A technology-aided multi-modal training approach to assist abdominal palpation training and its assessment in medical education

Kinaesthetic Learning Activities (KLA) are techniques for enhancing the motor learning process to provide a deep understanding of fundamental skills in particular disciplines. With KLA learning takes place by carrying out a physical activity to transform empirical achievements into representative cognitive understanding. In disciplines such as medical education, frequent hands-on practice of certain motor skills plays a key role in the development of medical students' competency. Therefore it is essential that clinicians master these core skills early on in their educational journey as well as retain them for the entirety of their career. Transferring knowledge of performing dexterous motor skills, such as clinical examinations, from experts to novices demands a systematic approach to quantify relevant motor variables with the help of medical experts in order to form a reference best practice model for target skills. Additional information (augmented feedback) on certain aspects of movements could be extracted from this model and visualised via multi-modal sensory channels in order to enhance motor performance and learning processes. This thesis proposes a novel KLA methodology to significantly improve the quality of palpation training in medical students. In particular, it investigates whether it is possible to enhance the existing abdominal palpation skills acquisition process (motor performance and learning) with provision of instructional concurrent and terminal augmented feedback on applied forces by the learner's hand via an autonomous multimodal displays. This is achieved by considering the following: identifying key motor variables with help of medical experts; forming a gold standard model for target skills by collecting pre-defined motor variables with an innovative quantification technique; designing an assessment criteria by analysing the medical experts' data; and systematically evaluating the impact of instructional augmented feedback on medical students' motor performance with two distinct assessment approaches(a machine-based and a human-based). In addition, an evaluation of performance on a simpler task is carried out using a game-based training method, to compare feedback visualisation techniques, such as concurrent visual and auditory feedback as used in a serious games environment, with abstract visualisation of motor variables. A detailed between-participants study is presented to evaluate the effect of concurrent augmented feedback on participants' skills acquisition in the motor learning process. Significant improvement on medical students' motor performance was observed when augmented feedback on applied forces were visually presented (H(2) = 6:033, p < :05). Moreover, a positive correlation was reported between computer-generated scores and human-generated scores, r = :62, p (one-tailed) < :05. This indicates the potential of the computer-based assessment technique to assist the current assessment process in medical education. The same results were also achieved in a blind-folded (no-feedback) transfer test to evaluate performance and short-term retention of skills in the game-based training approach. The accuracy in the exerted target force for participants in the game-playing group, who were trained using the game approach (Mdn = 0:86), differed significantly from the participants in control group, who trained using the abstract visualisation of the exerted force value (Mdn = 1:56), U = 61, z = -2:137, p < :05, r = -0:36. Finally, the usability of both motor learning approaches were surveyed via feedback questionnaires and positive responses were achieved from users. The research presented shows that concurrent augmented feedback significantly improves the participants' motor control abilities. Furthermore, advanced visualisation techniques such as multi-modal displays increases the participants' motivation to engage in learning and to retain motor skills

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This work presents a serious game designed to improve the performance in users’ control abilities applied to pressure sensitivity. In particular, the aim of this work is part of a larger goal of providing medical students with further opportunities of palpation experiences and assistance as part of their education. Typically medical students are limited by the number of volunteers they can practice on and the amount of time they can interact with more experienced practitioners to further develop fundamental palpation skills. Correct palpation skills are crucial as they inform the diagnosis in a large number of healthcare fields and a skill required by most healthcare professionals. The ability to be able to enhance the educational process of healthcare professionals’ palpation skills could lead to a more holistic student experience. This work presents a serious game in which one aspect of palpation, hand control ability through the correct application of pressure to a patient, is the target for user improvement. A serious game modelled on the infinite runner genre was designed to be controlled via an input device developed in-house with off-the-shelf components that translates real-world pressure to in-game movement. The game was tested in a participant trial involving a game-playing group (n = 15) and a control group (n = 15) and a significant improvement in a blind-folded pressure test was observed for the game-playing group. User feedback via a questionnaire also showed a positive response of the game

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A technology-aided multi-modal training approach to assist abdominal palpation training and its assessment in medical education

Computer-assisted multi-modal training is an effective way of learning complex motor skills in various applications. In particular disciplines (eg. healthcare) incompetency in performing dexterous hands-on examinations (clinical palpation) may result in misdiagnosis of symptoms, serious injuries or even death. Furthermore, a high quality clinical examination can help to exclude significant pathology, and reduce time and cost of diagnosis by eliminating the need for unnecessary medical imaging. Medical palpation is used regularly as an effective preliminary diagnosis method all around the world but years of training are required currently to achieve competency. This paper focuses on a multimodal palpation training system to teach and improve clinical examination skills in relation to the abdomen. It is our aim to shorten significantly the palpation training duration by increasing the frequency of rehearsals as well as providing essential augmented feedback on how to perform various abdominal palpation techniques which has been captured and modelled from medical experts. A comparative evaluation on usability and effectiveness of the method is presented in this study. Four professional tutors were invited to take part in the design, development and assessment stages of this study. Widely-used user centred design methods were employed to form a know-how document and an assessment criterion with help of medical professionals. Our interface was used to capture and develop a best practice model for each palpation tasks for further assessment. Twenty three first year medical students divided into a control group (n = 8), a semi-visually trained group (n = 8), and a fully visually trained group (n = 7) were invited to perform three palpation tasks (superficial, deep and liver). The medical students’ performances were assessed using both computer-based and human-based methods where a positive correlation was shown between the generated scores, r = .62, p (one-tailed) < .05. The visually-trained group significantly outperformed the control group in which abstract visualisation of applied forces and their palmar locations were provided to the students during each palpation examination (p < .05). Moreover, a positive trend was observed between groups when visual feedback was presented, J = 132, z = 2.62, r = 0.55