Health care education is coming to life at the University of Houston, with pioneering technology transforming the way students learn. Professors who previously relied primarily on textbooks, models and illustrations to teach their students are now bringing patients into living classrooms. But these aren’t just any patients. They’re different ages and ethnicities, each with their own maladies and idiosyncrasies. UH is among the first in the nation to employ two new cutting-edge technologies for training the next generation of health professionals.


Optometric Clinical Skills Simulation Lab

In the last year, UH College of Optometry students began hands-on training in a first-of-its-kind simulation lab that offers them 24/7 access to virtual patients. The Optometric Clinical Skills Simulation Lab, which will better prepare students to administer patient care when they start clinical rotations, is the only one at an optometric program in the country and the largest in the world.

“When students come in this room and see the technology, they’re blown away,” said assistant professor Heather Anderson, who led the initiative to bring the simulation lab to UH. “The simulators have two components. The patient interface is a smooth black sheet of plastic with a 3-D face, and that face turns into the patient you’re examining. The simulators take on the demographics of whatever cases are programmed into the computer, so now we can have the students examine elderly eyes, diseased eyes and eyes from all different ethnicities.”

This is done through an augmented headband-mounted light that’s used to obtain a view of the retina through a handheld lens in a procedure called indirect ophthalmoscopy. It’s the same headband worn by professionals, but instead of having plain lenses to look through, it has LED screens mounted in it to create the images of the lifelike patients. The other component of the simulators is a touchscreen computer that brings up the different patient cases and faces. All images are based on actual clinical cases, so the images the students see are derived from real patient retinal photographs.

“When you look through the LED screens, you see a patient that’s blinking and moving their eyes and looking back at you with the ethnicity and age of the patient you’re examining,” Anderson said. “The simulators are very realistic in that they do get tired. They’ll blink and close their eyes if you remain in one position with the light for too long and don’t give them breaks. They respond the way a patient would, so if you spend too much time exposing the retina to the light, you’ll even see a tear come down the cheek of the virtual patient.”

In the traditional academic setting, students use each other as patients during their earliest lessons in optometry. Typically, though, they have healthy retinas, so students aren’t getting real-world exposure to diseases until they start with clinical rotations. Additionally, to teach students how to detect disease in the back of the eye requires that the patient be dilated. It becomes difficult for a student ‘patient’ to be dilated frequently when they need to go home and study, since dilation lasts several hours.

The technology records precisely what students see, their examination skills and, ultimately, the quality of patient care they provide.
The technology records precisely what students see, their examination skills and, ultimately, the quality of patient care they provide.

With this technology, students gain 24/7 access to dilated patients and can examine the retinas of these virtual patients any time they want. Another benefit is that students traditionally have been taught disease through photographs, textbooks and computer images and are not physically examining patients with these diseases until they get to the clinic. This technology enables them to go through the physical examination process to see diseased eyes and better prepare for that detection before they’re administering patient care.

The curriculum built into the software is extensive, teaching pattern recognition to familiarize students with a variety of pathologies, as well as giving them practice in diagnostics and proper equipment usage. Students are quizzed after each exercise and cannot progress to another case until they’ve mastered the previous level. The simulation equipment maps out the parts of the retina the students have looked at, so now their professors are able to objectively quantify how successful students have been in examining 100 percent of the retina.

This gives faculty an objective way to analyze a student’s progress. In current practice, when students are learning these techniques, their professors are looking over their shoulders in a little mirror that reflects what the students see. It can be difficult to quantify how fully the student has examined the retina. This technology, however, records precisely what students see, their examination skills and, ultimately, the quality of patient care they provide, with data stored on each student’s activities, tracking their progress and performance.

In addition to the simulators now being able to tell faculty how much of the retina students examined, they also reveal how much time it took them. This allows faculty to know if students are doing an efficient exam that would be acceptable to a patient’s comfort. Another evaluation tool used in conjunction with these simulators is a series of multiple choice questions about each case as to whether or not students correctly identified the pathology and then identified the correct treatment strategy.

“Many of the diseases we’re looking for have dimension to them, so if you look in a patient’s eye that is simulating a retinal detachment, you can see the depth of the retina floating as it’s detached,” Anderson said. “It’s very realistic. Seasoned doctors have gone in to examine the equipment and say it feels so natural. You put the headband on and feel like you’re examining an actual patient.”

Feedback from the students has been overwhelmingly positive. Among the features that most seem to appeal to them is the realistic aspect of having authentic patient cases that relate directly to actual human beings, giving them an idea of what to expect when they get to clinical rotations. Another aspect students find advantageous is that the mistakes they make while initially learning on these virtual patients don’t have consequences for real people. Some students are so enthralled that they’ve hunkered down for marathon training sessions, with 10 students completing the first semester’s worth of training by the end of the first weekend the lab was open.

The 10 Eyesi ophthalmoscopes — five each of both the direct and indirect models — are designed to train for the examination of the retina and were designed by ophthalmologists and simulation technology experts in Germany at VRMagic, a provider of virtual reality medical training simulators for eye care professionals.

Joining Anderson in the effort to bring the Eyesi system to UH were assistant professor David Berntsen and clinical associate professor Amber Gaume-Giannoni. With this new technology, students gain exposure to more than 200 clinical cases of pathology built in to the patient simulators. This mode of education capitalizes on the philosophy of pattern recognition to identify disease presentation and gives all students an equal opportunity to gain exposure to a variety of eye conditions.

When the simulation lab opened in the fall 2014 semester, second-year optometry students were given first crack at it. In spring 2015, access was also granted to first-year students. Ultimately, students will be able to benefit from the simulators through all four years of their time at the optometry college, as well as during their residencies.

BodyViz Technology Takes Biology Classes to New Dimensions

In the College of Natural Sciences and Mathematics, new technology is helping research faculty transform the way undergraduate biology and biochemistry students learn about human anatomy, physiology and pathology. The BodyViz system was acquired at the start of the spring 2013 semester.

UH was only the second institution in Texas to introduce this technology and the first to use it for higher education and research.

The other, at Houston Methodist Hospital, is using it in a clinical setting as a part of surgical planning.

UH is one of only a handful of higher education institutions across the country to offer this technology outside a clinical setting. At UH, the BodyViz enables both students and faculty to tackle research questions using 3-D visualizations of MRI and CT scan data from actual living patients. It gives them an opportunity to explore inside the human body. The software is especially advantageous for researchers and students working toward careers in science and health care, as more and more doctors and surgeons are using 3-D visualization programs, like BodyViz, in professional medicine.

“We are training the future health professionals. They’re going to be tomorrow’s doctors, nurses, physician assistants, optometrists, pharmacists and dentists,” said Tejendra Gill, instructional professor in the department of biology and biochemistry and director of laboratory instruction. “We need to expose them to this state-of-the-art technology, because they will be using these types of tools in those fields all the time. Understanding and being able to manipulate these images opens up the sciences beyond the classroom, giving them the experiences of what it’s like to be a professional. These are skills they can take to professional schools.”

The BodyViz system allows for visualization inside the bodies of living humans and takes it a step even beyond access to cadavers. While both are important, undergraduates at college-level institutions don’t usually have access to cadaver labs.

“It’s as close to a cadaver lab as you can get,” said Chad Wayne, an instructional associate professor of human physiology in the department of biology and biochemistry. “In essence, it’s a virtual cadaver lab, which has its own advantages, such that you can analyze the architecture of the human body and see the relationship between the organs, blood vessels, bones, muscles, cartilage and tissue that you wouldn’t normally get to see. In a cadaver, while it will still be there, it’s compacted and doesn’t always look right.”

In working with BodyViz, users put on 3-D glasses, pick up an Xbox video game controller and manipulate images of body systems, organs and tissues from a wide cross section of patients. They can fly in, out, through, around and up close to detailed, three-dimensional scans of real body parts, systems and all that makes them up. Using the Xbox controller and mouse, students can rotate the image or cut through it by moving a virtual knife in any given direction to slice through a particular structure for a deeper look. It goes beyond what a textbook and traditional lectures can do, giving life to the material that students are learning in the classroom.

BodyViz screen capture of an abdominal aortic aneurysm.
BodyViz screen capture of an abdominal aortic aneurysm.

“Users are able to peel away layers with the Xbox controller to see the distinct structures of different organs and other systems in color for a very good 3-D view inside the body, giving them a way to better see the interplay between function and structure,” Gill said. “By stripping away these layers, students are able to see the spatial relationships between the internal organs that they wouldn’t ordinarily get to see in a regular textbook. Using the virtual knife to cut through the body in any direction, students can go inside not only to study the organs, but also until they get to a specific pathological condition, revealing an unprecedented look inside at any kind of malformation, fracture, tumor, aneurysm or growth a person may have.”

Another benefit, he says, is that these images are coming from authentic patient cases, so the images they see were created in real-time from living human beings.

“To understand structure, students need to hold, touch and manipulate it. In traditional lecture classes, the only exposure students really have to the human body is the illustrations that are very cartoonish and drawn in a perfect or ideal structure, which is not true to life. And in the laboratory, you have plastic and clay models, again crafted to match an ideal, but humans are imperfect,” Wayne said. “The advantage of the BodyViz system is it really allows you to see what it looks like in a living, breathing human being. You really are seeing what it will look like inside a human if it were actually functional, so you get to see all the quirks and the different things.”

Both professors say this immersive type of technology has led to more inquisitive students, widening their horizons and leading to more creative thinking.

“This is an investment we’re making in the education of our future generations,” Gill said. “We’re providing them the tools and resources to help them stand out, not just teaching them the chapters, but also the concepts. It forces them to move beyond just regurgitating information and lets them develop problem solving and critical thinking skills.”

Echoing the sentiment, Wayne says, “BodyViz forces students to look at anatomy as more of a concept. By doing so, all of a sudden, it’s no longer that pretty picture in the book or the pretty plastic model. It becomes a tangible reality. Ultimately, it’s the concepts that will drive students forward in their education.”

The professors both have witnessed firsthand how thrilled students have been with the BodyViz system and how it has stimulated their thinking and inspired them to go on in pursuit of advanced degrees, training and jobs in the medical field. Gill says their classes and labs are filled to the brim, with more than 500 students using the BodyViz each semester.

“By being exposed at a very early point in their education to start seeing how this technology works, we’re arming them with the skills that will allow them to succeed,” Wayne said. “If you can ignite their passion early on, they’re going to excel and going to pursue it.”

Installation of the BodyViz system was supported by the UH department of biology and biochemistry and by a UH Quality Enhancement Plan Curriculum Development Grant awarded to Gill and Wayne, who jointly wrote the grant and received generous support from Dan Wells, who is now the dean of the College of Natural Sciences and Mathematics.

While mostly pre-health majors in the areas of biology, nutrition, kinesiology, and health and human performance have been using BodyViz, it’s open to all undergraduate and graduate students, as well as researchers, regardless of major.