Mrs. Kim enters the clinic. She is elderly, Korean, and also…a virtual avatar? That may come as a shock, but when we sought to develop a way to improve care for an aging America, a video game ended up being the ideal solution.
It all started back in 2008. That’s when an Institute of Medicine report concluded that the best health care is provided by a well-educated team of professionals who know how to work together. Teamwork matters. Then, Medicare announced new payment mechanisms that will require health providers to deliver care to older adults based on the outcomes of the care provided, rather than a fee for services. Health care providers must work together in order to achieve the best outcomes. Easier said than done, of course.
Practicing teamwork must start during a provider’s education, which is a difficult undertaking due to packed curricula and inflexible class schedules. That’s why I, along with University of Vermont colleagues and a team of professional gamers, created a “virtual clinic” for health care students from eight disciplines to interview an elderly patient and then discuss the best interventions for her care together.
How the Virtual Clinic Works
Just like a traditional video game, students start by choosing their own “avatar.’ Think “The Sims.” They decide on sex, race, hairstyle, and even clothing choice. Then, they enter the clinic to interview their patient. There, they meet Mrs. Kim – and at certain points, they also meet members of her family.
Each interview uncovers different aspects of the patient’s history that are important for the team to consider. The following types of interviews are available:
- Primary Care Provider (for nurse practitioner/medical students)
- Physical Therapy (for physical therapy and exercise science students)
- Nutrition (for dietary and communication science students)
- Pharmacy (for pharmacy students)
- Social Work (for social work students)
During the interview, students choose questions that are culturally appropriate, open-ended, jargon-free, and consistent with the principles of Motivational Interviewing (Rollnick, Miller, & Bulter, 2008). They also have to listen to an interview at the pace of an elder and review the notes of the last primary care visit, labs, and notes from a recent emergency room visit.
One student said: “The interviews are very realistic in regards to patient-practitioner interaction, and the patience required to obtain all necessary information.”
Coordinating Patient Care as a Team
After interviewing “Mrs. Kim” in the virtual clinic, the students participate in an interprofessional video conference. The nurse practitioner student is responsible for presenting the meeting agenda, stating the goal of the conference, involving the other students by utilizing their chosen meeting roles, and guiding the participants to arrive at a prioritized action plan.
Of this, a student expressed: “It was a great experience hearing other professionals’ perspectives – a great learning experience for all, really very enriching, especially considering that any provider must have enough knowledge to know when to refer and what services can be provided by others.
“Players” to Date
Recently, 89 student participants conducted and finished 191 interviews in the virtual clinic. Some students visited the virtual clinic multiple times to prepare for the video conference. A qualitative analysis found students appreciated practicing interview techniques in a place that was “free of judgment.” Some expressed frustrations about the interview questions posed, or the pace of speech of the Korean elder; while others appreciated the feedback on open-ended questioning and viewing the interviews of other disciplines.
Mrs. Kim’s answers highlighted a Korean culture that is not as common in Vermont. With the virtual clinic as a preparation for the interprofessional video conference, the students were able to bring unique information from their interview to share with others. The virtual clinic interview helps students develop patient/family-centered and culturally-responsive interviewing skills.
The overwhelming majority of students who have participated think the virtual clinic and videoconferencing is a valuable experience. They gain skill in interprofessional practice, learn more about what other professions bring to a team, and value the interprofessional discussion focused on patient-centered goals rather than discipline-specific goals.
The UVM virtual clinic has provided a convenient, acceptable and fun format for teaching students across the disciplines to work together, particularly for improving the care of elders. One of our students put it best: “It is a great reminder that health care works as a team! Everyone brings a different perspective to the mutual goal of caring for our patient.”
Mary Val Palumbo, DNP, APRN GNP-BC, is an associate professor in the UVM College of Nursing and Health Sciences and a gerontological nurse practitioner. She sees patients at the UVM Medical Center Memory Program and is the principle investigator of the HRSA Advanced Nursing Education grant that supported this work.