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Trends in virtual reality technologies for the learning patient
NextMed convened the Medicine Meets Virtual Reality 22 (MMVR 22) conference in 2016. Since 1992, the conference has brought together a diverse group of researchers to share creative solutions for the evolving challenge of integrating virtual reality tools into medical education. Virtual reality (VR) and its enabling technologies utilize hardware and software to simulate environments and encounters where users can interact and learn. The MMVR 22 symposium proceedings contain projects that support a variety of learners: medical students, practitioners, soldiers, and patients. This report will contemplate the trends in virtual reality technologies for patients navigating their medical and healthcare learning. The learning patient seeks more than intervention; they seek prevention. From virtual humans and environments to motion sensors and haptic devices, patients are surrounded by increasingly rich and transformative data-driven tools. Applied data enables VR applications to simulate experience, predict health outcomes, and motivate new behavior. The MMVR 22 presents investigations into the usability of wearable devices, the efficacy of avatar inclusion, and the viability of multi-player gaming. With increasing need for individualized and scalable programming, only committed open source efforts will align instructional designers, technology integrators, trainers, and clinicians. Curriculum and InstructionCurriculum and Instructio
Virtual Reality Games for Motor Rehabilitation
This paper presents a fuzzy logic based method to track user satisfaction without the need for devices to monitor users physiological conditions. User satisfaction is the key to any product’s acceptance; computer applications and video games provide a unique opportunity to provide a tailored environment for each user to better suit their needs. We have implemented a non-adaptive fuzzy logic model of emotion, based on the emotional component of the Fuzzy Logic Adaptive Model of Emotion (FLAME) proposed by El-Nasr, to estimate player emotion in UnrealTournament 2004. In this paper we describe the implementation of this system and present the results of one of several play tests. Our research contradicts the current literature that suggests physiological measurements are needed. We show that it is possible to use a software only method to estimate user emotion
A Digital Twin for Training Marine Pollution Control
This paper presents a Digital Twin to prepare an international response to marine pollution events. This research is conducted by a multidisciplinary team of information systems and marine pollution experts to create a digital environment suitable to represent near-real-time pollution events, assisting the command structure and combat teams in improving performance and knowledge of standard protocols. The reported results were obtained in the first year of the project and included (1) the Digital Twin architecture, (2) the simulation of the natural conditions, and (3) the prototype of the performance evaluation dashboard. Our findings suggest that current simulation systems help inform decisions but are insufficient to prepare complex scenarios requiring coordination between multiple agents operating in extreme conditions. Digital Twins can help in preparing procedures and evaluating performance in digital representations. This study contributes to a recent Digital Twin literature trend that aims to create digital replicas of comprehensive sociotechnical scenarios
A Graduatte Level Immersive-Simulattion Program for Teaching and Assessing Fundamental Skills in Entry Level Clinical Perfusionists.
Background: The clinical perfusionist is a member of the open-heart-surgery team and responsible for operating the life support equipment that replaces the function of the patient\u27s heart and lungs and arrests and restarts the patient\u27s heart in the course of a Cardiopulmonary Bypass (CPB) procedure. In the perfusionists scope of practice, the consequence of unskilled actions, inaccurate understanding or delayed decision making may result in significant patient morbidity or even death. Historically, perfusion students have learned and practiced their skills within a clinical preceptorship program in which an experienced clinician allows the novice student to operate the life support equipment under their direct supervision and consultation. While there is clinical evidence from numerous surgical specialties which establishes that learning curve associated errors have a negative effect on patient outcomes, this has not been researched for clinical perfusionists. Despite this evidence gap, the professions leaders have been instrumental in driving educational innovation and the development of medical simulation models that may reduce the patient\u27s exposure to learning curve associated morbidity by developing competence with high-risk clinical skills prior to patient contact. The purpose of this research is to develop, validate and apply novel medical simulation techniques and technologies to the preparation of entry level clinical perfusionists and demonstrate pre-clinical competence with the fundamental perfusion skills.Methods and Results: To inform the development of a skills curriculum we conducted two national surveys using online survey tools. Through these surveys we validated a list of fundamental skills, and the deconstructed sub-elements involved in the conduct of these skills. Additionally, we identified the typical ranges of physiologic and technical parameters that clinicians maintain during clinical procedures. With this foundational benchmark data we validated the performance of a simulated patient to establish that the patient surrogate generates data that is substantially similar to the physiologic and technical data that a perfusionist would manage during a live clinical procedure. This validated simulation technology was then incorporated into a high-fidelity simulation suite and applied to an innovative immersive curriculum which included hands on repetitive practice, live and video supported self, peer and expert observation and feedback as well as a battery of high-stakes assessments. The validity and fidelity of the simulated experience was established through analysis of over 800 opinions generated over 10 years by novice and expert perfusionists after performing simulated cases. Finally, the efficacy of the simulation curriculum was assessed by comparing our simulation trained students to a national pool of their peers from other schools and expert clinicians. Through this process we generated the first measurements of the typical learning curve for the fundamental skills of CPB, the first estimates of error rates for students navigating the learning curve and the first benchmark measures of competent performance in a simulated environment. This data establishes that students learning in traditional clinical training programs conduct three-fold more errors than experts and will have approximately 99 high-risk patient encounters prior to developing competence with fundamental skills. By comparison, simulation trained students demonstrated competence with fundamental skills that was similar to the experts with almost no high-risk patient encounters. Discussion: The implications to patient safety are clearly implied. These studies establish that there is a high level of agreement among clinicians regarding the skills that are necessary to operate perfusion equipment and that realistic simulation environments can be designed and applied to the development of student\u27s fundamental perfusion skills without exposing patients to the threat of students learning curve associated errors. This data may catalyze a larger national dialog regarding Entrustable Professional Activities for perfusionists and influence national accreditation standards for educational programs
From cockpit to operating theatre to drilling rig floor: five principles for improving safety using simulator-based exercises to enhance team cognition.
For over 30 years, aviation has conducted training courses to enhance team performance and improve safety involving simulation with observation and directed feedback. Participants' performance is observed by trained and experienced observers who then provide feedback using behaviour-based evidence noted during the simulator exercise. More recently, in healthcare, operating theatre personnel have adopted simulator-based training (SBT), observation and feedback for learning and practice to reduce the potential for human errors and improve safety. Maritime and nuclear power also incorporate high-fidelity simulators and feedback in team training interventions including technical and non-technical skills. The design and development of drilling rig simulators means that drill crews can now practise and test out their decision-making and receive feedback from observers, with the aim of improving team non-technical skills and consequently reducing the potential for errors. This paper presents five principles gleaned from research and the experiences of both aviation and healthcare to be applied to the development of simulator-based exercising for drilling teams. The principles include: (a) developing learning objectives and expected performance standards; (b) training the team as a whole; (c) using a structured observation tool; (d) providing feedback during a structured debrief; (e) repeat the SBT regularly to enhance expertise and retain performance standards. It is anticipated that these principles can be generalised for simulator-based exercising to benefit team social and cognitive competences in other high-hazard or process industries
Team training in safety and security via simulation: a practical dimension of maritime education and training
In the rather extended maritime domain, a term that should be the epicentre of any successful careerbuilding path is tailor-made training via cutting-edge simulators. To cut a long story short, the breadth of operations on the various types of ships has expanded to such a large extent that extensive practical training drills are becoming a compelling need to contribute to competent seafarers. This type of training can guarantee the positive outcome in their decision-making process and help the seafarers often being under continuous pressure, to suitably respond to the various safety and security threats on-board a vessel. The several conventions and codes introduced by the International Maritime Organization (IMO) – including MARPOL (International Convention for the Prevention of Pollution from Ships), SOLAS (International Convention for the Safety of Life at Sea), but moreover ISPS Code (International Ship and Port Facility Security Code) and STCW (Standards of Training Certification and Watch-keeping) being probably the most well-known examples both within and outside the maritime community – posing and requesting significant performance demands on crews. Sophisticated simulation series that promote teamwork and cooperation are the tools urgently needed to maximize training efficacy. Handling safety situations under stress (emergency response), crisis management and reactions towards a security incident are important aspects of Maritime Education and Training (MET). The authors’ approach to address those aspects utilizes enhanced simulation based team training. They argue that an effective way to gain experience and achieve corresponding skills, are practice runs on specially designed simulators that realistically represent complex conditions on-board vessels, following the respective prompts though realistic scenarios. The concept of a safety & security training simulator is introduced; the research work related to the implementation of a learning objective oriented development of simulation training scenarios and the pedagogic value added by simulation to MET are also discussed. A very important recommendation is that maritime training needs should not be regarded simply as a means to achieve regulatory compliance. The value imparted by simulation as a pedagogic tool to the maritime teaching and learning process is tremendous; adopting the learning objective oriented development of simulation training scenarios in order to effectively address pre-identified learning outcomes is the right methodology to nurture competent seafarers
Recomendaciones para desarrollar un programa de formación en simulación quirúrgica laparoscópica. Perspectivas obtenidas tras 12 años de formación de cirujanos
Introduction. The use of simulation in surgery has made it possible to shorten learning curves through deliberate practice. Although it has been incorporated long ago, there are still no clear recommendations to standardize its development and implementation. This manuscript aims to share recommendations based on our experience of more than twelve years of employing and improving a methodology in laparoscopic surgical simulation. Topics for Reflection. To transfer surgical skills to a trainee, we base our methodology on a three-pillar framework: The hardware and infrastructure (tools to train with), the training program itself (what to do), and the feedback (how to improve). Implementing a cost-effective program is feasible: the hardware does not need to be high fidelity to transfer skills, but the program needs to be validated. These pillars have evolved over time by incorporating technology: the on-site guidance from experts has changed to a remote and asynchronous modality by video recording the trainee’s execution, and by enabling remote and asynchronous feedback. The feedback provider does not necessarily have to be an expert clinician in the subject, but a person previously trained to be a trainer. This allows for deliberate practice until mastery has been reached and learning curves are consolidated. Conclusions. Recommendations based on the experience of our center have been presented, explaining the framework of our strategy. Considering these suggestions, it is hoped that our simulation methodology can aid the development and implementation of effective simulation-based programs for other groups and institutions.Introducción. El uso de la simulación en cirugÃa ha permitido acortar las curvas de aprendizaje mediante la práctica deliberada. A pesar de que se ha incorporado previamente, aún no existen recomendaciones claras para estandarizar su desarrollo e implementación. Este manuscrito pretende compartir recomendaciones basadas en nuestra experiencia, con más de doce años empleando y mejorando una metodologÃa en la simulación quirúrgica laparoscópica. Temas de reflexión. Para transferir las habilidades quirúrgicas a un aprendiz, basamos nuestra metodologÃa en un marco de tres pilares: El hardware y la infraestructura (herramientas con las que entrenar), el programa de entrenamiento (qué hacer), y la retroalimentación (cómo mejorar). La implementación de un programa rentable es factible: el hardware no necesita ser de alta fidelidad para transferir las habilidades, pero el programa necesita ser validado. Estos pilares han evolucionado a lo largo del tiempo incorporando tecnologÃa: la presencia de expertos ha evolucionado a una modalidad remota y asincrónica mediante la grabación en vÃdeo de la ejecución del alumno, y permitiendo su retroalimentación. Aquel que entrega retroalimentación no tiene que ser necesariamente un clÃnico experto en la materia, sino una persona previamente formada como instructor. Esto permite una práctica deliberada hasta dominar la habilidad y establecer curvas de aprendizaje. Conclusiones. Se han presentado recomendaciones basadas en la experiencia de nuestro centro, explicando el marco de nuestra estrategia. Teniendo en cuenta estas sugerencias, se espera que nuestra metodologÃa de simulación pueda ayudar al desarrollo e implementación de programas efectivos basados en la simulación a otros grupos e instituciones
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