The patient is 61 years old, an African American man named Alex Carson who, according to the emergency technicians’ report, fainted at airport security after visiting his family in New York. He’s lying on a bed in an isolated hospital room, awaiting attention. His blood pressure is elevated, his heart rate is fast, and his temperature is 104 degrees. His history shows he is a daily smoker who has chronic obstructive pulmonary disease and diabetes.
Jennifer Stand, who is pursuing a master’s degree in nursing at Northeastern, must determine how to proceed. Carson’s recent travel and symptoms indicate he may have COVID-19. But should Stand attach an IV? Stabilize him? Run respiratory tests? Check his cardiovascular system?
“With that one, you kind of know it’s COVID from the start,” Stand says. “But you have to know what to do, what tests to run and support what you think. It’s realistic but it’s a very different kind of experience.”
Treating Alex Carson is very different because Alex Carson is not a patient at all. He is a 3D character featured in Full Code, an online application that gives medical professionals access to a simulated emergency room in a virtual hospital brimming with 86 patients suffering ailments from the mundane (a seven-year-old girl exhibiting a fever) to the dire (a 47-year-old man who has been electrocuted) to the exotic (a 39-year-old man with a rare snakebite). And there is Carson, who might be the world’s most frequently examined COVID-19 patient, digitally diagnosed by thousands.
Disseminating cases like Carson’s is the goal of Full Code, a cross-platform app developed by Michael McLinn, a 2003 graduate of Northeastern. Full Code has been a labor of love, built and perfected even as he worked other jobs over the past five years. McLinn has spent the bulk of his career in medical technology, making healthcare more accessible to patients through websites and apps. He had an interlude writing finance software, which didn’t last long.
“I wanted to feel that I was contributing in a useful way to the larger world,” McLinn says. “It’s easier to feel that way working in healthcare.”
At no time in the last century has healthcare been under such strain and one casualty of that strain has been medical education. That could be an opening for McLinn’s work to take on more significance.
In March, shortly after Northeastern, acting on the guidance of public health authorities, moved to online instruction, many hospitals in the region shut their doors to medical and nursing students as they prepared for a wave of COVID-19 patients.
For Stand and her classmates, that created a big problem. She needed to finish experiential learning credit hours before graduation at the end of April but hospitals had stopped those programs.
One of Stand’s instructors, Stephen Wood, was wrestling with this problem when, late one evening last month, he thought of Full Code, which he used often (at least, he admits, when not playing a baseball app on his phone).
He found that McLinn and his chief programmer, Lucas Haber, are Northeastern graduates, and reached out to McLinn, putting him in touch with Maria van Pelt, dean of the School of Nursing. They reviewed the idea of using Full Code with their students, who approved. Within days, Northeastern was signed up to give full access to nursing students, with Wood allowed to monitor their progress through an administrative page only he could access.
“It makes them think about what they’re ordering, why they’re ordering it, coming up with a differential, talking to consults,” Wood says. “It is a lot of the things we’d want them doing. I can look at how much time they’re spending on each case and get some data on how they’re doing to make sure that they’re not just logging on, killing a 3D character and calling it a day.”
McLinn wants to give instructors like Wood more access to students’ interaction with the app, to further develop Full Code for universities. The app is a success among individuals—nearly 500,000 users globally have downloaded it since 2017, and it qualifies in the U.S. for continuing education and recertification credit.
But it has the pedigree to be even more useful in classrooms. The medical content was written mostly by one of Boston’s most-respected medical teachers, Dr. Kimo Takayesu, the associate residency director at Massachusetts General Hospital from 2004-18. McLinn approached Takayesu three years ago with a cold call (or, in this case, cold email), just as he was stepping away from MGH’s residency program.
“It was a good opportunity for him to do something different and leverage his experience,” McLinn recalls..
More schools are seeing the possibilities of Full Code. McLinn has signed six universities, including the trial run with Northeastern, as clients in the last few months. He also has developed a tool that allows teachers to design their own cases, building on the app’s base of patients.
“That way,” McLinn says, “they can do it exactly the way the school wants, teach what they want their students to know.”
In the short term, Full Code has given Stand and other students the tools to graduate while allowing them to practice safe physical distancing. Increased concern for safety, though, will remain in the long term, as hospitals gird against COVID-19 and future viruses. Authentic simulators like Full Code could earn a bigger place in medical education, where hands-on teaching must be balanced against student and hospital safety.
“Hospitals are dangerous,” McLinn says. “The whole world has a much higher level of appreciation for emergency room physicians, nurses and all the medical professionals on the front lines now. So I feel honored to work with the doctors and nurses I have contact with. I just hope that we can help in some way.”