Professional Experience Placement

There were a number of presentations at the Context Sensitive Health Informatics conference that can impact on supervision of students. During the next few weeks I will discuss aspects of those papers in relation to facilitation, PEP or work integrated learning.

Dissemination of the outcomes of a remote tele assistance project named Helping Hands was presented. This project was undertaken as a seed funded project from the OLT. This project was initiated to improve how health science students learn procedural skills whilst on placement in healthcare settings in Australia by applying and customising an augmented reality or AR tele-assistance system to make remote guidance and instruction more accessible. Hand hygiene was chosen as it is a procedural skill that health science students need to master during their preparation to become health professionals. The World Health Organisation guidelines were used as this is the ‘usual’ instruction within our University and Australian healthcare environments.

It was a three staged project that focused on The project took a staged approach: Stage 1 determined the user requirements of the system and assessed potential technical challenges. Stage 2 was a usability trial to ensure that clinical skill outcomes were not being compromised by using the approach. The hypothesis that there would be no significant difference in outcomes for students undertaking Helping Hands instruction compared to “usual instruction” was tested under supervised, simulated conditions in a clinical skills simulation laboratory. The confidence of student participants to perform the hand hygiene procedure was assessed by survey prior to and following the intervention (usual instruction or Helping Hands).

The instructor’s unit consisted of a screen, camera and headset (microphone and headphones). The instructor watched the real-time image from the HMD camera of the student conducting the procedure on a display screen. A camera mounted on a support arm over the display screen captured the instructor’s hand gestures which were then sent to the student’s near-eye display. The learning or procedural skill outcomes were assessed using an empirical measure of hand hygiene success. A protocol to measure residual Glitterbug which is a simulated bacterial load solution was developed and trialled in the usability study. Students hands were photographed under UV light to visualise residual Glitterbug after they had either usual instruction and after being instructed via Helping Hands. These were analysed by a registered nurse who was independent from the project and blinded to the cohorts.

Stage 3 was a feasibility field trial where Helping Hands was used with students in a patient care area in two states of Australia, the Northwest of Tasmania and in Sydney, New south Wales with Launceston in Tasmania to test remote instruction, ensuring that patient safety and ethical standards were maintained. Students at both sites provided written feedback about the equipment and ease of use. Both groups indicated there could be positive and negative feelings by patients.  Both groups suggested ensuring patients were informed about the reasons for the use of the technology and had an understanding of why it could be used, and it could be viewed as positive for their care. Both groups were very encouraging and enthusiastic about the use of the technology as an educational tool in the future. There was no difference found in use of Helping hands or usual instruction.

Helping Hands is a wearable solution that addresses the need for a hands-free, portable, remote audio and visual guidance system that has broad applicability across the health arena. The application of this technology in learning and teaching scenarios represents a significant step in simulated learning. The project has application across a range of healthcare settings with a significant benefit for WIL environments in which staffing levels are lower and those where students may find access to an on-site instructor more difficult, such as in rural and remote areas.

The technology developed by this project allows procedural experts to share their skills and acumen with one or more novices without the need to be in the same physical location as the learner. This can represent a significant saving in time, resources and a more effective utilisation of expertise. Furthermore, educational outcomes were not comprised by this novel method of instruction. Feedback from participants indicated use of the technology was not viewed as a barrier to their learning. Respondents indicated they believed patients with education, would understand the need for deployment of the technology, to guide a clinician or student in a new or rare procedure, and could be of benefit by improving health outcomes.

In a broader context, the technology has potential for use in many other healthcare situations such as emergency childbirth, road trauma, expeditionary medicine and remote area nursing, where front-line health professionals may need to call upon a distant procedural expert. The technology also has potential for use in clinical situations necessitating a high level of biosecurity such as those found in bio-containment patient care units, or during the treatment of highly contagious diseases (ie Ebola or SARS or MRSA). The technology also has potential for non-healthcare uses where remote instruction is required. The Helping hands innovation has the potential to transform supervision and therefore has the capacity to transform practice.

If you have any comments about direct and indirect supervision using remote guidance you are welcome to post them here.  please join us @PEPCommunity