From Distance to Presence

UND’s Remotely Operated Biomedical Telepresence Systems project revolutionizes telemedicine and team-based healthcare education in the United States

“These are huge. They should be implemented into every medical program there is,” noted the white-coated medical student as she finished her home health simulation at the UND School of Medicine & Health Sciences (SMHS) Simulation Center late in 2017. “This was literally the most valuable learning experience I had this semester.”

Knowing that UND is already a leader in medical simulation in the upper Midwest, this particular third-year student had gotten used to honing her clinical skills in the School’s “Sim Center.” But something just felt different—better—about this latest session.

The simulation was part of the School’s new Remotely Operated BiOmedical Telepresence Systems (ROBOTS) project, a series of three interconnected scenarios that follow a single patient over the course of her medical treatment for a myocardial infarction, or heart attack. Building on the existing simulation program at UND, ROBOTS represents a potential paradigm-shift in medical education: not only is it highly interprofessional—involving students from social work, nursing, and physical and occupational therapy—but it also trains students in the latest developments in telehealth.



Back in 2015, Senior Associate Dean for Education and Faculty Affairs Gwen Halaas, M.D. (now retired), and Associate Dean for Teaching and Learning, Rick Van Eck, PhD, teamed up with Simulation Center Director and Associate Professor of Medicine Jon Allen, M.D., and Associate Professor of Family and Community Medicine Eric Johnson, M.D.. The group sought to develop curricula to teach both interprofessional healthcare and telehealth (or telemedicine) in order to prepare healthcare professionals for the future in rural healthcare.

After winning the support of Dean Joshua Wynne, the team pitched its idea to the American Medical Association as part of the Accelerating Change in Medical Education consortium of 32 leading medical schools. The AMA invited SMHS to join the consortium and the team took off, expanding the project to include six Double Robotics 2-wheeled robots—imagine a Segway with a tablet for a head—for the telemedicine component.

The team also realized that telemedicine in the future will extend far beyond a patient or provider interacting with a faraway physician through a fixed screen. The robots mobilize the tele-physician by connecting her to a device that can be maneuvered throughout the clinical setting as she interacts with colleagues and the patient.


“…I play one on TV”

According to both Johnson and Allen, while most medical students enter their studies aware of the need for and value of learning about telemedicine, they often struggle to understand how their etiquette, voice modulation, and body language have to change when interacting with patients through a screen— and how the screen alters the doctor-patient relationship.

“There’s so much students need to learn with the camera, so we need to train them for those skills as well,” explained Johnson, “but these robots are designed to be driven around— to be in the room with you. What that does differently from typical telemedicine is give you a sense of agency that you wouldn’t normally have.”

“This is a game-changing experience for healthcare,” said Van Eck, who is also the School’s Dr. David and Lola Rognlie Monson Endowed Chair for Medical Education, “because it creates ‘telepresence,’ which is the feeling for both doctor and patient that they are together in the same space. And there’s research that shows that this translates to better patient satisfaction—the patient feels more like the doctor was listening to them or cared—all because the robot allows the physician to behave as if they are really there in person.”

Furthermore, the researchers are quick to point out that what drives these simulations is the need to provide the best possible healthcare outcomes by providing the best possible healthcare education.

“And that means interprofessional teamwork,” added Johnson. “Given the unique mission of the UND SMHS to train healthcare providers for North Dakota, we felt it was important to recognize the role that telemedicine plays in interprofessional teamwork.”

“You might be able to pick up a phone or stick your head out the door at Johns Hopkins and call in any number of different specialists, but with rural healthcare, you need to reach beyond your own setting,” said Allen, noting that the School’s North Dakota context requires training students how to collaborate in person and at a distance. “I’m not aware of anyone doing this sort of thing anywhere else—combining telepresence robots with interprofessional simulation is particularly novel.”


Building confidence

Such training is especially valuable in North Dakota in so far as it helps provide the state with more health practitioners of all types.

“Through our rural, underserved scenarios, students are learning that even if they are working in those environments, they’re not all by themselves,” said Johnson. “It’s good to know that I can work in Hettinger and still get a cardiologist telemed consult right now from Bismarck. I think students look at that as they make decisions about specialization and choosing where to practice and feel more supported, more encouraged, especially in a rural environment.”

“That leads to getting more doctors back into a rural state,” Allen quickly added. “If they can feel comfortable with telemed, they’ll feel more comfortable being that primary care physician out in Tioga or Garrison or somewhere else where there aren’t specialists. Now, they’ve got those specialists at arms-length, regardless of where they practice.”

For Van Eck, not only do health students understand the pace at which health care is changing today, but they recognize that future models of care are less likely to rely on the co-location of providers and patients.

“They see the value in learning about telemedicine,” he concluded. “We heard dozens of positive comments about how each profession holds a different piece of the puzzle and how satisfying it is to work as a team to provide better healthcare than any one profession could do alone.”