Virtual Medical Worlds for Team Training (updated)

Team Training in Virtual Worlds

© 2008, Innovation in Learning Inc. Overview Presentation

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.



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



‘Avatars’ in a 3D world

Second Life

Qwaq



Avatars controlled by learners or role players

• Navigation in world is through the keypad or mouse• Headset supports in-world conversation



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



Virtual Hospital(Begun at Stanford University SUMMIT, and continued as a collaboration between Innovation in Learning and Forterra Systems)



Urban and Emergency Scenes



Photo-inspired Virtual 3D

Environment – – –

Photos taken in Adult ED at Stanford University

Medical Center

July 2006

In-hospital multi-bay Emergency Department room



Residents practicing triage



Nurse shift change



High school students practicing CPR scenarios

A collaboration of the Karolinska Institutet, Stockholm, Forterra Systems Inc, and Stanford University



The Virtual Medical Environmentand its user interface



Avatar Health Visualization

Graphical User Interface Diagnostic Display

Images and Text 3D Patient Avatar



Virtual Trauma Patient – under the hood



A Dynamic Model of Patient Physiology



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



Controlled Trial Study of Learning Efficacy

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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




Managing trauma with HPS manikinQuickTime™ and aTIFF (Uncompressed) decompressorare needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressorare needed to see this picture.



Managing Trauma in the Virtual Emergency Room




Clinical Scenarios for Virtual ED

1. Male: pneumothorax and femur fracture after auto collision2. Male; bicycle rider falls from bike path, suffers spleen rupture3. Male; car driver, hypoglycemia and femur fracture4. Male; ethanol induced fall, with head injury, obstructed airway5. Female;(2nd trimester pregnancy); with renal laceration after

auto collision6. Male; construction worker fall, liver rupture, fracture of femur7. Male: construction worker, flail chest and dislocated shoulder8. Male: bicycle rider with severe hand and abdominal injury after

auto collision and being ‘run-over’ 9. Female; elderly pedestrian with facial fractures and

unconsciousness after auto collision.10. Female (3rd trimester pregnancy); auto collision with femoral

neck fracture, and vaginal bleeding (placental abruption)




Roles

Role player Learner

Facilitator



Performance measurement using principles of EMCRM

(Emergency Medicine Crew Resource Management)

1. Know your environment

2. Anticipate and plan for crises

3. Assume a leadership role

4. Communicate effectively with other team members

5. Call for help early enough

6. Distribute workload optimally

7. Allocate attention wisely

8. Utilize all available resources

9. Utilize all available information

10. Maintain a professional behavior




A debrief sessionQuickTime™ and aTIFF (Uncompressed) decompressorare needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressorare needed to see this picture.



EMCRM Performance scores

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 GroupN=15 N=16




P o s i t i o n s / R o l e s o f P a r t i c i p a n t s

1 2

32

1

3

1

0

5

1 0

1 5

2 0

ED RNED

Physician

EM

Resident

Chief

Resident-Surgery Surgery

Resident

Surgery

Intern

# Participants

P r i o r T r a i n i n g i n C B R N E

3

6

8

5

0

5

1 0

1 5

2 0

N o Y e s

# Participants

S t a n f o r d

S a n M a t e o

F e e l i n g I m m e r s e d

1 1

6

11

31

6

2

0

5

1 0

1 5

2 0

N o t a t a l l S o m e o f t h e

t i m e

N o t s u r e M u c h o f t h e

t i m e

A l l o f t h e

t i m e

# Participants

S t a n f o r d

S a n M a t e o

C o n f i d e n c e P r i o r t o E x e r c i s e s

7

23

8

1

10

5

1 0

1 5

2 0

N o t

C o n f i d e n t

S o m e w h a t

C o n f i d e n t

C o n f i d e n t V e r y

C o n f i d e n t

E x t r e m e l y

C o n f i d e n t

# Participants

S t a n f o r d

S a n M a t e o

C o n f i d e n c e A f t e r E x e r c i s e s

9

12

5

5

0

5

1 0

1 5

2 0

N o t

C o n f i d e n t

S o m e w h a t

C o n f i d e n t

C o n f i d e n t V e r y

C o n f i d e n t

E x t r e m e l y

C o n f i d e n t

# Participants

S t a n f o r d

S a n M a t e o

U s e f u l n e s s f o r T e a m S k i l l s T r a i n i n g

1

5

3

1

4

5

3

0

2

4

6

8

1 0

1 2

N o t U s e f u l S o m e w h a t

U s e f u l

U s e f u l V e r y U s e f u l E x t r e m e l y

U s e f u l

# Participants

S t a n f o r d

S a n M a t e o

Results of our other studies using Virtual Worlds

(Stanford Hospital and San Mateo General Hospital)




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.





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



Thank you for your attention !

http://www.InnovationInLearning.com/

Innovation in Learning Inc.12600 Roble Ladera RdLos Altos Hills, CA [email protected]

Research and prototype development funded by:TATRC (USAMRMC)Wallenberg FoundationForterra Systems Inc.Innovation in Learning Inc.




Innovation in Learning Inc.12600 Roble Ladera RdLos Altos Hills, CA [email protected]

Health & Medicine

Virtual Medical Worlds for Team Training (updated)