A Microsoft HoloLens Mixed Reality Surgical Simulator for Patient-Specific Hip Arthroplasty Training

Surgical simulation can offer novice surgeons an opportunity to practice skills outside the operating theatre in a safe controlled environment. According to literature evidence, nowadays there are very few training simulators available for Hip Arthroplasty (HA). In a previous study we have presented a physical simulator based on a lower torso phantom including a patient-specific hemi-pelvis replica embedded in a soft synthetic foam. This work explores the use of Microsoft HoloLens technology to enrich the physical patient-specific simulation with the implementation of wearable mixed reality functionalities. Our HA multimodal simulator based on mixed reality using the HoloLens is described by illustrating the overall system, and by summarizing the main phases of the design and development. Finally, we present a preliminary qualitative study with seven subjects (5 medical students, and 2 orthopedic surgeons) showing encouraging results that suggest the suitability of the HoloLens for the proposed application. However, further studies need to be conducted to perform a quantitative test of the registration accuracy of the virtual content, and to confirm qualitative results in a larger cohort of subjects

Enhancing Nonverbal Communication Through Virtual Human Technology: Protocol for a Mixed Methods Study

Background: Communication is a critical component of the patient-provider relationship; however, limited research exists on the role of nonverbal communication. Virtual human training is an informatics-based educational strategy that offers various benefits in communication skill training directed at providers. Recent informatics-based interventions aimed at improving communication have mainly focused on verbal communication, yet research is needed to better understand how virtual humans can improve verbal and nonverbal communication and further elucidate the patient-provider dyad. Objective: The purpose of this study is to enhance a conceptual model that incorporates technology to examine verbal and nonverbal components of communication and develop a nonverbal assessment that will be included in the virtual simulation for further testing. Methods: This study will consist of a multistage mixed methods design, including convergent and exploratory sequential components. A convergent mixed methods study will be conducted to examine the mediating effects of nonverbal communication. Quantitative (eg, MPathic game scores, Kinect nonverbal data, objective structured clinical examination communication score, and Roter Interaction Analysis System and Facial Action Coding System coding of video) and qualitative data (eg, video recordings of MPathic–virtual reality [VR] interventions and student reflections) will be collected simultaneously. Data will be merged to determine the most crucial components of nonverbal behavior in human-computer interaction. An exploratory sequential design will proceed, consisting of a grounded theory qualitative phase. Using theoretical, purposeful sampling, interviews will be conducted with oncology providers probing intentional nonverbal behaviors. The qualitative findings will aid the development of a nonverbal communication model that will be included in a virtual human. The subsequent quantitative strand will incorporate and validate a new automated nonverbal communication behavior assessment into the virtual human simulation, MPathic-VR, by assessing interrater reliability, code interactions, and dyadic data analysis by comparing Kinect responses (system recorded) to manually scored records for specific nonverbal behaviors. Data will be integrated using building integration to develop the automated nonverbal communication behavior assessment and conduct a quality check of these nonverbal features. Results: Secondary data from the MPathic-VR randomized controlled trial data set (210 medical students and 840 video recordings of interactions) were analyzed in the first part of this study. Results showed differential experiences by performance in the intervention group. Following the analysis of the convergent design, participants consisting of medical providers (n=30) will be recruited for the qualitative phase of the subsequent exploratory sequential design. We plan to complete data collection by July 2023 to analyze and integrate these findings. Conclusions: The results from this study contribute to the improvement of patient-provider communication, both verbal and nonverbal, including the dissemination of health information and health outcomes for patients. Further, this research aims to transfer to various topical areas, including medication safety, informed consent processes, patient instructions, and treatment adherence between patients and providers

Collaborative behaviours and professional culture traits in real-time interprofessional clinical simulation

Interprofessional education (IPE) has been proposed as a method of creating a collaborative practice ready workforce in healthcare. Postulated benefits of the technique include improving communication between professional groups, which in turn should help to prevent serious untoward events and ultimately improve patient outcomes. Critics of the method have cited poorly designed IPE as a method of reinforcing physician power, and argued there is a paucity of data linking undergraduate IPE to tangible benefits in a patient-facing setting. Simulation has been increasingly used as a method for delivery of IPE, with positive outcomes cited by students and educators alike. Virtual Patients and avatars have been recently used as a delivery method for healthcare education, but there is a paucity of data regarding their use in IPE. Simulation is not a panacea for IPE, many simulations focus on the acute phase of care naturally excluding healthcare professions who are not involved in those situations. Findings from acute simulations may not apply to sub-acute scenarios. Method A sub-acute real-time virtual patient simulation was designed then delivered to educators (n=6) and undergraduate students (n=33) from the professions of medicine, nursing, pharmacy and physiotherapy. Qualitative data was gathered according to a constructivist paradigm using unstructured observation of in-simulation behaviour, focus groups and semi-structured interviews. Results Data was analysed according to Braun and Clarke’s method of thematic analysis. Five themes were identified: technology, education, collaboration, intrinsic behaviours and stereotyping. The simulation was educationally successful with participants citing improved recognition of the skills of other professional groups, and improved physiological and pharmacological knowledge. The real-time aspect of the simulation improved clinical reasoning and forced students to make prescribing decisions, which was cited as beneficial for future practice. The sub-acute nature of the simulation resulted in participants hyper-observing their VP to the detriment of patient care. Good levels of collaboration, team working and appropriate communication were facilitated but students were observed to subconsciously selfstereotype. Conclusions Sub-acute real-time virtual patient simulation appears to be a valid method of enabling students to learn with and from one another. It conveys benefit over traditional educational methods such as classroom-based, problem-based and experiential learning as students are given full responsibility for patient care with little supervision. Self-stereotyping amongst students suggests that students convey stereotypical messages about their own profession to others. This may aid team-building in the undergraduate setting, but if these stereotypical views are transferred to advanced practice, there may be detrimental consequences for team formation and patient care

Simulación y competencias no técnicas en el contexto de emergencia pre-hospitalar: estudio cualitativo

Unidade de Monitorização em Indicadores de Saúde - UMISAbstract - To understand the importance that nurses assign to simulation in the development of non-technical skills in cardiac arrest event in pre-hospital setting. Background Nursing is projected in the future, developing a patient centred approach consistent with the values, needs and desires of patients, considering process of care as a complex intervention. Simulation based on scenarios is an opportunity to recreate this complexity in a virtual way, to develop the non-technical skills. Methods This study uses an inductive, interpretative and constructivist qualitative research. 7 nurses were interviewed. It was developed a thematic analysis content. Results Three themes were identified: Simulation scenarios in pre-hospital emergencies; The acquisition of knowledge to skills development and Construction of the virtual from the real Conclusions The interviewed nurses present weakness of knowledge about simulation types. Debriefing is relevant to the learning skills: critical thinking. thinking, clinical judgement and decision making.Resumo - Compreender a importância que os enfermeiros atribuem à simulação no desenvolvimento de competências não técnicas no evento paragem cardíaca em ambiente préhospitalar. Enquadramento A enfermagem é projetada no futuro, desenvolvendo uma abordagem centrada na pessoa consistente com a valorização de valores, necessidades e desejos destes, considerando o processo de cuidados como intervenção complexa. A simulação baseada em cenários é uma oportunidade para recriar essa complexidade de forma virtual, no desenvolvimento de competências não-técnicas. Metodologia Este estudo utiliza uma pesquisa qualitativa indutiva, interpretativa e construtivista. Foram entrevistados 7 enfermeiros. Foi desenvolvida análise de conteúdo temática. Resultados Foram identificados três temas: cenários de simulação em emergências pré-hospitalares; A aquisição de conhecimento para o desenvolvimento de habilidades e Construção do virtual a partir do real. Conclusões Os enfermeiros entrevistados apresentam conhecimentos a melhorar em relação aos tipos de simulação. Consideram o Debriefing relevante para as habilidades de aprendizagem: pensamento crítico, julgamento clínico e a tomada de decisão.Resumen - Comprender la importancia que los enfermeros atribuyen a la simulación en el desarrollo de competencias no técnicas en el evento paro cardíaco en ambiente prehospitalario. Background La enfermería se proyecta en el futuro, desarrollando un enfoque centrado en la persona consistente con la valorización de valores, necesidades y deseos de éstos, considerando el proceso de cuidar como intervención compleja. La simulación basada en escenarios es una oportunidad para recrear esta complejidad de forma virtual, en el desarrollo de competencias no técnicas. Metodología Este estudio utiliza una investigación cualitativa inductiva, interpretativa y constructivista. Se entrevistaron a 7 enfermeros. Se desarrolló un análisis de contenido temático. Resultados Se identificaron tres temas: escenarios de simulación en emergencias prehospitalarias; La adquisición de conocimiento para el desarrollo de habilidades y la construcción del virtual a partir del real. Conclusiones Los enfermeros entrevistados presentan conocimientos a mejorar en relación a los tipos de simulación. El Debriefing es considerado como relevante para las habilidades de aprendizaje: el pensamiento crítico, el juicio clínico y la toma de decisiones.info:eu-repo/semantics/publishedVersio

Enhancing Nonverbal Communication Through Virtual Human Technology: Protocol for a Mixed Methods Study

Background: Communication is a critical component of the patient-provider relationship; however, limited research exists on the role of nonverbal communication. Virtual human training is an informatics-based educational strategy that offers various benefits in communication skill training directed at providers. Recent informatics-based interventions aimed at improving communication have mainly focused on verbal communication, yet research is needed to better understand how virtual humans can improve verbal and nonverbal communication and further elucidate the patient-provider dyad. Objective: The purpose of this study is to enhance a conceptual model that incorporates technology to examine verbal and nonverbal components of communication and develop a nonverbal assessment that will be included in the virtual simulation for further testing. Methods: This study will consist of a multistage mixed methods design, including convergent and exploratory sequential components. A convergent mixed methods study will be conducted to examine the mediating effects of nonverbal communication. Quantitative (eg, MPathic game scores, Kinect nonverbal data, objective structured clinical examination communication score, and Roter Interaction Analysis System and Facial Action Coding System coding of video) and qualitative data (eg, video recordings of MPathic–virtual reality [VR] interventions and student reflections) will be collected simultaneously. Data will be merged to determine the most crucial components of nonverbal behavior in human-computer interaction. An exploratory sequential design will proceed, consisting of a grounded theory qualitative phase. Using theoretical, purposeful sampling, interviews will be conducted with oncology providers probing intentional nonverbal behaviors. The qualitative findings will aid the development of a nonverbal communication model that will be included in a virtual human. The subsequent quantitative strand will incorporate and validate a new automated nonverbal communication behavior assessment into the virtual human simulation, MPathic-VR, by assessing interrater reliability, code interactions, and dyadic data analysis by comparing Kinect responses (system recorded) to manually scored records for specific nonverbal behaviors. Data will be integrated using building integration to develop the automated nonverbal communication behavior assessment and conduct a quality check of these nonverbal features. Results: Secondary data from the MPathic-VR randomized controlled trial data set (210 medical students and 840 video recordings of interactions) were analyzed in the first part of this study. Results showed differential experiences by performance in the intervention group. Following the analysis of the convergent design, participants consisting of medical providers (n=30) will be recruited for the qualitative phase of the subsequent exploratory sequential design. We plan to complete data collection by July 2023 to analyze and integrate these findings. Conclusions: The results from this study contribute to the improvement of patient-provider communication, both verbal and nonverbal, including the dissemination of health information and health outcomes for patients. Further, this research aims to transfer to various topical areas, including medication safety, informed consent processes, patient instructions, and treatment adherence between patients and providers. International Registered Report Identifier (IRRID): DERR1-10.2196/4660

Virtual patient design : exploring what works and why : a grounded theory study

Objectives: Virtual patients (VPs) are online representations of clinical cases used in medical education. Widely adopted, they are well placed to teach clinical reasoning skills. International technology standards mean VPs can be created, shared and repurposed between institutions. A systematic review has highlighted the lack of evidence to support which of the numerous VP designs may be effective, and why. We set out to research the influence of VP design on medical undergraduates. Methods: This is a grounded theory study into the influence of VP design on undergraduate medical students. Following a review of the literature and publicly available VP cases, we identified important design properties. We integrated them into two substantial VPs produced for this research. Using purposeful iterative sampling, 46 medical undergraduates were recruited to participate in six focus groups. Participants completed both VPs, an evaluation and a 1-hour focus group discussion. These were digitally recorded, transcribed and analysed using grounded theory, supported by computer-assisted analysis. Following open, axial and selective coding, we produced a theoretical model describing how students learn from VPs. Results: We identified a central core phenomenon designated ‘learning from the VP’. This had four categories: VP Construction; External Preconditions; Student–VP Interaction, and Consequences. From these, we constructed a three-layer model describing the interactions of students with VPs. The inner layer consists of the student's cognitive and behavioural preconditions prior to sitting a case. The middle layer considers the VP as an ‘encoded object’, an e-learning artefact and as a ‘constructed activity’, with associated pedagogic and organisational elements. The outer layer describes cognitive and behavioural change. Conclusions: This is the first grounded theory study to explore VP design. This original research has produced a model which enhances understanding of how and why the delivery and design of VPs influence learning. The model may be of practical use to authors, institutions and researchers

Simulation Genres and Student Uptake: The Patient Health Record in Clinical Nursing Simulations

Drawing on fieldwork, this article examines nursing students’ design and use of a patient health record during clinical simulations, where small teams of students provide nursing care for a robotic patient. The student-designed patient health record provides a compelling example of how simulation genres can both authentically coordinate action within a classroom simulation and support professional genre uptake. First, the range of rhetorical choices available to students in designing their simulation health records are discussed. Then, the article draws on an extended example of how student uptake of the patient health record within a clinical simulation emphasized its intertextual relationship to other genres, its role mediating social interactions with the patient and other providers, and its coordination of embodied actions. Connections to students’ experiences with professional genres are addressed throughout. The article concludes by considering initial implications of this research for disciplinary and professional writing courses