Search

Virtual Medical Worlds for Team Training (updated)

Loading...

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

0 comments

Post a comment

    Post a comment
    Embed Video
    Edit your comment Cancel

    Notes on slide 1

    Multi-player virtual worlds are well-suited to training teams to work together.

    There are many types of virtual worlds but they all share most of the above characteristics.

    Each character in these 3D worlds is controlled by a real person.

    The following movies show avatars conversing in authentic social or professional scenarios.

    While we were at at Stanford University, SUMMIT, we initiated our partnership with Forterra Systems to create a 3D medical space using their multiplayer virtual world engine, OLIVE, to create a Virtual Emergency Department. The simulation was used to train for mass casualty emergencies including chemical exposures that required decontamination using the ‘decon’ tent seen here outside the VED.

    From top left, going clockwise: A view of Peninsula City, a virtual world. The “high school” is seen in the foreground. EMTs at the scene of a bomb explosion. The Incident Commander is directing the others to their tasks. Triage on a person injured by the bomb blast. Checking ABS (Airway, Breathing, Circulation) prior to administering CPR. Ambulance arrives at the Emergency Department entrance of the “Hospital” in Peninsula City. In a mass casualty scenario, numerous ambulances arrive, creating a scene of urgency and chaos that requires skilful management of medical resources and teams. It should be noted that each of the people seen in this picture is an ‘avatar’, managed by a different real person, who may be physically located anywhere in the world.

    A view of the inside of the Emergency Department. The 3D space is developed from photos of a real Emergency Department.

    As shown in the following movie, residents practice triage of victims arriving from a mass casualty incident. The pace of the scenario engages the learners and they fully immersed in managing this unfamiliar but important situation.

    Information exchange at shift change is is difficult, and loss of information is an important cause of morbidity and mortality. Training for structured information exchange, and practice of a range of scenarios, is one way to improve quality and reduce error.

    A different 3D world to teach high school students the decision making surrounding the use of CPR (cardio-pulmonary resuscitation). A Virtual World developed as a collaboration of the Karolinska Institutet, Stockholm, Forterra Systems Inc, and Stanford University See video at http://forterrainc.com/index.php/resources/screens-a-video/99-high-school-cpr-wm

    See the following movie.

    The user interface supports examination of the patient, application of physical treatments such as cleaning a wound and applying compression bandages, administration of medications, and supplying blood or a saline drip. The monitor gives the minute-by-minute health status of the patient.

    Each virtual patient has physiology model that represents his or her injury or The model is dynamic, changing over time, and responding to the care giver’s interventions. The diagram shows the model variables and the available interventions.

    A web demo supports examination and study of the physiology model outside its presentation in the virtual patient.

    Before we embarked on extensive development of virtual worlds, we studied the efficacy of one of our early virtual worlds in 2004. This one was built on Adobe Systems’ Atmosphere engine, which is no longer available. We used that world to compare the learning in the virtual world with that using the current gold standard, the physical manikin.

    The full study consisted of a training session, where the interface and goals were taught. Then the team went through 6 scenarios. The first and last were test scenarios. There was no debrief after these test scenarios. The middle four scenarios were learning scenarios, with debrief sessions. The performance was scored in all six scenarios.

    Meanwhile, a ‘control’ team underwent the same scenarios but using a physical manikin instead of a virtual world. In this situation, the physical manikin is in a physical simulated operating room. The team works around the real bed. The manikin is realistic in that it has a pulse, breathes, and can have its vital signs measured. Air, blood, fluids and medication can be administered. The experience is close to that of working with a real patient.

    In this early version of the virtual world, the patient’s vital signs were shown in a text box in the upper left (not on a simulated monitor). Treatment was via menu selections.

    Ten trauma situations were developed and administered in the study.

    The team around the bed included Learners and Role Players. The role players played supporting roles in the team, while the learners took the role of the lead physician and the supporting physician. A Facilitator observed the performance of the team members in the virtual world and could, if necessary issue comments, suggestions or instructions. All team members wore headsets with microphones, allowing them to sit in different rooms but to be virtually in a common space, around the patient’s bed.

    All team members knew the learning objectives of the exercise, the ability to follow the principles of appropriate resource management while providing correct medical management of the patient’s condition.

    Each learning session consisted of one of the trauma scenarios, followed by a debrief session with the facilitator. During the debrief, the facilitator led a non-judgmental discussion about the actions taken during the scenario, with the learners discussing their thoughts, concerns and opinions. Typically, most of the learning takes place during this discussion rather than during the scenario itself.

    The two groups were termed the HPS group (Human Patient Simulator, or the physical manikin) and the VED group (the Virtual Emergency Department). The pre-test and post-test performance was measured for both the groups. The results are graphed above. Two conclusions can be drawn. First, in both the HPS and VED groups, learning occurs, as shown by the improved performance during the post-test compared to the pre-test. Second, both HPS and VED groups show similar improvement from pre- to post-test, indicating that the virtual environment has resulted in learning comparable to that with the gold standard, the physical manikin. This key result encouraged us to continue our development of virtual learning environments, and we will continue to test the efficacy of these new learning environments.

    In additional studies with residents, nurses and emergency department physicians, we studied their perception of their CBRNE management capabilities before and after training with the virtual world.

    From these studies, we derive a range of conclusions and possible future directions.

    1 Favorite

    Virtual Medical Worlds for Team Training (updated) - Presentation Transcript

    1. Virtual Reality for Team Training Parvati Dev, PhD, President Wm LeRoy Heinrichs, MD PhD, Exec Medical Officer Innovation in Learning Inc. http://www.InnovationinLearning.com/ Virtual world images and movies from our technology partner, Forterra Systems, unless noted otherwise.
    2. What is a Virtual World?
      • It is an online environment, usually 3D
      • A ‘player’ is represented by an ‘avatar’ in the world
        • You see other people as their avatars. Use voice or text chat
      • It is immersive
        • You have a sense of ‘presence’ or ‘being there’
      • It is social.
        • You talk with others and interact with them.
      • It is populated with interactive objects
        • Objects include drugs, devices, computers, furniture.
      • It may include simulations
        • Such as virtual patients, with dynamic models of physiology
      • It may be game-like, have goal-oriented activities
      • Building and customization is a popular activity
    3. ‘Avatars’ in a 3D world Second Life Qwaq
    4. Avatars controlled by learners or role players
      • Navigation in world is through the keypad or mouse
      • Headset supports in-world conversation
    5. Avatar interaction A soldier returns home virtually to meet his family Physician/nurse consoling an injured child A movie icon indicates that the movie will be played on the next slide
    6. Virtual Hospital (Begun at Stanford University SUMMIT, and continued as a collaboration between Innovation in Learning and Forterra Systems)
    7. Urban and Emergency Scenes
    8. In-hospital multi-bay Emergency Department room Photo-inspired Virtual 3D Environment – – – Photos taken in Adult ED at Stanford University Medical Center July 2006
    9. Residents practicing triage
    10. Nurse shift change
    11. High school students practicing CPR scenarios A collaboration of the Karolinska Institutet, Stockholm, Forterra Systems Inc, and Stanford University
    12. The Virtual Medical Environment and its user interface
    13. Avatar Health Visualization Graphical User Interface Diagnostic Display Images and Text 3D Patient Avatar
    14. Virtual Trauma Patient – under the hood
    15. A Dynamic Model of Patient Physiology
    16. Virtual Patients currently available from IIL
      • Trauma, hemorrhage and hypovolemic shock
        • Dynamic model of physiology
          • Implemented as licensable software module and as a web demo
          • Generates almost an infinite variety of patients
        • 12 specific scenarios developed by us using this physiology
          • Implemented by Forterra Systems in a Virtual Hospital
      • Aphyxiation, nerve toxins, anaphylactic shock
        • Dynamic model of physiology
          • Available as a written set of rules
        • 10 specific scenarios developed by us using this physiology
          • Implemented by Forterra Systems in a Virtual Hospital
      • Infection, sepsis
        • Dynamic model of physiology
          • Available as a written set of rules
    17. Controlled Trial Study of Learning Efficacy
    18. Study design and subjects
      • Explain interface and goals
      • Pre-test with trauma scenario (no debrief)
        • Score with EMCRM rating sheet
      • Four learning scenarios (trauma), with debrief
      • Post-test with trauma scenario
        • Score with EMCRM rating sheet
      • 4th year medical students or 1st year residents
      • Control group learnt with HPS manikin
        • N=15
      • Intervention group used Virtual ED
        • N = 16
    19. Managing trauma with HPS manikin
    20. Managing Trauma in the Virtual Emergency Room
    21. Clinical Scenarios for Virtual ED
      • Male: pneumothorax and femur fracture after auto collision
      • Male; bicycle rider falls from bike path, suffers spleen rupture
      • Male; car driver, hypoglycemia and femur fracture
      • Male; ethanol induced fall, with head injury, obstructed airway
      • Female;(2 nd trimester pregnancy); with renal laceration after auto collision
      • Male; construction worker fall, liver rupture, fracture of femur
      • Male: construction worker, flail chest and dislocated shoulder
      • Male: bicycle rider with severe hand and abdominal injury after auto collision and being ‘run-over’
      • Female; elderly pedestrian with facial fractures and unconsciousness after auto collision.
      • Female (3 rd trimester pregnancy); auto collision with femoral neck fracture, and vaginal bleeding (placental abruption)
    22. Roles Role player Learner Facilitator
    23. Performance measurement using principles of EMCRM (Emergency Medicine Crew Resource Management)
      • Know your environment
      • Anticipate and plan for crises
      • Assume a leadership role
      • Communicate effectively with other team members
      • Call for help early enough
      • Distribute workload optimally
      • Allocate attention wisely
      • Utilize all available resources
      • Utilize all available information
      • Maintain a professional behavior
    24. A debrief session
    25. EMCRM Performance scores N=15 N=16 0.00 10.00 20.00 30.00 40.00 50.00 HPS Group Pretest Sum Scores Posttest Sum Scores Pretest Sum Scores Posttest Sum Scores Virtual ED Group
    26. Results of our other studies using Virtual Worlds (Stanford Hospital and San Mateo General Hospital)
    27. Lessons from our studies
      • Multiplayer virtual worlds are effective learning environments for individuals in a team.
      • They are also effective in teaching confidence in dealing with unexpected situations such as CBRNE.
      • The studies applied to trauma management. They should be extended to other medical situations.
      • Individual performance assessment instruments need to be augmented to include team performance.
      • Learners like these simulated but authentic learning scenarios and would welcome their inclusion in their curricula.
    28. Innovation in Learning
      • We build individual and team expertise
        • through Immersive Role-playing Experiences
        • in Virtual Worlds
      • Products:
        • Virtual Patients with Medical Models
        • Virtual Hospitals and Clinics
      • Services:
        • Training & Workshops
        • Curriculum & Content
    29. Thank you for your attention ! http://www.InnovationInLearning.com/ Innovation in Learning Inc. 12600 Roble Ladera Rd Los Altos Hills, CA 94022 [email_address] 650-208-8142
      • Research and prototype development funded by:
        • TATRC (USAMRMC)
        • Wallenberg Foundation
        • Forterra Systems Inc.
        • Innovation in Learning Inc.
    30. Innovation in Learning Inc. 12600 Roble Ladera Rd Los Altos Hills, CA 94022 [email_address] 650-208-8142

    + Parvati DevParvati Dev, 4 months ago

    custom

    460 views, 1 favs, 0 embeds more stats

    Multiplayer virtual worlds are very suited for trai more

    More info about this document

    © All Rights Reserved

    Go to text version

    • Total Views 460
      • 460 on SlideShare
      • 0 from embeds
    • Comments 0
    • Favorites 1
    • Downloads 19
    Most viewed embeds

    more

    All embeds

    less

    Flagged as inappropriate Flag as inappropriate
    Flag as inappropriate

    Select your reason for flagging this presentation as inappropriate. If needed, use the feedback form to let us know more details.

    Cancel
    File a copyright complaint
    Having problems? Go to our helpdesk?

    Categories

    Tags

    more
    -->
    Search
    RSS Feed
    What's new?

    © 2009 SlideShare Inc. All Rights Reserved