How TECHNOLOGY has changed the way we learn and study

Dr Christopher Mathew, Resident, SingHealth Anaesthesiology Residency Programme shares with us his thoughts on how technology has changed the way he learns and study as a junior resident.

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The use of technology in medical residency training is nothing new. Many aspects of residency training have benefited from the incorporation of technological advancements, from real-time tracking of residency requirements to developing 3D models for honing of procedural skills by trainees. Indeed, the ubiquity of technology in residency is reflected in the exponential increase of publications regarding the use of technology in residency, as evidence by a cursory database search over the last decade. As a junior resident, I have come to appreciate the various aspects through which technology has influenced my life as a resident.

A key component of residency training is the requirement to fulfil a minimum number of teaching hours per month. A large portion of these comprises departmental morning teachings, in addition to occasional half-day lectures and simulation workshops organized for residents. Prior to the COVID pandemic, I vividly remember attending morning teachings where staff were often packed in a small tutorial room, jostling to make room for the steady stream of colleagues trickling in. Being on leave or post-call often meant that one had to give these a miss. All that has now become a thing of the past, with most teachings being streamed live on video-conferencing platforms.

The shift online overcomes many physical limitations such as space and travel constraints and greatly facilitates staff attendance at these teachings. It also opens up these teachings to external speakers to share their wealth of knowledge and experience despite being miles apart. Indeed, I dare say that this has become the new normal in conducting department teachings and I look forward to the greater opportunities to participate in them.

For most of my residency training, I had grown accustomed to using electronic charting of vital signs intraoperatively. Recently, I was posted to an institution that was still using handwritten paper charting. Needing to manually plot vital signs every 5 minutes seemed like a huge step back when compared with the automatic charting I was used to. Thankfully, the department soon shifted to electronic charting as well, which was a great relief (at least to me).

Having a brush with how things were done prior to the advent of electronic charting deepened my appreciation for technology. It made me realize the workload such systems take off our hands, freeing up our attention which can be channeled towards making clinical decisions for our patients. At the end of the case, a concise and compact anaesthetic summary chart can be churned out at the touch of a button, thereby facilitating the handover between the intraoperative and postoperative teams.

The implications of such technology are also more far-reaching than we might think, with potential impact on patient safety. One key aspect in assessing a patient prior to anaesthesia involves reviewing prior records to determine how their airway was secured and what difficulties, if any, were encountered. Especially in this line of work, being caught unaware of such things when inducing a patient could very well result in disastrous consequences.

Manually recording such crucial information on handwritten charts runs the risk of accidental misplacement, degradation in the quality of the chart over time or even difficulty in making out information due to incomprehensible handwriting. It doesn’t help that we doctors already have a notorious reputation for poor penmanship. Thus, shifting to electronic charts allows for much a much neater presentation of this information and easier retrieval by our colleagues even from remote locations without having to thumb through stacks of old, yellowed patient notes or trying to decipher the grade of the larynx from the previous operation.

Technology can also play an important role in augmenting our training and familiarity in handling rare but life-threatening conditions. Perioperative complications such as anaphylaxis and malignant hyperthermia are exceedingly rare but when they do arise, the response of the anaesthetist needs to be swift and unfaltering. While this may seem like a tall order, technology provides an elegant solution to the problem through simulation training. All the simulations I have participated in thus far have begun with a familiarisation session with an ultra-realistic mannequin with life-like eyes (with pupillary responses to light, no less), palpable pulses and an ability to vocalise symptoms in response to questions. The use of such advanced mannequins greatly enhances the realism of the training and allows for the simulation of more complex scenarios, thereby allowing us to cultivate our skills in handling pathologies we might otherwise encounter once in a lifetime (literally).

However, the implementation of technology in our practice is not without its obstacles. Often, implementation of new technology into an existing workflow may meet some scepticism from those who have become set in their ways. Adopting new technology also involves a learning curve that may seem unnecessarily steep to some who feel more comfortable in practising the way they have been for decades. But making the initial effort to get over the curve will allow us to reap great benefits and keep up with the newest developments in our own fields.As patients become more tech-savvy and familiar with the latest technologies, choosing to ignore the latest developments may leave us trailing behind. As they say, a rolling stone gathers no moss.

Furthermore, the cost of newer technological gadgets and software may act as a deterrent but we should keep in mind the long-term benefits that can come despite an initial high start-up cost. The scalability and adaptability of most technological systems makes them very cost-effective in the long run despite the initial necessary modifications to the existing workflows and practices. Despite technological advancements progressing at an unwavering pace, this may in turn prove to be its own downfall if not implemented cautiously.

One good example that comes to mind is SEDASYS, a computer-assisted personalised sedation system (CAPS) by Ethicon which first received approval from the Food and Drug Administration (FDA) in 2013. While its primary goal of automating procedural sedation for gastrointestinal endoscopic procedures seemed promising, it came as no surprise to some when the parent company pulled the plug on this barely 3 years later citing a lack of uptake. Some of the purported reasons for this include the inability to properly titrate sedation to desired depths (of both the patients and proceduralists), the lack of cost-savings and its inability to tweak the drug regime to accommodate any inherent pharmacokinetic variability.

Almost 10 years ago, Hemmerling and Terrassini already opined that the use of robots in the field of anaesthesia was fast becoming a reality, with innovations such as BIS-guided automated sedative administration, robots for intubation and even robotic nerve blocks being described 1 . More recently, even more complex automated sedation systems like the AnaConDa TM and MIRUS TM systems have been developed but still remain in their infancy. While most of these have yet to take root in daily anaesthesia practice, the possibilities appear boundless.

As junior trainee just starting out on this journey of residency, I cannot help but wonder – will these augment our practice as anaesthetists or just prove that with the right technology, even in the field of medicine, no job is indispensable? Unsettling as this thought may seem, we can take comfort in the fact that there are some things technology probably can never replace in our line of work.

The ability to make split-second judgement calls in emergency situations, meticulously titrating dosages of drugs based on an array of haemodynamic parameters and even deciding whether or not to proceed with anaesthesia for a high-risk patient are some things technology can never imitate regardless of the complexity of the algorithm. In life-or-death emergencies, no man-made machine can hold a candle to the remarkable ability of the human mind to adapt and respond.

Yet another thing that technology might never be able to replicate is that of the human touch. The words of reassurance to a patient undergoing an operation for the first time and the gentle squeeze of the hand as they gradually go under are things that may make a world of difference to our patients but can never be replicated by any machine. Indeed, while technology continues to proliferate around us in a plethora of ways, it helps to remember that at best, it only serves to complement, and not replace, our efforts to uphold patient care, safety and satisfaction.

References

1. Hemmerling TM, Terrasini N. Robotic anesthesia: not the realm of science fiction any more. Curr Opin Anaesthesiol. 2012 Dec;25(6):736–42.

2. Ramos Torres D. Reconciling Technology and People: Quality of Care During End-of-Rotation Transfers. Acad Med. 2018 May;93(5):678–9.