Conference presentation: Nils Fredrik Kleven, Ekaterina Prasolova-Førland, Mikhail Fominykh, Arne Hansen, Guri Rasmussen, Lisa Millgård Sagberg, and Frank Lindseth: "Virtual Operating Room for Collaborative Training of Surgical Nurses," in Nelson Baloian, Frada Burstein, Hiroaki Ogata, Flavia Santoro, and Gustavo Zurita Eds., the 20th International Conference on Collaboration and Technology (CRIWG), Santiago, Chile, September 7–10, 2014, Springer, ISBN: 978-3-319-10165-1, pp. 223–238. doi>10.1007/978-3-319-10166-8_20 Slides by Ekaterina Prasolova-Førland

1. Virtual Operating room for collaborative training of surgical nurses
Nils Fredrik Kleven, Ekaterina Prasolova-Førland, Mikhail Fominykh,
Norwegian University of Science and Technology
Arne Hansen, Guri Rasmussen
Sør-Trøndelag University College
Lisa Millgård Sagberg
St. Olav’s University Hospital
Frank Lindseth
Sintef Medical Technology

2. Motivation
•At the core of educational activities of health professionals at all levels is the patient
–As the hospitals improve their effectiveness, there is dramatically less time for the student-patient contact
=> Students need more ‘patient’ time
–A patient is treated by a team of specialists, with complex collaborative procedures and practices within the team
=> Students need to practice on complex interactions within a team of professionals
•There is a need for solutions to facilitate practice and explorative learning experiences to meet these challenges
= > Online virtual university hospital as a venue for learning, research, and development

3. Related work: types of medical virtual worlds
•Reconstruction of real life institutions
•Interactive simulations and visualizations
–Anatomy
–Procedures
•Team training (e.g. with roleplay)
–Emergency
–Nursing
–Patient communication
•Public health and education
–Patient support groups and socializing
•Treatment and reconvalescence

4. Imperial College London

5. The cranial nerve skywalk (University of Kentucky/UWA)

6. Active Worlds: Time Critical Training (Cardiac Arrest)
S. Parab (2010)

7. Nursing simulation: post-partum hemorrhage (Youtube)

8. Communication training for palliative care
Lowes, S., Hamilton, G., Hochstetler, V., & Paek, S. (2013)

9. Emergency Training (University of Illinois at Chicago)
“It’s an urban nightmare scenario:
A plane has released anthrax over Chicago. Millions are exposed and you have 48 hours to give people antibiotics.”

10. vAcademia: medical call center training

11. Virtual Ability

12. Treatment of phobias and PTS
www.virtuallybetter.com, USC Institute for Creative Technologies

13. Virtual Operating room – St. Olavs

14. Waiting room => sluice => operating room

15. Learning objectives
•Learning objective L1: Reassuring a patient in advance of an important and complex operation
•Learning objective L2: Dealing with relatives
•Learning objective L3: Communicating / dealing with patients with immigrant background, especially women
•Learning objective L4: Reassuring / dealing with children in advance of an operation
•Learning objective L5: Dealing with a seriously ill and potentially dying patient
•Learning objective L6: Performing basic medical tasks prior to the operation (e.g. moving the operating table and disinfection)

16. 4 typical learning scenarios
1.A 35-year-old woman is admitted to the gynecological department. She is on her way to a surgery for an abscess that will be operated in spinal anesthesia.
2.An immigrant woman is going to a scheduled hip operation. Her husband comes with her along with the nurse from the ward. She speaks poor Norwegian, and her husband must therefore be there to translate. She is concerned with keeping her hijab on and wishes to be treated by female personnel only.
3.A five-year-old boy arrives to the sluice with his mother and nurse from the ward. He is going to recto- and gastroscopy.
4.A man in the age of 40 is going to surgery due to a malignant brain tumor. He has two teenage children that he alone is responsible for back home.

17. Study setting and data collection
•Participants
•9 post-graduate surgical nursing students from Sør- Trøndelag university college
•Data sources
•Screen capture with sound of role-plays
•Written notes and sound capture of discussions
•Questionnaire (28 questions)
‒Competences of the participants
‒Use of the platform during the role play
‒Suitability of the simulation for providing knowledge and skills
‒Open questions, proposals for changes and improvements

18. A surgical nursing student participating in the roleplay

19. Virtual Operating room: roleplay

20. Interaction: nurses, patients, relatives

21. 0%
20%
40%
60%
80%
100%
not at all
to a little extent
neutral
to some extent
to a great extent
Can the simulation improve skills in communication and interaction with patients?

22. 0%
20%
40%
60%
80%
100%
not at all
to a little extent
neutral
to some extent
to a great extent
Can the simulation improve skills in communication and interaction with the relatives of the patient?

23. 0%
20%
40%
60%
80%
100%
not at all
to a little extent
neutral
to some extent
to a great extent
Can the simulation improve skills in communication/collaboration with other health professionals?

24. 0%
20%
40%
60%
80%
100%
not at all
to a little extent
neutral
to some extent
to a great extent
Can the simulation be used as a supplement to preparing surgical nursing students?

25. What other areas in medicine could benefit from simulation in virtual worlds?
Coordination of teams at operating rooms or emergency rooms Procedural training Anatomy visualization Diagnostic training Informing patients and relatives Providing health information to the general population
18%
23%
20%
18%
13%
10%

26. Student feedbacks
•Fun and immersive experience:
•telling the patient’s husband to step away from the instrument table when he gets too close, as these instruments are sterile and prepared for surgery
•“The role plays got better eventually. Got more comfortable after some practice”
•“it does take a while to learn”, but “a day more with role- playing, and they would be skilled”
•“the scenarios would have been too difficult if you do not have any real experience, one would not know how to proceed”
•“use our hands more”
•Missing anesthesia nurses

27. Discussion & improvements suggestions
•“More items to interact with needs to be included if surgical nurses are to treat and communicate with a patient”
•Improving navigation and interactivity
•Improving feedback during roleplaying, using teachers/experts & virtual humans
•Body language
•More gaming elements
•Designing a ‘perfect’ Virtual Hospital
•Realism vs. efficiency?

28. Conclusions and future work
•Creating guidelines
•For developing virtual hospital as an arena for educational activities for medics and non-medics
•For developing roleplaying scenarios
•Additional evaluations:
–Surgical nurses at earlier stages of study
–Anesthesia nurses
–Non-medics
–Using Oculus Rift
•Additional technological developments:
•Kinect and CAVE
•Adding new hospital buildings (labs, examination rooms), interactive features and virtual patients

29. Virtual Operating room and Oculus Rift

30. Virtual Operating room and Oculus Rift (2)

31. Virtual Operating room in a CAVE (EU Visionair project)

32. Thank you!
Nils Fredrik Kleven nilsfrk@stud.ntnu.no Ekaterina Prasolova-Førland ekaterip@ntnu.no Mikhail Fominykh mikhail.fominykh@ntnu.no Arne Hansen arne.hansen@hist.no Guri Rasmussen guri.rasmussen@hist.no Lisa Millgård Sagberg lisa.millgard.sagberg@ntnu.no Frank Lindseth frank.lindseth@sintef.no