Spring 2014
Technology in an Academic Environment

synapse: University of Nevada, Reno School of Medicine

Third-year medical student James Verlanic

Third-year medical student James Verlanic performs a drill that enhances bi-manual dexterity and hand-eye coordination, skills crucial in the performance of laparoscopic surgery. Photo by Edgar Antonio Núñez

Smartphones, webinars, apps are used daily across campuses

By Anne McMillin, APR

A student enters the Savitt Medical Library and heads, not for the stacks, but for an electrical outlet to hook up her laptop computer.

A resident pulls his smartphone from his lab coat to check an app that describes side effects from a medication he is about to prescribe for a patient.

The use of technology in the modern academic medical setting has made time-consuming research a thing of the past, leading to more efficient use of students’, residents’ and faculty time.

The University of Nevada School of Medicine is making use of such technology in a variety of forms in academic and clinical settings across the state.

In the Clinic

Many faculty members in departments that have migrated to the School of Medicine’s new electronic medical records system are enthusiastic about the use of technology in the clinical setting, and while the learning curve has been steep with the new electronic system, they recognize it is the way of the future.

The implementation of electronic medical records in the Las Vegas internal medicine clinic has been an exciting opportunity for the department, according to John Varras, M.D., chair, because it has helped facilitate communication between physicians of different specialties as doctors can immediately see full notes and studies of patients seen by other providers.

“It is a highly efficient way of tracking laboratories and studies and is very effective in the primary care setting to track preventive care to assure patients receive appropriate screenings, vaccinations and treatments at the appropriate times. We hope that utilization of the electronic medical records will enhance the quality of the care we give our patients.”

Across town at the School of Medicine’s pediatrics center in Las Vegas, Rani Kharrubi, M.D., an assistant professor and pediatrics hospitalist who works closely with both residents and patients, uses technology in several aspects of his professional life.

A computer mounted on a rolling cart offers him great flexibility when entering or pulling up orders for labs, medications or nursing instruction for young patients.

Many times over the last several years, a parent has come into the clinic with a smartphone image or video of their child’s condition as a visual representation to help in diagnosis.

“Smartphone images have been particularly helpful, especially with the progression of rashes as it helps me make the diagnosis and manage the patient,” he said.

Conversely, he uses medical apps to show images of conditions to parents and help him explain what the child is experiencing. He has several favorites he uses including one on infectious diseases and another with pharmaceutical information on dosages and side effects.

While Jeremy Bearfield, M.D. ’11, co-chief resident in the Reno family medicine program, limits his smartphone use in front of patients, he constantly relies on the technology throughout the workday.

“I use apps to keep up-to-date on the newest treatment guidelines and to stay current on research publications,” he said, adding that it is important to him to have medical evidence available to him when practicing evidence-based medicine.

One application stores his physician’s patient notes online for all his attending physicians and students to see.

“It is more timely than using hospital computers and cuts down on errors,” he said.

“But I do use hospital apps to get lab results, even from my home computer.”

While in an exam room with a patient, Bearfield takes hand-written notes so as not to appear to be rude or impersonal, or put up a physical barrier between himself and the patient.

Yet curiously, he says older patients are often fascinated by his use of technology and ask to see what he is looking at on a phone or computer.

“I will even email web sites to patients to give them the right information on a medical condition,” he said, adding that probably 20 percent of his patients self-diagnose using web information or “scare themselves into a cancer.”

He sees part of his role is to educate and train patients about finding accurate medical information on web sites, which, in turn, empowers them about their own health care.

In the hospitals where Bearfield sees patients—the Veterans’ Administration, Renown Health and St. Mary’s Regional Medical Center—three different electronic medical records systems are in use and he has had to learn each, something he knows older physicians have struggled with doing to varying degrees.

While the older generations may take longer to adapt to technology in the clinical setting, Bearfield sees medical students using it without hesitation.

“I like that students can look up information right away; it is helpful in a team setting,” he said.

In the Library

The Savitt Medical Library, located in the Pennington Medical Building on the Reno campus, is keeping up with current trends in technology by providing equipment and services desired by today’s learners.

Terry Henner, library director, explained that services offered by the library have been a function of library industry trends over time.

“Emerging trends are driven by the marketing practices of book publishers,” he said.

“We have seen the pendulum stuck on both ends. At one point, we offered online databases with a fee for the connection, before moving to buying books on CD so that students can load the content locally. Now we are back to online subscriptions for widespread distribution.”

The Savitt Medical Library currently has access to 350 e-books through its online subscriptions that are accessible from anywhere in the state for those with library access.

Henner added that the library is looking at ways to buy e-books preloaded onto tablets and then offering those tablets for loan to students who then, effectively, carry around their own library, even when off-campus.

With the proliferation of smartphone apps aimed at the medical community, Henner has taken the extra step of easing the pain of adopting new technology by hiring two coordinators to test medical apps and make recommendations.

Webinars are now available to help learners use the library’s resources for those needing a little extra help or time. The goal is to demonstrate how to use the library’s databases and its software applications on multiple platforms.

“We are also moving into developing workshops on using technology in medical education and clinical settings via webinars,” Henner said, adding that his goal is to break ground in the use of technology so others can use it.

Another technology being implemented at the library is called ‘screencasting’ where brief video captures of computer screens are created and posted online to answer specific questions about information-related tasks.

“It’s a great way to deliver personalized, easy to understand instruction to the user’s desktop,” Henner said.

Finally, the Savitt Library is moving toward digitizing its resources that are in the original print or film format. Cassette tapes of oral history have been digitized.

In the Teaching Environment

The Clinical Simulation Center delivers high quality education for health care students and professionals by providing access to modern instructional technology and curriculum design.

High-Fidelity Simulation Labs Each of the five high-fidelity simulation rooms recreate a specific hospital environment with a specialized high-tech manikin that allows students to take vital signs and make assessments. Through a two-way mirror to the central control center, faculty and staff continually monitor student performance and can dynamically alter patient physiology, dialogue and behavior in real time. Training scenarios are live streamed to the rest of the class in one of four debriefing rooms, and are digitally captured and recorded for playback.

Skills Training Labs The Simulation Center has two clinical workstation labs, which are primarily utilized to teach repetitive skills-based tasks. Here, IV arms, chest tube manikins and ear exam heads are used to teach the many specific and complicated skills necessary by health care professionals. Each room has 24 laptops for student use, as well as smart panel technology. Unique in these rooms are the cameras that videotape faculty demonstrations from above, allowing all students to see specific hand movements.

Surgical Labs The surgical skills lab has a full array of surgical instrumentation from typical open instruments to laparoscopic instrumentation devices. The LapMentor has the capability to train laparoscopic procedures; including bariatric and obstetric and gynecological procedures. The GIMentor is capable of simulating endoscopic gastrointestinal procedures. This lab is also a certified Fundamentals of Laparoscopic Surgery test center with two qualified proctors and five endoscopy towers, with the capability of establishing full operating room simulations and scenarios.

Classroom At the William N. Pennington Health Sciences building in Reno, faculty and staff use software to integrate and compress the audio, visual and data training components into one file to offer playback in a secured environment for an enhanced learning experience using the technology. Podcasts of lectures are now offered by some faculty.

Kathleen Keef, Ph.D., professor of physiology and cell biology who teaches kidney and acid base balance lectures in Block Two, sees advantages to having her lectures recorded for student access at a later date.

“Being recorded provides a way to go back and review the portions of the lecture they may have missed,” she said, but added that she still expects students to be present for class.

“My priority as a lecturer is clarity, and visual aids such as diagrams and pictures greatly improve clarity and help me get abstract concepts across to students.”