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

Editorial: Challenges for the usability of AR and VR for clinical neurosurgical procedures

There are a number of challenges that must be faced when trying to develop AR and VR-based Neurosurgical simulators, Surgical Navigation Platforms, and “Smart OR” systems. Trying to simulate an operating room environment and surgical tasks in Augmented and Virtual Reality is a challenge many are attempting to solve, in order to train surgeons or help them operate. What are some of the needs of the surgeon, and what are the challenges encountered (human computer interface, perception, workflow, etc). We discuss these tradeoffs and conclude with critical remarks

A Virtual University Infrastructure For Orthopaedic Surgical Training With Integrated Simulation

This thesis pivots around the fulcrum of surgical, educational and technological factors. Whilst there is no single conclusion drawn, it is a multidisciplinary thesis exploring the juxtaposition of different academic domains that have a significant influence upon each other. The relationship centres on the engineering and computer science factors in learning technologies for surgery. Following a brief introduction to previous efforts developing surgical simulation, this thesis considers education and learning in orthopaedics, the design and building of a simulator for shoulder surgery. The thesis considers the assessment of such tools and embedding into a virtual learning environment. It explains how the performed experiments clarified issues and their actual significance. This leads to discussion of the work and conclusions are drawn regarding the progress of integration of distributed simulation within the healthcare environment, suggesting how future work can proceed

Healthcare Robotics

Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key stakeholders, care settings, and tasks; reviewing recent advances in healthcare robotics; and outlining major challenges and opportunities to their adoption.Comment: 8 pages, Communications of the ACM, 201

Improving Health Care Quality and Safety: The Development and Assessment of Laparoscopic Surgery Instrumentation, Practices and Procedures

Adverse events due to medical errors are a leading cause of death in the United States exceeding the mortality rates of motor vehicle accidents, breast cancer and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors since they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. In order to mitigate errors and protect patients, a multidisciplinary approach was taken to improve minimally invasive surgery. Clinical, human factors, and biomedical engineering principles and methodologies were used to develop and assess laparoscopic surgery instrumentation, practices and procedures. First, the foundational understanding and the imperative to transform health care into a high quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. The remainder of this dissertation presents the experimental results of four studies used to develop and assess laparoscopic surgery instrumentation, practices and procedures. In the first experiment, a novel hand-controlled electrosurgical laparoscopic grasper was developed and evaluated to eliminate the use of foot pedals, reduce surgery-related discomfort, and minimize the risk of actuation errors. The final three studies compared the emerging technique of single-incision surgery to conventional laparoscopic surgery to determine whether there were any technical, physical or subjective performance differences across the two surgical techniques. In all, these studies contribute towards the improvement of the quality and safety of minimally invasive surgery. Advisor: M. Susan Hallbec

Improving Health Care Quality and Safety: The Development and Assessment of Laparoscopic Surgery Instrumentation, Practices and Procedures

Adverse events due to medical errors are a leading cause of death in the United States exceeding the mortality rates of motor vehicle accidents, breast cancer and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors since they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. In order to mitigate errors and protect patients, a multidisciplinary approach was taken to improve minimally invasive surgery. Clinical, human factors, and biomedical engineering principles and methodologies were used to develop and assess laparoscopic surgery instrumentation, practices and procedures. First, the foundational understanding and the imperative to transform health care into a high quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. The remainder of this dissertation presents the experimental results of four studies used to develop and assess laparoscopic surgery instrumentation, practices and procedures. In the first experiment, a novel hand-controlled electrosurgical laparoscopic grasper was developed and evaluated to eliminate the use of foot pedals, reduce surgery-related discomfort, and minimize the risk of actuation errors. The final three studies compared the emerging technique of single-incision surgery to conventional laparoscopic surgery to determine whether there were any technical, physical or subjective performance differences across the two surgical techniques. In all, these studies contribute towards the improvement of the quality and safety of minimally invasive surgery. Advisor: M. Susan Hallbec

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

Computer-simulated environment for training : challenge of efficacy evaluation

Computer-assisted instruction has been around for decades. There has been much speculation about the benefits of computer-mediated learning. Numerous applications have been developed in different domains incorporated with emerging technologies. In recently years, advanced technologies, such as Augmented Reality (AR) and Virtual Reality (VR), have received much attention in their potential of creating interactive learning experience for the users. However, related literature and empirical studies indicated that learning effects in computer-simulated environments or Virtual Environments (VEs) are not systematically tested. Furthermore, the performance and learning in computer-simulated learning environment need to be evaluated through more rigorous methods. This paper suggests that 1) the efficacy of VEs is subject to a close examination, not only in terms of how VE-based training systems are easy of use, but also in terms of how effective learning is; 2) evaluation of learning in computer simulated learning environments is required to be reconsidered in terms of theoretical basis and evaluation methodologies that are relevant to the measurement of training effectiveness in computer-simulated virtual learning environment. This paper explains on how learning can be assessed in VEs through the lens of training evaluation.<br /

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

Empirical evidence, evaluation criteria and challenges for the effectiveness of virtual and mixed reality tools for training operators of car service maintenance

The debate on effectiveness of virtual and mixed reality (VR/MR) tools for training professionals and operators is long-running with prominent contributions arguing that there are several shortfalls of experimental approaches and assessment criteria reported within the literature. In the automotive context, although car-makers were pioneers in the use of VR/MR tools for supporting designers, researchers started only recently to explore the effectiveness of VR/MR systems as mean for driving external operators of service centres to acquire the procedural skills necessary for car maintenance processes. In fact, from 463 journal articles on VR/MR tools for training published in the last thirty years, we identified only eight articles in which researchers experimentally tested the effectiveness of VR/MR tools for training service operators’ skills. To survey the current findings and the deficiencies of these eight studies, we use two main drivers: i) a well-known framework of organizational training programmes, and ii) a list of eleven evaluation criteria widely applied by researchers of different fields for assessing the effectiveness of training carried out with VR/MR systems. The analysis that we present allows us to: i) identify a trend among automotive researchers of focusing their analysis only on car service operators’ performance in terms of time and errors, by leaving unexplored important pre- and post-training aspects that could affect the effectiveness of VR/MR tools to deliver training contents – e.g., people skills, previous experience, cibersickness, presence and engagement, usability and satisfaction and ii) outline the future challenges for designing and assessing VR/MR tools for training car service operators