First Time Rounds…with Some Help
It's Dr. James' first month as an intern at Triton-Smith Hospital. He's eager to put his medical training to use, but feels overwhelmed navigating rounds solo with real patients. Luckily, he has some new partners along for the ride: Clara, the hospital's AI assistant, and Dr. Singh, a veteran doctor attending via teleconference.
As Dr. James enters the first patient's room wearing the latest, unobtrusive AR headset, not much bigger than a pair of glasses. Clara's voice quietly but clearly speaks in his ear with an analysis of the chart. "77 year old female patient, admitted for pneumonia-like symptoms. X-rays show abnormal fluid in the lungs. I've compiled a list of potential diagnoses and recommended tests." This quick synopsis helps Dr. James efficiently orient himself.
Dr. James smiles and greets his patient by her full name. Clara has a full list of important personal, as well as medical, information visually and auditorily available for Dr. James if he needs a reminder. After greetings are exchanged, Dr. James asks some questions while Clara transcribes notes and highlights relevant details. Dr. James then asks his patient for permission to have another doctor view the exam to make sure he’s providing the best care. His patient agrees, and Dr. Singh appears on the video screen in the room and in Dr. James’ view on his headset. Dr. Singh listens and watches as Dr. James performs a physical exam and 3D anatomical models spring up on Dr. James’ headset to demonstrate exactly where he should palpate and auscultate. Following Clara's cues, with Dr. Singh supervising, Dr. James moves through the exam with confidence.
Moving room to room with Clara and Dr. Singh, Dr. James becomes more assured and skillful with each successive patient. Dangerous heart arrhythmias, drug dosages, complex social dynamics - the combined wisdom of cutting-edge technology and human expertise helps him tackle issues head on.
By the end of rounds, Dr. James has seen more pathology, had his clinical thinking challenged, and practiced more procedures than he could've imagined possible on his own as a novice. With Clara scanning charts, projecting interactive 3D imagery, and monitoring patients, plus Dr. Singh providing sage counsel, he was able to focus completely on learning.
Afterwards, Dr. James and Dr. Singh summarize, review and discuss the day’s rounds via the headset, or on a full size computer screen, whichever the doctors prefer. Dr. Singh provides feedback, asking thoughtful questions and correcting any misconceptions. Together, they reason through each case again. For Dr. James’ 77 year old female patient, they land on a diagnosis of pneumonia and an appropriate antibiotic. Dr. James authorizes the script electronically through his headset while Clara takes notes and updates all records for all Triton-Smith staff to see instantly.
Humans, AI and Telemedicine as a Team
Artificial intelligence (AI), augmented reality (AR), and telemedicine each bring unique benefits to clinical training and medical rounds. AI assistants like Clara can rapidly digest patient charts and labs to identify critical information. Backed by natural language processing and machine learning algorithms, they can suggest likely diagnoses based on symptoms, past cases, and scientific literature. Tracking data over time also enables an AI to flag changes in vital signs or disease progression. This helps focus the human physician's attention on what truly requires it.
AR allows interns like Dr. James to access 3D anatomical models, visualizations of scans and tests, decision trees, and step-by-step procedural instructions right within their field of vision. A 2014 study found that AR technology allowed interns to perform central line insertion procedures faster and with fewer mistakes compared to textbook instructions (Huang et al.). With AR, physicians can stay focused on the patient while seamlessly referencing relevant data. Vital sign monitors, medication dosage calculators, and teleconference calls can also hover in a physician's periphery without breaking focus. This allows for efficient task management.
Finally, telemedicine opens up a conduit to experienced specialists like Dr. Singh. While AI and AR can provide extensive information, there is no substitute for a real-time conversation with a human expert clinician. Telemedicine allows interns to present cases and think out loud to senior physicians. The back-and-forth exchange helps solidify clinical reasoning skills. Telemedicine also enables timely consultations and learning opportunities that distance would otherwise preclude.
Together, AI, AR, and telemedicine amplify the strengths of both people and technology. AI acts as an efficient first pass analysis of patient data. AR then provides interactive overlays to augment the physician's senses. Telemedicine connects human experts to weigh in with nuanced assessments. The combined potential is greater than the sum of its parts. Moving forward, this synthesis of minds and machines could profoundly enhance clinical education and patient care. The next generation of physicians, like Dr. James, will be able to provide better, faster treatment while rapidly acquiring skills through on-the-job AI and AR support. The future of medical rounding could be exponentially more enriching for learners and patients alike.
Works Cited
Huang, T.K., et al. “Augmented Reality as a Telemedicine Platform for Remote Procedural Training”. Surgical Innovation, vol. 22, no. 5, 2015, pp. 522-526.
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