Virtual Clinic Research Articles

Feasibility and value of a domiciliary spirometry programme in the assessment of severe asthma: a real-world evaluation.

Domiciliary spirometry (DS) is a novel tool that is widely employed in the assessment of respiratory disease. We assessed real-world feasibility, effectiveness and value of a physiologist-led home spirometry programme in patients with treatment-refractory severe asthma. Patients were referred and provided with a hand-held DS device. Patients completed baseline measurements in a physiologist-led virtual clinic and were instructed to provide further values during any periods of respiratory symptoms. Outcome measures included prevalence of new obstructed events, DS adherence and uptake of this approach. 112 patients were enrolled from November 2020 to January 2023. 102 individuals, mean±sd age 44±13 years (86% female) with median (IQR) forced expiratory volume in 1 s % predicted 88% (77-97%), successfully recorded baseline spirometry values. During follow-up (24 months), 11 (11%) were identified with new obstructive spirometry and were subsequently able to be commenced on biologic therapy. Patient engagement was poor with median (IQR) of 4 (2-6) attempts of contact made before baseline values were recorded, and 2 (1-3) attempts required to record technically acceptable values. Continued DS use was suboptimal; 34% failed to use their device after baseline and only 10% continued at the end of the study period. The cost of DS measurements was greater than a single hospital-based visit but enables multiple event capture. Overall, DS measurement uptake was poor, with a minority of patients continuing to use the device at the end of the study period. However, for those that engage, DS provides an alternative approach to traditional hospital-based spirometry measurements that can alter clinical management.

MA01.09 A Novel Advanced Nurse Practitioner Virtual Clinic for Patients with Low Probability of Lung Cancer

MA01.09 A Novel Advanced Nurse Practitioner Virtual Clinic for Patients with Low Probability of Lung Cancer

How safe and effective are paediatric virtual fracture clinics? A systematic review.

Virtual fracture clinics (VFC) involve a consultant-led multidisciplinary team meeting where cases are reviewed before a telephone consultation with the patient. VFCs have the advantages of reducing waiting times, outpatient appointments and time off school compared to face-to-face (F2F) fracture clinics. There has been a surge in VFC use since the COVID-19 pandemic but there are still concerns over safety in the paediatric population. Fractures make up a large burden of paediatric injuries, therefore research is required on the safety and efficacy of paediatric VFCs. This systematic review will look at the safety and effectiveness of paediatric VFCs, as well as determine the cost-effectiveness and parent preferences. As per the PRISMA guidelines two independent reviewers searched the following databases: Medline, Embase and Web of Science. Studies were included if children under 18 years old presented to A&E with a suspected or confirmed simple un-displaced fracture and were referred to a VFC. The primary outcomes assessed were effectiveness and safety, with the secondary outcomes of cost-effectiveness and parent satisfaction. Six studies met the inclusion criteria for this systematic review. There was a high rate of direct discharge from the VFC leading to reduced outpatient appointments. All patients were seen within 72 h of presentation. There were limited incidences of missed fractures and the rates of re-presentation were similar to that of F2F orthopaedic clinics. There were significant cost savings for the hospitals and high parent satisfaction. VFCs have shown to be safe and effective at managing most stable, low operative risk paediatric fractures. Safety must be ensured with a telephone helpline and an open return to fracture clinic policy. More research is needed into specific paediatric fracture types to be managed in the VFC. https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier: CRD42023423795.

Impact of cystic fibrosis multidisciplinary virtual clinics on patient experience, time commitments and costs.

The experience of outpatient care may differ for select patient groups. This prospective study evaluates the adult patient experience of multidisciplinary outpatient cystic fibrosis (CF) care with videoconferencing through telehealth compared with face-to-face care the year prior. People with CF without a lung transplant were recruited. Patient-reported outcomes were obtained at commencement and 12 months into the study, reflecting both their face-to-face and telehealth through videoconferencing experience, respectively. Three patient cohorts were analysed: (i) participants with a regional residence, (ii) participants with a nonregional including metropolitan residence and (iii) participants with colonised multiresistant microbiota. Seventy-four patients were enrolled in the study (mean age, 37 ± 11 years;50% male;mean forced expiratory volume in the first second of expiration, 60% [standard deviation, 23]) between February 2020 and May 2021. No differences between models were observed in the participants' rating of the health care team, general and mental health rating, and their confidence in handling treatment plans at home. No between-group differences in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) were observed. Travel duration and the cost of attending a clinic was significantly reduced, particularly for the regional group (4 h, AU$108 per clinic;P < 0.05). A total of 93% respondents preferred to continue with a hybrid approach. In this pilot study, participants' experience of care and quality of life were no different with face-to-face and virtual care between the groups. Time and cost-savings, particularly for patients living in regional areas, were observed. Most participants preferred to continue with a hybrid model for outpatient care.

Implementation evaluation of a teledermatology virtual clinic at an academic medical center

BackgroundTeledermatology (TD) is an evidence-based practice that may increase access to dermatologic care. We sought to use the Exploration, Preparation, Implementation, and Sustainment (EPIS) and the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) frameworks to evaluate implementation of TD at Duke.MethodsThe EPIS and RE-AIM frameworks were deployed to design and implement a TD program that leveraged the strengths of the Duke University Health System and addressed previously reported barriers to implementation of store-and-forward and synchronous TD models. In the resultant hybrid TD model, trained primary care providers (PCPs) sent e-comm referrals with clinical and dermatoscopic images to dermatology. These e-consults were reviewed asynchronously and patients were scheduled for a synchronous video visit with dermatology within days. Dermatologists managed the patient plan. This hybrid TD model was piloted at four primary care clinics. Pertinent outcomes from a TD-adapted RE-AIM framework were tracked using electronic health record data. Patient satisfaction was assessed using a post-video visit survey (n = 18). Implementation barriers and facilitators were also collected through provider surveys (n = 24 PCPs, n = 10 dermatologists, n = 10 dermatology residents).ResultsAt four PCP clinics throughout 9/1/2021–4/30/2022, there were 218 TD referrals. Video visits occurred on average 7.5 ± 0.5 days after referral and 18/18 patients completing the post-visit survey were satisfied. Adoption varied between clinics, with one placing 22% of all dermatology referrals as TD and another placing 2%. The primary PCP barriers to TD were time burdens, lack of fit in clinic flow, and discomfort with image taking. Top-endorsed potential facilitating interventions included allowing for rash referrals without dermoscopy and assurance for clinical evaluation within 3 days.ConclusionsThe use of implementation science frameworks allowed for identification of system and contextual strengths which informed the hybrid TD pilot. Barriers and facilitating interventions will provide guidance for expansion and ongoing maintenance of TD.

Virtual multidisciplinary ALS clinic care during the COVID-19 pandemic: a Canadian cohort.

Virtual multidisciplinary ALS clinic care during the COVID-19 pandemic: a Canadian cohort.

Integration of Telehealth in Routine Perinatal Care: A Model of Care for Primary Healthcare Clinics in Saudi Arabia.

This study aims to introduce a new model of antenatal/postnatal care that integrates virtual clinics with the current model of care, including a discussion on the current model, pre-existing barriers, and prenatal framework, and the need for transition to telehealth beyond the pandemic. In antenatal primary health care centers, such as King Abdulaziz Medical City (KAMC), low-risk antenatal/postnatal care receives clinical care through complete physical attendance in antenatal/postnatal clinics in primary care clinics for pregnancy follow-up and in tertiary hospitals for fetal ultrasound and invasive procedures if needed. Pregnancy is confirmed through a regular family medicine (FM) clinic where risk assessment through history, physical examination, and investigations are carried out. If the pregnant woman is at low risk, she will be started on folic acid, 1 mg or 5 mg based on the risk assessment (if it was not received before). Pregnant women will be given a telehealth appointment for the lab results. Concomitantly, the pregnant women will receive an appointment in the antenatal clinics, which board-certified family physicians run. High-risk patients will be referred to the hospital for further care. Current postnatal care is delivered through regular booking with the FM clinic through physical attendance sometimes, and virtual care is provided upon physican/patientrequest. Current care meets the past quality care and patient expectations. However, with the current Saudi Vision 2030 and after the experience with virtual care during the COVID-19pandemic, the current services need to move a step forward to meet the rapidly developing medical care/needs in Saudi Arabia. Various challenges must be addressed, and new models must be included in clinical care for pregnant and postnatal women. Introducing virtual antenatal/postnatal care to the current care could be a new era in maternity primary health care; this model will move the clinical care provided to pregnant/postnatal women a step forward that meets the excellence of high-quality, evidence-based medical care.

Dentistry and metaverse: A deep dive into potential of blockchain, NFTs, and crypto in healthcare

Blockchain technology and the metaverse have the potential to revolutionize dentistry and healthcare by enhancing data security, patient empowerment, disaster victim identification, and the delivery of dental services. In this review, we discuss the current state of the art in the field of dentistry and the future of dentistry, highlighting the advantages and challenges of utilizing blockchain technology for disaster victims’ identification. Blockchain's applications in Disaster Victim Identification (DVI) offer a humanitarian dimension, helping bring solace to families in times of tragedy. Moreover, blockchain's potential to establish virtual health clinics and telemedicine platforms could bridge healthcare gaps in underserved regions.

Can a Fully Electronic Patient Record-Based Virtual Fracture Clinic Increase Compliance With British Orthopaedic Association Guidelines for the Assessment of Acute Orthopaedic Trauma Patients?

Introduction There is clear guidance for the follow-up of acute orthopaedic trauma patients within 72 hours of presentation as per British Orthopaedic Association (BOA) guidelines. The virtual fracture clinic (VFC) model has been adopted nationwide to increase compliance with these guidelines. Traditionally our VFC was paper-based, but recently it has been made completely electronic with the introduction of Hive which is a comprehensive electronic patient record (EPR). The aim of this audit was to assess the effectiveness of the Hive VFC and to see the impact it has on improving the patient experience. Methods Data was collected retrospectively by looking at referrals to the Hive VFC across a seven-month period from its date of introduction. No patients were excluded and data was collected for 2,158 patients. Patient demographics, referral details, and outcomes were recorded on a Microsoft Excel version 16.0 for Windows spreadsheet (Microsoft Corporation, Washington, United States). Data was analysed using Microsoft Excel. Results Data was collected for 2,158 patients between September 9, 2022, and March 31,2023, in the Hive VFC. The largest proportion of injuries was found in the foot and ankle region with 32% of referrals (n=688), followed by hand and wrist with 30% (n=651), upper limb with 28% (n=595), and lower limb with 7% (n=142). There was a 50.4% (n=125)increase in the number of patients seen in the VFC across the study period with 248 patients being seen in September 2022, increasing to 373 in March 2023. The number of patients with acute traumatic orthopaedic injuries that were assessed within 72 hours on average was 94.5% per month. There was an increase of 7.3% during the study period from September 2022 to March 2023, 89.9% to 96.5%, respectively. Conclusion We believe that Hive VFC is a clinically sound and effective way of assessing acute traumatic orthopaedic patients and increasing compliance with BOA and NICE guidelines. The number of patients needing acute orthopaedic assessment is rising steadily, and this should alert us to find more convenient, time and cost-saving methods of delivering safe and effective patient care.

LOW RISK OF DELAYED TALAR SHIFT IN STABLE WEBER B FRACTURES MANAGED WITH A FUNCTIONAL BRACING PROTOCOL WITH EARLY WEIGHT BEARING

Stable Weber B fractures are typically treated non-operatively without complications but require close monitoring due to concerns over potential medial deltoid ligament injuries and the risk of delayed talar shift. Following recent evidence suggesting this is unlikely, a functional protocol with early weight bearing was introduced at Glasgow Royal Infirmary (GRI) following a pilot audit.This study aims to evaluate the risk of delayed talar shift in isolated Weber B fractures managed with functional bracing and early weight-bearing, particularly if signs of medial ligament injury are present.We conducted a retrospective review of 148 patients with isolated Weber B fractures without talar shift at presentation that were reviewed at the virtual fracture clinic at our institution between July 2019 and June 2020. The primary outcome was the incidence of delayed talar shift. Secondary outcomes were other complications and adherence to protocol.48 patients had medial signs present and of these 1 (2%) showed possible talar shift on X-rays at 4 weeks, and was kept under review. This patient had a normal medial clear space at 3 months. No patients with medial signs not documented (n=19) or not present (n=81) had delayed talar shift. 10% of patients (n=15) had at least 1 complication: delayed union (n=2); non-union (n=3); ongoing pain (n=14).Functional bracing with early weight-bearing is a safe, effective protocol for managing isolated Weber B fractures without initial talar shift. This study concludes that the risk of delayed talar shift is low in all patients, with or without medial signs.

Getting it Right First Time in Trauma Clinic: How a Pandemic Improved Service Provision for Orthopaedic Patients

Introduction: The 2019 coronavirus outbreak (COVID-19) fast became a global pandemic. In the United Kingdom, guidlines were introduced to help control the spread of this virus. Hospitals made significant changes to accommodate for the change in demand. Orthopaedic trauma services needed to remain, however, the management of orthopaedic trauma needed modifying to comply with government and hospital guidelines. Method: Queens’s hospital, Burton, is a level III trauma unit. The orthopaedic department manages upper and lower limb trauma as well as head and chest and spine trauma. Injured patients can be referred to the orthopaedic team from the community or from the Major and Minor Emergency Department. To accommodate new guidelines, the orthopaedic department introduced a ‘virtual clinic’ and a ‘trauma clinic’. The virtual clinic took place in the morning and discussed referrals from the day before. The ‘trauma clinic’ followed on from the virtual clinic and lasted the remainder of the day. Results: The intervention introduced to Queens’s hospital was beneficial for patients, staff and for the hospital. It improved waiting times, reduced the time patients spent in hospital, reduced the number of hospital attendees and enhanced knowledge of common orthopaedic injuries for staffing involved in reviewing and managing these injuries. Conclusion: For our department, these changes improved service provision, staff education and patient safety. These benefits could be seen in other trusts if a similar method of managing trauma patients was introduced.

FRI524 Improving The Quality Of Life In Patients With Not Adequately Treated Hypothyroidism: The Impact Of Comprehensive Thyroid Care For Hypothyroid Patients

Abstract Disclosure: V. Högqvist Tabor: Consulting Fee; Self; Butterfly Technologies Inc. M. Tarasova: Employee; Self; Butterfly Technologies Inc. Owner/Co-Owner; Self; Butterfly Technologies Inc. G. Cohen-Skalli: Owner/Co-Owner; Self; Butterfly Technologies Inc. F. Dubois: Employee; Self; Butterfly Technologies Inc. B. Curran: Employee; Self; Butterfly Technologies Inc. Underactive thyroid is affecting approximately 25 million people in the USA. Even though the treatment of the basic condition has been established in form of hormone replacement, there is a considerably large group of patients that continues to experience a plethora of hypothyroidism symptoms and suffer from poor quality of life. The lack of individualized approach, combined with the lack of preventive health management strategies, increases the risk of many health complications: obesity, type 2 diabetes, depressive spectrum disorders, infertility, muscle and bone problems, heart conditions, and dementias. Presently, the Paloma Health Thyroid Solution consists of a virtual clinic providing holistic thyroid care and an app for hypothyroid patients, it enables patients to receive care by medical experts in the field of endocrinology, autoimmune diseases and hypothyroidism as well as a nutritionist. In addition, it provides at-home thyroid hormone test kits, symptom recording, offers a library of informational articles, and connects the community of hypothyroid patients. The 12-week program offered to new patients facilitates learning about the most important aspects of managing the condition, including implementation of a phased elimination diet (known as the Autoimmune Protocol, AIP). Patients reported to feel more empowered, taken care of and understood after using Paloma Health Thyroid Solution. At the same time physicians have a real-time patient dashboard, and can promptly recognise signs of health worsening in patients and help correct the health management. In order to evaluate the usefulness of the approach, we have selected 45 patients that were diagnosed with hypothyroidism for at least six months, have been prescribed hormone replacement treatment, and have reported (i) low energy, (ii) low focus, (iii) sensitivity to cold, and (iv) headaches. Symptoms were recorded on a 5-point Likert scale starting from the most intense symptom experience to the absence of the symptom. We analyzed recorded symptoms, starting at the first day when patients started using Paloma Health Thyroid Solution and for the next 12 weeks. We averaged symptom experiences per patient, per week in order to have a better representation of symptom intensity for each given week. We found that patients using Paloma Health comprehensive services significantly improved symptoms related to an under-active thyroid: energy, focus, intolerance to cold and headache. The improvement was first detectable after 2 weeks of start of Paloma Health Thyroid Service, and continued the positive improvement trend for the full duration of the time period. Here we show for the first time that using the combination of accessible and individualised approach, coupled with digital technology enabling easy access to both skilled healthcare specialists as well as the vetted information and empathic support services (care manager and community) can help patients experiencing unresolved thyroid symptoms, despite previously prescribed therapy. Using virtual clinics offering preventive health management catered specifically to each individual holds a promise of helping the group of patients that currently do not fully benefit from one approach-fits-all treatment that has been hampering hypothyroid health management for the past 40 years. This approach has the potential to both reduce the burden on patients and healthcare practitioners and save costs for payers. Presentation: Friday, June 16, 2023

Comprehensive Telehealth Model to Support Diabetes Self-Management

As the number of patients with diabetes continues to increase in the United States, novel approaches to clinical care access should be considered to meet the care needs for this population, including support for diabetes-related technology. To evaluate a virtual clinic to facilitate comprehensive diabetes care, support continuous glucose monitoring (CGM) integration into diabetes self-management, and provide behavioral health support for diabetes-related issues. This cohort study was a prospective, single-arm, remote study involving adult participants with type 1 or type 2 diabetes who were referred through community resources. The study was conducted virtually from August 24, 2020, to May 26, 2022; analysis was conducted at the clinical coordinating center. Training and education led by a Certified Diabetes Care and Education Specialist for CGM use through a virtual endocrinology clinic structure, which included endocrinologists and behavioral health team members. Main outcomes included CGM-measured mean glucose level, coefficient of variation, and time in range (TIR) of 70 to 180 mg/dL, time with values greater than 180 mg/dL or 250 mg/dL, and time with values less than 70 mg/dL or 54 mg/dL. Hemoglobin A1c was measured at baseline and at 12 and 24 weeks. Among the 234 participants, 160 had type 1 diabetes and 74 had type 2 diabetes. The mean (SD) age was 47 (14) years, 123 (53%) were female, and median diabetes duration was 20 years. Median (IQR) CGM use over 6 months was 96% (91%-98%) for participants with type 1 diabetes and 94% (85%-97%) for those with type 2 diabetes. Mean (SD) hemoglobin A1c (HbA1c) in those with type 1 diabetes decreased from 7.8% (1.6%) at baseline to 7.1% (1.0%) at 3 months and 7.1% (1.0%) at 6 months (mean change from baseline to 6 months, -0.6%, 95% CI, -0.8% to -0.5%; P < .001), with an 11% mean TIR increase over 6 months (95% CI, 9% to 14%; P < .001). Mean HbA1c in participants with type 2 diabetes decreased from 8.1% (1.7%) at baseline to 7.1% (1.0%) at 3 months and 7.1% (0.9%) at 6 months (mean change from baseline to 6 months, -1.0%; 95% CI, -1.4% to -0.7%; P < .001), with an 18% TIR increase over 6 months (95% CI, 13% to 24%; P < .001). In participants with type 1 diabetes, mean percentage of time with values less than 70 mg/dL and less than 54 mg/dL decreased over 6 months by 0.8% (95% CI, -1.2% to -0.4%; P = .001) and by 0.3% (95% CI, -0.5% to -0.2%, P < .001), respectively. In the type 2 diabetes group, hypoglycemia was rare (mean [SD] percentage of time <70 mg/dL, 0.5% [0.6%]; and <54 mg/dL, 0.07% [0.14%], over 6 months). Results from this cohort study demonstrated clinical benefits associated with implementation of a comprehensive care model that included diabetes education. This model of care has potential to reach a large portion of patients with diabetes, facilitate diabetes technology adoption, and improve glucose control.

Facilitators of and barriers to perinatal telepsychiatry care: a qualitative study

ObjectivesPerinatal mental health disorders such as anxiety, depression and bipolar disorder can negatively impact the health of women and their children without appropriate detection and treatment. Due to increases in...

Editor's Spotlight/Take 5: Do Orthopaedic Virtual Clinic Visits Demonstrate Cost and Time Efficiencies Compared With In-person Visits?

Editor's Spotlight/Take 5: Do Orthopaedic Virtual Clinic Visits Demonstrate Cost and Time Efficiencies Compared With In-person Visits?

'When the visible body is no longer the seer': The phenomenology of perception and the clinical gaze in video consultations.

Video technology enabled professionals and patients to conduct consultations during the COVID-19 pandemic when in-person health care was minimised to reduce the spread of the virus. We present findings of a study of video-consulting through in-depth qualitative remote interviews with 40 health professionals, managers, support staff and 10 patients in health-care services across the UK from 2020 to 2021. Drawing on Foucault's concept of the clinical gaze, Merleau-Ponty's work on the phenomenology of perception and Ihde's postphenomenology we interpreted the ways in which remote consultations shaped patient-professional interactions, mediating and framing what was seen, revealed and known. We found that participating in video consultations not only involved creative adaption and adjustment to a virtual clinic but also changed how professionals and patients saw and were seen. We argue that this mode of consulting can transform boundaries and perceptions, alter aspects of clinical presence, knowledge and embodiment and thus both change and incorporate the clinical gaze.

Pathophysiologic Basis of Connected Health Systems.

Since the start of the COVID-19 pandemic, there has been a rapid transition to telehealth across the United States, primarily involving virtual clinic visits. Additionally, the proliferation of consumer technologies related to health reveals that for many people health and care in the contemporary world extends beyond the boundaries of a clinical interaction and includes sensors and devices that facilitate health in personal environments. The ideal connected environment is networked and intelligent, personalized to promote health and prevent disease. The combination of sensors, devices, and intelligence constitutes a connected health system around an individual that is optimized to improve and maintain health, deliver care, and predict and reduce risk of illness. Just as modern medicine uses the pathophysiology of disease as a framework for the basis of pharmacologic therapy, a similar clinically reasoned approach can be taken to organize and architect technological elements into therapeutic systems. In this work, we introduce a systematic methodology for the design of connected health systems grounded in the pathophysiologic basis of disease. As the digital landscape expands with the ubiquity of health devices, it is pivotal to enable technology-agnostic clinical reasoning to guide the integration of technological innovations into systems of health and care delivery that extend beyond the boundaries of a clinical interaction. Applying clinical reasoning in a repeatable and systematic way to organizing technology into therapeutic systems can yield potential benefits including expanding the study of digital therapeutics from individual devices to networked technologies as therapeutic interventions; empowering physicians who are not technological experts to still play a significant role in using clinical reasoning for architecting therapeutic networks of sensors and devices; and developing platforms to catalog and share combinations of technologies that can form therapeutic networks and connected health systems.

Outcomes of Emergency Department Patients With Opioid Use Disorder Utilizing a Virtual Addiction Bridge Clinic: A Case Series.

Within the last decade, there has been a dramatic increase in the rate of emergency department (ED) visits and death from opioid overdose. Those who present to the ED are at high risk for subsequent morbidity and mortality. Despite effective treatment, many patients do not get rapidly connected to outpatient care. The aim of this investigation was to describe outpatient treatment engagement after ED discharge among patients with opioid use disorder (OUD) enrolled in a virtual Addiction Bridge Clinic (ABC). This was a retrospective case series describing an ED-initiated referral for rapid telehealth follow-up among patients with OUD. The primary outcome was addiction treatment engagement among those who completed the initial virtual ABC visit (engaged in ABC) vs. those who did not complete an ABC visit (Not engaged in ABC) at 1 week, 1 month, and 3 and 6 months timepoint intervals after the initial ED presentation. Of the N = 201 patients referred to the ABC between March and December 2021, a majority were Black (71%) and male (77%). Of the 201 referrals, 85 (42%) completed an initial ABC telehealth visit. Subsequent treatment engagement was 26% at 1 week, 26% at 1 month, 22% at 3 months, and 18% at 6 months after the index ED visit. A telehealth-enabled virtual addiction bridge clinic is one potential approach to reduce barriers to rapid treatment access. Strategies are needed to improve subsequent addiction treatment engagement after a virtual addiction bridge clinic visit.

Follow-up of patients with coeliac disease: experience from a nurse led virtual clinic

Follow-up of patients with coeliac disease: experience from a nurse led virtual clinic

Application of Combined Teaching Methods Using Virtual Clinic "Dimedus" and Robot-Simulator "Apollo" in the Process of Training in the Provision of Emergency Medical Care

An important task of training students in simulation centers is to teach algorithms of actions in extreme situations, to make the right decision as quickly as possible and to perform manipulations flawlessly. The article discusses the main advantages of using a combined teaching method using the virtual clinic "Dimedus" and the robot simulator "Apollo", which allows you to maximize the benefits of virtual learning, effectively use the emergency class, and objectively evaluate the formation of individual educational and practical skills.