Over the last 30 years, Dr. George Kondos, professor and vice head in the Department of Medicine, has taught thousands of first-year University of Illinois Chicago medical students how to perform the cardiovascular physical exam using a highly advanced simulator who goes by the name Harvey.
Dr. Kondos typically conducts the teaching sessions in-person. But with COVID-19, these in-person teaching sessions needed to be converted to virtual teaching sessions. This was not an easy task since heart sounds and other subtle physical exam findings need to be displayed so students would understand the difference between a normal patient and a patient with one of the various cardiac diseases.
Harvey is a lifesize manikin able to simulate 50 different cardiovascular diseases through heart sounds and lifelike pulses in the neck and chest. It serves as a simulator for students to be able to hear sounds mimicking various diseases and feel the pulse that would correspond to these diseases.
“You can give 20 common heart sounds and murmurs to primary care physicians and they’ll get about 10% of them correct, and that’s because they’ve never been really taught how to listen to the heart sounds,” said Kondos.
Comparing Harvey to airplane simulators that have taught pilots how to react to events in the air from the safety of the ground, Dr. Kondos said Harvey is used to train young doctors how to assess and treat a patient by simulating conditions a new doctor would confront bedside with a patient.
Normally, Harvey would join Dr. Kondos as he traveled to the College of Medicine’s Peoria, Rockford and UIC campuses, where he would teach more than 300 students yearly.
Prior to the pandemic when he would have had to drive to each of the campuses, he would give the same lessons independently to the students on each of the campuses. He previously conducted the sessions surrounded by the students, who would break out into small groups.
Since COVID-19 forced teaching to go virtual, Harvey, which was developed by UIC College of Medicine Class of ’61 alum Michael Gordon, also been has forced to do its teaching online.
“Obviously COVID made a little bit of a problem for us, but we converted it from an actual in-person course to an online course,” said Kondos. “I ran them through the normal physical and gave them findings of the abnormal physical exam.”
Recently, Kondos used Harvey to simultaneously teach more than 300 students — 182 in Chicago, 55 in Rockford and 66 students in Peoria — who took part in an online cardiology plenary course introducing them to the cardiac exam.
He did this by using various examples that students could see virtually; for example, he used cotton swabs to dramatize the strength of the carotid pulse by laying the stick of the swab flat across Harvey’s neck as the pulse sent the stick and swab tip moving up and down along with the sound of the pulse.
“Even though you don’t have the actual patient here, you can simulate to students what they’re actually seeing and then also not only that, but you can show students various examples of disease states,” Kondos said. “We all recognize simulators are no substitute for a real patient. However, if you can’t make the diagnosis on a simulator you probably would miss the diagnosis on a real patient.”
Katherine Knowles, a first-year medical student, said that while she is looking forward to in-person classes, she appreciated the attention the faculty gave to setting up cameras to give proper stethoscope placement and changes in Harvey’s jugular venous pulse.
She said she has been amazed at how quickly she and her peers have adapted to online learning and how it has become second nature to communicate with each other electronically. She said that since she and most of her peers had grown up with technology, adapting to virtual learning was not as much of an impediment and could actually aid them when the pandemic goes away.
“If anything, understanding how to work around the screen-induced barrier of virtual patient examination in addition to in-person exams, will aid us in the future as physicians conducting telehealth appointments,” Knowles said. “These are skills that many current physicians may not have had the opportunity to fully practice prior to the necessary transition to virtual telehealth appointments in the midst of this pandemic.”
The class with Harvey provided a wonderful opportunity to be familiar with the various heart sounds, areas of auscultation, and other important cardiovascular maneuvers employed in a cardiac exam.
“I liked the ease and low stakes nature of starting with a simulator,” said student Louis Darkwa. “I liked certain additional maneuvers done on Harvey — like placing a Q-tip on its carotid artery to make its pulse more visible. This Q-tip on the carotid artery is a move not performed on real human patients but on Harvey, it was a great pedagogical technique.”
One of the other benefits that happened with them having to go online is that it allowed it to become more manageable.
“Many times these class sizes are so big that everybody can’t really see everything and these are subtle kinds of things that you’re showing,” Kondos said. “So with Harvey, it’s actually helped because here the students can see, they can hear — probably better than they can in a large group — and you can engage them in discussion.”
Another student, Kevin Cao, said that he believes he and his peers are in a unique situation, having been the first medical school class to be formally taught online.
“The way Dr. Kondos taught us via Zoom integrated more descriptive, anecdotic and illustrative ways of demonstrating what a physical exam would look like with Harvey and subsequently with real patients,” Cao said. “As a result, we used our imaginations to play out scenarios with the clinical vignettes and try to become more sensitive to what I think would appear in real life.”
Source- UIC Today