By K. Richard Douglas
The pace of change and innovation accelerate with each new year. Novel ideas for building a better mousetrap are enabled by advancing technology. Resourceful minds, focused on the newest capabilities, devise new platforms and systems to meet the needs of a changing world.
The pandemic produced many changes in the world and one of the challenges that it spawned was how to overcome the conundrum of in-person training in an environment of social distancing and a highly transmissible virus.
For many professions, continuing education credits are an ever-present requirement as well as credits to maintain certifications and registrations.
The healthcare technology management (HTM) profession was one of the occupational fields that was faced with additional challenges because of social distancing and quarantine requirements. This impacted national conferences, association meetings, CE classes, vendor training and college courses.
Yet, despite the restrictions created by the pandemic, resourceful thinking paired with high-tech, provided a bridge between instructors/presenters and biomeds. Also, with the greater need for biomeds to backfill the vacancies of baby-boom retirees, the resourcefulness of colleges and technical schools, to provide the highest level of training, has spawned incredible training environments.
Apple is said to be working on a powerful mixed-reality headset — augmented reality/virtual reality (AR/VR) — that is slated to be launched in 2023. Although the concept is not new, applications for the technology continue to evolve. Navigation using 3D maps might be an application for the new product, along with live text or even mapping out rooms.
The use of AR/VR in training has proven to hold several benefits. Some companies have embraced this technology.
Also, during the pandemic, the use of remote training was instrumental in keeping the training momentum, using several different platforms.
Training is part of being an HTM professional; whether that training be to fulfill continuing education (CE) requirements, OEM training, management training, training from an ISO or routine in-house training.
Making training more accommodating or more immersive or lifelike increases the effectiveness and usefulness of the experience.
Biomeds had their hands full during the pandemic, standing up COVID-19 surge units, re-appropriating equipment, swapping out departments, extra-sanitizing and staffing challenges. Add the new challenges confronting training to the mix, and the need for resourcefulness, creativity and flexibility were in high demand.
Making the Best Use of AR/VR in Training
One company that has fully embraced the use of AR/VR in training within the health care industry is GE Healthcare. They say that; “Talent development plays a critical role in GE Healthcare’s culture and continued success as a leading provider of medical technology, pharmaceutical diagnostics and digital solutions.”
The difference between augmented reality and virtual reality is that augmented reality simply augments one’s surroundings while virtual reality is an immersive experience that creates a simulated environment.
“One of the most effective ways to learn is by doing. Using augmented reality (AR) and virtual reality (VR) in our service and clinical training, we create experiences that replicate the real work environment and workflow. This enables teams to safely learn and perform real-life activities in a virtual learning environment,” says Rick Ludwig, principal learning architect with GE Healthcare.
Ludwig says the move is from knowledge-based training to a practice-based approach in which students experience simulated, real-life situations with systems and software. GE Healthcare’s Learning Innovations team leverages 3D models produced by its engineering teams when designing and building products to build virtual learning environments, so students are practicing with accurate models.
“With augmented reality, a student can bring up a full-sized CAT scanner in their own living room, look under the covers to see components and walk around it to gain an appreciation of the machine’s scale. Students are given the ability to simulate a procedure before, during, and after training. Students can then learn on the job, using AR to overlay the computer-aided design (CAD) on top of the physical machine and show step-by-step exactly where and what the service engineer needs to interact with to complete the task,” Ludwig says.
The AR/VR approach is utilized in the training of new biomeds as well.
“Technological innovation is fueling exponential change in higher education. The most impactful initiative we are undertaking is our investment in mixed reality (MR) curriculum and content development for use in biomedical and imaging training. The use of virtual and augmented reality content provides an opportunity for students to engage in training that would otherwise be too dangerous, too expensive, or simply inaccessible to them,” says Dr. Richard L. “Monty” Gonzales, president of the College of Biomedical Equipment Technology in San Antonio, Texas.
He says that by identifying and narrowly defining critically important interactions, they can design discreet and highly effective learning interactions that compliment traditional hands-on or interactive distance learning (IDL) education.
The approach has also won favor with Injector Support and Service (ISS) in Winter Garden, Florida.
“Technology is a major tool in education and training, expanding the limits of medical device training and the traditional classroom experience. The most obvious way it is shaping education is through mixed reality, including virtual reality and augmented reality. Our partnership with the Imaging Academy will bring virtual reality training directly to the student, offering a complete remote training experience, prior to ever touching a piece of equipment,” says ISS President Ryan Clarke.
“We have discovered that students engaging in VR training prior to hands-on training perform better and possess a greater retention rate than students engaging in traditional training only,” he says.
Ludwig says that GE Healthcare also uses VR in instructor-led training at its training institute and remotely.
“This method is shifting towards self-paced learning in which VR technology would allow remote-based field engineers to train autonomously at the time of need. This technology can help improve retention of skills significantly,” he says.
He says that GE Healthcare also utilizes virtual machines to help deliver console-based training in a one-to-one learning methodology. Each student is given the ability to learn how a system’s console works without risk of damage to a real machine.
“Altogether, GE Healthcare has hundreds of mixed reality scenarios, resulting in students experiencing these technologies thousands of times each month. The expectation is for these technologies to vastly expand over the coming months and years,” Ludwig adds.
The approach seems to be excitedly adapted by tech-savvy learners who embrace high-tech applications.
“This approach has revolutionized the way we deliver training. Students love the opportunity to interact with the system from their home, experiment with hardware and software, make mistakes and learn so that they are confident and prepared for customer interaction,” says Dana Milnes, training strategy and technology director with GE Healthcare.
Some in HTM education see VR as another great tool to use for training but can’t discount hands-on training.
“As for VR and the future of BME education, I would say that while it is a useful tool that can supplement training. It may never truly replace hands-on learning but it does have its place in areas such as medical imaging where you could work on very expensive and dangerous equipment without the fear of downtime and safety issues. In the education world it could also allow students to work on a variety of equipment that many schools don’t have simply due to cost and size,” says James Linton, MiM, PmP, Cmbb, AAMIF, professor/coordinator of biomedical engineering technology at St. Clair College in Ontario, Canada.
He says that the real benefit is people can practice working on equipment anytime, day or night, to prepare. It is similar to how a surgeon may perform a walkthrough prior to a difficult case. The large argument is always that VR training isn’t as good as hands-on, but in the same vein, texting or email is not as good as in-person conversations.
“Instead, VR is another stream we can use to train the next generation and validate the skills of those in the field who potentially haven’t touched certain pieces in years. I think back to when I started as a BME manager after 7-plus years as a field service engineer in pharmacy automation, that first IV pump after 7-plus years away from school was quite daunting. I would’ve loved a way to test and improve some long dormant skills in a safe environment instead of one an expensive, important and potentially dangerous piece of equipment,” Linton says.
Replicating the Health Care Environment
When a student is sitting in a classroom learning to be a biomed, it is difficult for them to conceptualize the hospital or other environment they may find themselves in as a biomed. With the demand for well-trained biomeds, every effort is needed to turn out the best HTM professionals as possible.
At the Collin College Technical Campus in Allen, Texas, professor of biomedical equipment technology, David W. Braeutigam, MBA, CHTM, CBET, AAMIF, ITIL, has gone to great lengths to replicate the health care environment in the biomed lab.
“I was fortunate to be able to design the new biomedical equipment technology program at Collin College. I basically had a clean slate to start with. My goal was to recreate specific areas of a hospital that a biomed would typically interact with clinicians and set the biomed lab to mimic those areas. I wanted the equipment the BMETs worked on to be in the environment they would see at a typical hospital. I was fortunate that the campus already had a physical therapy department so I did not have to recreate that area for the students,” Braeutigam says.
He says that he created a doctor’s office area, two ICUs, a central monitoring unit (CMU) that displayed the hardwired bedside monitors and telemetry, an operating room, a recovery room, a NICU, a clinical lab, an IV pump station with automated IV pump analyzers, and a biomed shop complete with work benches and supplies.
“I had headwalls placed for each of the ICUs and the NICU that included power and network for both GE and Philips monitoring. I had a network closet installed in the biomed shop area that interfaced the bedside monitors to the CMU,” Braeutigam says.
He says that the doctor’s office has an exam table, a wall mounted oto/ophthalmoscope with NIBP and temperature, a vital signs monitor, a hyfrecator, a tabletop autoclave, a 12-lead ECG machine, a centrifuge and a microscope.
The ICUs have Philips and GE monitors mounted to the headwall and hardwired via ethernet to their respective networks, regular and emergency power, dummy gas outlets, and future wiring for a nurse call system. The monitors are mounted to the headwall just like in an ICU. The ICU also has patient beds, Alaris and Hospira IV pumps, hypo/hyperthermia units and ventilators.
“The CMU has Philips and GE central station computers for bedside monitors and telemetry. The OR has an operating table, plans for an anesthesia machine, a surgical video tower, a tourniquet, several models of ESUs and patient monitoring. The recovery room has a stretcher, Philips and GE patient monitoring, a fluid/blanket warming cabinet and a Bair Hugger unit,” Braeutigam adds.
He says that the NICU has a radiant warmer, an incubator, baby scales, fetal monitors, a birthing bed, Alaris and Hospira IV pumps, syringe pumps, PCA pumps, and Philips and GE patient monitoring. The clinical lab has urine analyzers, blood gas analyzers, basic and high-speed centrifuges, several cell washing centrifuges, several models of microscopes, a lab incubator, a blood bank refrigerator and a lab scale.
“Throughout the biomed lab are several crash carts with defibrillators to mimic what they would find in the hospital,” Braeutigam says.
He says plans include having a nurse call system installed (he had the headwalls prewired for nurse call) and to also have a PACS system installed this summer.
Innovative Training in an Evolving Environment
While the pandemic proved to be a historic inflection point in so many ways, it challenged training techniques with more remote focus being the norm out of necessity.
“Innovatus has designed educational sessions targeted at both HTM professionals and the health care staff. Prior to the pandemic, most sessions were held on-site and in-person. One item that we identified with this approach to training, is that not long after our visit, old habits returned. The pandemic forced us to change our approach to fully virtual sessions. Even though in-person is now possible, our sessions have remained virtual, and moving to virtual sessions has actually resulted in improved results,” says Ted Lucidi, CBET, clinical, technical and commercial specialist with Innovatus Imaging in Pittsburgh, Pennsylvania.
He says that their approach is focused on training one or more HTM team members to be in-house experts for probe and coil care and handling practices.
“We provide them with the knowledge, documentation and support needed to succeed,” he says.
“HTM professionals use the same tools that we would use as if we were on-site, and the Innovatus team collaborates to develop comprehensive solutions to maximize device lifecycle. It’s a true partnership. This approach builds confidence and trust in the HTM team, and places greater ownership on clinical departments. It’s now quite easy to determine which departments choose to engage in implementing best-practices and those who choose to remain status quo. Shifting to virtual training can result in improved outcomes depending upon the approach,” Lucidi says.
Experience has shown many who train that a multi-faceted approach will keep the interest of students.
“At ReNew Biomedical, we realize that all apprentices learn differently and respond to various teaching styles. We strongly encourage our instructors to use a multi-sensory approach during our training sessions. Each week, we attempt to engage our students through tactile training on the workbench and visual or auditory training through in-class lectures or video tutorials,” says Jill Taylor, co-owner of ReNew Biomedical.
She says that it isn’t unusual that they allow students to teach a part of a course they feel qualified for, which enables them to gain confidence in their ability to instruct or mentor others and provides additional insight or perspective to the material covered.
“We often use learning software to administer quizzes about complex concepts, and we do our best to make learning fun by playing games such as ‘Knowledge Bowl Fridays’ or ‘Name This Tool,’ where they can earn rewards for their knowledge and hard work,” Taylor says.
Maull Biomedical Training uses a mix of approaches to get the best results.
“Maull Biomedical Training utilizes both classroom and distance learning techniques to teach biomeds how to operate, maintain and repair contrast injectors. Our training is broken into three parts; Introduction to Contrast Injectors, Model Specific Operation Training and Model Specific Maintenance Training. The first two parts of the training are done online with videos and quizzes; the students watch a video and then must answer quiz questions and get at least a 75 percent passing grade to move on to the next section. The third part of the training, the maintenance training, can be done hands-on in a classroom or the student can download our software program that uses videos to provide the maintenance training with step-by-step instructions taking them through the entire PM procedure for each model,” says Steve Maull, owner of Maull Biomedical Training LLC in Aurora, Ohio.
He says that his company is partnering with Imaging Academy to soon produce a virtual reality program that will teach the students the intro, operation and maintenance courses.
“We recently unveiled a version of it at AAMI and it was very promising,” he says.
Training is evolving with the times.
As for the general future of BME education, Linton say that his college has been accommodating as the BME/HTM world continues to change. It allows the staff to update and overhaul the program as needed.
“It’s because of this that we have been able to pivot and adjust to match what we see as the future of education,” Linton says.
He said it is addressing the needs of HTM as well as all of the specialties within the field while “also embedding in students a sense of humbleness and how our whole profession is meant to save lives — no different than a doctor, we just use different tools, if you will,” Linton says.