A Med School Mulligan: Technology Drives TCMC

At various points during his 35 years at West Virginia University, Dr. Robert D'Alessandri felt certain there had to be a better way.

"In the '90s, we were still teaching students the same way we taught them in the '30s," says the school's former vice president for health sciences and dean of its medical school. "I kept saying, 'if I had this to do over again, I'd do things differently.' "

A little more than two years ago, he got his chance. He was hired as the first president and dean of The Commonwealth Medical College, based in Scranton.

"When this job came up, I saw it as a great opportunity to do what I always said I wanted to do, to do it differently," he says. "Our goal is to prepare our students for practice in the future, and to make sure they have the capacity and the ability to provide care for their patients in a healthcare system that's going to be dramatically different from the one they're learning in today."

A big part of that difference is going to be technological developments, which is why the school developed with technology integration as one of its cornerstones.

"If you look at our mission statement, it's in there. So right from the beginning, we wanted to differentiate ourselves," D'Alessandri says. "We don’t want to be 130th medical school in the country."

Instead, the school aims to be an influential force in the industry, pushing the adoption of cutting-edge technology by producing tech-savvy physicians so desired by residency programs that the facilities are willing to upgrade their equipment to match the students' technology demands.

In an ever-expanding world where location is no longer the obstacle it was, many of those new technologies being integrated at TCMC deal with connectivity and communications. The college, which welcomed its inaugural class this school year, outfits each student with a laptop with Internet access through a cell-phone network so they can check coursework, review the school's online library and connect with contacts wherever they can get cell service.

D'Alessandri expects that one outcome of that will be a revolution in how patients interact with doctors. All through e-mail, they will be able to make appointments, receive test results and medical advice, have prescriptions forwarded instantly to a local pharmacy and give specialists access to relevant medical history when being referred.

"In the new world of information systems, they would be able to go online with your permission and access your information," he says. "You expand that beyond a region to a state."

For example, a patient who recently had blood work done could receive an e-mail noting a high cholesterol count with a message from the doctor explaining the significance. Depending on the severity, it could include a note to call the office or information about a medication the doctor is prescribing, along with a prescription that's already been forwarded to the patient's pharmacy of choice.

"What we believe we're doing is beginning to influence healthcare as it goes forward," D'Alessandri says.

The beginning doesn't end there. The school is really a network of three major campuses in Scranton, Wilkes-Barre and Williamsport, along with various satellites where students receive in-the-field instruction from mentor-physicians. Beyond that, each student is paired with a family of patients, whom they follow throughout school. The idea is sort of a co-op to get students experience in practical issues, such as bedside manner and a medical-practice setting.

All that roaming presents a challenge to keeping students connected with homework, faculty feedback and other classroom responsibilities. Wayne Thompson, the school's chief information officer and associate dean of technology, is tasked with making sure that happens.

"We've really built this environment on the premise that we don't know where the student or faculty will be at any given time," he says. "I think we have built this environment with technology being an integral part for students, and a potential differentiator compared to other universities."

That environment unfolds on multiple levels. First, the students are given the technology to keep them connected at all times. Second, much of the school's curriculum is Web-based, accessible through a student portal. Third, the system is designed to be interchangeable to accept new technologies as they become available.

"if you can build in that flexibility, it prevents you from tearing it down when you face another challenge," he says. "By making it Web-based on the other side, we've really allowed for geography to be taken out of the equation."

Thompson previously spent 15 years at a similar position for other health services, so he has what he calls a "fair amount of experience in exactly this role."

That said, creating the infrastructure from its foundations wasn't easy or cheap. "Two years ago, there were six people in half of a floor in a building in downtown Scranton with laptops, and that was the extent of the technology here," he says.

Now, the IT staff has 13 employees, and, while he can't peg the expenditures exactly, he's confident "we've certainly spent a couple of million dollars."

That doesn't include the technology students get to touch. Maria Olenick is a registered nurse and the director of the school's Clinical Skills and Simulation Center, which means she's in charge of the "human patient simulators."

Fake people might be a better description. "They cough, they sweat, they bleed. We can provide a voice for them," says Olenick of the simulators, which run upwards of $100,000 each.

Beginning in their second year, students use them extensively to diagnose ailments, treat with intravenous--albeit fake--drugs and monitor responses.

"When I went to school, they used to learn how to give injections on oranges. Now they're giving injections on places that are more anatomically correct," Olenick says. "Before, we had to tell them (how patients reacted to students' decisions). Now we don't have to tell them. They can see it for themselves. They see it happening.  When they make mistakes, because we know they'll make mistakes, we can talk about how to make things better without putting real patients at risk. We liken it to flight simulators. You wouldn't want someone flying your plane unless they've practiced before."

From a youthful energy unlike other medical schools to access to advanced technology--one student said he chose TCMC mostly for its proximity to Geisinger Health System and its interpretive MRI--the school's first class feels the school differentiates itself.

"It was hard to ignore the excitement that surrounded the college," says Tyler Dowling, an Allentown native who spent his undergraduate years at Franklin & Marshall College in Lancaster.

When the school's permanent headquarters opens in downtown Scranton--expected in spring 2011--the program will have 12 simulators, says Olenick, including adults, pregnant women and babies.

The technological thrust doesn't end with student education, though, because that education can't advance without research pushing it. It's a concept that Robert Shivers, an associate professor of microbiology and immunology, calls "benchtop to bedside."

"The longterm goal  is to advance the understanding of the biology of a given system we know, and advance the education of the medical students," he says. "It's two sides of the same coin."

To that end, the school has invested several million dollars, by Shivers' account, on research technology, such as a massive, three-dimensional microscope that records experiment results in real time and a machine that speeds up research exponentially by testing a wide array of potential matches simultaneously.

The confocual laser microscope costs upwards of $375,000 and takes up half a room with its appendages, but the science it investigates delves deep into the inner workings of individual cells. "Normally, microscope imaging is a single plane," Shivers says. "It's like you're looking at the top of a table surface."

But that misrepresents the location of biological machinery in cells, he says, and doesn't always identify what they're doing. Since things like proteins don't look the same from all angles, researchers used to be forced to imagine how they interact and assume when that generally happens.

The confocual allows researchers to immerse themselves within the cell so they can see exactly when and how their experiments are working. Additionally, the microscope is fitted with lasers that can highlight various units in a cell so that researchers can track each of their specific movements during an experiment.

All told, the confocual can capture four images at different heights within the cell and four images of specifically highlighted units--every half second. It's a process that Shivers says reduces a day's worth of tedious work documenting each interaction individually into 20 minutes of real-time oooh-aaaah science.

"Research has progressed to the point where people want to see a live reaction," he says. "This technology helps us because previously everything was fixed slices, and not the same level of resolution that we can get with this microscope. You would have to look at 100 cells to see how they progressed along the way."

It's that kind of instant impact that's driving research these days. "There are some experiences we can do with the confocual that we couldn't have done previously," Shivers says. "It makes it so we can stay focused on what's really important."

And that, in turn, allows for students to be trained on new things as they're being developed.

"How often do you get to start a brand new school?" says Adam Klein, a student from Huntingdon Valley who got his bachelor's degree from Penn State University. "You're not just a bar code. You're not just a statistic. You're the future of medicine."

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Rory Sweeney writes on energy and the environment when he's paid to and sits around talking about them when he's not. Send feedback here.

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Photos:

Maria Olenick MS, CRNP and director of clinical skills and simulation prepares an infant SIM for students. Each SIM has a computer and various scenarios which can be played out through them.

Associate dean of technology and chief information officer of TCMC Wayne Thompson points out some of the tools that connect the college to various sites.

Kate Delmar MA, standardized patient trainer, adjusts the computers to some of the SIM patients.

Maria Olenick MS CRNP works on Harvey, a cardia and breathing SIM.

Kate Delmar, MA

All Photographs by Aimee Dilger