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This slide set was part of a workshop on virtual environments at AMIA 2009 with Kanav Kahol of ASU.
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© 2009, Dev AMIA 2009 Workshop1 of 46
Virtual Environments forTraining in Healthcare
(Plaza A, Hilton, San Francisco)
Parvati Dev, PhD, Innovation in Learning Inc, Los Altos Hills, CA
Kanav Kahol, PhD, Arizona State University, Tempe, AZ
(sponsored by the Education Working Group)
AMIA’2009 Workshop #09
© 2009, Dev AMIA 2009 Workshop2 of 46
Today’s Program
• Overview of virtual worlds, from Flash to immersive 3D
• Teaching clinical procedures and team work in virtual
worlds
• Teaching business processes in virtual environments
• Using virtual worlds to capture activities in real worlds
• Discussion and Brainstorming
© 2009, Dev AMIA 2009 Workshop3 of 46
Getting together
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Sharing information - collaboration
QuickTime™ and a decompressor
are needed to see this picture.
© 2009, Dev AMIA 2009 Workshop5 of 46
Social
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Fun ! -- Extends real life(World of Warcraft)
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Why?
• The space feels real, its three-dimensional– I know how to move and find things
• Though I wish it was easier to navigate !
• I feel the others are really present• It is quite easy to share and collaborate
– Wish it was easier to bring in my simulations and programs– Powerpoints and spreadsheets are not enough– But I like that my documents can be left behind for next time
• Voice is good• Often the technology does not work
© 2009, Dev AMIA 2009 Workshop8 of 46
MD Kiosk Virtual Health Island (Second Life)
http://www.youtube.com/watch?v=U3Szet7MJEM&feature=related
© 2009, Dev AMIA 2009 Workshop9 of 46
Medical Centers
Ann Myers Medical Center
http://www.youtube.com/watch?v=QnTzgon-Wto&feature=related
National Health Service Polyclinic, UK
http://secondhealth.wordpress.com/
© 2009, Dev AMIA 2009 Workshop10 of 46
Medical Centers
Stanford University Emergency Department
http://summit.stanford.edu/research/VEDII.html
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http://vw.ddns.uark.edu/index.php?page=overview
Healthcare Logistics (U Arkansas)
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Virtual Patients for Virtual Worlds
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Virtual Surgeon Open Heart Game
http://www.youtube.com/watch?v=8SAder8uMro&feature=related
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Related medical information- cleft palate 3D surgical model
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Virtual World Platforms
Virtual World PlatformVirtual World Platform
Virtual PatientsVirtual Patients
3D BuildingClinic
3D BuildingClinic
Medical Objects with
behaviors
Medical Objects with
behaviors
Virtual World server
Virtual World server
ClientClient
Scenarios based on CurriculumScenarios based on Curriculum
Tracking and Performance Assessment
Tracking and Performance Assessment
User Authentication and Performance
Database
User Authentication and Performance
Database
ClientClient
© 2009, Dev AMIA 2009 Workshop16 of 46
Virtual World Platforms
Virtual World server
Virtual World server
ClientClient
User Authentication and Performance
Database
User Authentication and Performance
Database
ClientClient
CLIENT:
• Renders 3D world, avatars
• GUI for interaction
• Code for ‘behaviors’ of objects
• May have application support (ppt etc)
SERVER:
• Has copy of world for download on login
• Maintains status of each avatar and object
• Sends/receives status updates to/from all clients
•Supports application sharing fromany client
MULTIPLE SERVERS:
•There may be additional servers for media e.g. VOIP, video
© 2009, Dev AMIA 2009 Workshop17 of 46
Virtual World Platforms
Virtual World server
Virtual World server
ClientClient
User Authentication and Performance
Database
User Authentication and Performance
Database
ClientClient
CLIENT:
• Forterra client (download)
• Second Life client (download)
• Qwaq/Teleplace (download)
• Sun, Sirikata, …
• Metaplace (in browser, Flash)
• Unity3D (in browser, plugin)
• Unisfair (in browser, Flash?)
• Whyville (in browser, Java)
SERVER:
• Forterra server (hosted)
• Second Life server (hosted)
• Qwaq/Teleplace (hosted)
•Sun, Sirikata, … (you host)
• Metaplace server (hosted, Flash)
• Unity3D server (hosted)
• Unisfair (hosted)
• Whyville (hosted)
Tixeo
© 2009, Dev AMIA 2009 Workshop18 of 46
Faux 3D + video/voice
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Lesson Plans ?
Collaborators:
Stanford University and Hospital
Forterra Systems
Innovation in Learning Inc
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A Medical Virtual World
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Subject Matter Experts
DevelopContent
DevelopBehaviors
IntegrateAnalysis &
DesignEvaluate
DevelopCurriculum
Analysis with SMEs determines high-value curriculum
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Example Scenario Timeline
Incident Command
Victims
Out of Hospital First Responders
Bystanders
911 Calls Madefrom Scene
Specify Safety &Evacuation Areas
Complete HazardAssessment
Manage Mediaat Scene
Hospital AlertSystem Activated
GeneralNotifications Made
ICS CommandSetup Complete
ICS Setupat Event
MCI PlanActivated
Hot / Warm / ColdZones Established
VictimsTriaged
Manage On SceneBystanders
VictimTransportation
Fire - 1st
Assignment ArrivesPolice Setup andEnforce Perimeter
Triage AreaSetup
TreatImmediates
Able VictimsSelf-Extricate
Able VictimsSelf Transport
to Hospitals
Victims Moved toHospital
BystandersArrive
Media CrewsArrive
Protective ActionsTaken
Overall Timeline: Out-of-Hospital Scenario - Detonation of Radioactive Dirty Bomb
© 2009, Dev AMIA 2009 Workshop23 of 46
Pre-Hospital Curriculum
Emergency Preparedness – Pre-hospital
Decontaminate at Scene
Triage, Decontamination, and Transport Set the Stage
for In-Hospital Treatment
Triage at the scene Transport to hospital
© 2009, Dev AMIA 2009 Workshop24 of 46
In-Hospital Curriculum
• Users are emergency physicians and nurses
• Present the stresses and challenges of a disaster – task loading
• Teams can succeed or fail to save patients
• Team coordination, communication, and leadership are key
. Patient avatars live or die in this persistent virtual world
Emergency Preparedness – In-hospital to Emergency Department
© 2009, Dev AMIA 2009 Workshop25 of 46
High School CPR Preparedness
• Students practice decision making
• When should CPR be given
• What actions besides CPR are needed
© 2009, Dev AMIA 2009 Workshop26 of 46
Curricula for Virtual Worlds
• Start by identifying the task(s) to be learned/practiced – the learning goal(s)
• Deconstruct the task into parts;• Identify the desired behaviors and attitudes
– the KSAs;• Set the context/situation in which these behaviors and attitudes will
be elicited;• Specify the desired actions of the trainees as well as the “supporting
roles”;• Elaborate on the basic scenario with more complex ones.
© 2009, Dev AMIA 2009 Workshop27 of 46
Deconstruct the tasks
Is victim breathing?
Victim collapses…
Check for airway obstruction.
Open airway: head tilt, chin lift.
Call 9-1-1
Look, listen, feel for breathing.
Give one rescue breath.
Give 30 chest compressions.
Continue until EMT arrives.
Clear airway.
Check for responsiveness.
Is victim breathing?
Victim collapses…
Check for airway obstruction.
Open airway: head tilt, chin lift.
Call 9-1-1
Look, listen, feel for breathing.
Give one rescue breath.
Give 30 chest compressions.
Continue until EMT arrives.
Clear airway.
Check for responsiveness.
© 2009, Dev AMIA 2009 Workshop28 of 46
Place tasks in a Scenario
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Example Scenario Timeline
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Score Sheet for Performance
CPR Performance Checklist
Performance Checklist for Scoring CPR recordings
Instructions: Yes/NoStudent gets one point for each of the following done correctly, and in the correct sequence.Some items qualify for .5 point.
1 Student responds to the collapse quickly (time between victim collapsing and student volunteering to do CPR is less than…5?...seconds.)
2 Student asks someone to "go call 911" (should be asking by name or by clothing, etc.) (half point if student does NOT say-and come back and tell me what happened…some type of request to 'report back')CPR Sequence of actions:
3 Student "checks for responsiveness" ("Are you OK?")4 Student "checks airway" for obstruction.5 Student "opens airway" by clicking "Head tilt, chin lift" button6 Student "checks for breathing" by leaning head over and "Look, Listen, Feel"7 Student "gives 2 rescue breaths" (half credit if student gives one rescue breath) 8 Student "gives 15 chest compressions" (half credit if student gives 30 chest compressions 9 Student loses a point if they stop CPR before someone else offers to help)
either another student/bystander or the EMT arrives
Total Score
© 2009, Dev AMIA 2009 Workshop31 of 46
Teaching business processes
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Tabletop Exercises
These are broadly intended to:• Validate plans and policies
• Promote team-building
• Achieve consensus
• Provide exposure to the decision-making process during an emergency
• Provide pre-event training and practice for operations or exercises
• Provide an opportunity to practice skills and improve individual performance under varying degrees of stress.
© 2009, Dev AMIA 2009 Workshop33 of 46
Incident Command Training
COMMAND STAFF• Incident Commander• Operations Chief• Logistics Chief• Planning Chief• Administration
(Finance) Chief• Security Chief
Dispensing antibiotic for Anthrax emergency
Fire on ship
http://www.commandsim.com/fireworld2007/startHere.html
© 2009, Dev AMIA 2009 Workshop34 of 46
Virtual oil rigs for emergency training
http://www.youtube.com/watch?v=uzr5UbdAuwQ
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Building a virtual oil refinery
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Collaborative Business Intelligence
• Business Intelligence – A process of information collection, mining, analysis, decision making– Small number of experts– Weeks to months
• Collaborative Business Intelligence– For example - Data center for hospital system has heating problem– Problem resolution needs many stakeholders– Need to move from strategic decision-making to operational decision-
making– Need real-time data, which is distributed, and requires multiple experts– Use document sharing, blogs, wikis, email, instant messaging,
conferencing, Webex, application sharing– Virtual worlds– The virtual collaboration platform provides mechanisms to capture user
decisions recorded in the virtual world and re-associate them with specific events, models and business processes
© 2009, Dev AMIA 2009 Workshop37 of 46
Links
3-D real-virtual worlds in health and healthcare, Maged N Kamel Bouloshttp://www.slideshare.net/sl.medic/3d-realvirtual-worlds-for-health-and-healthcare
Second Health (National Health Service in Second Life)http://secondhealth.wordpress.com/http://www.youtube.com/watch?gl=GB&hl=en-GB&v=Qtn5wcDA0isand numerous other videos
Imperial College, London:Ten weeks of activities to understand social networks, gaming and virtual worlds
(Second Life)http://learning20atimperial.wordpress.com/http://www.slideshare.net/learning20/2009-virtual-worlds-and-second-life
Podcasting in Plain English from CommonCrafthttp://www.youtube.com/watch?v=y-MSL42NV3c
Twitter in plain Englishhttp://www.youtube.com/watch?v=ddO9idmax0o
Social Networking in Plain Englishhttp://www.youtube.com/watch?v=6a_KF7TYKVc
Daden, a virtual worlds consulting company inUKhttp://www.daden.co.uk/pages/knowledge.html
has a number of interesting white papers
Heart Murmur Sim by Jeremy Kemp (San Jose State College)http://www.youtube.com/watch?v=xJY2Iwbzop4&feature=related
Ann Myers Medical Center (Second Life)http://www.youtube.com/watch?v=QnTzgon-Wto&feature=related
MD Kiosk on Virtual Health Islandhttp://www.youtube.com/watch?v=U3Szet7MJEM&feature=related
Emergency Preparedness simulationshttp://www.youtube.com/watch?v=3lanlNxY-2E&feature=relatedhttp://www.youtube.com/watch?v=RwQlHNlpVcE&feature=related
Virtual Patienthttp://www.youtube.com/watch?v=TU-TRXdSN7s&feature=related
New York Universityhttp://www.youtube.com/watch?v=K546pruIa0A&NR=1&feature=fvwp
Stanford Universityhttp://www.youtube.com/watch?v=TkuLAOzL0zU&NR=1
MUVERShttp://www.youtube.com/watch?v=NxwUMs4VCag&feature=related
Univ Texas and Breakaway
Virtual Surgeon Open Heart Gamehttp://www.youtube.com/watch?v=8SAder8uMro&feature=related
Virtual World Platforms (not exhaustive)http://www.forterrainc.com/http://www.secondlife.com/ and http://www.secondlifegrid.net/http://www.multiverse.net/http://www.metaplace.com/http://www.vastpark.com/http://www.unity3d.comhttp://www.sirikata.com/http://www.teleplace.com/ previously QwaqSun Wonderlandhttp://wiki.java.net/bin/view/Javadesktop/ProjectWonderland#Content_Creation
Learningwhyville.net
© 2009, Dev AMIA 2009 Workshop38 of 46
Links to our movies
Virtual Emergency Department (VEDII) - Users
Virtual Emergency Department (VEDII) Interface - GUI
Virtual Emergency Department (VEDII) - entire video (2:11 min)
http://www.youtube.com/watch?v=zUb2Z8ZTl6g
http://www.youtube.com/watch?v=6FEdUndV1Aw
http://www.youtube.com/watch?v=7KfO4vjf_II
© 2009, Dev AMIA 2009 Workshop40 of 46
Abstract: AMIA’2009
ABSTRACTVirtual Environments for Training in Healthcare
Parvati Dev, PhD, Innovation in Learning Inc, Los Altos Hills, CAKanav Kahol, PhD, Arizona State University, Tempe, AZ
(sponsored by the Education Working Group)
AbstractThree-dimensional virtual environments are the basis of highly popular online multi-person video games (World of Warcraft, Neverwinter Nights). The same technology has been used by educators to construct virtual learning environments for education in business, humanities, libraries, military, and healthcare. Some environments, such as those in Second Life, are exploratory, with structure provided through organized meetings and presentations ‘in-world’. Other environments resemble videogames, with sequential levels of play, providing a structured progress through the learning material, albeit in a game-like format. This workshop invites informatics educators and practitioners to participate in discussing current and potential uses of 3D virtual environments for learning and work in healthcare. Selected presentations on the topic will seed the discussion in the workshop.
Structure of Workshop:The workshop will open with short presentations on different healthcare training applications that use virtual environments.
キキ Short overview of virtual worlds, from Flash to immersive 3D キキ Examples of coursework in virtual worlds キキ Teaching clinical procedures and team work in virtual worlds キキ Teaching business processes in virtual environments キキ Using virtual worlds to capture activities in real worlds
We will then move to an open brainstorming session where we list ideas for potential new applications. Small groups will each choose an idea to elaborate. Groups will come back to present their results.
Education goals:キ キキ What are virtual environments for learning キ キキ Technologies underlying these virtual environmentsキ キキ Current uses of virtual environments
Who should attend: Educators and researchers; physicians, nurses, and other healthcare professionals; hospital administrators; computer scientists, system developers, and programmers.