, in all of their complex and varied forms. They are vessels for life.

 

PARISA THEPMANKORN B’20 is still obsessed with The Sims.