Digital Game-Based Support for Learning the Phlebotomy Procedure in the Biomedical Laboratory Scientist Education

Practice-based training in education is important, expensive, and resource-demanding. Digital games can provide complementary training opportunities for practicing procedural skills and increase the value of the limited laboratory training time in biomedical laboratory science (BLS) education. This paper presents how a serious game can be integrated in a BLS course and supplement traditional learning and teaching with accessible learning material for phlebotomy. To gather information on challenges relevant to integrating Digital Game-Based Learning (DGBL), a case was carried out using mixed methods. Through a semester-long study, following a longitudinal, interventional cohort study, data and information were obtained from teachers and students about the learning impact of the current application. The game motivated students to train more, and teachers were positive towards using it in education. The results provide increased insights into how DGBL can be integrated into education and give rise to a discussion of the current challenges of DGBL for practice-based learning.Digital Game-Based Support for Learning the Phlebotomy Procedure in the Biomedical Laboratory Scientist EducationpublishedVersio

Enhancing the E-Commerce Experience through Haptic Feedback Interaction

The sense of touch is important in our everyday lives and its absence makes it difficult to explore and manipulate everyday objects. Existing online shopping practice lacks the opportunity for physical evaluation, that people often use and value when making product choices. However, with recent advances in haptic research and technology, it is possible to simulate various physical properties such as heaviness, softness, deformation, and temperature. The research described here investigates the use of haptic feedback interaction to enhance e-commerce product evaluation, particularly haptic weight and texture evaluation. While other properties are equally important, besides being fundamental to the shopping experience of many online products, weight and texture can be simulated using cost-effective devices. Two initial psychophysical experiments were conducted using free motion haptic exploration in order to more closely resemble conventional shopping. One experiment was to measure weight force thresholds and another to measure texture force thresholds. The measurements can provide better understanding of haptic device limitation for online shopping in terms of the availability of different stimuli to represent physical products. The outcomes of the initial psychophysical experimental studies were then used to produce various absolute stimuli that were used in a comparative experimental study to evaluate user experience of haptic product evaluation. Although free haptic exploration was exercised on both psychophysical experiments, results were relatively consistent with previous work on haptic discrimination. The threshold for weight force discrimination represented as downward forces was 10 percent. The threshold for texture force discrimination represented as friction forces was 14.1 percent, when using dynamic coefficient of friction at any level of static coefficient of friction. On the other hand, the comparative experimental study to evaluate user experience of haptic product information indicated that haptic product evaluation does not change user performance significantly. However, although there was an increase in the time taken to complete the task, the number of button click actions tended to decrease. The results showed that haptic product evaluation could significantly increase the confidence of shopping decision. Nevertheless, the availability of haptic product evaluation does not necessarily impose different product choices but it complements other selection criteria such as price and appearance. The research findings from this work are a first step towards exploring haptic-based environments in e-commerce environments. The findings not only lay the foundation for designing online haptic shopping but also provide empirical support to research in this direction

Academic methods for usability evaluation of serious games: a systematic review

In the last years, there has been an increasing interest in the design of video games as a tool for education, training, health promotion, socialization, etc. Usability, which is a key factor in any video game, becomes even more important in these so-called Bserious games^, where the users’ special characteristics should be considered, and the game efficacy depends on the users’ adherence and engagement. However, evaluation of the usability of this kind of games requires a redefinition of techniques, methods and even terminology. In this paper, we elicit six research questions and conduct a systematic review of the scientific literature, which resulted in the selection of 187 papers that contained the most relevant responses. The conclusions of this systematic review illustrate the general status of current academic usability evaluations of these games and the main trends in the selection of methodologies and how are they applied. This view may be a very valuable foundation for future researchMinisterio de Ciencia e Innovación PROCUR@-IPT-2011-1038-90000

Contextualising simulation: the use of patient-focused hybrid simulation for clinical skills education

This thesis documents a research programme into the use of Patient-Focused Hybrid Simulation (PFHS) for clinical skills education. PFHS is an approach to simulating clinical skills that combines a simulated patient (SP) with a part-task trainer (PTT) embedding the simulation of procedural skills within a more holistic clinical context, potentially overcoming some of the shortcomings of single modality simulation. Although promising, there remains limited evidence supporting its use. Two studies were conducted using a mixed-method approach. The first study was based on the simulation of the management of a traumatic skin laceration and consisted of two parts: 1) investigating the use of PFHS as a means of introducing clinical challenge by modifying the clinical context in which a procedure is performed; 2) exploring clinician’s perception of the use of PFHS and PTT for assessing of clinical competence. These findings suggest that by changing the clinical context in which a procedure is performed, PFHS can potentially be used to objectively simulate challenge. It also demonstrated that PFHS when compared to PTT simulations was better able to induce authentic clinical behaviour within the simulation. Central to this is the presence of a human being (SP). The second study compared the use of PFHS to patients for the training and assessment of cardiovascular examination skills. Within the limitations of this study, no significant difference was observed between PFHS and real patient-trained students in terms of their post-training performance of cardiovascular examination on real patients. There also appeared to be degree of concurrent validity between assessment of competency with PFHS and with real patients when conducted as an Objective Structured Clinical Examination (OSCE). The work presented provides additional evidence to the existing literature to support the use of PFHS in clinical skills education. However, it also raises a multitude of questions particularly of how PFHS as well as simulation in general should be used and future directions for simulation research.Open Acces

Exploring the activities and outcomes of digital teaching and learning of practical skills in higher education for the social and health care professions: a scoping review

Higher education for health care professionals faces numerous challenges. It is important to develop and apply methods supporting education, especially the practical skills. This scoping review aimed to explore the activities and learning outcomes of digital technology in practical skills teaching and learning in higher education for the social and health professions. Scoping review recommendations and the PRISMA-ScR checklist were applied. Randomized controlled trials published between 2016 and 2021 involving students in higher education who were taking courses in the social sciences and health care and reported interventions with digital technology activities and practices in practical teaching and learning were included. The CINAHL Plus, PubMed, Scopus, ERIC, and Sociological Abstracts/Social Services Abstracts databases were searched. Teaching methods were blended, e-learning or other online-based, and digital simulation-based activities. Teaching and learning environments, methods, resources, and activity characteristics varied, making a summary difficult. Interventions were developed in a face-to-face format prior to digitalization. The outcomes were measured at the knowledge level, not at the performance level. One-third of the studies showed a significant improvement in practical skills in the intervention group in comparison to the control conditions. The use of digital technology in the learning and teaching process have potential to develop of students' skills, knowledge, motivation, and attitudes. The pedagogy of technology use is decisive. The development of new digital methods for teaching and learning practical skills requires the engagement of students and teachers, in addition the researchers.publishersversionPeer reviewe

Creating a real-time movement sonification system for hemiparetic upper limb rehabilitation for survivors of stroke

Upper limb paresis is a common problem for survivors of stroke, impeding their ability to live independently, and rehabilitation interventions to reduce impairment are highly sought after. The use of audio-based interventions, such as movement sonification, may improve rehabilitation outcomes in this application, however, they are relatively unexplored considering the potential that audio feedback has to enhance motor skill learning. Movement sonification is the process of converting movement associated data to the auditory domain and is touted to be a feasible and effective method for stroke survivors to obtain real-time audio feedback of their movements. To generate real-time audio feedback through movement sonification, a system is required to capture movements, process data, extract the physical domain of interest, convert to the auditory domain, and emit the generated audio. A commercial system that performs this process for gross upper limb movements is currently unavailable, therefore, system creation is required. To begin this process, a mapping review of movement sonification systems in the literature was completed. System components in the literature were identified, keyword coded, and grouped, to provide an overview of the components used within these systems. From these results, choices for components of new movement sonification systems were made based on the popularity and applicability, to create two movement sonification systems, one termed ‘Soniccup’, which uses an Inertial Measurement Unit, and the other termed ‘KinectSon’ which uses an Azure Kinect camera. Both systems were setup to translate position estimates into audio pitch, as an output of the sonification process. Both systems were subsequently used in a comparison study with a Vicon Nexus system to establish similarity of positional shape, and therefore establish audio output similarity. The results indicate that the Soniccup produced positional shape representative of the movement performed, for movements of duration under one second, but performance degraded as the movement duration increased. In addition, the Soniccup produced these results with a system latency of approximately 230 ms, which is beyond the limit of real-time perception. The KinectSon system was found to produce similar positional shape to the Vicon Nexus system for all movements, and obtained these results with a system latency of approximately 67 ms, which is within the limit of real-time perception. As such, the KinectSon system has been evaluated as a good candidate for generating real-time audio feedback, however further testing is required to identify suitability of the generated audio feedback. To evaluate the feedback, as part of usability testing, the KinectSon system was used in an agency study. Volunteers with and without upper-limb impairment performed reaching movements whilst using the KinectSon system, and reported the perceived association of the sound generated with the movements performed. For three of the four sonification conditions, a triangular wave pitch modulation component was added to distort the sound. The participants in this study associated their movements with the unmodulated sonification condition stronger than they did with the modulated sonification conditions, indicating that stroke survivors are able to use the KinectSon system and obtain a sense of agency whilst using the system. The thesis concludes with a discussion of the findings of the contributing chapters of this thesis, along with the implications, limitations, and identified future work, within the context of creating a suitable real-time movement sonification system for a large scale study involving an upper limb rehabilitation intervention.Upper limb paresis is a common problem for survivors of stroke, impeding their ability to live independently, and rehabilitation interventions to reduce impairment are highly sought after. The use of audio-based interventions, such as movement sonification, may improve rehabilitation outcomes in this application, however, they are relatively unexplored considering the potential that audio feedback has to enhance motor skill learning. Movement sonification is the process of converting movement associated data to the auditory domain and is touted to be a feasible and effective method for stroke survivors to obtain real-time audio feedback of their movements. To generate real-time audio feedback through movement sonification, a system is required to capture movements, process data, extract the physical domain of interest, convert to the auditory domain, and emit the generated audio. A commercial system that performs this process for gross upper limb movements is currently unavailable, therefore, system creation is required. To begin this process, a mapping review of movement sonification systems in the literature was completed. System components in the literature were identified, keyword coded, and grouped, to provide an overview of the components used within these systems. From these results, choices for components of new movement sonification systems were made based on the popularity and applicability, to create two movement sonification systems, one termed ‘Soniccup’, which uses an Inertial Measurement Unit, and the other termed ‘KinectSon’ which uses an Azure Kinect camera. Both systems were setup to translate position estimates into audio pitch, as an output of the sonification process. Both systems were subsequently used in a comparison study with a Vicon Nexus system to establish similarity of positional shape, and therefore establish audio output similarity. The results indicate that the Soniccup produced positional shape representative of the movement performed, for movements of duration under one second, but performance degraded as the movement duration increased. In addition, the Soniccup produced these results with a system latency of approximately 230 ms, which is beyond the limit of real-time perception. The KinectSon system was found to produce similar positional shape to the Vicon Nexus system for all movements, and obtained these results with a system latency of approximately 67 ms, which is within the limit of real-time perception. As such, the KinectSon system has been evaluated as a good candidate for generating real-time audio feedback, however further testing is required to identify suitability of the generated audio feedback. To evaluate the feedback, as part of usability testing, the KinectSon system was used in an agency study. Volunteers with and without upper-limb impairment performed reaching movements whilst using the KinectSon system, and reported the perceived association of the sound generated with the movements performed. For three of the four sonification conditions, a triangular wave pitch modulation component was added to distort the sound. The participants in this study associated their movements with the unmodulated sonification condition stronger than they did with the modulated sonification conditions, indicating that stroke survivors are able to use the KinectSon system and obtain a sense of agency whilst using the system. The thesis concludes with a discussion of the findings of the contributing chapters of this thesis, along with the implications, limitations, and identified future work, within the context of creating a suitable real-time movement sonification system for a large scale study involving an upper limb rehabilitation intervention

Evaluating virtual reality simulation for transvaginal scan training in gynaecology

Ultrasound has a broad range of clinical applications and is increasingly being used at the point of care. Growth in use means an increasing need to train health professionals to perform ultrasound proficiently. This thesis appraises the evidence for the use of simulation in gynaecological ultrasound scan training. The thesis explores the role of simulation in training, the validity of a virtual reality simulator for transvaginal ultrasound, and its use in real clinical practice. As transvaginal ultrasound is an intimate examination the opinions of women on having a scan and training health professionals were sought. A systematic review showed that use of simulation training in gynaecological ultrasound when compared with standard theoretical and clinical approaches is associated with significant improvements for both learners and patients. Outcomes such as acquisition of skill, confidence and competence favour incorporating simulation into training, as does reduction in patient discomfort. An attempted pilot feasibility study, challenged the notion that simulation using the Medaphor Transvaginal ScanTrainer® is effective as a self-directed tool. However, the simulator did demonstrate construct validity and was felt to be useful in teaching a systematic approach to performing gynaecological ultrasound. Women were supportive of simulation to reduce discomfort and increase trainees confidence in clinical practice

An exploration of the effect of simulation on perceptions of medical students’ preparedness for professional practice; a mixed-methods, longitudinal study

Studies have shown that some medical students do not feel prepared to practice as a foundation doctor (FY1) once they graduate. Although there have been various reforms in medical education, levels of preparedness have remained static since 2012. Preparedness is vital to ensure patients are getting the best, safest care, and to avoid stress, anxiety and burnout in junior doctors. Technology-enhanced learning has become commonplace in medical education; with this, simulation has been introduced in wide-ranging ways. Although the evidence for simulation improving patient outcomes is clear across postgraduate and continuing professional education, studies have failed to systematically show the same outcomes for undergraduates, despite the widespread use of simulation in undergraduate medical curricula. This mixed-methods, two-phase study was designed to explore the effects of simulation on perceptions of students’ preparedness for professional practice. The study took a longitudinal format, over two academic years, gathering data (with questionnaires and interviews) from two participant groups; fifth-year medical students and key stakeholders. The study compared two diverse simulation formats; ward simulation and bleep simulation, both designed to develop the knowledge and non-technical skills required for the transition to professional practice. The results of this thesis suggest that simulation has a role in preparing students for the knowledge required for professional practice and may result in a change in behaviour longitudinally. However, there is an apparent disconnect between stakeholder and student perceptions of preparedness, and while students may feel prepared, their supervisors and other stakeholders do not agree. Furthermore, despite feeling prepared, students still feel concerned and anxious about the transition to professional practice. The results also highlighted the difficulties in thoroughly preparing students for the complexities of becoming an independent practitioner and emphasises the importance of support and continued learning throughout the foundation years