Volume 88, No.4, May-June 2002


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Thinking Differently, Technology Goes to School, by Pamela Babcock next > 1 2 3

Education has gone electronic, from medical mannequins to global teleconferencing to law books on laptops. "Smart" classrooms are getting good grades across campus.

Ethernet Cables into the hub
photo:Les Todd

tan, a virtual patient currently programmed to replicate a truck driver, is in poor health. He's sixty-one years old, overweight, drinks too much, and exercises too little. And on this particular morning in a treatment area at Duke Medical Center, he's about to suffer a far more serious problem. With the click of a mouse, he's given a tension pneumothorax—a punctured lung.

Lying on an operating-room table with a blue cloth shielding his plastic privates from view, Stan begins breathing heavily and the left side of his chest stops moving. His heart rate climbs, the blood pressure and oxygen level in his blood decrease, and he becomes short of breath. Before long, Jeffrey Taekman, a Duke anesthesiologist, steps in to do something. "That's a controversy, whether you should let someone kill the mannequin," says Taekman. "I don't think anyone has killed Stan yet."

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Stan's a sophisticated, computerized simulator designed to mimic a real patient in a variety of scenarios. He's a hands-on teaching tool at Duke Medical Center, where hightech touches include a $750,000 Human Simulation and Patient Safety Center that opened in April and a student auditorium incorporating a dazzling array of technological advances that are perhaps the most forward- thinking on campus.

At Duke's Fuqua School of Business on a recent morning, colleagues look up at an eight-foot-wide video screen that's part of Fuqua's Global Conference System. With the push of a button, another time zone comes to life as technology links Fuqua staff to counterparts in Frankfurt. "Guten tag," they say, and their life-size images beam from the wall and their gaze meets at eye level, as if seated inches across the table, rather than halfway around the globe. The audio is so realistic you hear a car horn honking from hidden speakers—in Deutschland or in Durham?

Meanwhile, at the law school on a recent afternoon, students aren't studying contract law from oft-dry, three-inch-thick law tomes. Instead, via computer laptops, they're immersing themselves, in video and audio vignettes with discussions from nearly fifty high-profile legal scholars, practitioners, and judges as part of a groundbreaking, DVD-ROM multimedia teaching tool conceptualized at Duke.

All around the university system, the move to "smart" classrooms is changing the way students learn and professors teach. Internet access, including wireless applications, other technical features such as patient simulators, SMART Board interactive whiteboards, sophisticated Duke-produced webcasts and DVDs, "telepresence"—all are just a sampling of a technology arsenal being deployed in recent years.

Duke Medical Center's training areas are full of heads and torsos, arms and legs. In med-school lingo, the noncomputerized body parts are known as "task trainers." But none match the sophistication of Stan, a $170,000, computercontrolled, life-size mannequin and control tower that exhibits symptoms and reacts to medicines and interventions like an actual person.

The medical center bought the high-fidelity patient in February 2001 from Medical Education Technologies Inc. (METI) of Sarasota, Florida. Housed in the Human Simulation and Patient Safety Center in Duke South, Stan has three "parents": the medical school, the nursing school, and the anesthesiology department. The Simulation Center also houses a pediatric patient simulator, aptly named Baby Stan.

The adult Stan—one of about twenty-five METI simulators in existence—is powered by a Mac G4 hooked up to a Linux computer controller and is run largely by pneumatics and electronics. His output is vital signs, including body temperature, pulse, and cardiovascular and pulmonary parameters. His pupils dilate and his vocal cords can constrict to impede attempts at inserting breathing tubes. He routinely suffers cardiac arrest, drug interactions, anaphylactic shock, and more complex conditions. A fluid system allows him to urinate and to give students the opportunity to tap chest fluids. Stan's eerie sounds give a sci-fi feel to a room when his breathing and heartbeat play through hidden speakers.

Taekman, who directs the center and is also assistant dean for educational technology and an assistant professor of anesthesiology at the medical school, says the simulator is an important technological teaching advancement. Not only does it help promote real-life hospital dynamics and teamwork, but it also reduces the need for students to do laboratory work with live animals. "The simulator is good for what-if scenarios," Taekman says. "There's a set way of treating most disease states, so you can't look at what happens to a patient if you try a different therapy. For example, you can't give a patient an overdose of a medication to see what happens. You also can teach a rare event in simulation, since we can have it happen commonly."

The simulator reacts to "pretend" intravenous drugs, which are administered via barcoded syringes filled with water and scanned to determine what drug is being injected. It can model either gender as young, old, healthy, or very ill. Switch out a few plastic body parts, and Stan becomes Stella. Stan also can be programmed to portray a number of cases the manufacturer has configured. Besides "Truck Driver," there's "Mr. Outta Joint," an orthopedic case; "Una Goodeye," an ophthalmology patient; and "Dr. Iven Fast," a combative, inebriated male who was just in a car accident.

In April, Stan moved into the new Simulation Center, modeled after a similar center at the Bowman-Gray School of Medicine at Wake Forest University in Winston-Salem. The center incorporates wireless capabilities, videotaping equipment, and a debriefing room complete with a SMART Board where students and faculty can share impressions following training. Video can be fed live to nearby lecture halls. "It's in the fiber-optic backbone of the hospital, so we can ship our scenarios anywhere in the world via the Internet," says Human Simulation Coordinator Gene Hobbs.

Taekman says he hopes to expand simulation to take full advantage of the technology. "We've got a group of about twenty faculty members who have committed to teaching over here," he says. He plans to use humanfactors engineering, with a combination of psychology and engineering, to study human performance in different scenarios. These studies could look into such variables as human- machine interface with the simulator and team interaction, considering such issues as what would be encountered in an emergency.

The Simulation Center is one of numerous high-tech teaching areas at Duke Medical Center. The 150-seat amphitheater classroom, where first-year medical students have most lectures, has laptop ports, power supplies, and built-in microphones for students; video cameras, CD, and DVD technology, and touchscreen displays for faculty; and a staffed control room. Like contestants on Who Wants to Be a Millionaire, students can respond to an instructor's questions via a hand-held remote keypad, rather than with a show of hands. Statistics are immediately tabulated and projected at the front of the room. Faculty can poll students with mini-quizzes to get an idea of their understanding of a concept in the middle of a teaching session. The keypad also can be used by the students in the auditorium who are observing and helping call the shots—via video—of a scenario in the nearby Simulation Center.

"We'll get them to a decision point, and then you're not putting the four or five people [in the Simulation Center] on the spot," Hobbs says. "Instead, they're making a decision as a group."

Across West Campus at the Fuqua School of Business, telepresence is one of the hottest topics, and it has nothing to do with television psychic Miss Cleo. Telepresence is high-performance videoconferencing used in Fuqua's Global Conference System, a high-speed, cross-continent video connection using Internet2, the next generation Internet, which features much faster data transmission through a bigger pipeline. The system allows Fuqua staff and faculty to meet, as needed, just by walking into a conference room linked to Frankfurt. In March, a virtual "ribbon cutting" was held to celebrate Fuqua's achievement of being the first institution—academic or corporate —to use Internet2 for telepresence.

"This is exciting stuff, and the future use of this is going to be powerful," says Nevin Fouts, associate dean for information technology at Fuqua. Eventually, Fuqua hopes to expand telepresence into the classroom for presenting guest speakers and other education programs.

On a recent demo of the system, Fouts began speaking with Felix Mueller, director of marketing and operations for Fuqua Europe; and Falko Friebe, IT coordinator in Frankfurt. The benefits are apparent. Both men appear relatively life-size and at eye level. It doesn't feel much different than sitting down and speaking to someone across the table. "This is a very useful tool because it allows us to sit down face-to-face," says Tim Searles, director of multimedia services for Fuqua. "You can't do that in a telephone call."

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