1 Motivation Motivation Errors in medicine (IOM reports) and need - PDF document

Outrageous Technologies in Developm ent Advanced Distributed Learning – The TOUCH Experience DI STRI BUTED I MMERSI VE VI RTUAL REALI TY SI MULATI ON for TRAI NI NG and PERFORMANCE ASSESSMENT Dale C. Alverson, MD Em erging Trends in Medical Sim ulation: I dentifying the Needs of the Medical Com m unity and Methods to Address Them MMVR January 2 7 , 2 00 4 1 DI STRI BUTED I MMERSI VE VI RTUAL REALI TY SI MULATI ON Project TOUCH Current Contributors Telehealth Outreach for Unified Community Health University of New Mexico • A Hawaii and New Mexico Collaboration University of Hawaii • Year 4 Pacific Telehealth and Technology Hui (TAMC/ VA) • Uniformed Services University of the Health • Sciences Retention Retention Acquisition Acquisition Experiential Principal Investigators Learning Managem en t Managem en t Student Patient Patient • Dale C. Alverson, MD Sim ulator Sim ulator I hear and I forget • Tom Caudell, PhD Data Data Virtual Virtual Sets Sets • Tim Goldsmith, PhD I see and I rem em ber Reality Reality • Stan Saiki, Jr, MD I do and I understand • Mark Bowyer, MD • Alan Liu, PhD • Gil Muniz, PhD Project TOUCH is made possible by grant number 4 D1BTM 00003-03-02 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, DHHS. Contributors I nterdisciplinary Project Presentation Table of Contents � Motivation Moad Mowafi MS Edward Aalseth MS • • Curtis Nakatsu MD J Rex Baker MD • • � Methods/ Tools David Nickles MS John A. Greenfield MS • • Jeffrey Norenberg PhD Karen Haines PhD • • Linda Saland PhD James R. Holten IV MS • • � Evaluation Results Andrei Sherstyuk PhD Joshua Jacobs MD • • Susan Stevens, MS Summers Kalishman PhD • • Kenneth L. Summers PhD Marcus F. Keep MD • • Diane Wax MPA Kathleen Kihmm • � Conclusions • David Wilks, MD Marlene Lindberg PhD • • Stewart Mennin PhD • � Next Steps 5 6 1

Motivation Motivation � Errors in medicine (IOM reports) and need to improve methods to train, assess competence and performance in � Creates environment for reification of abstract order to decrease errors and improve patient safety concepts to improve human understanding Each year m ore than 46 ,00 0 people die as a result of m edical errors. Medical sim ulation im proves patient � Opportunities to apply new methods in advanced safety by offering new w ays to “train and m aintain” computing, visualization = “perceptualization” skills. and advanced communication networks � Increased demand for simulation in lieu of using animals � Complements other methods of simulation or actual patients prior to further training training such as standardized patients and robotic simulators � Responding to new approaches to how people learn by creating interactive experiential training environments � Allows interaction and collaborative learning and training independent of distance (ADL) 7 8 Flight Simulation Metaphor Presentation Table of Contents � Motivation � Methods/ Tools � Evaluation Results � Conclusions Based on the concept of a distributable flight simulator in which individual trainees and � Next Steps instructors can work together virtually despite physical separation at different locations 9 Artificial Intelligence Rules-based Artificial Intelligence • Simulations are driven by rules- based artificial intelligence that are founded in principles of knowledge- based design to meet specific training/ learning goals, objectives and requirements The simulation A. I. engine dynamically governs changes in physiology, physical findings, movement and events, as well as responses to the user 11 12 2

Typical rules Tool: Flatland /* Bleeding rules *****************************************************************/ nantecedents = 1 ; r = make_rule( nantecedents, 5 * sizeof(float) ) ; sprintf(r->name,"%s_BP-%d",rs->name,rulecount++) ; � Perceptualization and Virtual set_antecedent_params( r, 0, prede, "string", "bandage_state", "on_head", "NULL" ) ; set_antecedent_params( r, 1, prede, "string", "bleeding_state", "TRUE", "NULL" ) ; Environments development tool r->consequencefunc = bleeding_off_consequence ; add_rule_to_ruleset(rs, r) ; � Developed at ECE & HPC, UNM nantecedents = 3 ; r = make_rule( nantecedents, 5 * sizeof(float) ) ; � IRIX/ Linux/ Unix/ MacOSX/ Windows* sprintf(r->name,"%s_BP-%d",rs->name,rulecount++) ; set_antecedent_params( r, 0, predge, "float", "timeminutes", "0.1", "NULL" ) ; � Open source core set_antecedent_params( r, 1, prede, "string", "bandage_state", "on_gurney", "NULL" ) ; set_antecedent_params( r, 2, prede, "string", "gauze_state", "on_gurney", "NULL" ) ; r->consequencefunc = bleeding_on_consequence ; add_rule_to_ruleset(rs, r) ; * Ported to Windows in conjunction with NCA TOUCH contains approximately 500 rules extracted SimCenter at USUHS from three experts. Validation. 13 14 TOUCH Patient Simulator Schematic Tracker Multicast to AG HMD User A I JoyWand Mr. Toma Instruments “Flatland” 3 -D Virtual Environm ent Platform 15 16 Inside the Virtual Environment Flatland I/ O for Immersion The Patient Simulator HMD 1 st Person View Joy Wand Head Mounted Display (HMD) VR Work Station Full Immersion 17 18 3

Communication Backbone Access Grid Next Generation Internet (NGI) � TCP/ I P based video conferencing system using m ulticasting: sim ultaneous interactions w ith m ultiple sites using m ultiple applications Supports collaborative VR � interaction � Lag tim e/ Latency Minim ization Open Source Code � Developed by the National Com putational Science Alliance and Argonne National Laboratory 19 20 AG Collaboration First Person Collaboration Access Grid Interfaces 21 22 UNM UH 23 24 Fully Immersive Interactive Virtual Reality 4

25 26 Presentation Table of Contents � Motivation � Methods/ Tools � Evaluation Results � Conclusions � Next Steps Safe Environm ents to Make Mistakes 28 Knowledge Structure & Evaluation Methods Concept Mapping Usability � � Validation; Face, content, concurrent, construct and predictive Changes in Knowledge Acquisition and � Knowledge Structure Comparative Experiments: 4 Comparison Study 1. Groups using medical students and a standardized case; text-based only (“gold standard”) or VR enhanced, with or without distance using the Access Grid Knowledge structure relatedness ratings using Expert know ledge netw ork of the 2 5 core hem atom a concepts 2. individual students ranging from first year to fourth year in their programs 29 30 5

Conclusions Presentation Table of Contents 1. Virtual collaboration within VR is possible with multiple participants � Motivation independent of distance � Methods/ Tools 2. Students accept use of VR for education and training � Evaluation Results 3. Participants felt more engaged in VR � Conclusions 4. Students feel they learned best from their mistakes in VR � Next Steps 31 Lessons learned – w hat Conclusions w orked, w hat didn’t 1. In comparative experiments, post- testing performance was similar � Interdisciplinary and interinstitutional team effort is between VR and non-VR Groups, as well synergistic and productive as distributed and non-distributed � Requires strong project management to coordinate and groups, indicating VR or distance insure appropriate progress (Hire a project coordinator) distribution “do no harm” and demonstrating concurrent validity with � Develop an agreed upon timeline and deliverables. Set standard PBL-case methods deadlines. Balance iteration and refinement with progress to completion 2. Knowledge structure relatedness ratings � Be realistic about achievement and completion of tasks. Don’t try to do more than is likely possible with time and were significantly improved in those resources allotted (tends to require more time than students with lower pre-VR relatedness anticipated) ratings (p = 0.014) 34 Lessons learned – w hat w orked, w hat didn’t Presentation Table of Contents � Need to assign specific project components and tasks to � Motivation an individual point of contact (POC) who takes responsibility for organization, planning, implementation and completion of that task � Methods/ Tools � Find funds to support individual contributors and investigators in order to provide “protected time” and justify effort. This is an ongoing issue for sustainment of effort � Evaluation Results � You can’t please everyone and meet all needs so prepare for negotiation and possibility of turn-over of participation � Conclusions � Address intellectual property rights and expectations � Develop criteria for presentation, publication and � Next Steps authorship and encourage presentation and publishing of results 35 36 6