Design and Development of an Immersive Virtual Reality Team Trainer for Advance Cardiac Life Support

abstract: Technology in the modern day has ensured that learning of skills and behavior may be both widely disseminated and cheaply available. An example of this is the concept of virtual reality (VR) training. Virtual Reality training ensures that learning can be provided often, in a safe simulated setting, and it may be delivered in a manner that makes it engaging while negating the need to purchase special equipment. This thesis presents a case study in the form of a time critical, team based medical scenario known as Advanced Cardiac Life Support (ACLS). A framework and methodology associated with the design of a VR trainer for ACLS is detailed. In addition, in order to potentially provide an engaging experience, the simulator was designed to incorporate immersive elements and a multimodal interface (haptic, visual, and auditory). A study was conducted to test two primary hypotheses namely: a meaningful transfer of skill is achieved from virtual reality training to real world mock codes and the presence of immersive components in virtual reality leads to an increase in the performance gained. The participant pool consisted of 54 clinicians divided into 9 teams of 6 members each. The teams were categorized into three treatment groups: immersive VR (3 teams), minimally immersive VR (3 teams), and control (3 teams). The study was conducted in 4 phases from a real world mock code pretest to assess baselines to a 30 minute VR training session culminating in a final mock code to assess the performance change from the baseline. The minimally immersive team was treated as control for the immersive components. The teams were graded, in both VR and mock code sessions, using the evaluation metric used in real world mock codes. The study revealed that the immersive VR groups saw greater performance gain from pretest to posttest than the minimally immersive and control groups in case of the VFib/VTach scenario (~20% to ~5%). Also the immersive VR groups had a greater performance gain than the minimally immersive groups from the first to the final session of VFib/VTach (29% to -13%) and PEA (27% to 15%).Dissertation/ThesisM.S. Computer Science 201

Virtual and Augmented Reality in Basic and Advanced Life Support Training

The use of augmented reality (AR) and virtual reality (VR) for life support training is increasing. These technologies provide an immersive experience that supports learning in a safe and controlled environment. This review focuses on the use of AR and VR for emergency care training for health care providers, medical students, and nonprofessionals. In particular, we analyzed (1) serious games, nonimmersive games, both single-player and multiplayer; (2) VR tools ranging from semi-immersive to immersive virtual and mixed reality; and (3) AR applications. All the toolkits have been investigated in terms of application goals (training, assessment, or both), simulated procedures, and skills. The main goal of this work is to summarize and organize the findings of studies coming from multiple research areas in order to make them accessible to all the professionals involved in medical simulation. The analysis of the state-of-the-art technologies reveals that tools and studies related to the multiplayer experience, haptic feedback, and evaluation of user’s manual skills in the foregoing health care-related environments are still limited and require further investigation. Also, there is an additional need to conduct studies aimed at assessing whether AR/VR-based systems are superior or, at the minimum, comparable to traditional training methods

The Effect of High-Fidelity Manikin-Based Human Patient Simulation on Educational Outcomes in Advanced Cardiovascular Life Support Courses

The use of high-fidelity manikin-based simulation has been studied in many healthcare education areas. However, the use of this education technology in the American Heart Association Advanced Cardiovascular Life Support (ACLS) course has not been well examined in the literature, despite this education program being one of the most widely taught standardized medical courses in the United States. This study examined high fidelity manikin-based simulation versus low-fidelity manikin-based simulation in the context of an actual ACLS course. Four outcomes were measured: learning outcomes as judged by an expert rater panel reviewing videos of subjects performing a simulated cardiac arrest event immediately after the conclusion of the course, and three self-reported measures examining confidence with the course material, motivation, and affect. A convenience sample of 34 subjects self assigned to one of two ACLS classes. One class utilized high-fidelity simulation (n=16) while the other used low-fidelity simulation (n=18). While the high-fidelity simulation group had a higher composite score for the video review (M= 220.88 vs. M=193.67), this did not reach a level of significance (p=.122). On item level analysis of the scoring, 7 of 14 items reached levels of significance (p \u3c .05). Although all items reported higher mean scores for the highfidelity simulation group, items that focused on manual tasks or actions in the first one to two minutes of the cardiac arrest event were more likely to be non-significant. Items that focused on actions that occurred later in the event or were expert rater assessments of team leader confidence and knowledge were more likely to be found significant. There was no statistical significance found in any of the self-reported measures examining confidence (p = .850), motivation (p = .899), and affect (p = .215)

Exploration, design and application of simulation based technology in interventional cardiology

Medical education is undergoing a vast change from the traditional apprenticeship model to technology driven delivery of training to meet the demands of the new generation of doctors. With the reduction in the training hours of junior doctors, technology driven education can compensate for the time deficit in training. Each new technology arrives on a wave of great expectations; sometimes our expectations of true change are met and sometimes the new technology remains as a passing fashion only. The aim of the thesis is to explore, design and apply simulation based applications in interventional cardiology for educating the doctors and the public. Chapters 1and 2 present an overview of the current practice of education delivery and the evidence concerning simulation based education in interventional cardiology. Introduction of any new technology into an established system is often met with resistance. Hence Chapters 3 and 4 explore the attitudes and perceptions of consultants and trainees in cardiology towards the integration of a simulation based education into the cardiology curriculum. Chapters 5 and 6 present the “i-health project,” introduction of an electronic form for clinical information transfer from the ambulance crew to the hospital, enactment of case scenarios of myocardial infarction of varied levels of difficulty in a simulated environment and preliminary evaluation of the simulation. Chapter 7 focuses on educating the public in cardiovascular diseases and in coronary interventional procedures through simulation technology. Finally, Chapter 8 presents an overview of my findings, limitations and the future research that needs to be conducted which will enable the successful adoption of simulation based education into the cardiology curriculum.Open Acces

A Simulation-Based Teaching Strategy to Achieve Competence in Learners

Background: Simulation-based education has become the mainstay of clinical education in health sciences and medical education. A simulation-based education is a result of work hour restriction placed on graduate learners, increased number of students requiring clinical experience, decreased number of clinical sites and lack of the availability to perform certain procedures by learners. Research has demonstrated that integration of a simulation-based educational teaching strategy in a curriculum and throughout continued learning achieves competence in learners. Methods: The review of the literature highlighted the following topics: (a) history of medical simulation, (b) fidelity used in simulation training, devices and equipment, (c) learning theories associated with simulation-based education, (d) role of simulation training in medical and health sciences education, e) advantages and disadvantages of simulation training, f) competence in simulation-based education, g) debriefing/reflection in simulation. Results: An extensive review of the literature supports the use of a simulation-based teaching strategy in health sciences and medical education. Learning theories associated with simulation-based education allow educators to provide teaching strategies that align with learner’s ability to achieve competence in learning clinical and procedural skills required for their profession. Conclusion: A simulation-based education integrated in all stages of learner education that provides deliberate/repetitive practice and feedback achieves competence in learners throughout a life-time of learning

Preparing for the future of cardiothoracic surgery with virtual reality simulation and surgical planning:a narrative review

Background and Objective: Virtual reality (VR) technology in cardiothoracic surgery has been an area of interest for almost three decades, but computational limitations had restricted its implementation. Recent advances in computing power have facilitated the creation of high-fidelity VR simulations and anatomy visualisation tools. We undertook a non-systematic narrative review of literature on VR simulations and preoperative planning tools in cardiothoracic surgery and present the state-of-the-art, and a future outlook. Methods: A comprehensive search through MEDLINE database was performed in November 2022 for all publications that describe the use of VR in cardiothoracic surgery regarding training purposes, education, simulation, and procedural planning. We excluded papers that were not in English or Dutch, and that used two-dimensional (2D) screens, augmented, and simulated reality. Key Content and Findings: Results were categorised as simulators and preoperative planning tools. Current surgical simulators include the lobectomy module in the LapSim for video assisted thorascopic surgery which has been extensively validated, and the more recent robotic assisted lobectomy simulators from Robotix Mentor and Da Vinci SimNow, which are increasingly becoming integrated into the robotic surgery curriculum. Other perioperative simulators include the CardioPulmonary VR Resuscitation simulator for advanced life support after cardiac surgery, and the VR Extracorporeal Circulation (ECC) simulator for perfusionists to simulate the use of a heart-lung machine (HLM). For surgical planning, there are many small-scale tools available, and many case/pilot studies have been published utilising the visualisation possibilities provided by VR, including congenital cardiac, congenital thoracic, adult cardiac, and adult thoracic diseases. Conclusions: There are many promising tools becoming available to leverage the immersive power of VR in cardiothoracic surgery. The path to validate these simulators is well described, but large-scale trials producing high-level evidence for their efficacy are absent as of yet. Our view is that these tools will become increasingly integral parts of daily practice in this field in the coming decade.</p

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 361)

This bibliography lists 141 reports, articles and other documents introduced into the NASA Scientific and Technical Information System during Mar. 1992. Subject coverage includes: aerospace medicine and physiology, life support systems and man/system technology, protective clothing, exobiology and extraterrestrial life, planetary biology, and flight crew behavior and performance

Exploring User Needs in the Development of a Virtual Reality-Based Advanced Life Support Training Platform: Exploratory Usability Study

Background: Traditional methods of delivering Advanced Life Support (ALS) training and reaccreditation are resource-intensive and costly. Interactive simulations and gameplay using virtual reality (VR) technology can complement traditional training processes as a cost-effective, engaging, and flexible training tool. Objective: This exploratory study aimed to determine the specific user needs of clinicians engaging with a new interactive VR ALS simulation (ALS-SimVR) application to inform the ongoing development of such training platforms. Methods: Semistructured interviews were conducted with experienced clinicians (n=10, median age=40.9 years) following a single playthrough of the application. All clinicians have been directly involved in the delivery of ALS training in both clinical and educational settings (median years of ALS experience=12.4; all had minimal or no VR experience). Interviews were supplemented with an assessment of usability (using heuristic evaluation) and presence. Results: The ALS-SimVR training app was well received. Thematic analysis of the interviews revealed five main areas of user needs that can inform future design efforts for creating engaging VR training apps: affordances, agency, diverse input modalities, mental models, and advanced roles. Conclusions: This study was conducted to identify the needs of clinicians engaging with ALS-SimVR. However, our findings revealed broader design considerations that will be crucial in guiding future work in this area. Although aligning the training scenarios with accepted teaching algorithms is important, our findings reveal that improving user experience and engagement requires careful attention to technology-specific issues such as input modalities

Improving Student Registered Nurse Anesthesiologists’ Skills and Confidence Through High-fidelity Simulation

Positive anesthetic outcomes require rapid and precise recognition and treatment of highly complex pathophysiologic states. Repeated exposure to low-frequency, high-stakes events in a realistic milieu facilitates timely and appropriate anesthetic interventions. Current evidence suggests high-fidelity simulation enhances anesthetic training and can improve patient outcomes by enhancing confidence, competence, and proficiency while removing the risk for patient harm during simulated events. This project’s aim was to improve student registered nurse anesthesiologists’ confidence and competence in routinely encountered anesthetic situations utilizing high-fidelity simulation. Prior to beginning clinical rotations, students participated in a high-fidelity routine anesthetic induction simulation and were challenged to diagnose and mitigate an esophageal or right-mainstem bronchus intubation. Overall, students self-reported improvements in confidence and competence with the anesthetic induction, endotracheal intubation, confirming appropriate endotracheal tube placement, and troubleshooting complications that may arise during an anesthetic induction

An architecture supporting the development of serious games for scenario-based training and its application to Advanced Life Support

The effectiveness of serious games for training has already been proved in several domains. A major obstacle to the mass adoption of serious games comes from the difficulties in their development, due to the lack of widely adopted architectures that could streamline their creation process. In this thesis we present an architecture supporting the development of serious games for scenario-based training, a serious games for medical training we developed exploiting the architecture and the results of a study about its effectivenes