Virtual reality environments to train soft skills in medical and nursing education: a technical feasibility study between France and Japan.

PURPOSE: To meet the urgent and massive training needs of healthcare professionals, the use of digital technologies is proving increasingly relevant, and the rise of digital training platforms shows their usefulness and possibilities. However, despite the impact of these platforms on the medical skills learning, cultural differences are rarely factored in the implementation of these training environments. METHODS: By using the Scrub Nurse Non-Technical Skills Training System (SunSet), we developed a methodology enabling the adaptation of a virtual reality-based environment and scenarios from French to Japanese cultural and medical practices. We then conducted a technical feasibility study between France and Japan to assess virtual reality simulations acceptance among scrub nurses. RESULTS: Results in term of acceptance do not reveal major disparity between both populations, and the only emerging significant difference between both groups is on the Behavioral Intention, which is significantly higher for the French scrub nurses. In both cases, participants had a positive outlook. CONCLUSION: The findings suggest that the methodology we have implemented can be further used in the context of cultural adaptation of non-technical skills learning scenarios in virtual environments for the training and assessment of health care personnel.

Training situational awareness for scrub nurses: Error recognition in a virtual operating room.

Virtual reality simulation provides interesting opportunities to train nurses in a safe environment. While the virtual operating room has proven to be a useful training tool for technical skills, it has been less studied for non-technical skills. This study aimed to assess "Error recognition in a virtual operating room", using a simulation scenario designed to improve situation awareness. Eighteen scrub-nurse students and 8 expert scrub-nurses took part in the experiment. They were immersed in a virtual operating room and reported any errors they observed. There were nineteen errors with various degrees of severity. Measures were retrieved from logs (number of errors, time for detection, movements) and from questionnaires (situation awareness, subjective workload, anxiety and user experience). The results showed that the participants who detected most errors had a higher level of situation awareness, detected high-risk errors faster and felt more immersed in the virtual operating room than those detecting fewer errors. They also felt the workload was lighter and experienced more satisfaction. Students explored the operating room more than experts did and detected more errors, especially those with moderate risk. Debriefings confirmed that virtual simulation is acceptable to trainees and motivates them. It also provides useful and original material for debriefings.

Recurrent large genomic rearrangements in BRCA1 and BRCA2 in an Irish case series.

Mutations in BRCA1 and BRCA2 confer a highly increased risk of cancers, mainly of the breast and ovary. Most variants are point mutations or small insertions/deletions detectable by Sanger sequencing. Large genomic rearrangements, including deletions/duplications of multiple exons, are not routinely detectable by Sanger sequencing, but can be reliably identified by Multiplex Ligation-dependent Probe Amplification (MLPA), and account for 5-17% mutations in different populations. Comprehensive mutation testing using these two methods has been facilitated via our centre since 2005. The aim of this study was to investigate the incidence of and phenotype associated with large genomic rearrangements in BRCA1 and BRCA2 in an Irish cohort. An observational cohort study was undertaken. Patients with large genomic rearrangements in BRCA1/BRCA2 were identified from a prospectively maintained database of MLPA test results. Phenotypic and genotypic data were retrieved by chart review. Large genomic rearrangements in BRCA1 were identified in 49 families; and in BRCA2 in 7 families, representing ~11% of mutations in BRCA1/BRCA2 in Ireland. The most common large genomic rearrangement in BRCA1 was deletion of exons 1-23 (11 families, 7 from Co. Galway). Other common mutations included deletions of exon 3 (8 families) and exons 1-2 (6 families). Deletion of exons 19-20 in BRCA2 represented the familial mutation in five families, all from East Ireland (Wexford/Wicklow/Dublin). It is evident that a significant proportion of highly penetrant pathogenic variants in BRCA1 and BRCA2 will be missed if testing is limited to PCR-based Sanger sequencing alone. Screening for large genomic rearrangements in BRCA1 and BRCA2 in the routine diagnostic workflow is critical to avoid false negative results.