Women can be 2 year computer techs and work in office jobs for 50k a year. Women do not need the low paid nursing assistant jobs and day care jobs. Good luck getting an 18 year old to do the hard physical labor risk for an RN with the real potential fir getting hiv hep c pneumonia law suits plus crazy family. Trump anti immigration is also killing the low paid immigrants willing to take these awful jobs. Bright women 40 years ago had 2 choices nursing or teaching. Now the join the National guard and become police officers. No sane person would take these high risk low status jobs except immigrants here for economic opportunity.
21
Commenters pointing out that technology is not nearly as important as learning how to interact with actual people ("the human touch") are, I think, missing the point. The tech isn't there to pre-empt or replace that, it's there to provide the early practice for that technical skill: would you like to be the first person a medical student or intern puts a central line in (a large-bore IV that goes into a big vein, like the ones in the groin or neck)? What about being a nursing student's first-ever urethral catheter insertion? In the 1990s, when I trained, I was regularly told, "don't practice on me." This tech can take some of the stress out of early-stage skill-learning for both students AND patients.
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Learning to care for patients is a never ending process. So it's called the "practice" of medicine. These innovative teaching techniques are all terrific; as is getting students (even premed students) involved as early as possible in clinical situations. Students love it and benefit from it. So do the vast majority of patients.
25
as just another dinosaur, i am glad people can practice on mannequins, but nothing can really prepare you for the panic of placing an instrument into the body of another human being. it is the fear and stress that leads to the humility necessary to be good without being arrogant. But it seems that the main loss from all this technology, is giving drs the work ethic that is required to provide caring treatment , which is rarely 9-5. again, i am a dinosaur, but i still feel privileged to be able to have this career, and i feel badly for those who only get a job.
32
Technology does have its place but I always tell students I tutor to "touch as many people as you can" (ethically, compassionately, professionally). You will learn more with your senses than you will with technology. Is the body warm, cool, sweaty? Do they have pitting edema? What sounds do you hear? That being said, there is a play for having mannequins you can do more with and adjust the vitals/EKG variables so that student can think more critically.
14
it seems like a million years ago, but the one thing I wish I'd had more exposure to was how to just go talk to my patients. Honestly, how to walk up, say "hey man! i'm your nurse for today! how are you!?" People in the bed are just people. They are all in some kind of crisis mode, and are desperate to be treated as human beings rather than just a set of diagnoses and list of medications and complaints. I had been an RN for over a year before I really figured it out... and it was a CNA who showed me the way -- pushing a bed down to the cath lab she called a patient their military rank (he was an officer), and it reminded me that we spend a huge amount of time learning how to treat the problems, but not learning how to relate to the people -- it changed how I interacted with patients. I spent over a decade in the OR taking people to surgery, holding their hand as the anesthesia team worked their magic... and I've never regretted being at least a little "familiar" with most of them. Our patients need to feel like they are will trusted, skilled people who welcome them, however briefly, into our family.
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There is no mannequin that can replace the touch, feel, response and smell of a human being. Yes,-- smell. My doctor husband was actually trained 38 years ago to smell his patients as there are diseases that can be picked up that way during a clinical exam. And having recently graduated a son from medical school, technology has served to keep med students away from the classroom due to online videotaped lectures. My kid was one of only a few who would attend and raise his hand to ask questions.
Technology has its' place but it can also detract from serious learning.
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From the perspective of a clinical educator with fellowship training in medical simulation, it is becoming ever more apparent that the advanced technologies involved in high- and low-fidelity simulation can and should only be used as a supplement to clinical education, rather than a replacement. Manikins, task trainers, and standardized patients lack the human variables that are only discovered through the interactions with real patients in possession of psychosocial-tolling medical illness and various degrees of health literacy, trying to navigate the most complex healthcare system in the world. One only needs to look as far as current survey data published by our healthcare professional institutions to realize that the primary ailment plaguing healthcare education is lack of clinical placements. The remedy for the looming shortage of healthcare professionals is not simply speeding up the assembly line production of healthcare students via robots and artificial patient encounters. Yes, Henry Ford would be disappointed. The polished, market-ready prototype healthcare student requires the same gentle weave (of quality clinical experiences) from which their proverbial white coat was fashioned. Perhaps “Clinical Rotations Matter” is our next movement. University presidents, deans, and program directors take note - the future quality of our healthcare depends on your evidence-based decisions.
18
It will always be difficult for us nurses who remember profound moments of learning like touching someone. 30 years of bedside nursing and 10 in a major university's school of nursing I know many things have changed, have to change we should say. My advice for new nurses and physicians is to learn and learn some more. Take care of yourselves because it is a great life choice!
16
The near future of medicine is English, as it is for air traffic control worldwide. Having followed the enormous problems Syrian refugees who are already qualified but who may not work in European countries simply through lack of local language skills. The reason Indian medical staff are found everywhere on the planet is thanks to the excellent Indian medical studies which are of course in English, and not in Hindi or any other Indian language.
6
Interesting, but . . .
. . . What happened to the human touch . . . the extra three minutes to connect with the patient, to soothe anxiety, to answer questions?
All the technology in the world cannot make up for kindness and empathy.
Those missing qualities can make a game-changing difference in healing. And to ignore them places all patients in jeopardy.
29
hate to say it but these are a bunch of gimmicks looking for a use. want good doctors? give them enough time with each patient to do an adequate history and physical exam. the state of medical care is abysmal because the basics aren't covered adequately and this doesn't require VR or some other device.
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The increasing use of technology in medicine detracts from a necessary truth and affirms a misunderstood fact. Technology detracts from the truth that the practice of medicine often is based in science, but science is not synonymous with technology. It is “often” based in science, but much of medicine is ritual. And it is especially based on the lore of public health. 90% of progress in health over history has been progress with respect to public health measures, not progress with regard to the ractice of medicine (I made that monetary figure up, but it isn’t inaccurate—call it “mathiness”—it’s less than the figure used by fellow medical faculty when I taught in a medical school many years ago).
The increased use of technology also brings to the fore a misunderstood fact that medicine is very much an art form. To those who think that art has nothing to do with truth, you should be apprised that you know very little about art.
15
Hmmmm.......... and what kind of technology deals with “I’m sorry, your insurance won’t pay for............”
As an RN Case Manager with a lot of other experience too, this was getting pretty hard to explain to patients.
How about a technology that tells patients to vote for people that care about pre-existing conditions? How about technology that tells people Trumpcare that we get emails about is a big sham? How about technology that helps people get insurance companies to approve healthcare needs without a hassle because they already have paid exorbitant fees for their premiums?
Or how about a little class for these students to just help them realistically know what they’re going to be dealing with when patients “can’t afford” to pay for the technology?
I’m all for technology and assistance in getting the best patient care - whatever it takes. But let’s figure how out people can actually get that care without going broke. When an old man has to either sell his truck or go it alone at home without nursing home care that he should get post op - what technology is going to help him?
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I like the idea of being able to practice important skills with a simulator.
However, other aspects of “new medicine”, seem to me dehumanizing.
Dr. Leroy Hood advocates for “P4 medicine” which he has described as (paraphrasing) reconceptualizing the “patient” as clouds of information that a multidisciplinary team would use to provide individualized therapy for.
Good therapy is critical, but the patient must always be the person on the other side of my log.
I don’t really like telemedicine either (at least, not yet ).
Stephen Rinsler, MD
Volunteer physician at a free clinic
17
They don’t look like doctors as much as video game players. The technology barrier between patient and doctor is literally there in these photos. Is it better care?
14
One purpose of the new technology is to reduce the time that medical school faculty need to spend with students. The faculty at my alma mater has more than doubled since I was there, yet the class size is exactly the same.
The best learning that I had in my training was with experienced doctors who mentored me. Technology can never convey the accumulated wisdom of experienced clinicians.
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A few years ago, I graduated from a Medical School with a state of the art Clinical Skill Lab similar to that which was described; now I am in the last year of my residency. The high tech gadgets (e.g. the life like mannequins) provided almost no benefit to my education. Were they fun to use? Yes. Interesting? Of course. But, in no way did they prepare me for live patients. The situations we practiced were often inappropriate to our level of education at that point (e.g. MS-2 students running codes not having done ACLS), and the high tech aspects of the skill lab felt like a farce. These type of skills are best practiced in real experience.
In contrast, the exposure to simulated patients (real scripted people) was invaluable. I learned the intricacies of the H&P by interviewing and examining these paid actors. With their permission, we performed our first full body exams which provided exposure before seeing our first patients. I rehearsed asking the questions of a proper history.
In my opinion, the high tech lab was a fluff selling point of the Medical School to lure in naive potential students with the glitz of (ultimately useless) technology. Sadly, Medical education is a business, and each new student is a source of revenue and potential future donor. The faculty and companies involved with these centers have vested (varying) interests in this equipment. So, it is unsurprising to read their rosy reviews in this article, but the reality is far more complex.
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@Alex As a long-time faculty member at a medical school that boasts such a high tech lab, thank you for speaking the truth. Unfortunately, I don't see these trends turning around.
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@Alex
Thank you for voicing this viewpoint.
I am a faculty at a training program with a lot of investment in such a center (not quite as high tech as the article) but each sim session for 2-4 fellows takes about 40 faculty hours to prepare. 2-4 other fellows just watch. i think there is too much emphasis on the tech and not enough on using the mind itself as a visualization tool.
Also, even if they reduce the pathology lesson to 5 minutes through VR, the brain can't learn everything faster just because the lesson got shorter - some things take time and experience.
41
The diseases we develop in the US are primarily preventable but very difficult to treat because it is diet and lifestyle changes that are required. Type 2 Diabetes is bankrupting the healthcare system but you don’t see Congress going after the culprits which is corporately produced processed foods. We have met the enemy and it is us. Also western thought is too obsessed with length of life versus quality of life. We need to develop a better comprehension of healthy living rather than the idea that we can expect the overpriced health care system to solve our self induced medical problems. We are a self destructive society and we are exporting our self destruction to the rest of the world.
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@jeff bunkers
And yet, there is relatively little interest in working to understand the human mind in order to enable us to change for the benefit of other members of the biosphere and ourselves.
We seem to actively avoid thinking about what makes us “tick” so badly.
15
I sure hope there is more "eyeball training" along with the techie stuff.
If you have interfaced with the medical system with an older person from your family that has dementia, you find lots of wonderful technology and endless data possibly coupled with your person not being turned in bed, not given food or pain meds because it hasn't occurred that the person with a fracture has dementia and cannot fill out the online menu and will never ask for medications. Bedsores that develop because the doc and nurse often don't check skin until the family says something is wrong.
We were grateful for top notch care and then were scratching our heads at what were just big giant holes in care unless you had an exhausted family member advocating for you. Hope that changes too.
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@Kay Johnson
I went 5 days without food in the hospital because I was never told about filling out a menu and was too sick to do so, anyway. And I'm not an elderly person with dementia. There were several other "giant holes in care" that made it a terrifying experience.
27
All the technology in the world will not make up for the lack of knowledge and lack of attention to details that can only be achieved in hands on one on one interaction and real examination of patients. Most doctors barely pay attention to the patient. Their focus is on
entering data into the system via computer so they bill for services. The patient care is marginal with a lot of misdiagnosis as the result.
35
@Surfer
Look at the first picture in the article; all 5 people are attending to the computer, not the patient, as was my experience in the hospital. I'm sure my misdiagnosis was not unusual because the lack of attention to the patient is the standard of care today.
30
The harsh reality that I have personally experienced is that seasoned providers with decades of experience
and a represent a invaluable resource are being forced into retirement by hospital conglomerates once these providers become eligible for Social Security and Medicare. These providers are being replaced by younger inexperienced cheaper healthcare workers. I became familar with this quote nearly fifty years go American surgeon William Osler who said “To study the phenomenom of disease without books is to sail a uncharted sea,but he who studies medicine without patients does not go to sea at all.” Aging providers may not be familar with the latest app but can reassure a worried parent about a toddler with a rash. That is the the true art of medicine which corporate medicine could care less about.
62
The article is fine but overlooks discussion of some other big problems on the shortage of nurses - getting nursing instructors. Lots of people applying to nursing schools but not enough space. Not enough because not enough instructors. Not enough because potential instructors can make more in the hospital than teaching. The teaching isn’t valued so not rewarded, even as we starve for more nurses.
The other weakness in having so much high tech approach as nice as it sounds - we still need a lot of primary care givers doing “down and dirty” work, not based on high tech. Students come to expect the latter, are off by the former - oh, and by the way, aren’t paid well enough for it either. How about maybe just a little more money for human care and maybe a little less for relying on tech.
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Without a doubt we need more RNs. So why has the 4 year BSN degree become required for most jobs? The fact that I can discuss German Lit or economics has NO impact on my ability to provide top notch nursing care. I have found 2 years associate degreed nurses better prepared to care for patients than RNs with 4 year BSN degrees. Praxis, via continuing education, is how to build the most competent highly skilled RNs we need. If nursing schools focused on 2 year programs we could train many many more new RNs than we do now
25
@Science Teacher I absolutely agree with you. I would love to teach nursing anywhere in the U.S., but I need a Master's (currently enrolled in MSN Ed. program) to teach at tech school or community college (PhD. for university). Sadly, when I do get my MSN Ed., the positions aren't tenured and they don't offer medical benefits at two year ADN schools. They are only contract jobs. I love teaching but I understand why nurses don't go into it. You can work with a BSN and make a lot more with benefits, even at part time whereas you have to have an MSN with no benefits and only contract work. It is something that needs to be addressed. Student loan repayment would also be nice for those who do go onto get MSN degrees for teaching.
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@nick RN As a hospital librarian who has worked for years with nursing students and nursing faculty, I completely agree that the now-often-mandated BSN to hire bedside nurses is a joke. I have had 20-year veteran ADNs in my office in tears because they were so frustrated by the pseudo-academic nonsense they were being put through just to keep their jobs. And by the clueless faculty who have never actually worked in a clinical setting (or did so years ago), but just stuck with teaching "nursing theory" and "critical thinking" and demanded papers written with impossible criteria out of ignorance of actual evidence-based literature. And the nurse managers who despair becase the new grads arrive on the floors with no idea how to give an injection. Our hospital has spent untold sums in building its own sim lab and intense new-hire training programs so the new kids DO get a chance to place a central line, manage a stroke, and evaluate a diabetic patient before they're turned loose on actual patients. Something is definitely awry; technology is only part of the answer.
20
Technology has the potential to be great in all scenarios...including healthcare. What people need to realize more than anything else ... is that caregiving in the medical world .... really good caregiving is ...an art just as much as it is is a skill. Technical skills can be learned in labs ... theory can be learned in lecture and books. Empathy compassion and understanding of humanity and illness however can’t be learned in my opinion. Either one possesses the skills or they don’t. In my almost 30 years of being in healthcare, I have seen shining examples on both ends of the success spectrum. I have had students “shadow” for clinical rotations ....that had plenty of knowledge on theory... but zero empathy, compassion or what I like to call situational awareness of what is happening in a life changing circumstance. I have also seen housekeepers and maintenance workers engage in empathetic compassionate interactions with patients and their loved ones. We as a society can teach people to technically do anything. The most important thing we should be teaching everyone from infancy is ...humanity. Healthcare is broken. Humanity has taken a back seat. As long as the system is dictated by insurance companies and pharma .... healthcare will remain broken. Caregivers in the medical field are experiencing a higher burnout rate than ever before. They are being asked to do more with less, being understaffed and over stressed . All the Technology in the world is not going to fix that.
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Nothing substitutes being at the bedside with a patient.
The structure of training RNs should more closely parallel that of MDs. Lots and lots of hours at the bedside with hands on experience and, after a certain number of hours, you progress to “residency” status, where you are the healthcare provider for your patients with consultation available from a credentialed RN.
This doesn’t happen because no one wants to pony up the dough to build the system that would make it happen.
29
@X
" .. Lots and lots of hours at the bedside with hands on experience and, after a certain number of hours, you progress to “residency” status .."
You do know that with M.D. grads, there are exams involved, right? Not just hours?
" .. This doesn’t happen because no one wants to pony up the dough .."
IMHO, that's a problem, all over the world .. as in, medicine "should be free." That is absurd, on its face.
3
I graduated from nursing school two years ago.
Oh, how I wish my school had these technologies available.
It takes practice, practice, practice before you become comfortable doing such routine things such as Foley catheter insertion and starting IVs on real patients.
Unfortunately, access to real patients is limited during school.
29
Let's hope that training will include the essential link between foods and health. Healing through specific foods is the way.
8
Care to elaborate on this at all? I don’t know of any specific examples of what you’re talking about
1
One of the greatest sins of the medical establishment is their general failure to properly train students in treating Chronic Fatigue Syndrome, one of the most common, debilitating diseases, which results in an almost complete lack of specialists. It is foisted off on primary care doctors, who might get an hour or so of instruction, if that, which tells them there's nothing particular to do for it. Wrong.
8
It’s so interesting how 90 % of patients who suffer this affliction are affluent with comorbid anxiety... I wonder how that came to be
5
The education of medical students and nurses involves a lot of learning from book, other clinician and the patients themselves. Medicine is an apprenticeship , one of the oldest one. The emphasis on technology misses the point that the most precious thing a doctor can have is empathy and to be ability to listen to the patients. As medicine becomes a big business and all people care is the bottom line we our loosing the ability to genuinely care for other people.
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@Virgil
I understand your concern for the emphasis on technology. But the reality of the situation is that nursing schools are fighting each other for clinical space. Community hospitals are closing all over America. And although nursing schools don't rely completely on high fidelity simulation, we are forced to use it more and more. We do our best to make it as realistic as possible.
15
@Virgil agree with you 150%! Sometimes we need to disconnect to reconnect. Doctors and other health care professionals do patients a disservice by not listening and being too caught up in technology, ego, and book "smarts". It is hard for them to think outside of the box and since healthcare is now a big business, health care professionals are more inclined to refer out to specialists and patients are lost through the system. I know from experience and from growing up with an old school doctor as a father. He would often times get patients that have been misdiagnosed and bounced around the system for 10+ years. All it takes is a listening ear, further investigation and a personalized approach. Money should not always be the be all end all. Insurance companies dictate quality/ scope of care and reimbursement. Until we get insurance companies and pharmaceutical companies out of bed with government, our only hope is that those entering the health care professions don't get jaded and are willing to go against the status quo. Those people are fewer and farther between unfortunately.
27
@Amelia
Medical practice has been taken over by corporations, and I think they bear far more responsibility for the poor state of doctor-patient interactions than doctors do. The current business model has done irreparable damage to healthcare practices and has destroyed the patient-doctor relationship. 'Old time' doctors like your dad who considered listening and interacting with the patient to be critical to good patient care actually hate the electronic medical records and 15-minute-encounters that have become part of the business of medicine. Doctors now have to TYPE (even though many of them are hunt-and-peck typists, having never taken a typing class in med school) their clinic notes into the electronic records. These notes have to be completed before they can move on to their next patient, which has been scheduled at 15-minute-intervals per business policy. This is not good, and it explains why doctors are looking at the computer instead of at us! They are under pressure all the time. The 'new' doctors, who are adept at working with computers and word processing, learned to practice in this way, and see us as numbers in the queue. It's a whole different mindset, and the business model is what created it. Healthcare will never be what it once was -- it's been destroyed and unless you are 'lucky' enough to be a patient in a concierge practice, there is no going back.
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