Virtual reality and serious gaming in re-engineering clinical teaching: A review of literature of the experiences and perspectives of clinical trainers

Re-engineer clinical teaching through innovative approaches such as virtual reality (VR) and Serious Gaming (SG) may increase patient safety. While several studies have focused on the experiences and perceptions of learners about VR and SG, few have if any have focused on the instructors. We reviewed and appraised published evidence to establish the experiences and intention to adopt VR and SG in clinical teaching. Relevant articles were sourced from five databases (PubMed/Medline, Informit, +A Education, ProQuest-ERIC, and CINHAL-EBSCO host). Experiences of clinical trainers were reported using the technological, pedagogical, and content knowledge (TPACK) model. The intention to adopt VR and SG was synthesized using the Technology Adoption Model (TAM). Clinical trainers had a positive attitude towards VR and SG. Those with longer professional experience were less likely to adopt VR and SG, while more experienced trainers were more likely to benefit from VR and SG. VR and SG are practical pedagogies for clinical instruction, but training is required for novice users. Cost-benefit analysis of VR and SG as clinical training approaches is needed

An eye-tracking based robotic scrub nurse: proof of concept

Background Within surgery, assistive robotic devices (ARD) have reported improved patient outcomes. ARD can offer the surgical team a “third hand” to perform wider tasks and more degrees of motion in comparison with conventional laparoscopy. We test an eye-tracking based robotic scrub nurse (RSN) in a simulated operating room based on a novel real-time framework for theatre-wide 3D gaze localization in a mobile fashion. Methods Surgeons performed segmental resection of pig colon and handsewn end-to-end anastomosis while wearing eye-tracking glasses (ETG) assisted by distributed RGB-D motion sensors. To select instruments, surgeons (ST) fixed their gaze on a screen, initiating the RSN to pick up and transfer the item. Comparison was made between the task with the assistance of a human scrub nurse (HSNt) versus the task with the assistance of robotic and human scrub nurse (R&HSNt). Task load (NASA-TLX), technology acceptance (Van der Laan’s), metric data on performance and team communication were measured. Results Overall, 10 ST participated. NASA-TLX feedback for ST on HSNt vs R&HSNt usage revealed no significant difference in mental, physical or temporal demands and no change in task performance. ST reported significantly higher frustration score with R&HSNt. Van der Laan’s scores showed positive usefulness and satisfaction scores in using the RSN. No significant difference in operating time was observed. Conclusions We report initial findings of our eye-tracking based RSN. This enables mobile, unrestricted hands-free human–robot interaction intra-operatively. Importantly, this platform is deemed non-inferior to HSNt and accepted by ST and HSN test users

Sensory substitution for force feedback recovery: A perception experimental study

Robotic-assisted surgeries are commonly used today as a more efficient alternative to traditional surgical options. Both surgeons and patients benefit from those systems, as they offer many advantages, including less trauma and blood loss, fewer complications, and better ergonomics. However, a remaining limitation of currently available surgical systems is the lack of force feedback due to the teleoperation setting, which prevents direct interaction with the patient. Once the force information is obtained by either a sensing device or indirectly through vision-based force estimation, a concern arises on how to transmit this information to the surgeon. An attractive alternative is sensory substitution, which allows transcoding information from one sensory modality to present it in a different sensory modality. In the current work, we used visual feedback to convey interaction forces to the surgeon. Our overarching goal was to address the following question: How should interaction forces be displayed to support efficient comprehension by the surgeon without interfering with the surgeon’s perception and workflow during surgery? Until now, the use the visual modality for force feedback has not been carefully evaluated. For this reason, we conducted an experimental study with two aims: (1) to demonstrate the potential benefits of using this modality and (2) to understand the surgeons’ perceptual preferences. The results derived from our study of 28 surgeons revealed a strong positive acceptance of the users (96%) using this modality. Moreover, we found that for surgeons to easily interpret the information, their mental model must be considered, meaning that the design of the visualizations should fit the perceptual and cognitive abilities of the end user. To our knowledge, this is the first time that these principles have been analyzed for exploring sensory substitution in medical robotics. Finally, we provide user-centered recommendations for the design of visual displays for robotic surgical systems.Peer ReviewedPostprint (author's final draft

Patient Willingness to Undergo Robotic Surgery: Identification and Validation of a Predictive Model

INTRODUCTION: The purpose of the current dissertation is to better understand the factors which make an individual willing (or unwilling) to undergo robotic surgery. Though surgical feasibility and provider perceptions are often studied, little research has investigated how patients perceive robotic surgical systems. METHOD: A two-stage approach was taken in order to build and validate a regression equation in order to predict an individual’s willingness to undergo robotic surgery based on several factors. Stage 1 employed a sample size of 1324 participants in order to build the model. Participants responded to a survey indicating their willingness to undergo robotic surgery, and answered questions related to their perceptions of the system, demographic information, and emotional responses. Stage 2 employed a sample size of 1335 participants, who responded to the exact same survey as Stage 2. The regression equation developed via Stage 1 was then tested using the participants from Stage 2 in order to validate the equation. RESULTS: In Stage 1, a backward stepwise regression was conducted on the twenty-one predictive factors of interest (age, gender, income, education level, ethnicity, perceived complexity, perceived value, familiarity, wariness of new technologies, fear of surgery, personality factors (openness, conscientiousness, extraversion, agreeableness, neuroticism), and affect (in the form of the six universal emotions). Of these twenty-one factors, eight were indicated to be significant predictors: perceived value, familiarity, wariness of new technologies, fear of surgery, openness, anger, fear, and happiness. These factors accounted for 62.7% of the variance in the model (62.4% adjusted). In Stage 2, several methods were used to validate the regression model, including: correlational analyses, a t-test, and calculation of the cross-validity coefficient. Correlational analyses indicated that the predicted scores of willingness in Stage 2 generated using the regression analyses were significantly correlated with the actual scores of willingness reported by participants. In addition, results of the t-test indicated that the predicted scores and actual scores were not significantly different. Further, the cross-validity coefficient was similar to the initial R2, indicating good fit of the model. CONCLUSION: Results of the study indicate that perceived value, familiarity, wariness of new technologies, fear of surgery, openness, anger, fear, and happiness are all significant predictors of willingness to undergo robotic surgery. These results not only benefit the literature on technology acceptance and robotic surgery, but also have practical applications for the way these systems are designed and marketed, and the way that patients are educated

Intelligent computing applications to assist perceptual training in medical imaging

The research presented in this thesis represents a body of work which addresses issues in medical imaging, primarily as it applies to breast cancer screening and laparoscopic surgery. The concern here is how computer based methods can aid medical practitioners in these tasks. Thus, research is presented which develops both new techniques of analysing radiologists performance data and also new approaches of examining surgeons visual behaviour when they are undertaking laparoscopic training. Initially a new chest X-Ray self-assessment application is described which has been developed to assess and improve radiologists performance in detecting lung cancer. Then, in breast cancer screening, a method of identifying potential poor performance outliers at an early stage in a national self-assessment scheme is demonstrated. Additionally, a method is presented to optimize whether a radiologist, in using this scheme, has correctly localised and identified an abnormality or made an error. One issue in appropriately measuring radiological performance in breast screening is that both the size of clinical monitors used and the difficulty in linking the medical image to the observer s line of sight hinders suitable eye tracking. Consequently, a new method is presented which links these two items. Laparoscopic surgeons have similar issues to radiologists in interpreting a medical display but with the added complications of hand-eye co-ordination. Work is presented which examines whether visual search feedback of surgeons operations can be useful training aids

A gaze-contingent framework for perceptually-enabled applications in healthcare

Patient safety and quality of care remain the focus of the smart operating room of the future. Some of the most influential factors with a detrimental effect are related to suboptimal communication among the staff, poor flow of information, staff workload and fatigue, ergonomics and sterility in the operating room. While technological developments constantly transform the operating room layout and the interaction between surgical staff and machinery, a vast array of opportunities arise for the design of systems and approaches, that can enhance patient safety and improve workflow and efficiency. The aim of this research is to develop a real-time gaze-contingent framework towards a "smart" operating suite, that will enhance operator's ergonomics by allowing perceptually-enabled, touchless and natural interaction with the environment. The main feature of the proposed framework is the ability to acquire and utilise the plethora of information provided by the human visual system to allow touchless interaction with medical devices in the operating room. In this thesis, a gaze-guided robotic scrub nurse, a gaze-controlled robotised flexible endoscope and a gaze-guided assistive robotic system are proposed. Firstly, the gaze-guided robotic scrub nurse is presented; surgical teams performed a simulated surgical task with the assistance of a robot scrub nurse, which complements the human scrub nurse in delivery of surgical instruments, following gaze selection by the surgeon. Then, the gaze-controlled robotised flexible endoscope is introduced; experienced endoscopists and novice users performed a simulated examination of the upper gastrointestinal tract using predominately their natural gaze. Finally, a gaze-guided assistive robotic system is presented, which aims to facilitate activities of daily living. The results of this work provide valuable insights into the feasibility of integrating the developed gaze-contingent framework into clinical practice without significant workflow disruptions.Open Acces

The adoption of virtual reality for medical training in the context of South African higher education.

Masters Degree. University of KwaZulu-Natal, Pietermaritzburg.Virtual reality (VR) is progressively being acknowledged as a useful tool for medical training. The adoption of VR for medical training in developing countries is at a slow pace compared to developed countries. The paucity of innovative systems such as VR training systems and the lack of exposure to these systems in developing countries tend to widen the gap in competency between medical professionals from developed and developing countries. VR in South Africa is a new concept and, therefore, limited literature exists from a South African educational perspective. This study aimed to fill the gap in literature from a South African perspective by investigating the determinants of the adoption of VR for medical training at the University of KwaZulu-Natal. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used as the guiding framework to investigate the perceived usefulness of using VR, the perceived effort required to use it, and the social factors and facilitating conditions that can influence its adoption for medical training. The study further aimed to determine the challenges associated with the adoption of VR for medical training within the South African higher education context. Findings from interviews with 12 purposively sampled lecturers revealed that most respondents perceived that VR would be easy to use for medical training should the necessary training and support be provided. Some respondents had not previously experienced VR immersive environments and hence felt that using VR for medical training would be difficult. The researcher deduced from the responses that the respondents would be influenced to adopt VR for medical training by other medical professionals who were currently using VR and that the degree of influence would be an important factor in adoption. Although the respondents perceived VR to be useful, they voiced that the adoption of VR for medical training at South African educational institutions could be hampered by challenges associated with the lack of infrastructure, knowledge of VR, finance, resistance to change, user’s inability to differentiate simulated environments from the real-world and poor design of the VR system (interface). The respondents suggested a gradual approach to VR adoption, forming partnerships with VR companies and seeking sponsorships or donations from alumni to address the finance-related impediments. Furthermore, to ensure the successful adoption of VR for medical training by South African educational institutions, they mentioned the need for: government to address financial constraints by increasing the budget allocated to South African healthcare; an effective change management process to address resistance to change; a cost-benefit analysis; and, finally, training to surmount the challenges.List of Tables on page ix