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

Human-Centred Design for Improving VR Training of Clinical Skills

With the advent of modern VR technology in 2016, its potential for medical simulation and training has been recognized. However, challenges like low user acceptance due to poor usability are frequently found, hampering wide-spread adoption. This research aims to address the usability of VR clinical skills simulations, particularly focusing on interaction design, and proposes improvements for higher learning outcomes and user retention. A literature review and a usability case study of an off-the-shelf clinical VR training application was conducted, revealing usability concerns and areas requiring improvement. The prevalent issues include difficulties with controls, hardware and the 'gulf of execution' in broader 'possibility space' - issues that extend beyond direct interaction designs. A market analysis further reinforced these findings, showing gaps in interaction affordances, pointing to design patterns and trends that could be improved for better usability and interaction. The synthesis of these findings indicate that the limitations of novel interaction schemes and understanding of the VR simulation's 'possibility space' affect the knowledge transferability. Given these issues and limitations in current VR clinical training simulations, this study outlines several Human-Centred Design recommendations for improvement, incorporating findings from wider VR design research. This research's findings seek to facilitate the development of more user-centric VR training applications, ultimately leading to enhanced training of healthcare professionals and improved patient outcomes. The study sets a foundation for future interaction design work, addressing the primary usability issues and limitations in current VR clinical simulations

Diverse approaches to learning with immersive Virtual Reality identified from a systematic review

To investigate how learning in immersive Virtual Reality was designed in contemporary educational studies, this systematic literature review identified nine design features and analysed 219 empirical studies on the designs of learning activities with immersive Virtual Reality. Overall, the technological features for physical presence were more readily implemented and investigated than pedagogical features for learning engagement. Further analysis with k-means clustering revealed five approaches with varying levels of interactivity and openness in learning tasks, from watching virtual worlds passively to responding to personalised prompts. Such differences in the design appeared to stem from different practical and educational priorities, such as accessibility, interactivity, and engagement. This review highlights the diversity in the learning task designs in immersive Virtual Reality and illustrates how researchers are navigating practical and educational concerns. We recommend future empirical studies recognise the different approaches and priorities when designing and evaluating learning with immersive Virtual Reality. We also recommend that future systematic reviews investigate immersive Virtual Reality-based learning not only by learning topics or learner demographics, but also by task designs and learning experiences

Diverse approaches to learning with immersive Virtual Reality identified from a systematic review

To investigate how learning in immersive Virtual Reality was designed in contemporary educational studies, this systematic literature review identified nine design features and analysed 219 empirical studies on the designs of learning activities with immersive Virtual Reality. Overall, the technological features for physical presence were more readily implemented and investigated than pedagogical features for learning engagement. Further analysis with k-means clustering revealed five approaches with varying levels of interactivity and openness in learning tasks, from watching virtual worlds passively to responding to personalised prompts. Such differences in the design appeared to stem from different practical and educational priorities, such as accessibility, interactivity, and engagement. This review highlights the diversity in the learning task designs in immersive Virtual Reality and illustrates how researchers are navigating practical and educational concerns. We recommend future empirical studies recognise the different approaches and priorities when designing and evaluating learning with immersive Virtual Reality. We also recommend that future systematic reviews investigate immersive Virtual Reality-based learning not only by learning topics or learner demographics, but also by task designs and learning experiences

Exploring the Usability of Game-Based Virtual Reality for Development of Procedural Skills in Undergraduate Nursing Students

Providing safe, high quality patient care requires that undergraduate nursing students learn and apply extensive content knowledge as they also begin to develop clinical judgment. Nursing students must learn several procedural skills and be ready to remember and competently perform these skills when the need arises during patient care. Some procedures require strict adherence to aseptic technique in order to protect patients from hospital-acquired infections. Consequently, nurse educators are challenged to find innovative and interactive ways to help students develop and remember these important fundamental skills while ensuring patient safety. This study used a mixed methods design to explore the usability of, and user-reaction to, a game-based virtual reality (VR) system. The unique system combines headgear and haptics to place the nursing student in a patient’s room in order to practice inserting a urinary catheter virtually. The study also compared control and experimental participants’ time-on-task, number of procedures completed in one hour, and ability to demonstrate aseptic technique during urinary catheter insertion two weeks post-practice session. All study participants were given one hour to practice catheter insertion, either on a task trainer or virtually. User reactions to the VR game were observed during gameplay and collected via survey immediately after each individual VR game practice session. Subjects rated the system solidly in the Acceptable range using the System Usability Survey (Brooke, 1996) and between Good and Excellent when including a comparative adjective rating scale (Bangor, Kortum, & Miller, 2009). Inclusion of minimal game elements (points and a timer) motivated participants to continue to practice in order to improve their scores and procedure completion time, as well as engage in competition against their peers. Subjects in the experimental group spent more time practicing and completed more procedures than subjects in the control group and rated the experience as highly engaging and enjoyable. The pass rate at two week follow-up catheter insertion demonstration was 60% for both groups. Results of this study suggest that combining VR technology with game-based learning provides an innovative and useful way for students to practice procedural skills prior to performing the procedure on patients. The next iteration of the system will include an emphasis on providing clearer feedback to promote more accurate practice and should then be tested on larger numbers of students at multiple sites

Effectiveness analysis of traditional and mixed reality simulations in medical training: a methodological approach for the assessment of stress, cognitive load and performance

La simulazione nell'educazione in medicina è considerata un metodo di formazione in grado di migliorare le competenze cliniche e il comportamento degli operatori sanitari e, di conseguenza, la qualità dell'assistenza per il paziente. Inoltre, l'utilizzo di nuove tecnologie come la Realtà Aumentata, offre ai discenti l'opportunità di esercitarsi in un ambiente immersivo. L'opportunità di sperimentare questo innovativo metodo didattico è efficace non solo nel ridurre il rischio di errori e approcci sbagliati ma anche nel provare ansia e stress simili a quelli avvertiti nella pratica reale. La sfida sta nel trovare il giusto equilibrio. I discenti devono infatti provare lo stesso stress che avvertirebbero lavorando ad un vero caso clinico ma, allo stesso tempo, devono essere controllati ed evitati possibili disturbi da stress post-traumatico, verificabili soprattutto nel campo della gestione delle emergenze (pronto soccorso). Inoltre, è fondamentale anche ottenere alte prestazioni e un apprendimento adeguato, evitando sovraccarichi cognitivi che influenzerebbero negativamente l’apprendimento. Tuttavia, ad oggi mancano ancora studi approfonditi sull'impatto che le simulazioni mediche hanno su stress, frustrazione, carico cognitivo e apprendimento dei discenti. Per questo motivo, l'obiettivo principale di questo studio è valutare l'efficacia del training tramite simulazione, analizzando prestazioni, ansia, stress e carico cognitivo durante simulazioni cliniche tradizionali (con manichino) ed avanzate (in realtà mista). A questo scopo, è stato sviluppato un approccio metodologico strutturato e completo per valutare le prestazioni, le condizioni emotive e cognitive degli studenti. Questo comprende l'acquisizione e l'analisi di parametri psicologici (valutazione soggettiva), segnali biometrici (valutazione oggettiva) e prestazioni. Questa indagine consente di evidenziare i punti deboli delle simulazioni e offre l'opportunità di definire utili linee guida per la riprogettazione e l'ottimizzazione delle stesse. La metodologia è stata applicata su tre casi studio: il primo si riferisce a simulazioni ad alta fedeltà per la gestione del paziente in pronto soccorso, il secondo si riferisce a simulazioni a bassa fedeltà per la pratica della rachicentesi. Per il terzo caso studio, è stato progettato e sviluppato un prototipo di simulatore in realtà mista per la rachicentesi, con l'obiettivo di migliorare il senso di realismo e immersione della simulazione a bassa fedeltà. 148 studenti sono stati coinvolti nei primi due casi studio osservazionali, mentre soltanto 36 studenti hanno preso parte allo studio pilota sulla simulazione in realtà mista. In tutti i casi di studio sono state effettuate analisi descrittive delle prestazioni, degli stati cognitivi ed emotivi. Per le simulazioni ad alta e bassa fedeltà, le analisi di regressione statistica hanno evidenziato quali variabili influenzano le prestazioni, lo stress e il carico cognitivo degli studenti. Per lo studio pilota sulla realtà mista, l'analisi della user experience ha sottolineato i limiti tecnici della nuova tecnologia.Simulation in medical education is considered a training method capable of improving clinical competence and practitioners’ behaviour, and, consequently quality of care and patient’s outcome. Moreover, the use of new technologies, such as augmented reality, offers to the learners the opportunity to engage themselves in an immersive environment. The opportunity to experiment with this innovative instructional method is effective not only in reducing the risk of errors and wrong approaches but also in experiencing anxiety and stress as in real practice. The challenge is to find the right stress balance: learners have to feel as if they were practicing in the real stressful clinical case, and, at the same time, post-traumatic stress disorders, verifiable especially in the emergency field, must be controlled and avoided. Moreover, it is fundamental also to obtain high performance and learning, thus avoiding cognitive overloads. However, extensive researches about the impact of medical simulations on students’ stress, frustration, cognitive load, and learning are still lacking. For this reason, the main objective of this study is to assess simulation training effectiveness by analysing performance, anxiety, stress, and cognitive load during traditional (with manikin) and advanced (with augmented reality) clinical simulations. A structured and comprehensive methodological approach to assess performance, emotional and cognitive conditions of students has been developed. It includes the acquisition and analysis of psychological parameters (subjective assessment), biometric signals (objective assessment), and task performance. This investigation allows to point out simulations’ weaknesses and offers the opportunity to define useful optimisation guidelines. The methodology has been applied to three case studies: the first one refers to high-fidelity simulations, for the patient management in the emergency room, the second one refers to low-fidelity simulation for rachicentesis. For the third case study, a prototype of a mixed reality simulator for the rachicentesis practice has been designed and developed aiming at improving the sense of realism and immersion of the low-fidelity simulation. While 148 students have been enrolled in the first two case studies, only 36 students have taken part in the pilot study about mixed reality simulation. Descriptive analysis about performance, cognitive and emotional states have been done in all the case studies. For the high-fidelity and low-fidelity simulations, the statistical regression analysis has pointed out which variables affect students’ performance, stress, and cognitive load. For the pilot study about mixed reality, the user experience analysis highlighted the technical limitations of the new technology

Relationship between Fidelity and Dose of Human Patient Simulation, Critical Thinking Skills, and Knowledge in an Associate Degree Nursing Program

This study examined the relationship between human patient simulation (HPS), critical thinking skills, and knowledge acquisition after HPS was integrated across the curriculum of an associate degree nursing program to determine if differences existed in critical thinking and knowledge of students based on the fidelity of HPS used and amount of student exposure to HPS. The effectiveness of HPS when used as a teaching strategy in lieu of traditional clinical experiences was examined to determine the impact on critical thinking and knowledge in relation to the percentage of traditional clinical experiences substituted with HPS. The National League for Nurses\u27 (NLN) Nursing Education Simulation Framework, based on Kolb\u27s experiential learning theory, provided the framework. An ex post facto design was used with a convenience sample of 187 graduates drawn from the six cohorts of graduates who graduated from the nursing program spring 2006 through spring 2010. The Health Education Systems Incorporated (HESI) exit exam\u27s (E2) composite score and HESI E2 critical thinking (CT) subscore, used to measure nursing knowledge and critical thinking skills, were compared among the six cohorts of graduates exposed to varying degrees of fidelity and number of hours of traditional clinical experiences substituted with HPS during their educational program. Analysis of variance revealed that a significant difference in knowledge (p = 0.012) existed between the six cohorts. In addition, analysis of covariance revealed that a significant difference in critical thinking skills (p = 0.003) existed between the six cohorts. Polynomial contrasts identified a significant, positive linear trend in HESI E2 mean scores (p = .001) and HESI E2 CT mean scores (p \u3c .001) across the six cohorts as exposure to and number of traditional clinical hours substituted with simulation increased. Significant statistical differences existing between pairs of cohorts were identified by pairwise comparisons of the six cohorts. The results supported the use of HPS as an effective teaching strategy in lieu of a small percentage of traditional clinical experiences. No significant statistical differences were identified in knowledge and critical thinking based on the fidelity of HPS used

Healthy Competition: Multiplayer Digital Games in Health Education

The focus of this dissertation is on the role of multiplayer digital games in adult education, with a particular emphasis on health education. Although interest in the use of digital games for serious applications has been increasing since the early 2000s, there is a significant gap in understanding on the use of multiplayer digital games in adult education. In the context of health education, there has been a large amount of research conducted in to the use of repurposed commercial games for predicting performance of trainees and health students on surgical simulators. However, beyond this niche research into game based learning is notably less cohesive. There has been some research into the use of digital games in areas such as for delivering insulin management training, but understanding of the processes for widespread application of games based learning in the health sector is limited. Additionally, almost no research has been undertaken into the use of multiplayer digital games in health education, whether it be for tertiary or adult learners. In this dissertation two digital games were developed, implemented and evaluated to explore the value of multiplayer games for supporting cooperation and collaboration in health education. The first game, They Know: Anatomy, was a real time team based strategy game designed to support anatomy revision by second year medical students. The second game, the Qstream: Cancer Cup Challenge, was a team based asynchronous online program designed to reinforce understanding of how to identify and manage adverse events by oncology registrars. A design research framework informed the methodology used in this dissertation. This framework emphasises the need to use multiple iteration cycles to develop a comprehensive understanding of player experiences with the digital games they encountered. Data on participant experiences with the digital games was collected using qualitative methods, including post-game surveys and semi-structured interviews. Between iterative cycles data on participant experiences with the digital games were analysed so that future implementations of the game could be modified to maximise cooperation and collaboration between players. At the conclusion of the study period data collected across all implementations of the digital games were analysed to increase understanding of how multiplayer digital games supported cooperation and collaboration between learners. Findings from this dissertation demonstrate that multiplayer digital games can be used to engage medical students in anatomy revision and medical oncologists in adverse events retraining. This is the first study to look at the use of digital games for either of these demographics. Additionally, this dissertation identified four ways through which multiplayer digital games foster collaboration between players: through the development of a team strategy to win the game, by facilitating !iii shared decision making, by working towards a shared goal, and by creating a sense of investment in a team. Finally, findings from this dissertation contribute to the literature on the implementation of game based learning in adult education. This is an under researched area, but one that warrants further focus in future if game based learning is going to be successfully incorporated into curricula and training activities for adult learners. This dissertation adds to the literature by presenting new knowledge on how and why multiplayer games support collaboration between learners. Additionally, it appears that multiplayer digital games offer diverse, flexible and immersive experiences to adult learners in a way that single player digital games may not. Finally, multiplayer digital games provide new avenues for support self-directed learning by encouraging cooperation between large groups of students in a manner that is not normally achieved in online learning environment

Simulation in medical education : a case study evaluating the efficacy of high-fidelity patient simulation

Indiana University-Purdue University Indianapolis (IUPUI)High-fidelity patient simulation (HFPS) recreates clinical scenarios by combining mock patients and realistic environments to prepare learners with practical experience to meet the demands of modern clinical practice while ensuring patient safety. This research investigated the efficacy of HFPS in medical education through a case study of the Indiana University Bloomington Interprofessional Simulation Center. The goal of this research was to understand the role of simulated learning for attaining clinical selfefficacy and how HFPS training impacts performance. Three research questions were addressed to investigate HFPS in medical education using a mixed methods study design. Clinical competence and self-efficacy were quantified among medical students at IUSMBloomington utilizing HFPS compared to two IUSM campuses that did not incorporate this instructional intervention. Clinical competence was measured as performance on the Objective Structured Clinical Examination (OSCE), while self-efficacy of medical students was measured through a validated questionnaire. Although the effect of HFPS on quantitative results was not definitive, general trends allude to the ability of HFPS to recalibrate learners’ perceived and actual performance. Additionally, perceptual data regarding HFPS from both medical students and medical residents was analyzed. Qualitative results discovered the utility of HFPS for obtaining the clinical mental framework of a physician, fundamental psychomotor skills, and essential practice communicating and functioning as a healthcare team during interprofessional education simulations. Continued studies of HFPS are necessary to fully elucidate the value of this instructional adjunct, however positive outcomes of simulated learning on both medical students and medical residents were discovered in this study contributing to the existing HFPS literature