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Description
Virtual Patient Simulations (VPS) are web-based exercises involving simulated patients in virtual environments. This study investigates the utility of VPS for increasing medical student clinical reasoning skills, collaboration, and engagement. Many studies indicate that VPS provide medical students with essential practice in clinical decision making before they encounter real life patients. The utility of a recursive, inductive VPS for increasing clinical decision-making skills, collaboration, or engagement is unknown. Following a design-based methodology, VPS were implemented in two phases with two different cohorts of first year medical students: spring and fall of 2013. Participants were 108 medical students and six of their clinical faculty tutors. Students collaborated in teams of three to complete a series of virtual patient cases, submitting a ballpark diagnosis at the conclusion of each session. Student participants subsequently completed an electronic, 28-item Exit Survey. Finally, students participated in a randomized controlled trial comparing traditional (tutor-led) and VPS case instruction methods. This sequence of activities rendered quantitative and qualitative data that were triangulated during data analysis to increase the validity of findings. After practicing through four VPS cases, student triad teams selected accurate ballpark diagnosis 92 percent of the time. Pre-post test results revealed that PPT was significantly more effective than VPS after 20 minutes of instruction. PPT instruction resulted in significantly higher learning gains, but both modalities supported significant learning gains in clinical reasoning. Students collaborated well and held rich clinical discussions; the central phenomenon that emerged was "synthesizing evidence inductively to make clinical decisions." Using an inductive process, student teams collaborated to analyze patient data, and in nearly all instances successfully solved the case, while remaining cognitively engaged. This is the first design-based study regarding virtual patient simulation, reporting iterative phases of implementation and design improvement, culminating in local theories (petite generalizations) about VPS design. A thick, rich description of environment, process, and findings may benefit other researchers and institutions in designing and implementing effective VPS.
ContributorsMcCoy, Lise (Author) / Wetzel, Keith (Thesis advisor) / Ewbank, Ann (Thesis advisor) / Simon, Harvey (Committee member) / Arizona State University (Publisher)
Created2014
Description
Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team. Such team-based procedures include surgical and clinical procedures, some of which are protocol-driven. Cost and time required for individual team-based training sessions, along with other factors, contribute to making the training complex and challenging. A great deal of research has been done on medically-focused collaborative virtual reality (VR)-based training for protocol-driven procedures as a cost-effective as well as time-efficient solution. Most VR-based simulators focus on training of individual personnel. The ones which focus on providing team training provide an interactive simulation for only a few scenarios in a collaborative virtual environment (CVE). These simulators are suited for didactic training for cognitive skills development. The training sessions in the simulators require the physical presence of mentors. The problem with this kind of system is that the mentor must be present at the training location (either physically or virtually) to evaluate the performance of the team (or an individual). Another issue is that there is no efficient methodology that exists to provide feedback to the trainees during the training session itself (formative feedback). Furthermore, they lack the ability to provide training in acquisition or improvement of psychomotor skills for the tasks that require force or touch feedback such as cardiopulmonary resuscitation (CPR). To find a potential solution to overcome some of these concerns, a novel training system was designed and developed that utilizes the integration of sensors into a CVE for time-critical medical procedures. The system allows the participants to simultaneously access the CVE and receive training from geographically diverse locations. The system is also able to provide real-time feedback and is also able to store important data during each training/testing session. Finally, this study also presents a generalizable collaborative team-training system that can be used across various team-based procedures in medical as well as non-medical domains.
ContributorsKhanal, Prabal (Author) / Greenes, Robert (Thesis advisor) / Patel, Vimla (Thesis advisor) / Smith, Marshall (Committee member) / Gupta, Ashish (Committee member) / Kaufman, David (Committee member) / Arizona State University (Publisher)
Created2014
Design and development of an immersive virtual reality team trainer for advance cardiac life support
Description
Technology in the modern day has ensured that learning of skills and behavior may be both widely disseminated and cheaply available. An example of this is the concept of virtual reality (VR) training. Virtual Reality training ensures that learning can be provided often, in a safe simulated setting, and it may be delivered in a manner that makes it engaging while negating the need to purchase special equipment. This thesis presents a case study in the form of a time critical, team based medical scenario known as Advanced Cardiac Life Support (ACLS). A framework and methodology associated with the design of a VR trainer for ACLS is detailed. In addition, in order to potentially provide an engaging experience, the simulator was designed to incorporate immersive elements and a multimodal interface (haptic, visual, and auditory). A study was conducted to test two primary hypotheses namely: a meaningful transfer of skill is achieved from virtual reality training to real world mock codes and the presence of immersive components in virtual reality leads to an increase in the performance gained. The participant pool consisted of 54 clinicians divided into 9 teams of 6 members each. The teams were categorized into three treatment groups: immersive VR (3 teams), minimally immersive VR (3 teams), and control (3 teams). The study was conducted in 4 phases from a real world mock code pretest to assess baselines to a 30 minute VR training session culminating in a final mock code to assess the performance change from the baseline. The minimally immersive team was treated as control for the immersive components. The teams were graded, in both VR and mock code sessions, using the evaluation metric used in real world mock codes. The study revealed that the immersive VR groups saw greater performance gain from pretest to posttest than the minimally immersive and control groups in case of the VFib/VTach scenario (~20% to ~5%). Also the immersive VR groups had a greater performance gain than the minimally immersive groups from the first to the final session of VFib/VTach (29% to -13%) and PEA (27% to 15%).
ContributorsVankipuram, Akshay (Author) / Li, Baoxin (Thesis advisor) / Burleson, Winslow (Committee member) / Kahol, Kanav (Committee member) / Arizona State University (Publisher)
Created2012
Description
The medical field is constantly looking for technological solutions to reduce user-error and improve procedures. As a potential solution for healthcare environments, Augmented Reality (AR) has received increasing attention in the past few decades due to advances in computing capabilities, lower cost, and better displays (Sauer, Khamene, Bascle, Vogt, & Rubino, 2002). Augmented Reality, as defined in Ronald Azuma’s initial survey of AR, combines virtual and real-world environments in three dimensions and in real-time (Azuma, 1997). Because visualization displays used in AR are related to human physiologic and cognitive constraints, any new system must improve on previous methods and be consistently aligned with human abilities in mind (Drascic & Milgram, 1996; Kruijff, Swan, & Feiner, 2010; Ziv, Wolpe, Small, & Glick, 2006). Based on promising findings from aviation and driving (Liu & Wen, 2004; Sojourner & Antin, 1990; Ververs & Wickens, 1998), this study identifies whether the spatial proximity affordance provided by a head-mounted display or alternative heads up display might benefit to attentional performance in a simulated routine medical task. Additionally, the present study explores how tasks of varying relatedness may relate to attentional performance differences when these tasks are presented at different spatial distances.
Contributorsdel Rio, Richard A (Author) / Branaghan, Russell (Thesis advisor) / Gray, Rob (Committee member) / Chiou, Erin (Committee member) / Arizona State University (Publisher)
Created2017
Description
In the modern age, where teams consist of people from disparate locations, remote team training is highly desired. Moreover, team members' overlapping schedules force their mentors to focus on individual training instead of team training. Team training is an integral part of collaborative team work. With the advent of modern technologies such as Web 2.0, cloud computing, etc. it is possible to revolutionize the delivery of time-critical team training in varied domains of healthcare military and education. Collaborative Virtual Environments (CVEs), also known as virtual worlds, and the existing worldwide footprint of high speed internet, would make remote team training ubiquitous. Such an integrated system would potentially help in assisting actual mentors to overcome the challenges in team training. ACLS is a time-critical activity which requires a high performance team effort. This thesis proposes a system that leverages a virtual world (VW) and provides an integrated learning platform for Advanced Cardiac Life Support (ACLS) case scenarios. The system integrates feedback devices such as haptic device so that real time feedback can be provided. Participants can log in remotely and work in a team to diagnose the given scenario. They can be trained and tested for ACLS within the virtual world. This system is well equipped with persuasive elements which aid in learning. The simulated training in this system was validated to teach novices the procedural aspect of ACLS. Sixteen participants were divided into four groups (two control groups and two experimental groups) of four participants. All four groups went through didactic session where they learned about ACLS and its procedures. A quiz after the didactic session revealed that all four groups had equal knowledge about ACLS. The two experimental groups went through training and testing in the virtual world. Experimental group 2 which was aided by the persuasive elements performed better than the control group. To validate the training capabilities of the virtual world system, final transfer test was conducted in real world setting at Banner Simulation Center on high fidelity mannequins. The test revealed that the experimental groups (average score 65/100) performed better than the control groups (average score 16/100). The experimental group 2 which was aided by the persuasive elements (average score 70/100) performed better than the experimental group 1 (average score 55/100). This shows that the persuasive technology can be useful for training purposes.
ContributorsParab, Sainath (Author) / Kahol, Kanav (Thesis advisor) / Burleson, Wnslow (Thesis advisor) / Li, Baioxin (Committee member) / Arizona State University (Publisher)
Created2010