Exploring engagement and emotional response to realism during simulation-based education: a mixed methods observational cohort study

Introduction: simulation-based education has been used as an innovative technique for healthcare education for over a century. Tools and frameworks are available to guide the design of scenarios, however, techniques used are changing due to digital innovation. Supporting literature: there are misconceptions associated with simulation fidelity and realism and evidence to investigate the impact of differing variations of realism on learning, engagement, and performance. However, a gap in the literature was identified regarding the effect of varied levels of realism on learner’s knowledge, emotions, and behaviours. Methodology: Bandura’s Social Learning Theory was the theoretical framework that guided this research. A research question, study aim, and objectives were generated to explore different simulation-based education scenarios, to discover whether realism had an effect on the quality of the learning experience, leading to enhanced knowledge, and positive emotions and behaviours. Constructionism was the broad philosophical underpinning; symbolic interactionism the theoretical perspective, and a dramaturgical approach was taken to conduct this study. Methods: an observational cohort study using concurrent embedded design was conducted where the cohort were observed during three different scenarios (Manikin scenario, Human simulated patient scenario and a Paper-case). A feasibility study and pilot study were conducted, with the results used to inform and guide the main research study. Mixed methods were employed; quantitative data to explore the research question and qualitative observational data to provide context and background. Methods included pre- and post-measurement of learner’s knowledge and emotions via self-reported questionnaires, baseline self-efficacy measurement, post-intervention realism assessment, plus observation of behaviours using both structured and unstructured participant observation. Findings: student learners (n=11) from a Pre-registration Masters in Physiotherapy programme participated in the study; n=9 (82%) were female, majority aged 21-30 years (n=7, 64%). There was a difference in realism between simulation modalities – the Human SP scenario was significantly more realistic than the other two modalities (p<0.001). Post-knowledge scores were significantly higher following the Human SP scenario (26/40) and Paper-case (29/40) (p=0.01). Knowledge scores decreased following the scenario with a Manikin (21/40-19/40); this difference was not significant (p=0.6). There was a statistically significant increase in pre/post knowledge following the scenario featuring a Human SP (p=0.01). There was no difference in self-efficacy between the different scenarios (p=0.42); all learners reported high self-efficacy. Interest was the strongest pre-scenario positive emotion; Fear was the strongest pre-scenario negative emotion. The Manikin scenario caused more negative emotional responses, and the Human Simulated Patient scenario produced more positive emotional responses. Overall, all negative emotions pre- and post-Paper-case were less intense than the other modalities. Six themes were generated from the unstructured observations related to learner’s behaviours during each of the three scenarios. Discussion: The Human SP scenario was perceived to be the most realistic modality; this realism enhanced the learner’s experience, producing a significant knowledge gain, positive emotional response, and positive behaviours. The Paper-case was perceived to be the least realistic; however, this did not inhibit the learning experience, as learners gained the highest post-knowledge scores following interaction with the Paper-case, which may be due to the lack of distraction, creating an optimum area for learning. The Manikin scenario was perceived to be not as realistic as the Human SP scenario; it produced negative emotional responses and more negative behaviours; however, manikin-based simulation is necessary in some instances for certain procedural simulation scenarios that may be harmful to a human simulated patient. Conclusion and recommendations: Considerations are needed when making decisions about the modality and level of realism of simulation-based education prior to the scenario design process. A conceptual framework outlining the interrelationships between systems and subsystems associated with simulation-based education is presented. An appreciation of learner’s response to realism should enhance the learning experience and ensure appropriate design and delivery of simulation

Immersive analytics for oncology patient cohorts

This thesis proposes a novel interactive immersive analytics tool and methods to interrogate the cancer patient cohort in an immersive virtual environment, namely Virtual Reality to Observe Oncology data Models (VROOM). The overall objective is to develop an immersive analytics platform, which includes a data analytics pipeline from raw gene expression data to immersive visualisation on virtual and augmented reality platforms utilising a game engine. Unity3D has been used to implement the visualisation. Work in this thesis could provide oncologists and clinicians with an interactive visualisation and visual analytics platform that helps them to drive their analysis in treatment efficacy and achieve the goal of evidence-based personalised medicine. The thesis integrates the latest discovery and development in cancer patients’ prognoses, immersive technologies, machine learning, decision support system and interactive visualisation to form an immersive analytics platform of complex genomic data. For this thesis, the experimental paradigm that will be followed is in understanding transcriptomics in cancer samples. This thesis specifically investigates gene expression data to determine the biological similarity revealed by the patient's tumour samples' transcriptomic profiles revealing the active genes in different patients. In summary, the thesis contributes to i) a novel immersive analytics platform for patient cohort data interrogation in similarity space where the similarity space is based on the patient's biological and genomic similarity; ii) an effective immersive environment optimisation design based on the usability study of exocentric and egocentric visualisation, audio and sound design optimisation; iii) an integration of trusted and familiar 2D biomedical visual analytics methods into the immersive environment; iv) novel use of the game theory as the decision-making system engine to help the analytics process, and application of the optimal transport theory in missing data imputation to ensure the preservation of data distribution; and v) case studies to showcase the real-world application of the visualisation and its effectiveness

Enhanced e-learning and simulation for obstetrics education

Background: In medicine, new media technologies have been used in recent years to simulate situations and techniques that may not be common enough for students to experience in reality or may not be visible to the naked eye. Especially in areas of medicine focusing on important surgeries or procedures, these simulated designs could train students and ultimately prevent possible risk or morbidity. Aims: The aim of this thesis was to develop a multipurpose hybrid educational resource based on a physical/software driven simulator platform enabling the use of multimedia properties like 3D and video to enhance the educational training of obstetrics students through haptic interactions. All of this content was enabled by the learning preferences of the obstetric students involved. Method: The learning resource was developed using a combination of student learning preference, online learning content, 3D, video, human patient simulations and sensor technology interaction. These mediums were all interconnected to create a multipurpose resource. The learning preference was collected through a developed student online survey, the results consequently informed the creation of the other aspects of the finished resource. The interactive aspects were created through position and orientation sensors and the 3D/video influences which localised the position and orientation of an object like a fetal model relative to a human patient simulator. All of these methods combined with added assessment contributions for obstetric tutors, enabled the finalising of a prototype. Conclusion: This form of learning resource has a vital role in the progressing higher level education in the digital age. This proposal is the development of a new type of joint simulator that allows students and practitioners physically involve themselves in a series of processes while assessing their own progression through real time digital feedback in the form of video narrative and analytics. Usability test was not conducted on the full resource (one on the video platform) due to time limitations

Proceedings of the 9th international conference on disability, virtual reality and associated technologies (ICDVRAT 2012)

The proceedings of the conferenc