The use of mixed reality technology for the objective assessment of clinical skills: a validation study

Background Mixed Reality technology may provide many advantages over traditional teaching methods. Despite its potential, the technology has yet to be used for the formal assessment of clinical competency. This study sought to collect validity evidence and assess the feasibility of using the HoloLens 2 mixed reality headset for the conduct and augmentation of Objective Structured Clinical Examinations (OSCEs). Methods A prospective cohort study was conducted to compare the assessment of undergraduate medical students undertaking OSCEs via HoloLens 2 live (HLL) and recorded (HLR), and gold-standard in-person (IP) methods. An augmented mixed reality scenario was also assessed. Results 13 undergraduate participants completed a total of 65 OSCE stations. Overall inter-modality correlation was 0.81 (p=0.01), 0.98 (p=0.01) and 0.82 (p=0.01) for IP vs. HLL, HLL vs. HLR and IP vs. HLR respectively. Skill based correlations for IP vs. HLR were assessed for history taking (0.82, p=0.01), clinical examination (0.81, p=0.01), procedural (0.88, p=0.01) and clinical skills (0.92, p=0.01), and assessment of a virtual mixed reality patient (0.74, p=0.01). The HoloLens device was deemed to be usable and practical (Standard Usability Scale (SUS) score = 51.5), and the technology was thought to deliver greater flexibility and convenience, and have the potential to expand and enhance assessment opportunities. Conclusions HoloLens 2 is comparable to traditional in-person examination of undergraduate medical students for both live and recorded assessments, and therefore is a valid and robust method for objectively assessing performance. The technology is in its infancy, and users need to develop confidence in its usability and reliability as an assessment tool. However, the potential to integrate additional functionality including holographic content, automated tracking and data analysis, and to facilitate remote assessment may allow the technology to enhance, expand and standardise examinations across a range of educational contexts

Perceptions of Expert Practice by Active Licensed Registered Nurse Therapeutic Touch® Practitioners

Therapeutic Touch® (TT) is a nursing modality, developed in 1972, with a long history of research completion. It is also one of the leading complementary and alternative medicine (CAM) therapies. A comprehensive review of the literature (over 350 studies) from the 1960s to 2015 demonstrated a gap related to delineating expertise related to clinical practice from the view of the practitioner. This study examined the state of expert practice as envisioned by those who themselves qualified as experts in the discipline of TT. This study utilized a qualitative descriptive independent focus group methodology (Krueger, 1994, 2006; Krueger & Casey, 2001, 2009). This methodology has become popular in nursing studies. The choice of a synchronous method to collect data was made to provide a unique environment supported by the online environment with the university-supported platform. Focus groups were used as a stand-alone and self-contained method to conduct the study (Hupcey, 2005; Morgan, 1997). The sample consisted of 12 expert, registered nurse (RN) TT practitioners (TTPs), with a minimum of three years of TT experience. They also had attended a minimum of three TT workshops/courses, which included advanced training in the discipline. The use of electronic media facilitated a sample drawn from three countries across two continents. Six very small, synchronous, online focus groups (Toner, 2009) were conducted to reach data saturation and minimum sample size acquisition. Rich data were collected from these experienced practitioners. Parameters explored were the practitioners\u27 description of expert practice, their own expertise, how research impacted their practice, and the direction TT is headed in the future. Findings were supported by the expert practice literature. Krieger\u27s (2002) concept of transformation was especially apparent in the lives of many of the participants in this study. Respondents described how TT had become an integral part of their lives and influenced their lives immeasurably. The importance of practice as one factor leading to expertise was very apparent among the participants. Many of the studies stress the need for practice in order to gain expertise in specialty practice. TT is a form of specialty practice by nurses, supported in a holistic framework and caring environment. Sharing, which includes mentorship, collaboration, and teaching, is an important part of an advanced practice model, and is apparent in the practice of these advanced TTPs. Expert practice includes the components of expert practice knowledge, which is a necessary prequel to the ability to share it with others. It is also a necessary component to provide leadership to others, to conduct research in the field, and to further one\u27s own practice goals

A Review and Selective Analysis of 3D Display Technologies for Anatomical Education

The study of anatomy is complex and difficult for students in both graduate and undergraduate education. Researchers have attempted to improve anatomical education with the inclusion of three-dimensional visualization, with the prevailing finding that 3D is beneficial to students. However, there is limited research on the relative efficacy of different 3D modalities, including monoscopic, stereoscopic, and autostereoscopic displays. This study analyzes educational performance, confidence, cognitive load, visual-spatial ability, and technology acceptance in participants using autostereoscopic 3D visualization (holograms), monoscopic 3D visualization (3DPDFs), and a control visualization (2D printed images). Participants were randomized into three treatment groups: holograms (n=60), 3DPDFs (n=60), and printed images (n=59). Participants completed a pre-test followed by a self-study period using the treatment visualization. Immediately following the study period, participants completed the NASA TLX cognitive load instrument, a technology acceptance instrument, visual-spatial ability instruments, a confidence instrument, and a post-test. Post-test results showed the hologram treatment group (Mdn=80.0) performed significantly better than both 3DPDF (Mdn=66.7, p=.008) and printed images (Mdn=66.7, p=.007). Participants in the hologram and 3DPDF treatment groups reported lower cognitive load compared to the printed image treatment (p \u3c .01). Participants also responded more positively towards the holograms than printed images (p \u3c .001). Overall, the holograms demonstrated significant learning improvement over printed images and monoscopic 3DPDF models. This finding suggests additional depth cues from holographic visualization, notably head-motion parallax and stereopsis, provide substantial benefit towards understanding spatial anatomy. The reduction in cognitive load suggests monoscopic and autostereoscopic 3D may utilize the visual system more efficiently than printed images, thereby reducing mental effort during the learning process. Finally, participants reported positive perceptions of holograms suggesting implementation of holographic displays would be met with enthusiasm from student populations. These findings highlight the need for additional studies regarding the effect of novel 3D technologies on learning performance

All Hands on Deck: Choosing Virtual End Effector Representations to Improve Near Field Object Manipulation Interactions in Extended Reality

Extended reality, or XR , is the adopted umbrella term that is heavily gaining traction to collectively describe Virtual reality (VR), Augmented reality (AR), and Mixed reality (MR) technologies. Together, these technologies extend the reality that we experience either by creating a fully immersive experience like in VR or by blending in the virtual and real worlds like in AR and MR. The sustained success of XR in the workplace largely hinges on its ability to facilitate efficient user interactions. Similar to interacting with objects in the real world, users in XR typically interact with virtual integrants like objects, menus, windows, and information that convolve together to form the overall experience. Most of these interactions involve near-field object manipulation for which users are generally provisioned with visual representations of themselves also called self-avatars. Representations that involve only the distal entity are called end-effector representations and they shape how users perceive XR experiences. Through a series of investigations, this dissertation evaluates the effects of virtual end effector representations on near-field object retrieval interactions in XR settings. Through studies conducted in virtual, augmented, and mixed reality, implications about the virtual representation of end-effectors are discussed, and inferences are made for the future of near-field interaction in XR to draw upon from. This body of research aids technologists and designers by providing them with details that help in appropriately tailoring the right end effector representation to improve near-field interactions, thereby collectively establishing knowledge that epitomizes the future of interactions in XR

Augmented Reality and Its Application

Augmented Reality (AR) is a discipline that includes the interactive experience of a real-world environment, in which real-world objects and elements are enhanced using computer perceptual information. It has many potential applications in education, medicine, and engineering, among other fields. This book explores these potential uses, presenting case studies and investigations of AR for vocational training, emergency response, interior design, architecture, and much more

Roundtable Discussion (RTD03) - Is there a downside to using Simulated Patients to teach and assess communication skills?

Background Simulated Patients (SPs) are widely used to facilitate the learning of communication skills enabling students to receive detailed feedback on experiential practice in a safe environment. They are also used in the assessment of students’ communication skills in Objective Structured Clinical Examinations (OSCEs). We have observed that our most experienced SPs are highly conversant with medical jargon and consultation skills and have almost become ‘medical faculty’. Consultations can therefore lack the true patient perspective, with SPs focussing their feedback on process rather than giving a true patient perspective. Roundtable objectives To consider the challenges in ensuring that highly experienced SPs continue to respond from a true patient perspective To critique whether the use of SPs in OSCE stations is a valid way to assess students’ communication skills with real patients To consider whether using consultations with Simulated Patients is useful for students in the later years of an Undergraduate medical course who are learning to integrate the different components of a consultation and reasoning clinically in a real-life clinical context To share best practice with colleagues Roundtable A brief interactive presentation including the authors’ experiences of working with experienced Simulated Patients which will draw on current literature regarding the evidence for using Simulated Patients in the teaching and assessing of communication skills Delegates will have the opportunity to take part in three roundtable discussions • OSCE Stations using SPs assess how good students are at communicating with SPs but not with real patients • Experienced SPs are in danger of responding with a faculty not a patient perspective • By using SPs in teaching we over focus on process and forget the global picture

WS19. From pedagogy to practice: implementing transformative learning in clinical reasoning

BackgroundHealthcare professionals must provide high quality care that is both efficient and safe. Underpinning this requirement is a presumption that individuals are able to make accurate clinical decisions. Knowledge is not sufficient: judgment and reasoning are required to translate clinical information into accurate decisions to produce effective care. Clinical reasoning skills need to be developed in healthcare professionals in a way that produces change in behaviour. This is aplies to the spectrum of healthcare education: from undergraduate to postgraduate to lifelong practice. Though much is understood about clinical decision-making theory, direction for systematic implementation of teaching in both undergraduate and postgraduate medical education programmes is lacking. In particular, evidence describing transformative teaching methods is limited. This workshop will explore how to design effective spiral curricula in clinical reasoning, compare and contrast experiences from three medical schools in the UK, discuss challenges in implementation, share a variety of teaching methods, provide hands on demonstration of technological resources that have produced changes in learner behaviour and support attendees to adapt methodology to their programmes.Structure of workshopWe will briefly review current knowledge on clinical decision-making learning before sharing experiences from three UK medical schools.Attendees will participate in discussions supported by interactive exercises to explore each subtopic. These exercises will include role play, video and trial of electronic teaching tools used in our current practice. The session will conclude with a reflection on principles and ideas shared during the event

Recent Advancements in Augmented Reality for Robotic Applications: A Survey

Robots are expanding from industrial applications to daily life, in areas such as medical robotics, rehabilitative robotics, social robotics, and mobile/aerial robotics systems. In recent years, augmented reality (AR) has been integrated into many robotic applications, including medical, industrial, human–robot interactions, and collaboration scenarios. In this work, AR for both medical and industrial robot applications is reviewed and summarized. For medical robot applications, we investigated the integration of AR in (1) preoperative and surgical task planning; (2) image-guided robotic surgery; (3) surgical training and simulation; and (4) telesurgery. AR for industrial scenarios is reviewed in (1) human–robot interactions and collaborations; (2) path planning and task allocation; (3) training and simulation; and (4) teleoperation control/assistance. In addition, the limitations and challenges are discussed. Overall, this article serves as a valuable resource for working in the field of AR and robotic research, offering insights into the recent state of the art and prospects for improvement

Development of Human-Computer Interaction for Holographic AIs

Virtual humans and embodied conversational agents play diverse roles in real life, including game characters, chatbots, and teachers. In Augmented Reality (AR), such agents are capable of interacting with the real world. To distinguish between both types of virtual agents, AR agents were conceptually redefined as "holographic Artificial Intelligences (AIs)". Holographic AIs are embodied virtual agents interacting with real objects in Augmented Reality (AR), and can respond to events both in virtual and real environments. This thesis provides a comprehensive investigation into holographic AIs, spanning from their design to their user experience. The purpose of this thesis is to investigate the creation and use of holographic AIs, by creating specific holographic AIs, and then examining how users perceive such entities in order to contribute to the improvement of the user experience. As a result, this thesis explores the design space for and methods for creating holographic AIs, proposing the novel PICS model which include the dimensions of persona, intelligence, conviviality, and senses. Following the PICS model, a set of holographic AIs are designed by using a method of semi-automatic reconstruction. An AI that resembles a human being in appearance and behaviour is endowed with multimodal interactions capable of creating the illusion of physicality. The initial proposed model is then refined based on the experience of creation. Basic body language gestures, such as nodding and opening the arms, are insufficient to engage users, particularly when it comes to intelligent tutoring systems. Therefore, this thesis specifically focuses on an open problem, the generation of re-usable standard instructional gestures. In an experiment, key instructional movements that can be employed by holographic AIs were identified and extracted as animations. The hitherto known range of representational gestures is, epistemologically, further expanded by transformational and imitation gestures, which show how humans manipulate spatio-motor information and characterise posture using hand motion. Therefore, the model can be extended to describe the holographic AI’s behaviour. Moreover, in order to assess the empirical validity of holographic AIs, this research explores learners' trustworthiness towards this novel technology - as a key criterion for efficacy of this AI approach. Trust and trustworthiness, in terms of holographic AIs, refers to a mindset that aids users in achieving objectives based on good intentions. Young learners’ perception of trust is largely influenced by affective aspects of trust, determined by how emotionally responsive a holographic AI is. These findings contribute to the design of personal holographic AIs that can perform a series of meaningful gestures that engage the learner’s attention for learning, which in turn fosters a reliable and trustworthy relationship. Both experiments are able to extend elements by adding gestures and holistic perception to this model

Creation of a Virtual Atlas of Neuroanatomy and Neurosurgical Techniques Using 3D Scanning Techniques

Neuroanatomy is one of the most challenging and fascinating topics within the human anatomy, due to the complexity and interconnection of the entire nervous system. The gold standard for learning neurosurgical anatomy is cadaveric dissections. Nevertheless, it has a high cost (needs of a laboratory, acquisition of cadavers, and fixation), is time-consuming, and is limited by sociocultural restrictions. Due to these disadvantages, other tools have been investigated to improve neuroanatomy learning. Three-dimensional modalities have gradually begun to supplement traditional 2-dimensional representations of dissections and illustrations. Volumetric models (VM) are the new frontier for neurosurgical education and training. Different workflows have been described to create these VMs -photogrammetry (PGM) and structured light scanning (SLS). In this study, we aimed to describe and use the currently available 3D scanning techniques to create a virtual atlas of neurosurgical anatomy. Dissections on post-mortem human heads and brains were performed at the skull base laboratories of Stanford University - NeuroTraIn Center and the University of California, San Francisco - SBCVL (skull base and cerebrovascular laboratory). Then VMs were created following either SLS or PGM workflow. Fiber tract reconstructions were also generated from DICOM using DSI-studio and incorporated into VMs from dissections. Moreover, common creative license materials models were used to simplify the understanding of the specific anatomical region. Both methods yielded VMs with suitable clarity and structural integrity for anatomical education, surgical illustration, and procedural simulation. We described the roadmap of SLS and PGM for creating volumetric models, including the required equipment and software. We have also provided step-by-step procedures on how users can post-processing and refine these images according to their specifications. The VMs generated were used for several publications, to describe the step-by-step of a specific neurosurgical approach and to enhance the understanding of an anatomical region and its function. These models were used in neuroanatomical education and research (workshops and publications). VMs offer a new, immersive, and innovative way to accurately visualize neuroanatomy. Given the straightforward workflow, the presently described techniques may serve as a reference point for an entirely new way of capturing and depicting neuroanatomy and offer new opportunities for the application of VMs in education, simulation, and surgical planning. The virtual atlas, divided into specific areas concerning different neurosurgical approaches (such as skull base, cortex and fiber tracts, and spine operative anatomy), will increase the viewer's understanding of neurosurgical anatomy. The described atlas is the first surgical collection of VMs from cadaveric dissections available in the medical field and could be a used as reference for future creation of analogous collection in the different medical subspeciality.La neuroanatomia è, grazie alle intricate connessioni che caratterizzano il sistema nervoso e alla sua affascinante complessità, una delle discipline più stimolanti della anatomia umana. Nonostante il gold standard per l’apprendimento dell’anatomia neurochirurgica sia ancora rappresentato dalle dissezioni cadaveriche, l’accessibilità a queste ultime rimane limitata, a causa della loro dispendiosità in termini di tempo e costi (necessità di un laboratorio, acquisizione di cadaveri e fissazione), e alle restrizioni socioculturali per la donazione di cadaveri. Al fine di far fronte a questi impedimenti, e con lo scopo di garantire su larga scala l’apprendimento tridimensionale della neuroanatomia, nel corso degli anni sono stati sviluppati nuovi strumenti e tecnologie. Le tradizionali rappresentazioni anatomiche bidimensionali sono state gradualmente sostituite dalle modalità 3-dimensionali (3D) – foto e video. Tra questi ultimi, i modelli volumetrici (VM) rappresentano la nuova frontiera per l'istruzione e la formazione neurochirurgica. Diversi metodi per creare questi VM sono stati descritti, tra cui la fotogrammetria (PGM) e la scansione a luce strutturata (SLS). Questo studio descrive l’utilizzo delle diverse tecniche di scansione 3D grazie alle quali è stato creato un atlante virtuale di anatomia neurochirurgica. Le dissezioni su teste e cervelli post-mortem sono state eseguite presso i laboratori di base cranica di Stanford University -NeuroTraIn Center e dell'Università della California, San Francisco - SBCVL. I VM dalle dissezioni sono stati creati seguendo i metodi di SLS e/o PGM. Modelli di fibra bianca sono stati generate utilizzando DICOM con il software DSI-studio e incorporati ai VM di dissezioni anatomiche. Inoltre, sono stati utilizzati VM tratti da common creative license material (materiale con licenze creative comuni) al fine di semplificare la comprensione di alcune regioni anatomiche. I VM generati con entrambi i metodi sono risultati adeguati, sia in termini di chiarezza che di integrità strutturale, per l’educazione anatomica, l’illustrazione medica e la simulazione chirurgica. Nel nostro lavoro sono stati esaustivamente descritti tutti gli step necessari, di entrambe le tecniche (SLS e PGM), per la creazione di VM, compresi le apparecchiature e i software utilizzati. Sono state inoltre descritte le tecniche di post-elaborazione e perfezionamento dei VM da poter utilizzare in base alle necessità richieste. I VM generati durante la realizzazione del nostro lavoro sono stati utilizzati per molteplici pubblicazioni, nella descrizione step-by-step di uno specifico approccio neurochirurgico o per migliorare la comprensione di una regione anatomica e della sua funzione. Questi modelli sono stati utilizzati a scopo didattico per la formazione neuroanatomica di studenti di medicina, specializzandi e giovani neurochirurghi. I VM offrono un modo nuovo, coinvolgente e innovativo con cui poter raggiungere un’accurata conoscenza tridimensionale della neuroanatomia. La metodologia delle due tecniche descritte può servire come punto di riferimento per un nuovo modo di acquisizione e rappresentazione della neuroanatomia, ed offrire nuove opportunità di utilizzo dei VM nella formazione didattica, nella simulazione e nella pianificazione chirurgica. L'atlante virtuale qui descritto, suddiviso in aree specifiche relative a diversi approcci neurochirurgici, aumenterà la comprensione dell'anatomia neurochirurgica da parte dello spettatore. Questa è la prima raccolta chirurgica di VM da dissezioni anatomiche disponibile in ambito medico e potrebbe essere utilizzato come riferimento per la futura creazione di analoga raccolta nelle diverse sotto specialità mediche