Some 20 years ago, when Dr. Colleen Donovan started watching the TV show “CSI: Crime Scene Investigation,” she was always impressed by the opening credits, “which started with a wide shot, then moved in for a closeup of the victim, then zoomed in for a view of an organ, then finally scaled down to a blood vessels and cells. Later, when I became an emergency medicine physician and medical simulation education specialist at Rutgers Robert Wood Johnson Medical School, I always wished I could do something like that in the classes I teach, which include college- and graduate-level students, fellows and practicing physicians who want to refresh their skills.”

Today, she’s able to do just that, “thanks to the blurring lines between technology and medicine,” Donovan noted. “Among other tech tools, I use an AR [Augmented Reality] headset so I can display real-time diagrams while discussing medical procedures. For example, we have advanced manikins that have a simulated pulse that can ‘bleed’ or go into labor, and as we work on them I can use the AR headset to supplement the patient presentation with cellular-level illustrations. It makes things even more real for my students.”

Some of her most creative medical-education ideas come from places like Disney World, she added. “We recently did a Halloween-themed escape room activity with Emergency Department doctors and students where we delivered electrical therapy to a realistic-looking manikin dressed as Frankenstein’s monster. Among other activities, teams of participants had to match a variety of ailments to the poison that can cause them. We also turned out the lights and had them use ultrasound to find and remove metallic objects from a model — this is a fun and engaging way to test their skills while applying time and competition pressure.”

But even as technology improves the ability of educators like Donovan to pass their knowledge on, it also brings some challenges. “It’s a tricky position because some of this technology is new to the educators, as well as to the people who will be using it,” she explained. “So, we have to first determine whether it meets the acceptable standards of care for patients, and then determine how to teach others to use it.”

She welcomes the challenge. “I’m very curious and I’m excited about new things,” said Donovan. “And I’ve always been interested in how technology informs decision making. “

Students often have “well developed technological skills that our educators haven’t mastered yet,” added Donovan. “Some studies have shown that skills with video games may be linked to improved hand-eye coordination — an important translatable skill to procedures and video-assisted surgeries. Skills with social media and internet searching may also be helpful as students weed through massive amounts of available information to find robust and reliable literature to guide their medical practice.”

An “experiential” approach enables students to better relate to the subject matter, she noted. “Instead of just telling them what an irregular heartbeat is like, I can show them – they can hear it, feel it, see it – so they’re immersed in the moment and can ask the tricky questions that will inform their own deeper understanding.”

Med-tech advances will enable health care professionals to provide even better care for patients, according to Dr. Charles Binkley, director of bioethics at Hackensack Meridian Health and associate professor of surgery at the Hackensack Meridian School of Medicine. “As a surgeon, for example, prior to a procedure I may be able to ask an AI program to review the sum of a patient’s electronic medical records and summarize, in a few paragraphs, what I need to know about the patient.”

“So, AI can support clinical decision making, and we are familiarizing future clinicians [doctors who have direct contact with and responsibility for patients, as opposed to theoretical or laboratory studies] with AI’s capabilities and its limits,” he added. “For example, how will a doctor decide what to do if their assessment does not agree with an AI-generated conclusion?”

Binkley says there is “a need to understand the underlying models used in AI. A heart-failure model that has been trained on middle-aged men may perform wonderfully for that cohort but will likely fail miserably if it’s applied to women. So, I’m advising medical students to inquire about the populations that AI programs were trained on, and I’m also advising them not to discard their own clinical judgement. The good news is that they’re entering medical school with a high level of familiarity with digital devices and social media, and I’m confident that today’s medical students can handle these and other issues.”

Digital twins

According to German folklore, everyone has a doppelgänger, or otherworldly identical twin. But technology is rapidly bringing the doppelgänger concept out of the realms of fantasy and into practice, where it may help health care professionals to improve and even save lives, according to Binkley. “The combination of the rise in wearables — which can constantly track a person’s vital signs among other data, combined with individuals’ genetic information, their electronic medical record and the potential of artificial intelligence, means that we’re beginning to be able to construct ‘digital twins,’ first of an individual’s organs and eventually a digital simulation of the entire person,” he said. “This means that, prior to performing a medical procedure or even prescribing drugs, we can model the potential effects on their digital equivalent to help determine the best course of action. Eventually, we should be able to create a digital clone of a person that can be updated throughout their lifetime.”

But building and maintaining digital twins raises ethical issues. “Some people may not have the same access to medical wearables, or to hospital systems that can offer this,” Binkley said. “Will this exacerbate the bifurcation of medical equity? And if everybody’s wearables, social media and other activities are uploaded to their digital twin, how will we ensure the confidentiality of their data?”

Environmental impacts also come into play, he noted. “Although digital twins may help to improve medical treatment, the computing power and electrical consumption involved will be enormous. How will that issue be addressed? Digital twins are on the horizon. The ethical and environmental issues they raise must be addressed before they become a reality.”