How virtual education may accelerate healthcare professional education during, and post, COVID-19
An essential component of healthcare professional education has historically been in-person and hands-on patient care and interaction under the supervision of clinical faculty. Yet the COVID-19 global pandemic has made face-to-face, hands-on clinical education challenging or impossible due to shortages or closures of clinical sites to students and faculty. Many healthcare professional students’ clinical training has been placed on hold, causing delays in educational programs and graduations at a time when there is a critical shortage of healthcare professionals. The pandemic has created an urgency for educational institutions and healthcare organizations to consider alternative methods by which clinical training can be delivered virtually. Prior to COVID-19, many educators thought of virtual education as a way to supplement learning, but not as an important method for learning to occur. However, many of the benefits of face-to-face interaction among students, professors, faculty, peers, and patients can now be replicated through virtual technologies.
Virtual Education to the Rescue During COVID-19
Providing quality educational sites for professional healthcare students “is challenging under any scenario but is a significant challenge amidst COVID-19 restrictions,” according to Dr. Patrick Quinlan, CEO of Hippo Technologies, Inc., a Seattle-based provider of virtual care and education solutions to the industry. As a result of the COVID-19 pandemic, healthcare professional educators have an urgent need to provide virtual experiences that can replace in-person clinical training and experience.
Most institutions have turned to online education for didactic learning. Some institutions were better prepared than others, with already well-established online education programs. Others did not have the proper tools and infrastructure, and simply used a virtual environment to post historical video lectures or host video conferences. The results for students have been spotty and inconsistent, depending on the level of preparedness and investment by the educational institutions. Few institutions have had a good solution to face-to-face, hands-on clinical training.
Virtual technologies can support, and even enhance, healthcare professional training and education, particularly in a COVID-19 world. Technologies such as head-mounted displays, smart glasses, virtual reality, augmented reality, and others provide the tools required to make virtual healthcare professional education not only possible, but highly successful. Definitions and more details about each technology can be seen in Fig. 1.
The primary benefit of virtual technologies is that they enable healthcare educators to train students around the world on a broad array of clinical experiences, providing a first-person view as if the student was in the room. For example, a faculty person wearing the Hippo Virtual Technologies headset connects virtually to students distributed around the world who use a mobile device or computer to connect to the faculty’s wearable headset and experience a “first person view” of what the faculty is seeing and hearing. “With Hippo Virtual Care, morning sessions can start in a busy inner city ER, and students can end the afternoon observing a small, underserved rural community hospital – allowing future clinicians to get a broad array of clinical experiences without setting foot in the training hospital or clinic,” explained Quinlan. With Hippo, “students can see through the eyes of the clinician and experience procedures as if they are there. Conversely, remote faculty can oversee students interacting with and caring for patients while wearing the Hippo device.”1
Fig. 1: Examples of virtual education tools used to accelerate healthcare professional education
Head-mounted Displays (HMD): HMDs like Hippo Virtual Care effectively bridge the gap between physical care and virtual care, enabling healthcare providers and educators to overcome the barriers of time, distance and training. These hands-free, voice-activated, head-worn tablets allow clinicians and faculty to communicate in real-time with remote colleagues or students, pull up medical records, and automatically access files and imaging during patient examinations, procedures, consults and rounding.11 Cameras mounted on the headset capture a first-person view of what the wearer sees.
Smart Glasses: Wearable computing devices such as Vuzix and Google Glass are web-connected and enabled to transmit multiple types of data and project it in the field of vision.12 Wearable glasses differ from head-mounted displays in that the wearer looks through the glasses, whereas with a head-mounted display, the field of vision is open.
Virtual Reality (VR): VR is a realistic and immersive computer simulation of a three-dimensional environment, created using interactive software and hardware, and experienced or controlled by movement of the body.13
Augmented Reality (AR): AR is an enhanced version of reality created by the use of technology to overlay digital information on an image of something being viewed through a device.14
Here are some other examples of how virtual technologies like Hippo can help clinical education challenges during COVID-19:
- Hospitals are eliminating the opportunity for potential medical or nursing residents to observe clinical patient rounds or interviewing for potential residency slots due to COVID-19 restrictions. A faculty person can conduct patient rounds and/or interviews in which remote applicants can participate virtually through the HIPAA-compliant Hippo headset and platform.
- Simulation lab instructors can create videos or live demonstrations of procedures to which remote students can log-in, either synchronously or asynchronously.
- Students who are unable to go to campus to demonstrate skills can conduct an assessment on a volunteer or standardized patient while wearing a Hippo headset; faculty can log in to the Hippo platform remotely to observe the student demonstrate the skill or assessment.
- Virtual education tools can save travel time and training costs and enable training from anywhere. VR and AR technologies allow students to simulate what a procedure is like virtually without the costs of traveling to a clinical site. Additionally, during COVID-19, virtual tools can allow hospitals to save time and money on the precautions necessary for safe learning and care during COVID-19. The opportunities to address challenges and enhance education are many, and we are only scratching the surface.
How Virtual Education Can Enhance Traditional Education Methods Post-COVID-19
There are limitations to traditional in-person training and education that existed even before COVID-19 that virtual education can mitigate, but many institutions have been resistant to change. Prior to COVID-19, virtual care was being leveraged to aid in some healthcare professional education. In fact, “for more than a decade, medical schools have been working to transform pedagogy by eliminating/reducing lectures; using technology to replace/enhance anatomy and laboratories; implementing team-facilitated, active, and self-directed learning; and promoting individualized and interprofessional education.”2 However, most virtual education was used in a relatively limited capacity.
The pandemic has forced institutions to be creative and open-minded about how technology can solve the immediate challenges amidst the pandemic, as well as confer a competitive advantage post COVID-19. Following are some challenges to traditional clinical training with potential solutions using virtual technologies:
- Lack of exposure to diverse clinical locations, diverse patient populations, the latest healthcare technology, and rare or complex diseases. In-person education often prevents students from accessing diverse insights and perspectives that they cannot obtain where they are located. For example, students in rural locations do not have access to urban clinical locations and patient populations. Additionally, students in the US do not have access to clinical locations and patient populations internationally. This lack of exposure can limit the learning of healthcare professionals. In-person education can also limit student access to the latest medical technologies and studies, as well as learning about rare or complex diseases that may or may not arrive in their clinic.
Without virtual care, students only have access to medical conditions and patient populations that are encountered in their facility or that are observed via video and pictures. Virtual learning, however, gives healthcare professional students the opportunity to observe and study patients and clinicians around the world. This broad exposure increases students’ chances of learning about rare disease states and diverse patient populations, and gives them more opportunities to learn how to care for a broad array of people and experience a variety of clinical settings at home and abroad.
- High costs and time. In-person education requires significant costs and time for educators to coordinate high quality learning experiences and install the precautions necessary to assemble students and faculty in a single location. Susan Groenwald, President Emerita of Chamberlain University noted the challenges she experienced with in-person clinical education, saying, ”It was challenging and costly to provide robust and meaningful clinical experiences to 31,000 nursing students distributed all over the US, especially the population of nurses studying to be family nurse practitioners.”3 With COVID-19, the group of in-person students is even more limited. Virtual technologies can provide a cost-effective alternative by expanding faculty reach.
- Challenges in assessing student outcomes in a distributed clinical environment. Educational institutions may be confronted with the challenges of documenting and assessing student outcomes across a broad array of clinical sites. Without the proper tools and infrastructure, calibration of assessment and proof of outcomes is challenging. Virtual technologies provide a platform for faculty to collect student and patient data and provide real-time guidance. For instance, smart glasses, VR, and AR “can be utilized whenever a screen or external monitor is already required. Head mounted displays can be implemented for very basic purposes such as education, simulation, or live streaming of visualized data. Ultimately, smart glasses would implement artificial intelligence engines in the daily clinical practice and several other promising applications for the future.”4
- Assessing students without a first-person view is a challenge. Although it is helpful for students to learn from faculty while standing next to them, faculty and students will never truly know what the other sees. With virtual tools, such as head-mounted displays and smart glasses, faculty and students can wear a device that provides a first-person view to enable students to “see through the eyes of the clinician.” Groenwald noted that “when you’re standing side-by-side, you often can’t see the view they see and many times they have an obstructed view because of an arm or a shoulder in the way. A wearable device like Hippo that provides a first-person view is brilliant because it allows you to see what the student sees, does, and says.”5
- Faculty can disrupt the rapport that students are trying to build with their patients by being in the room. When students are trying to connect with their patients, having faculty in the room can make that connection difficult. Whether its interrupting or undermining student decision-making, faculty can often be unhelpful despite their best intentions. Once again, Groenwald agreed that in some ways, virtual training can be more effective than having a faculty in the room: “Having the faculty remote, even if they’re in the hallway observing on a computer, enables the students to establish that rapport with the relationship unimpeded. And the reverse is true…The student can be anywhere in the world seeing and hearing what the faculty is seeing.”6
- Potential healthcare professional shortage. With the predicted shortage of healthcare clinicians including physicians, nurses, and specialists, it is essential for educators to train students effectively while virtual to maintain a pipeline of future healthcare professionals. As of June 2020, the Association of American Medical Colleges predicted that the US may see an “estimated shortage of between 54,100 and 139,000 physicians, including shortfalls in both primary and specialty care, by 2033.”7 The US Department of Labor’s Bureau of Labor Statistics(BLS) projects a 10% increase in jobs in the healthcare sector from 2019 to 2029, amounting to 1.9 million new jobs over 10 years.8 The BLS lists registered nursing (RN) to be among the top healthcare occupations with the most significant job growth and projects that the RN workforce will grow by as much as 13% by 2029.9 To meet this demand, there is currently a need for more than 200,000 new RNs to enter the workforce each year, yet more than 80,000 applicants to US nursing baccalaureate programs were rejected in 2019 due to a nursing faculty shortage, lack of clinical sites, physical space, clinical preceptors and budget constraints.10 And the shortage is likely greater after more retirements and need arising from COVID-19.
While virtual tools cannot solve the healthcare professional shortages problem, virtual training can certainly help by effectively extending the reach of the available workforce to leverage qualified faculty and clinical sites, and to save money.
Looking Forward: Virtual Education Promises a Better All-round Experience
The potential for virtual and augmented technologies within healthcare professional education is still relatively nascent. Certain virtual technologies, such as Head-mounted Displays, Smart Glasses, VR, and AR have the potential to accelerate this transformation and may be the cure to educational challenges seen prior to, and during, COVID-19. The tragedies that have ensued as a result of the pandemic may also be a catalyst for healthcare professional education, not just by increasing the use of virtual education, but also by increasing the accessibility and quality of education more broadly. And while virtual education can never completely replace face-to-face, hands on clinical education, it can certainly enhance both the learning and practice of clinical care now and in the future.
[1, 11] Hippo Virtual Care. (2020). Retrieved from https://myhippo.life/
 Rose, S., MD, MSEd. (2020). Medical Student Education in the Time of COVID-19. JAMA Network. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2764138
[3, 5, 6] Interview with Susan Groenwald, Member Of The Board Of Advisors at Hippo Technologies, Inc. (2020)
[4, 12] Wrzesińska, N. (2015, December). The use of smart glasses in healthcare – review (Rep.). Retrieved https://medtube.net/science/wp-content/uploads/2014/03/The-use-of-smart-glasses-in-healthcare-%E2%80%93-review.pdf
 The Complexities of Physician Supply and Demand: Projections From 2018 to 2033 (Rep.). (2020, June). Retrieved https://www.aamc.org/system/files/2020-06/stratcomm-aamc-physician-workforce-projections-june-2020.pdf
 Bureau of Labor Statistics (2019). Occupational Outlook Handbook. Retrieved from https://www.bls.gov/ooh/healthcare/home.htm).
 American Association of Colleges of Nursing 2019-2020 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, Washington, DC https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Faculty-Shortage
 Virtual reality. (n.d.). Retrieved from https://www.dictionary.com/browse/virtual-reality?s=t
 Augmented Reality. (n.d.). Retrieved from https://www.merriam-webster.com/dictionary/augmentedreality