Virtual Medical Worlds for Team Training (updated)


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Multiplayer virtual worlds are very suited for training medical teams. We develop customized medical spaces, such as an emergency department, with patients, beds, ambulances, medications, and other monitoring and treatment devices. We also present the results of a study on the efficacy of such environments for learning.

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Virtual Medical Worlds for Team Training (updated)

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