Theme Distribution

Project Leaders

Description

Overview

The proliferation of Virtual-Reality (VR) platforms, ranging from high-fidelity platforms that require specialized hardware and software to commodity virtual worlds accessible through inexpensive laptops, presents a great opportunity for simulation-based training in a broad range of professional disciplines. The long-term objective of the Healthcare Simulation (HLTHSIM) project is twofold. First we will develop a general conceptual framework of health-care skills and competencies and map them to appropriate VR platforms, on which scenarios for the practice of such skills can be developed. Second, we focus on two ends of the skill spectrum, i.e., multi-disciplinary health team activities – such as emergency response for example - and highly precise surgical procedures, to develop specialized VR-based simulations with which to train the next generation of health professionals.

Research Plan

The Healthcare Simulation project (HLTHSIM) is developing methodologies and tools for the design, development, and evaluation of augmented reality (AR) based simulations. We are designing platforms integrating sensing devices to perceive the real world, VR tools to simulate complex environments, processes and phenomena based on data collected through these sensing devices, and actuators through which to change the state of the real and virtual worlds for training future and practicing health professionals. From a methodological perspective, we are interested in exploring the pedagogical value of “serious games.”

We have chosen to address two kinds of training scenarios with these platforms: (a) surgical training and (b) inter-professional health team problem solving, within an emergency response context. Surgeons tend to perform better after playing video games, according to reports in the media. Far from being merely anecdotal reports, recent studies have continued to add substance to these media news items. Indeed, the interesting question is not 'whether' interactive multimedia exercises will improve surgical performance, but how can multi-modal training exercises best be designed for a range of surgical procedures? In addition, health care delivery is becoming increasingly team-based. Services ranging from acute care to epidemic tracking and containment require collaboration between front-line health teams and researchers in both face-to-face and online environments. Simulations of realistic complex scenarios in virtual worlds will prepare future health professionals to effectively communicate and collaborate to solve problems and provide better patient care.

In order to improve surgical training, a variety of simulators are available. These include ‘box trainers’ and VR or AR simulators. Box trainers provide realistic ‘haptic feedback’ (the contact sensation of actual tissue or phantom materials) but do not have instrumentation for recording of trajectories or precise timing that would allow for an objective assessment of skill acquisition. Shanu (2002) and Stefanidis (2010) showed surgical residents trained to perform laparoscopic surgery using these trainers were more proficient and made fewer errors in the operating room than those who received no virtual reality simulated education. VR simulators do give an objective assessment but are inferior in terms of the realism of the visual experience, and often have unrealistic haptic feedback. On the other hand, realistic haptic feedback is provided by the fact that the surgeon practices using real materials and instruments, and objective assessment is also possible because the position of the instruments can be determined. We plan to develop a collection of training case studies using AR and multi-modal visual displays of 3D Biomedical imagery. The training cases will range from generic visual-spatial skills development, to the rehearsal of very specific surgical procedures and scenarios. We are exploring a set of specific case studies, including

• Laparoscopic Cholecystectomy (gall bladder removal),
• Ultrasound-Guided Prostate Biopsy,
• Robotically-Assisted Mitral Valve Repair, and
• 3D Neuroendoscopy.

The evaluation of these immersive multimodal displays will rely on quantitative methodologies from Experimental Psychology and Cognitive Science, such as

• 2D Pattern Recognition (Pattern Detection Task),
• 3D Shape Matching (Shepard and Metzler task),
• Targeting time and accuracy (Fitts’ Methodology), and
• Trajectory Analysis (Accot and Zhai).

Virtual reality is also used in one of our projects to evaluate the ability of the trainee to see in stereo (simulation of the floor of the third ventricle as seen in an endoscopic third ventriculostomy procedure), and correlate it to his ability to see with a 3D-stereoendoscope, and localize a target to evaluate the benefit of the 3D vs. 2D endoscopic image as well as training of the student.

In “Collaborative Problem Solving” tasks, we will develop AR serious games across the real and virtual worlds to support three key mechanisms for learning as represented by the principles of Collin’s Cognitive Apprenticeship Model – modeling, scaffolding and reflection. Modeling occurs when the student observes the expert or practitioner demonstrating a specific skill or task. Scaffolding describes the specific supports introduced into the learning environment to assist the learner with developing the skill. Finally, reflecting upon the experience allows for students to transfer the learning into new contexts. This model is characterized by: a) identification of the processes of the task and making it visible to the learners; b) situating abstract tasks in authentic contexts so relevancy to workplace is evident and c) varying the diversity of situations so learners can transfer their learning into new contexts. The objective is to support the development (on their own and in combination) of three types of skills:

• collaborative skills related to inter-professional communication and collaboration,
• clinical-diagnostic skills, with visualization of physiological processes, thus enhancing people’s understanding of them, and
• skills in the actual execution of tasks and procedures relevant to the various simulated scenes.

These original set of targeted skills will be extended to take into account the recently published set of CanMeds set of competencies (http://rcpsc.medical.org/canmeds/index.php) as identified by the the Royal College of Physicians and Surgeons in Canada.

Our simulation-based training games will be integrated in appropriate courses of current discipline-specific health-science curricula. After each simulation session, students will be tested on their overall knowledge (factual, conceptual and applied) based on standard checklists, as well as simulation-specific assessment instrument that we will develop. Students will be given questionnaires to determine level of realism in the virtual world and their perceived sense of social presence within the game. Focus group interviews will be conducted to explore in more depth the development of skills, both task-based and communication and the relationship between the level of realism and social presence.

Anticipated Contributions

In summary, the use of VR, AR and online immersive worlds to assist in the training of specific tasks or procedures, and development of communication and collaboration skills across health professionals are emerging as important tools for clinicians and educators. The systematic design, development and evaluation of these educational tools is key for successful integration into health curricula as well as for their relevance to re-certification policies and processes. This project addresses these areas related to a broad set of applications within the contexts of surgery and emergency medicine.