Jeffrey Tully

Recording medical students' encounters with standardized patients using Google Glass: providing end-of-life clinical education.

Problem Medical education today frequently includes standardized patient (SP) encounters to teach history-taking, physical exam, and communication skills. However, traditional wall-mounted cameras, used to record video for faculty and student feedback and evaluation, provide a limited view of key nonverbal communication behaviors during clinical encounters. Approach In 2013, 30 second-year medical students participated in an end-of-life module that included SP encounters in which the SPs used Google Glass to record their first-person perspective. Students reviewed the Google Glass video and traditional videos and then completed a postencounter, self-evaluation survey and a follow-up survey about the experience. Outcomes Google Glass was used successfully to record 30 student/SP encounters. One temporary Google Glass hardware failure was observed. Of the 30 students, 7 (23%) reported a “positive, nondistracting experience”; 11 (37%) a “positive, initially distracting experience”; 5 (17%) a “neutral experience”; and 3 (10%) a “negative experience.” Four students (13%) opted to withhold judgment until they reviewed the videos but reported Google Glass as “distracting.” According to follow-up survey responses, 16 students (of 23; 70%) found Google Glass “worth including in the [clinical skills program],” whereas 7 (30%) did not. Next Steps Google Glass can be used to video record students during SP encounters and provides a novel perspective for the analysis and evaluation of their interpersonal communication skills and nonverbal behaviors. Next steps include a larger, more rigorous comparison of Google Glass versus traditional videos and expanded use of this technology in other aspects of the clinical skills training program.

Ultrasound-Guided Central Venous Access Using Google Glass

BACKGROUND The use of ultrasound during invasive bedside procedures is quickly becoming the standard of care. Ultrasound machine placement during procedures often requires the practitioner to turn their head during the procedure to view the screen. Such turning has been implicated in unintentional hand movements in novices. Google Glass is a head-mounted computer with a specialized screen capable of projecting images and video into the view of the wearer. Such technology may help decrease unintentional hand movements. OBJECTIVE Our aim was to evaluate whether or not medical practitioners at various levels of training could use Google Glass to perform an ultrasound-guided procedure, and to explore potential advantages of this technology. METHODS Forty participants of varying training levels were randomized into two groups. One group used Google Glass to perform an ultrasound-guided central line. The other group used traditional ultrasound during the procedure. Video recordings of eye and hand movements were analyzed. RESULTS All participants from both groups were able to complete the procedure without difficulty. Google Glass wearers took longer to perform the procedure at all training levels (medical student year 1 [MS1]: 193 s vs. 77 s, p > 0.5; MS4: 197s vs. 91s, p ≤ 0.05; postgraduate year 1 [PGY1]: 288s vs. 125 s, p > 0.5; PGY3: 151 s vs. 52 s, p ≤ 0.05), and required more needle redirections (MS1: 4.4 vs. 2.0, p > 0.5; MS4: 4.8 vs. 2.8, p > 0.5; PGY1: 4.4 vs. 2.8, p > 0.5; PGY3: 2.0 vs. 1.0, p > 0.5). CONCLUSIONS In this study, it was possible to perform ultrasound-guided procedures with Google Glass. Google Glass wearers, on average, took longer to gain access, and had more needle redirections, but less head movements were noted.

Experiences in Adoption of Teledermatology in Mohs Micrographic Surgery Using Smartglasses for Intraoperative Consultation and Defect Triage

Decades after its development, Mohs micrographic surgery (MMS) remains the first-line treatment for skin malignancies in functionally and aesthetically sensitive areas. By nature, the size, shape, and extent of Mohs defects are not known prior to margins being cleared by histological examination. In many large institutions, multiple patients are treated concurrently, and the decision for optimal method and surgeon for defect closure is a collaborative effort between multiple subspecialists. This may include dermatology, plastic surgery, otorhinolaryngology, and other surgical subspecialties. Although effort is always made to communicate effectively, tools that improve the communication between physicians participating and collaborating in patient care will improve outcomes and make these processes less strenuous and more efficient. This conflagration of complicated scheduling, defect repair triage, and coordination between multiple departments provides an ideal environment for the application of intradepartmental telemedicine. We report with great interest that telemedicine and other telecommunication technologies are increasingly used to coordinate care in surgery and dermatology. For example, Lamel et al have explored the use of mobile phones for skin cancer screening and Kanthraj has described the successful use of teledermatology for remote consultation in dermatosurgery. Additionally, plastic surgeons have used third-generation smart phones for triaging wounds and other traumas. Telehealth technologies have also been used in MMS, especially for the purpose of telepathology. For example, distinguishing between basal cell carcinoma from benign histology on difficult frozen sections may be aided by dynamic telepathology intraoperatively. Smartglasses (Google Glass, Google Inc, Mountain View, CA) are a new telecommunication device, computer engineered to fit into a pair of eye-glasses (Figure 1). They are hands-free, voice-activated tools that present information to the user on a small translucent optical display. These features make smartglasses well suited to dermatological surgery where infection control and complex procedures prevent the surgeon from using other devices like computers or cell phones. Our device is also fitted 552735 SRIXXX10.1177/1553350614552735Surgical InnovationHamann et al research-article2014

Allergy Consultation via Smart Glasses: Cases Reports of Real-Time Clinical Decision Support for Suspected Oral Metal Allergy

Objectives: We explore and describe clinical experiences of the early adoption of smart glasses, for dermatology/ allergy decision support in two cases of suspected oral metal allergy. Materials and methods: Smart glasses were used to facilitate physician-dentist communication during dentalexamination for two patients with concerns for metal allergy and bio-incompatibility. Results: Clinical use of smart glasses has reduced the burden of multiple visits and facilitated coordinated care for complex patients with suspected oral metal allergy. Conclusions: Smart glasses technology may be used for hands-free videoconferencing during exams and procedures to coordinate care and consult experts in cutaneous allergy, increasing quality of care in complex cases and decreasing patient consults and visits. Clinical relevance: Smart glasses and other telecommunication devices will play larger roles in healthcare in the future, especially where their use will decrease visits and potentially decrease cost of care.