Advances in Teaching & Learning Day Abstracts 2005

Proceedings of the Advances in Teaching & Learning Day Regional Conference held at The University of Texas Health Science Center at Houston in 2005

Pblcloud Virtual Patient Simulator: Enhancing Immersion Through Natural Language Processing

PBLCLOUD VIRTUAL PATIENT SIMULATOR: ENHANCING IMMERSION THROUGH NATURAL LANGUAGE PROCESSING Pierre Martin M.Ed.(1), Lisa DelSignore M.D.(2), and Traci A. Wolbrink M.D. M.P.H.(2) (1)Yale School of Medicine (2)From the Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Management, Boston Children’s Hospital and the Department of Anesthesia, Harvard Medical School, Boston, MA, USA. (Sponsored by JH, Department of Pediatrics, Yale School of Medicine) Virtual patient simulation has been utilized to teach interviewing skills, often employing selection-based methods (e.g., multiple-choice lists and menu-based prompts) to simulate doctor-patient conversations. Users have evaluated these systems as inauthentic, which can diminish user immersion (influenced by control, realism, distraction and sensory factors) and, in turn, negatively affect skill acquisition, mastery and transfer. Our objectives were to design and develop PBLCloud, a scenario-based and highly interactive platform that uses natural language processing to support a more realistic doctor-patient conversation and create an immersive clinical learning environment. PBLCloud was developed utilizing an iterative design thinking process and its initial evaluation involved a mixed methods approach. We recruited a convenience sample of 11 participants: three (27%) fourth-year medical students from Harvard Medical School as well as two (18%) residents, four (36%) fellows and two (18%) attendings from Boston Children’s Hospital. There were two rounds of formative evaluation testing with eight participants in Round 1 and three participants in Round 2. Each participant completed a semi-structured think–aloud protocol exploring our pilot case, 10-item system usability scale (SUS) and 10-item open-ended questionnaire. The chat-based functionality provides users with computer-generated context-specific responses during the historical encounter. Users have the opportunity to perform physical examinations, review incorporated multimedia, order and interpret diagnostic investigations, order therapeutic interventions that have appropriate effects on patient vitals and laboratory data, formulate and refine a differential diagnosis, receive just-in-time feedback regarding user-initiated actions and complete embedding learning exercises. 73% of participants strongly agreed that PBLCloud was useful (i.e., it is clinically-oriented, realistic, provides helpful feedback and is widely applicable) and 64% of participants strongly agreed that their experience with the system was enjoyable (i.e., it is relevant with an engaging interface). It was deemed to be more interactive and engaging than other simulators and 82% of participants were very interested in utilizing the system in the future. The average SUS score for Round 1 and 2 were 79.7 ± 12.0 and 82.5 ± 19.8 respectively. Areas of improvement were identified, in particular, the unsatisfactory response accuracy of the chat-based functionality. Future work will include the investigation of various strategies to optimize the platform’s natural language processing algorithm as well as the formal evaluation of the system’s validity, reliability, level of induced user immersion and educational impact. We anticipate that PBLCloud will serve as a cost-effective and scalable approach for the instruction and assessment of clinical reasoning

AN INVESTIGATION OF MEDICAL DEVICE DESIGN AND PHYSICAL ERGONOMICS IN HEALTHCARE

Human factors and process engineering are becoming a prominent area of research and application for industrial engineering principles as healthcare providers seek to improve patient safety, quality the optimization of resources. Human factors engineering and ergonomics play a crucial role in the pursuit of operational excellence and patient safety in healthcare. These disciplines contain the tools required to develop instrumentation, technology and training that can improve the usability of medical technology and the quality of care that patients receive. Designing tasks, tools and processes for optimal human use can enhance performance, reduce errors and improve safety. This thesis encompasses three journal articles. The first paper addresses how physical ergonomics can be used to evaluate and improve skill acquisition in endotracheal intubation. Significant differences in muscle utilization and wrist postures were observed between experience levels and genders of clinicians. Differences in muscle utilization and wrist postures were found to be significantly related to instrument grasp characteristics, identifying potential ergonomic best practices. The second paper investigates the mechanical design of laparoendoscopic single-site (LESS) surgical ports from a human factors perspective. This study characterized the differences in resistance and range of motion afforded by each LESS port during simulated single-incision use. The resistance of each port varied significantly with respect to instrument positions. The final paper explored each LESS surgical port against standard laparoscopy by using a validated laparoscopic training task to assess the usability and performance of each device. Instrument mobility was restricted by the LESS ports, but it did not affect task performance significantly. While each device exhibited positive and negative human factors attributes for clinicians and patients, it was concluded that procedural factors rather than device familiarity should influence LESS port selection. Advisor: M. Susan Hallbec

Use of Fiberoptic Intubation Simulation to Enhance Skill and Confidence Among Anesthesia Providers

Background The purpose of this study was to describe the usefulness of a video-recorded low-fidelity Fiber Optic (FO) intubation simulation and its effect on anesthesia providers’ confidence and skill in performing FO intubation. Method The study was conducted during the 2019 IANA Airway Workshop using a post-test only study design. All participants who volunteered to participate in the simulation were asked to watch a video-recorded instruction on FO intubation. Immediately after viewing the video, the participants completed a hands-on simulation while the researchers recorded their FO intubation times. Participants were allowed up to three recorded attempts. Results Fifty-eight participants completed the hands-on simulation and the post-simulation questionnaires. Results showed an improvement in skill as evidenced by faster mean FO intubation times for each of the three attempts (27.34 sec, 24.99 sec, and 16.13 sec). The FO simulation was found to be effective as demonstrated by participants rating the simulation as both useful (M = 3.73; SD = -0.77; Range = 1 to 4) and instilling a sense of confidence (M = 3.58; SD = 0.81; Range = 1 to 4). Conclusion The simulation enhanced anesthesia providers’ skill and confidence in FO intubation and was found useful by the participants

Validity and usability of a virtual reality intraocular surgical simulator

Cataract surgery is one of the most common surgical procedures in Sweden and around 90 000 operations are made each year. An aging population with increased demands on quality of life and good visual acuity, has led to an increased rate of surgery and more surgeons needs to be trained. Training of new cataract surgeons is done on scarce wet-lab training but mainly on patients. Training is costly and complications are higher for new surgeons compared to experienced ones. In the airline industry simulators are used for training. Pilots have to prove competent before flying a new airplane. No such standards exist for new cataract surgeons. Surgical simulators have been used in other surgical fields for training and reports have shown that training has improved performance on real operations. The purpose of this work was to validate Eyesi, a surgical simulator for cataract surgery training, and analyze learning curves. Furthermore we set out to investigate whether factors like stereoacuity and sex would be important for performance in the simulator. Evidence for construct validity was found for cataract specific modules capsulorhexis, hydromaneuvers and phaco divide and conquer and for manipulating modules cataract navigation training, cataract forceps training and cataract cracking and chopping training. Analysis of learning curves showed significant improvement throughout training. Evidence for concurrent validity was established for the capsulorhexis module. For the hydromaneuvers and phaco modules, the innate simulator scoring could not distinguish surgical skill but discrimination was dependent on video based human scoring. Stereoacuity was found to correlate with performance on the simulator but there were large individual variations. An individual’s sex had no influence on performance. We have shown that Eyesi can differentiate cataract surgical skill and that naïve can train in the simulator and improve. Stereoacuity has an effect on performance but there were large individual variations. Simulation-based training has the potential to move the early learning curve out of the operating room

Game-Based Learning, Gamification in Education and Serious Games

The aim of this book is to present and discuss new advances in serious games to show how they could enhance the effectiveness and outreach of education, advertising, social awareness, health, policies, etc. We present their use in structured learning activities, not only with a focus on game-based learning, but also on the use of game elements and game design techniques to gamify the learning process. The published contributions really demonstrate the wide scope of application of game-based approaches in terms of purpose, target groups, technologies and domains and one aspect they have in common is that they provide evidence of how effective serious games, game-based learning and gamification can be

Haptic-Enhanced Learning in Preclinical Operative Dentistry

Background: Virtual reality haptic simulators represent a new paradigm in dental education that may potentially impact the rate and efficiency of basic skill acquisition, as well as pedagogically influence the various aspects of students’ preclinical experience. However, the evidence to support their efficiency and inform their implementation is still limited. Objectives: This thesis set out to empirically examine how haptic VR simulator (Simodont®) can enhance the preclinical dental education experience particularly in the context of operative dentistry. We specify 4 distinct research themes to explore, namely: simulator validity (face, content and predictive), human factors in 3D stereoscopic display, motor skill acquisition, and curriculum integration. Methods: Chapter 3 explores the face and content validity of Simodont® haptic dental simulator among a group of postgraduate dental students. Chapter 4 examines the predictive utility of Simodont® in predicting subsequent preclinical and clinical performance. The results indicate the potential utility of the simulator in predicting future clinical dental performance among undergraduate students. Chapter 5 investigates the role of stereopsis in dentistry from two different perspectives via two studies. Chapter 6 explores the effect of qualitatively different types of pedagogical feedback on the training, transfer and retention of basic manual dexterity dental skills. The results indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visualdisplay VR-driven feedback. A pedagogical model for integration of haptic dental simulator into the dental curriculum has been proposed in Chapter 7. Conclusion: The findings from this thesis provide new insights into the utility of the haptic virtual reality simulator in undergraduate preclinical dental education. Haptic simulators have promising potential as a pedagogical tool in undergraduate dentistry that complements the existing simulation methods. Integration of haptic VR simulators into the dental curriculum has to be informed by sound pedagogical principles and mapped into specific learning objectives

Implementation of Virtual Reality (VR) simulators in Norwegian maritime pilotage training

With millions of tons of cargo transported to and from Norwegian ports every year, the maritime waterways in Norway are heavily used. The high consequences of accidents and mishaps require well-trained seafarers and safe operating practices. The normal crews of vessels are supported by the Norwegian Coastal Administration (NCA) pilot service when operating vessels not meeting specific regulations. Simulator training is used as part of the toolset designed to educate, train, and advance the knowledge of maritime pilots in order to improve their operability. The NCA is working on an internal project to distribute Virtual Reality (VR) simulators to selected pilot stations along the coast and train and familiarize maritime pilots with the tool. There has been a lack of research on virtual reality simulators and how they are implemented in maritime organizations. The goal of this research is to see if a VR-simulator can be used as a training tool within the Norwegian Coastal Administration's pilot service. Furthermore, the findings of this study contribute to the understanding of VR-simulators in the field of Maritime Education and Training (MET). The thesis is addressing two research questions: 1. Is the Virtual Reality training useful in the competence development process of Norwegian maritime pilots? 2. How can the Virtual Reality simulators improve training outcomes of today’s maritime pilot education? The data gathered from the systematic literature review corresponds to the findings of the interviews. Considering the similarities with previous study findings from sectors such as healthcare, construction, and education, it is concluded that the results of the interviews can be generalized. For maritime pilots, the simulator offers recurrent scenario-based training and a high level of immersion. Pilots can learn at home, onboard a vessel, at the pilot station, and in group settings thanks to the system's mobility and user-friendliness. In terms of motivation and training effectiveness, the study finds that VR-simulators are effective and beneficial. The technology received positive reviews from the pilots. The simulator can be used to teach both novice and experienced maritime pilots about new operations, larger tonnage, and new operational areas, according to the findings of the research. After the NCA has utilized VR-simulators for some time, additional research may analyze the success of VR-simulators using a training evaluation study and investigate the impact of VR-training in the organization