The Present and Future of Virtual Reality in Medical Education: A Narrative Review.

Virtual reality (VR) uses computer-generated and three-dimensional environments to create immersive experiences through the use of interactive devices that simulate virtual environments in many forms, such as 3D, screen-based, or room-based. Users can engage in the environment with objects, characters, and scenes, making individuals assume they are experiencing a real-life scenario. VR has been adopted across medical and nursing fields to supplement clinically relevant and practical teaching. However, the effectiveness of this interactive form of learning has come a long way with improvements in accessibility, cost, and technicalities. The immersive simulated environment that VR has to offer today initially began with screen-based learning and then the 360-video method. These previously sought-out methods were eventually found to disconnect the students from engaging in the learning environment that present-day VR systems are designed to provide. Interactive VR offers a dynamic platform for medical training. These simulations benefit the learner by allowing them to interact within case scenarios and virtual wards, as well as with patients, colleagues, and relatives. To mimic real-life encounters, the student can take a patient's history and physical exam, investigate, diagnose, and provide treatment. The simulated patient can express emotions, concerns, and signs of a poor state of health. All these factors play into a healthcare provider's competency to think critically and clinically in decision-making. This practice is now being used in many surgical programs and medical education curricula. The use of simulation in VR is continuously being proven to decrease injury, increase operation speed, and improve overall outcomes in patient-centered care. VR simulation differs from in-person simulation training in that the VR modality of learning is more accessible and replicable than the latter. By comparing research studies and reviews of medical programs that incorporated VR into their curricula, we were able to assess the state of VR in medical education and where this technology could lead to future implementation in medical programs. Our review aimed to give insight into the existing evidence, the gaps in the use of VR in medical education, and the potential benefits this modality of learning can have going forward in this field of study. Medical students have demonstrated significantly enhanced knowledge gain when using immersive interactive VR over screen-based learning. Given the improvements in students' performance due to these dynamic and collaborative learning experiences, immersive VR training will become a standard in the development of clinical skills and ensure patient safety. Although the emphasis on empathy began later in the journey of gaining VR as a part of medical education, there is a need to gain those skills as early as possible in medical school. Implementing the use of VR as a supplement in medical education allows students to practice simulated patient encounters along with an array of different academic endeavors. By doing so, students will gain competency and confidence as they encounter patients during their clinical rotations and clinical practice.

Compartment Syndrome of All Extremities in the Setting of COVID-19-Induced Systemic Capillary Leak Syndrome With Superimposed Myositis.

Three years following the pandemic's emergence, COVID-19 has continued to affect much of the symptomatic population with widely varied respiratory complaints, fevers, numerous unexpected prodromal manifestations, and unknown long-term consequences. Scattered cases involving myopathies, rhabdomyolysis, and compartment syndrome have also been reported throughout the pandemic. Some similar cases have been attributed to systemic capillary leak syndrome (SCLS). Here, we report the development of compartment syndrome involving all extremities in a 57-year-old vaccinated female known to have COVID-19. In retrospect, we believe the clinical severity and the patient's sudden deterioration can also be attributed to the lesser-known SCLS. Treatment required fasciotomies of both forearms, arms, and legs. This is the most significantly involved case, leading to survival reported thus far. Lab abnormalities, misleading imaging, and symmetric involvement of all extremities posed a significant challenge to proper diagnosis and treatment. This case serves as a reminder for providers to remain cognizant of neurovascular emergencies during the workup of critically ill patients when the presentation is unrecognized and usual treatments are refractory. Its purpose is also to contribute to the global understanding of and response to COVID-19.

The association between operating margin and surgical diversity at Critical Access Hospitals.

CONTEXT: Surgical volume is correlated with increased hospital profitability, yet many Critical Access Hospitals (CAHs) offer few or no inpatient surgical services. OBJECTIVES: This study aims to investigate the impact of the presence of different inpatient surgical services on CAH profitability. METHODS: The study design was a cross-sectional analysis of financial data from the most recent fiscal year (FY) of 1299 CAHs. Multiple linear regression was utilized to assess how the operating margin was affected by the number of different inpatient surgical services offered per hospital. Covariates known to be associated with hospital profitability included occupancy rate, case mix index (CMI), system affiliation, ownership status (public, private, or nonprofit), and geographic region. RESULTS: The regression model for the CAH operating margin returned an R2 value of 0.18. Each additional inpatient surgical service corresponded to a 1.5% increase in operating margin (p=0.0413). Each 10% increase in occupancy rate and 0.1 increase in CMI corresponded to a 0.9% increase in operating margin (p=0.0032 and p=0.0176, respectively). The number of surgical services offered per CAH showed positive correlations with occupancy rate (r=0.23, p<0.0001) and CMI (r=0.59, p<0.0001). CONCLUSIONS: A positive correlation exists between operating margin and the diversity of inpatient surgical specialties available at CAHs. Furthermore, providing surgery allows CAHs to accommodate higher occupancy rates and case mixes, both of which are significantly and positively correlated with CAH operating margin.

The Confidence and Accuracy of Medical Students Trained in Ultrasound or Landmarks for Performing Knee Aspiration.

Introduction Medical students are trained using anatomical landmarks in order to perform many procedures, such as knee aspirations. With the growing popularity and use of ultrasound, the question arises whether training students with ultrasound instead of landmarks increases their skill. Previous research has shown increased accuracy and confidence in residents who trained with ultrasound compared to landmarks only. No studies to date have analyzed the effect of ultrasound learning versus landmark learning in medical students. Objective The purpose of this study is to analyze the confidence and accuracy of medical students when taught knee aspiration using ultrasound training compared to students taught with landmarks only. Methods The project was deemed exempt by the Edward Via College of Osteopathic Medicine (VCOM) Institutional Review Board (IRB) because it falls under the quality improvement category (IRB number 1806802-1). Subjects were randomized into two groups: one trained in ultrasound and one trained in landmarks for performing knee aspirations. Both groups were tested for accuracy by the ability to aspirate fluid from the model and the number of attempts; each student was given a maximum of three attempts. Documentation included the number of attempts for each student or "no fluid" for those exceeding three attempts. They were then surveyed for confidence. The study took place in an educational setting at VCOM-Carolinas. A total of 42 first-year medical students participated in this study. Results Fisher's exact test showed statistically significant results for confidence (p<0.001) between the ultrasound group (N=22) and non-ultrasound group (N=20) with a power of 0.285. The accuracy of aspirating fluid was not found to be statistically significant (p=0.4805). Conclusions Although no significant differences in the accuracy of knee aspirations at short term were seen, there was a clear improvement in student confidence and perceived capability of the skill. Those students who learned using ultrasound-guided techniques were more confident in their ability to accurately perform the technique when compared to their peers.

Effect of a standardized patient encounter on first year medical student confidence and satisfaction with telemedicine.

CONTEXT: Although the coronavirus 2019 (COVID-19) pandemic has accelerated the use of telemedicine platforms across the country, medical students may lack confidence in their ability to conduct satisfactory patient encounters and practice clinical medicine through telemedicine. OBJECTIVES: To evaluate the role of a standardized patient encounter on first year medical student confidence and satisfaction in using telemedicine. METHODS: One hundred and sixty two first year medical students recruited from Edward Via College of Osteopathic Medicine-Carolinas campus were surveyed on their confidence and satisfaction with using telemedicine platforms before and after conducting a patient encounter. Participant confidence and satisfaction were assessed with a five point Likert scale: "not confident," "a little confident," "somewhat confident," "confident," and "extremely confident." RESULTS: Of 162 students, 103 (63.6%) completed the preencounter survey and 74 (45.7%) completed the postencounter survey. Before the standardized patient encounter, 37 participants (35.9%) reported that they were "a little confident" and 20 participants (19.4%) reported that they were "not confident" in their ability to conduct a patient interview using a telemedicine platform. Following the encounter, 24 students (32.4%) reported feeling "somewhat confident", and 32 (43.2%) reported feeling "confident" in their ability. CONCLUSIONS: Medical students' confidence and satisfaction with telemedicine improved after a standardized patient telemedicine experience in this study. This experience allowed students to practice the unique skills required for telemedicine. Medical schools might consider adding a telemedicine curriculum and standardized patient experiences in the undergraduate medical setting.

The Value Surgical Services Bring to Critical Access Hospitals.

Purpose Critical Access Hospitals (CAHs) serve rural populations and receive government subsidies to compensate for their relatively high overhead costs and low occupancy rates. Twenty-nine percent of all hospitalizations in the United States include a surgical procedure, and hospitalizations involving surgery accounted for nearly half of all hospital revenue in 2011. This study aims to determine the value surgical services bring to CAHs and their impact on the viability of these facilities.  Methods Public access data from the American Hospital Directory (AHD) was analyzed about each hospital's revenue and surgical services offered. Excel was utilized to randomly select 300 CAHs from a pool of 1350 CAHs based on a 95% confidence interval and a 5% margin of error. Linear regression models were fit to the data evaluating the association of net income with the number of surgical services offered per hospital and the association of total margin with the number of surgical services offered per hospital. Models were adjusted for location, occupancy rate, and case mix index.  Findings The linear regression model demonstrated that for every additional surgical service provided by a CAH, the hospital net income increased by $630,528 (p=0.0032). A similar trend was observed when modeling profitability. The total margin increased 0.73% for each additional surgical service added, albeit without statistical significance (p=0.1342). CAHs providing two or three surgical services showed tighter group variance than those not offering surgery or only offering one surgical service.  Conclusions Net income was significantly correlated to the number of surgical services offered at CAHs. Furthermore, CAHs offering more surgical services seem to have more predictable profits than those offering less surgical services. CAHs would financially benefit from offering more or expanding surgical services at their facilities.