Challenges, solutions, and best practices in telemental health service delivery across the pacific rim-a summary.

The Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, in conjunction with the American Telemedicine Association's Annual Mid-Year Meeting, conducted a 1-day workshop on how maturing and emerging processes and applications in the field of telemental health (TMH) can be expanded to enhance access to behavioral health services in the Pacific Rim. The purpose of the workshop was to bring together experts in the field of TMH from the military, federal agencies, academia, and regional healthcare organizations serving populations in the Pacific Rim. The workshop reviewed current technologies and systems to better understand their current and potential applications to regional challenges, including the Department of Defense and other federal organizations. The meeting was attended by approximately 100 participants, representing military, government, academia, healthcare centers, and tribal organizations. It was organized into four sessions focusing on the following topic areas: (1) Remote Screening and Assessment; (2) Post-Deployment Adjustment Mental Health Treatment; (3) Suicide Prevention and Management; and (4) Delivery of Training, Education, and Mental Health Work Force Development. The meeting's goal was to discuss challenges, gaps, and collaborative opportunities in this area to enhance existing or create new opportunities for collaborations in the delivery of TMH services to the populations of the Pacific Rim. A set of recommendations for collaboration are presented.

Transforming an educational virtual reality simulation into a work of fine art.

This paper outlines user interface and interaction issues, technical considerations, and problems encountered in transforming an educational VR simulation of a reified kidney nephron into an interactive artwork appropriate for a fine arts museum.

Algorithmically generated music enhances VR nephron simulation.

While sonification has enjoyed much attention in VR simulation studies, music has generally been incorporated as ambiance. This is partially due to difficulties with manipulating it interactively in real-time while maintaining a sensible musicality. This paper discusses how algorithmically generated music is used to provide ambiance, characterize the visual representation of molecular particle flow, provide orientation cues to the user, and enhance recognition of chemical gradient balances in a reified model of the kidney nephron. The technical obstacles related to the use of music in this context are also addressed.

Reification of abstract concepts to improve comprehension using interactive virtual environments and a knowledge-based design: a renal physiology model.

Several abstract concepts in medical education are difficult to teach and comprehend. In order to address this challenge, we have been applying the approach of reification of abstract concepts using interactive virtual environments and a knowledge-based design. Reification is the process of making abstract concepts and events, beyond the realm of direct human experience, concrete and accessible to teachers and learners. Entering virtual worlds and simulations not otherwise easily accessible provides an opportunity to create, study, and evaluate the emergence of knowledge and comprehension from the direct interaction of learners with otherwise complex abstract ideas and principles by bringing them to life. Using a knowledge-based design process and appropriate subject matter experts, knowledge structure methods are applied in order to prioritize, characterize important relationships, and create a concept map that can be integrated into the reified models that are subsequently developed. Applying these principles, our interdisciplinary team has been developing a reified model of the nephron into which important physiologic functions can be integrated and rendered into a three dimensional virtual environment called Flatland, a virtual environments development software tool, within which a learners can interact using off-the-shelf hardware. The nephron model can be driven dynamically by a rules-based artificial intelligence engine, applying the rules and concepts developed in conjunction with the subject matter experts. In the future, the nephron model can be used to interactively demonstrate a number of physiologic principles or a variety of pathological processes that may be difficult to teach and understand. In addition, this approach to reification can be applied to a host of other physiologic and pathological concepts in other systems. These methods will require further evaluation to determine their impact and role in learning.

Affordable virtual environments: building a virtual beach for clinical use.

Virtual Reality has been used for clinical application for about 10 years and has proved to be an effective tool for treating various disorders. In this paper, we want to share our experience in building a 3D, motion tracked, immersive VR system for pain treatment and biofeedback research.

Virtual reality training improves students' knowledge structures of medical concepts.

Virtual environments can provide training that is difficult to achieve under normal circumstances. Medical students can work on high-risk cases in a realistic, time-critical environment, where students practice skills in a cognitively demanding and emotionally compelling situation. Research from cognitive science has shown that as students acquire domain expertise, their semantic organization of core domain concepts become more similar to those of an expert's. In the current study, we hypothesized that students' knowledge structures would become more expert-like as a result of their diagnosing and treating a patient experiencing a hematoma within a virtual environment. Forty-eight medical students diagnosed and treated a hematoma case within a fully immersed virtual environment. Student's semantic organization of 25 case-related concepts was assessed prior to and after training. Students' knowledge structures became more integrated and similar to an expert knowledge structure of the concepts as a result of the learning experience. The methods used here for eliciting, representing, and evaluating knowledge structures offer a sensitive and objective means for evaluating student learning in virtual environments and medical simulations.

Anatomy and the access grid: exploiting plastinated brain sections for use in distributed medical education.

Computerized animation is becoming an increasingly popular method to provide dynamic presentation of anatomical concepts. However, most animations use artistic renderings as the base illustrations that are subsequently altered to depict movement. In most cases, the artistic rendering is a schematic that lacks realism. Plastinated sections provide a useful alternative to artistic renderings to serve as a base image for animation. The purpose of this study is to describe a method for developing animations by using plastinated sections. This application is used in Project TOUCH as a supplemental learning tool for a problem-based learning case distributed over the National Computational Science Alliance's Access Grid. The case involves traumatic head injury that results in an epidural hematoma with transtentorial uncal herniation. In addition, a subdural hematoma is animated permitting the student to contrast the two processes for a better understanding of dural hematomas, in general. The method outlined uses P40 plastinated coronal brain sections that are digitized and to which contiguous anatomical structures are rendered. The base illustration is rendered, interpolated, and viewed while audio narration describes the event. This method demonstrates how realistic anatomical animations can be generated quickly and inexpensively for medical education purposes by using plastinated brain sections.

Integration of advanced technologies to enhance problem-based learning over distance: Project TOUCH.

Distance education delivery has increased dramatically in recent years as a result of the rapid advancement of communication technology. The National Computational Science Alliance's Access Grid represents a significant advancement in communication technology with potential for distance medical education. The purpose of this study is to provide an overview of the TOUCH project (Telehealth Outreach for Unified Community Health; http://hsc.unm.edu/touch) with special emphasis on the process of problem-based learning case development for distribution over the Access Grid. The objective of the TOUCH project is to use emerging Internet-based technology to overcome geographic barriers for delivery of tutorial sessions to medical students pursuing rotations at remote sites. The TOUCH project also is aimed at developing a patient simulation engine and an immersive virtual reality environment to achieve a realistic health care scenario enhancing the learning experience. A traumatic head injury case is developed and distributed over the Access Grid as a demonstration of the TOUCH system. Project TOUCH serves as an example of a computer-based learning system for developing and implementing problem-based learning cases within the medical curriculum, but this system should be easily applied to other educational environments and disciplines involving functional and clinical anatomy. Future phases will explore PC versions of the TOUCH cases for increased distribution.

Virtual patient simulator for distributed collaborative medical education.

Project TOUCH (Telehealth Outreach for Unified Community Health; http://hsc.unm.edu/touch) investigates the feasibility of using advanced technologies to enhance education in an innovative problem-based learning format currently being used in medical school curricula, applying specific clinical case models, and deploying to remote sites/workstations. The University of New Mexico's School of Medicine and the John A. Burns School of Medicine at the University of Hawai'i face similar health care challenges in providing and delivering services and training to remote and rural areas. Recognizing that health care needs are local and require local solutions, both states are committed to improving health care delivery to their unique populations by sharing information and experiences through emerging telehealth technologies by using high-performance computing and communications resources. The purpose of this study is to describe the deployment of a problem-based learning case distributed over the National Computational Science Alliance's Access Grid. Emphasis is placed on the underlying technical components of the TOUCH project, including the virtual reality development tool Flatland, the artificial intelligence-based simulation engine, the Access Grid, high-performance computing platforms, and the software that connects them all. In addition, educational and technical challenges for Project TOUCH are identified.

Distributed interactive virtual environments for collaborative medical education and training: design and characterization.

Project TOUCH (Telehealth Outreach for Unified Community Health) is a collaborative effort between University of New Mexico and University of Hawaii. The purpose of the project is to demonstrate the feasibility of using advanced technologies to overcome geographical barriers to delivery of medical education and to enhance the learning process within a group setting. This has led to the design and implementation of a new system that addresses the critical requirements for collaborative virtual environments: consistency, networking, scalability, and system integration. The objective of this study is to evaluate the performance of the collaborative system based on use patterns during Project TOUCH sessions.

Distributed interactive virtual environments for collaborative experiential learning and training independent of distance over Internet2.

Medical knowledge and skills essential for tomorrow's healthcare professionals continue to change faster than ever before creating new demands in medical education. Project TOUCH (Telehealth Outreach for Unified Community Health) has been developing methods to enhance learning by coupling innovations in medical education with advanced technology in high performance computing and next generation Internet2 embedded in virtual reality environments (VRE), artificial intelligence and experiential active learning. Simulations have been used in education and training to allow learners to make mistakes safely in lieu of real-life situations, learn from those mistakes and ultimately improve performance by subsequent avoidance of those mistakes. Distributed virtual interactive environments are used over distance to enable learning and participation in dynamic, problem-based, clinical, artificial intelligence rules-based, virtual simulations. The virtual reality patient is programmed to dynamically change over time and respond to the manipulations by the learner. Participants are fully immersed within the VRE platform using a head-mounted display and tracker system. Navigation, locomotion and handling of objects are accomplished using a joy-wand. Distribution is managed via the Internet2 Access Grid using point-to-point or multi-casting connectivity through which the participants can interact. Medical students in Hawaii and New Mexico (NM) participated collaboratively in problem solving and managing of a simulated patient with a closed head injury in VRE; dividing tasks, handing off objects, and functioning as a team. Students stated that opportunities to make mistakes and repeat actions in the VRE were extremely helpful in learning specific principles. VRE created higher performance expectations and some anxiety among VRE users. VRE orientation was adequate but students needed time to adapt and practice in order to improve efficiency. This was also demonstrated successfully between Western Australia and UNM. We successfully demonstrated the ability to fully immerse participants in a distributed virtual environment independent of distance for collaborative team interaction in medical simulation designed for education and training. The ability to make mistakes in a safe environment is well received by students and has a positive impact on their understanding, as well as memory of the principles involved in correcting those mistakes. Bringing people together as virtual teams for interactive experiential learning and collaborative training, independent of distance, provides a platform for distributed "just-in-time" training, performance assessment and credentialing. Further validation is necessary to determine the potential value of the distributed VRE in knowledge transfer, improved future performance and should entail training participants to competence in using these tools.

Medical students learn over distance using virtual reality simulation.

INTRODUCTION: This article presents the results of a demonstration project that was designed with the goal to determine the feasibility and acceptability of medical students in using distance technology and virtual reality (VR) simulation within a problem-based learning (PBL). METHODS: This pilot project involved students from the Universities of New Mexico and Hawaii and compared (1) control groups consisting of medical students in a tutor-guided PBL session using a text-based case, (2) distance groups using the same text-based case but interacting over distance from multiple sites, (3) groups using a VR simulation scenario integrated into the case without interaction over distance, and (4) combination groups interacting over distance from multiple sites with integration of a VR simulation scenario. RESULTS: The study results suggest that it is possible to successfully conduct a PBL tutorial with medical students from two institutions with the integration VR and distributed distance interaction in combination or independently. The addition of these modalities did not interfere with learning dynamics when compared with traditional tutorial sessions. CONCLUSIONS: These findings suggest the feasibility and acceptability by students in the use of VR simulation integrated into a PBL learning session, as well as multipoint distance technologies that allowed interaction between students and tutors in different locations. The authors believe that these modalities can be applied where students and tutors from different institutions are in separate locations and can be used to support interactive experiential learning in a distributed network or on site and suggest areas for additional research.