Training Medical Communication Skills with Virtual Patients: Literature Review and Directions for Future Research

Effective communication is a crucial skill for healthcare providers since it leads to better patient health, satisfaction and avoids malpractice claims. In standard medical education, students’ communication skills are trained with role-playing and Standardized Patients (SPs), i.e., actors. However, SPs are difficult to standardize, and are very resource consuming. Virtual Patients (VPs) are interactive computer-based systems that represent a valuable alternative to SPs. VPs are capable of portraying patients in realistic clinical scenarios and engage learners in realistic conversations. Approaching medical communication skill training with VPs has been an active research area in the last ten years. As a result, the number of works in this field has grown significantly. The objective of this work is to survey the recent literature, assessing the state of the art of this technology with a specific focus on the instructional and technical design of VP simulations. After having classified and analysed the VPs selected for our research, we identified several areas that require further investigation, and we drafted practical recommendations for VP developers on design aspects that, based on our findings, are pivotal to create novel and effective VP simulations or improve existing ones

Effects of Social Conditions in a Virtual Exergame for Cognitive Rehabilitation in Multiple Sclerosis

Rehabilitation is essential for individuals with multiple sclerosis (MS) to improve their quality of life and mitigate the progression of the disease. Cognitive deficits, which commonly affect MS patients, significantly impact daily functioning and well-being. This paper focuses on the development of a digital version of the Tangram puzzle using virtual reality (VR) to promote logical reasoning, attention, and social interactions to enhance engagement in cognitive rehabilitation for MS patients. The developed simulation integrates social presence in the form of a non-playable character (NPC) intending to improve player performance and motivation to ultimately promote engagement and adherence to treatment. A user study involving different game modes with the NPC in either a supporting or interfering role, was conducted to evaluate the effectiveness and usability of the Tangram VR exergame. After collecting and analyzing questionnaire scores and performance data, our results suggest that the application was well-received by users, and the introduction of an NPC had an impact in terms of execution times and sense of frustration, depending on its behaviour. Nonetheless, only a limited set of significant differences between modes was found, suggesting that further study is necessary to validate the results fully

IdealCity: a Hybrid Approach to Seismic Evacuation Modeling

In recent years, the analysis of the community response in case of disastrous events has become a research topic of paramount relevance due to the increasing number of calamities like flooding, hurricanes, and earthquakes. In particular, the possibility to use computer simulations to model and study the behaviour of thousands of people during an emergency evacuation can pro-vide valuable information to support many processes involved in emergency management. To this end, this work presents IdealCity, a hybrid model for evacuation simulation that couples the representation of the built environment and the transportation network with an agent-based simulation of the urban population. IdealCity can estimate the buildings’ damages and debris generated by a seismic event along with their effects on the other model layers (the agents and the roads). Besides that, the simulation takes into consideration as well the emergency response system by modelling shelters, hospitals, and ambulances (each of which has a specific behaviour within the environment). The model has been implemented and tested in a challenging test-bed that considers about 900,000 individuals, four different seismic scenarios, and three different times of the day. Results show that IdealCity can be used not only for predicting the population response but also for allowing decision-makers to estimate and intervene on critical response parameters, thus improving the inherent community resilience

Assessing Visual Cues for Improving Awareness in Collaborative Augmented Reality

Augmented Reality (AR) is an emerging technology that offers new and compelling design opportunities for Computer Supported Cooperative Work (CSCW). To foster collaboration and communication in AR-based CSCW, users should be able to understand how others interact with the shared environment. One of the most effective ways to support this awareness is to link user interactions to visual cues (VCs) that provide immediate cognitive feedback about the actions of other users (e.g., pointing, annotating, or manipulating objects). However, AR-based CSCW is in many ways still in its infancy in terms of visual language, and further research is needed, especially to evaluate the effectiveness of different VCs in improving user awareness in collaborative, co-located AR scenarios. To this end, this paper presents an evaluation of different VCs based on previous literature. Experiments were conducted with different scenarios covering the main purposes for which VCs are used and in which users had to perform tasks with increasing complexity. Results show that volunteers positively evaluated the VCs offered, as they effectively supported user awareness and provided contextual and spatial information to all participants

Large scale simulation of pedestrian seismic evacuation including panic behavior

Understanding human behavior and predicting evacuation processes subsequently to an earthquake are critical aspects to provide valuable information to support disaster response activities. One possible and relevant aspect that characterizes human behavior in emergency situations is panic reactions, which can lead to dysfunctional and irrational responses by fugitives. Given the relevance of this component, this paper implements a panic behavior model in a large-scale agent-based model considering phenomenal parameters, such as seismic damage to the built environment, disruption of roads by earthquake-induced falling debris, and injuries of individuals. The proposed model is applied and tested in IdealCity, a virtual city simulation environment which resembles the geometry of the city of Turin, with about 900,000 inhabitants. The numerical simulations show that the inclusion of a panic behavior model increases the evacuation time despite the increased speed of agents during the evacuation process and this is probably caused by the fact that pedestrians tend to perform random actions before reaching their destination. Furthermore, existing human relationships between agents tend to convert the crowd from individual agents to group of agents that move together, and this behavior might affect the shelter saturation time of both shelters and hospitals as shown in the simulations analyzed in this paper

Assessing the Usability of Different Virtual Reality Systems for Firefighter Training

The use of Virtual Reality (VR) based learning environments for training firefighters is becoming more and more common. The key advantages of these approaches is that they allow the development of experiential learning environments, where trainees can be involved into and interact with complex emergency scenarios, including those that cannot rely for the training on real world systems and environments due to costs or security concerns. Despite that, current VR training systems are still affected by a number of weaknesses, mainly related to usability and to the (limited) sense of presence conveyed by the virtual environment (VE), which can negatively affect the expected learning outcomes. To this end, in order to gain further insight into this problem, this work aims at assessing the usability of a firefighter training application deployed in three VR systems and exploiting serious games in the educational approach. The VR systems under analysis provide different levels of immersion and offer different approaches to manage interaction and locomotion inside the VE. Experimental results, obtained through a user study, show differences among the three systems. In particular, the devices and metaphors used to manage locomotion in VR seem to be the most critical parameters with respect to usability and learners' achievements

Leveraging a Collaborative Augmented Reality Serious Game to promote Sustainability Awareness, Commitment and Adaptive Problem-Management

The sustainable development of our global world requires innovative educational approaches to foster people's ability to pursue common goals under ever-changing and uncontrollable environmental conditions. Serious games can meet this need by engaging learners in collective problem-solving activities that mimic real-world sustainability problems and scenarios. This paper presents the design and evaluation of Sustain, a collaborative and co-located multiplayer sustainability serious game. Sustain is an Augmented Reality based urban development game that aims to promote player awareness and commitment to sustainability problems and enhance players' ability to address these problems through collaborative and adaptive problem management approaches. Sustain was developed based on nine key game features that implement principles of serious game design tailored for sustainability. The evaluation of the game leveraged a multimodal approach that included in-game analytics, questionnaires, and observational data from ninety-nine participants and aimed to assess learning outcomes and identify relationships between game features and effects achieved. Results suggest that Sustain was effective in changing players' awareness of and commitment towards sustainability issues. Team adaptive behaviours and increasing collaborative interactions were observed during the game, even during phases that did not require close collaboration, which is altogether suggestive of increased collaborative and adaptive problem-management capabilities. These findings suggest that the development of sustainability serious games based on design principles and features similar to those implemented in Sustain can lead to impacts crucial for sustainability education