They stared blankly back. One shrugged.
"CO2, exactly," he said, referring to the level of carbon dioxide in the blood. A high level of partial "pressure" could mean the patient isn't getting enough oxygen. "PCO2, just like you said (cough, cough)."
They all laughed. Lesson learned.
But these students were standing in the intensive care unit of Boise's Veterans Affairs Medical Center, and their teacher was 500 miles away, at the University of Washington in Seattle.
Ross, Boise pulmonary specialist Dr. Paula Carvalho and others are trying new ways to teach medical skills, and if this works, it could save lives and improve health care throughout the rural West and around the world.
Med schools know they can lecture from afar. And students learn hands-on skills from the doctors and hospitals where they spend their later training years. But Ross wants to devise a way to do hands-on training remotely, too.
"If we can in fact show that we can teach skills this way, we can change the outcomes of health care," Ross said in an interview over the same video-conference technology he was using to teach the Boise students. "You improve the skill of birthing a baby -- especially with difficult deliveries -- in the Third World, and you have changed the outcomes in medical care."
Now, remote lectures and other courses are taught via expensive telecommunications equipment, costing around $3,500 for a unit, and requiring other infrastructure, including broadband connections and servers.
But as every fan of games like "Halo" or "World of Warcraft" can tell you, an inexpensive version of this technology already exists in homes around the world. And that's where Ross and the school's Institute for Surgical and Interventional Simulation hope to turn next: the X-Box 360.
The small X-Box modules can be cheaply fitted with wireless audio and video. That's how gamers team up to fight dragons or enemy soldiers in the "massively multiplayer online" games that can require dozens of individuals to work together to achieve certain levels.
This technology can also help instructors show how to perform medical techniques -- and then watch, in close-up, as the students practice them miles away.
The students wouldn't necessarily use gaming joysticks but would take advantage of the interactive video and audio available on the consoles.
Medical trainers can get an X-Box for $350, one-tenth of the cost of the systems used now. At that price, consoles can be placed in hospitals everywhere, Ross said. And today's future doctors won't need technicians to help them navigate the technology, Ross said, "because they know how to play it."
The WWAMI program -- pronounced "whammy" -- lets medical school students learn in Washington, Wyoming, Alaska, Montana and Idaho, all through the medical school in Seattle. The program brings medical education to these rural states that cannot afford their own medical schools.
"And we have really been quite successful in doing that," said Carvalho, a former WWAMI student herself who agreed to come, "kicking and screaming," to Boise, then fell in love with it and stayed.
Students and trainees are scattered across more than 200 sites over 25 percent of the country.
The challenge has always been to provide the same high level of training in Havre, Mont., Juneau, Alaska, and Boise as the students have in Seattle.
"Telemedicine is very important to the WWAMI region," Carvalho said. "We have to make sure the training at every site is consistent."
The students in Boise were learning "endotracheal intubation" -- the sometimes-tricky procedure of
inserting a breathing tube down a patient's throat.
Done wrong, a doctor can break teeth, pump air into a patient's stomach, or -- worst-case -- fail to get oxygen into the vessels in time.
And though Ross walked the students through some of the reasons why doctors need to manage the respirator system and talked about which patients can be harder to intubate (the obese, for example), it was Carvalho who grabbed the instruments and the test dummies and demonstrated the skills needed.
If she hadn't been there, it would have been harder for Ross to illustrate the subtle feel of the instruments needed to make the procedure work.
That illustrates the challenge for the university -- and for medicine in general -- when it comes to remote training.
"That's one of the things we're studying -- distributive learning," Ross said. "What's the best way to teach these people?"
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(c) 2007, The Idaho Statesman (Boise, Idaho). Via Newscom.
