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. 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.
- 3. ‘Avatars’ in a 3D world Second Life Qwaq
- 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
- 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
- 17. Controlled Trial Study of Learning Efficacy
- 19. Managing trauma with HPS manikin
- 20. Managing Trauma in the Virtual Emergency Room
- 22. Roles Role player Learner Facilitator
- 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)
- 30. Innovation in Learning Inc. 12600 Roble Ladera Rd Los Altos Hills, CA 94022 [email_address] 650-208-8142
Editor's Notes
- 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.