Arizona Health Sciences Center Students Practice Use of Telemedicine in a Rural Setting

Interprofessional simulation involving nursing, medicine and pharmacy students was funded by the Advanced Nursing Education Grant, awarded to the University of Arizona College of Nursing.

Ten health sciences students from the University of Arizona recently participated in a pilot simulation using telemedicine to support patient care in a rural setting. The event was funded by the Advanced Nursing Education Grant awarded to the UA College of Nursing, and was a collaborative effort among the Arizona Area Health Education Centers (AHEC) Program, the Arizona Simulation Technology and Education Center (ASTEC) and the Arizona Telemedicine Program (ATP).

During the event, the students tested a cutting-edge teaching/learning model, implementing iPad technology in an interprofessional patient care simulation. Four students, two each from the UA Colleges of Nursing and Pharmacy, participated in the simulation remotely from Flagstaff, Kingman and Phoenix via iPad video conferencing. They provided support to a six-student, in-person team delivering care to a simulation manikin experiencing a heart attack. The in-person team consisted of two students each from the UA Colleges of Medicine, Nursing and Pharmacy. Both groups were facilitated by an expert simulation instructor.

“This is a perfect concept, and one I envisioned when I wrote the grant three years ago,” said Sally J. Reel, PhD, RN, FNP, FAAN, principal investigator of the grant, associate vice president for interprofessional education, collaborative practice & community engagement, and director of Arizona AHEC. “This concept involves two important aspects: creating the virtual clinic, and developing teaching and learning opportunities for students who are not located on the same campus. These are both realities in today’s world, and we need to be able to teach and practice in these environments.”

The scenario involved an adult patient (the simulation manikin) coming into a rural clinic on the Navajo Reservation in northern Arizona for his two-week follow-up appointment after experiencing a heart attack and subsequent stent replacement. When the in-person student team began their examination, the patient reported feeling chest pains and began to suffer another heart attack. The in-person student team immediately jumped into action to save the patient, while the remote student team provided additional expertise and support in directing and monitoring patient care. 

One student from the in-person team served as team leader to oversee and direct the patient’s care, while another student monitored communication between both teams to ensure the remote team knew the steps being taken and the in-person team followed through on care recommendations made by the remote team. The other students at the patient’s bedside provided IV medications, delivered chest compressions, monitored the patient’s airway and prepared needed supplies.

The students participated in a second round of the same simulation to further advance their understanding and coordination of team roles, streamline communication and better utilize the support and expertise provided by the remote student team. Both times the students succeeded in saving the patient’s life.

During the pilot simulation, the outlined goals of testing the iPad video conferencing technology and determining the usefulness of such technology in expanding the reach of student learning opportunities and educational simulations were achieved. In addition, students had the opportunity to reflect on and improve their skills working as a team, implementing constructive, interprofessional communication and self-assessing their level of clinical knowledge and comfort in a code situation. 

During debriefing sessions, the students agreed the exercise was a great opportunity to practice communication with other health-care professionals in a real-life clinical situation. “It comes down to practice and experience,” said pharmacy student Aaron Leyba.

Danielle Correia, a medical student, also noted the benefit of the interprofessional nature of the simulation, adding, “It’s great to have different knowledge bases.”

Nurse practitioner student Karina Bechtold reflected on how this type of experience could help her and other nursing students transition into advanced practice. “In the future, if I get this [simulation] opportunity again, I should move into the leadership role,” she said.

Building on the success of this pilot simulation, leaders from Arizona AHEC, ASTEC and ATP are aiming to develop an innovative, interprofessional simulation curriculum. Applications of this teaching/learning model include training for providing patient care through telemedicine, creating a virtual patient care environment for students located at different campuses, and simulating specific scenarios, such as after-hours care, low-resource settings and accessing off-site clinical expertise.

This event was sponsored in part by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant #D09HP25031 Technology Enhanced Rural Interprofessional Primary Care FNP Education, Sally J. Reel, PhD, RN, FNP, FAAN, Principal Investigator. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor would any endorsements be inferred by the DN, BHPr, HRSA, DHHS, or the U.S. Government.