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It’s well past the era when physicians’ primary means of exchanging information was an impromptu roundtable in the surgeons’ lounge, learning about their colleagues’ latest discoveries or preferred techniques over cups of coffee. One of the great boons of the modern age of medicine is the ability to share new advances with the whole planet at the speed of a mouse click.

OPENPediatrics is one of the resources taking advantage of that amazing connectivity. The online network connects doctors and nurses around the globe, distributing everything from the fundamentals of pediatric care to the most groundbreaking research. In a continuing effort to expand offerings, OPENPediatrics recently teamed with the digital marketing agency Genuine to launch a set of online simulators.

To learn more, Surgical Products interviewed Traci Wolbrink, MD, MPH, associate in critical care medicine research at Boston Children’s Hospital and the associate director of OPENPediatrics. 

Traci Wolbrink, MD, MPH

To begin, can you provide some general background on the work of OPENPediatrics?

A philanthropic effort launched at Boston Children’s Hospital in 2012, OPENPediatrics is an online community of clinicians sharing best practices from all resource settings around the world through innovative collaboration and digital learning technologies.

Through OPENPediatrics, clinicians can access academically rigorous and peer-reviewed content, including guided learning pathways, expert lectures and demonstrations, interactive device simulators, protocols, and medical calculators. Clinicians can also form and join groups, share digital resources, and engage in online discussions of key aspects of pediatric care. OPENPediatrics even connects our community members through a free video chat service.

OPENPediatrics has been accessed from every country and territory on the globe (excluding Antarctica) and has registered users from 145 countries and more than 2,300 hospitals and universities. Our resources have been viewed or downloaded more than 1 million times and OPENPediatrics has received numerous awards, including the 2016 American Society of Nephrology Innovations in Kidney Education award, the 2015 Microsoft Education Tech Award from the Tech Museum of Innovation, and two MITX awards for our interactive simulators. OPENPediatrics is certified by the Health on the Net foundation as a trustworthy source of online health information.

(Image credit: OPENPediatrics)

OPENPediatrics has recently teamed with Genuine to develop open-access digital learning tools. Can you tell us about these tools?

OPENPediatrics has worked with Genuine on three simulators: mechanical ventilation, peritoneal dialysis, and hemodialysis. All three are structured in a similar fashion and contain:

1. A Knowledge Guide: Text and interactive steps to demonstrate how to use life-saving medical technologies

2. A Tactics Section: Short clinical problems for the learner to solve.

3. Cases: Teach how to set-up, titrate and troubleshoot pediatric clinical scenarios using these life-saving medical technologies

The Mechanical Ventilator simulator is an immersive online mechanical ventilation training tool. The virtual ventilator incorporates real-time changes in vital signs, ventilatory parameters, patient appearance, arterial blood gases, chest X-rays, and more. Users are required to interpret physiologic, imaging and ventilator data, formulate diagnoses, and make changes to best treat their patients.

The Peritoneal Dialysis simulator was created in collaboration with a team of nephrologists from the United States and South Africa. This resource offers stand-alone education on all elements of managing a child on peritoneal dialysis, including: assessment of patient and dialysate; monitoring and responding to patient variables and laboratory results; and identifying complications from device manipulations.

In the Hemodialysis simulator, which is expected to launch in 2017, the learner is taught the key concepts of hemodialysis and a structured approach to set up a circuit and choose an initial prescription for a patient need. Then the learner applies what they have learned to a variety of virtual patients. The learner receives hints and feedback throughout the activities and also receives an end-of-activity feedback sheet that outlines key learning points.

Peritoneal Dialysis Simulator from OPENPediatrics and Genuine (Image credit: OPENPediatrics)

How do you envision these tools and others like them impacting the learning curve for physicians as they adopt new or modified treatments?

Emerging pressures from a new generation of technologically literate medical learners are urging medical educators to develop and study new teaching strategies for the 21st Century. Serious games (games developed for a purpose other than entertainment, such as teaching a specific knowledge or skill) are designed to keep players engaged as they educate, train, or change behavior, and are appealing to the Millennial learners. Serious games actively engage the adult learner, allow control of learning pace and timing, provide directed feedback, and leverage cognitive motivations inherent in games. They also offer a theoretical benefit over traditional educational modalities for the adult learner, and have the potential to provide dramatic transformations of educational practice and become a vehicle for leveling of access to knowledge and information on the care of critically ill patients across the world.

Serious games also offer enhanced convenience, scalability, education structured to meet the need of the adult learner, and the ability to practice patient care, especially those patient situations deemed low-volume and high-risk. For example, mechanical ventilation, which is an important skill in pediatric critical care medicine, requires complex thought processes and the ability to integrate information from multiple sources simultaneously. One must understand key physiological concepts, integrate clinical data and learn how to make appropriate modifications to achieve adequate oxygenation and ventilation goals. Another key element of learning mechanical ventilation enabling the ability to practice on a variety of different types of patients with varying disease processes.

All of these elements, can be incorporated into a virtual simulator to allow the learner to practice on simulated patients, prior to actual critically ill children. We hope that these simulators will improve healthcare profession education, making it more efficient, more effective, and more engaging.

Where does this model of information sharing and education go from here?

Our next step is to study the effectiveness of this type model in medical education. We are currently conducting a 32 center international study to investigate the educational gains and retention of mechanical ventilation knowledge in pediatric residents.  

Additionally, we will continue to optimize the existing simulators and use lessons learned to create additional simulators to teach other skills in pediatric medicine.

Is there anything else you’d like to add?

A user story: YoungMin Ko, a pediatric nurse in South Korea with a long-held interest in simulation technology, founded the RN Simulation Institute Korea. Through RNSim, Ko partners with nursing schools to offer simulation education courses to nursing students and nurses, because he sees simulation as a way to address the central challenges facing nursing education. He wanted to find a way to provide respiratory training because “real [ventilation] hands-on experience is very rare. There is absolutely no ventilator for training purposes [in Korea].” After learning about the OPENPediatrics virtual ventilator simulator at a conference, Ko knew he had found a training tool unlike any he had seen before.

“It was not difficult to know that the virtual ventilator of OP would be the one for Korean nurses and nursing students to learn how to care [for] patients [on a] ventilator,” Ko said. Since March 2015, Ko has conducted training courses for more than 400 nursing students at Shinhan University and other colleges using OPENPediatrics to teach students how to care for ventilated patients. Ko and his students found the interactive and dynamic learning experience provided by the ventilator simulator to be a uniquely beneficial tool. The ventilator “covers the process from the VERY beginning to end and everything has great direction on how to use. That, I didn’t see in textbooks.”

The interactivity of the ventilator also encouraged his students to think critically, as Ko added, “The fact that the OP program doesn’t come with answers is very good. I once asked OP for an answer, and the reply was ‘here’s how you can find the answer.’”

The virtual ventilator scales training by connecting learners to a community of experts available to answer questions online, but it is designed to encourage active learning and engagement.

Ko and his students found the ventilator simulator to be such a powerful learning tool that they recently presented the program at a medical conference in Korea, and plan to offer more training courses in the future.

“I was very surprised to see all the good [material] for free. I plan to take this to other conferences and show them,” Ko said. “I am really grateful for this initiative and would like to somehow make this known more.”

More recently, Ko has begun using the OPENPediatrics Peritoneal Dialysis simulator to teach students that procedure as well.

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