Collaborative virtual reality based advanced cardiac life support training simulator using virtual reality principles.

BACKGROUND: Advanced Cardiac Life Support (ACLS) is a series of team-based, sequential and time constrained interventions, requiring effective communication and coordination of activities that are performed by the care provider team on a patient undergoing cardiac arrest or respiratory failure. The state-of-the-art ACLS training is conducted in a face-to-face environment under expert supervision and suffers from several drawbacks including conflicting care provider schedules and high cost of training equipment. OBJECTIVE: The major objective of the study is to describe, including the design, implementation, and evaluation of a novel approach of delivering ACLS training to care providers using the proposed virtual reality simulator that can overcome the challenges and drawbacks imposed by the traditional face-to-face training method. METHODS: We compare the efficacy and performance outcomes associated with traditional ACLS training with the proposed novel approach of using a virtual reality (VR) based ACLS training simulator. One hundred and forty-eight (148) ACLS certified clinicians, translating into 26 care provider teams, were enrolled for this study. Each team was randomly assigned to one of the three treatment groups: control (traditional ACLS training), persuasive (VR ACLS training with comprehensive feedback components), or minimally persuasive (VR ACLS training with limited feedback components). The teams were tested across two different ACLS procedures that vary in the degree of task complexity: ventricular fibrillation or tachycardia (VFib/VTach) and pulseless electric activity (PEA). RESULTS: The difference in performance between control and persuasive groups was not statistically significant (P=.37 for PEA and P=.1 for VFib/VTach). However, the difference in performance between control and minimally persuasive groups was significant (P=.05 for PEA and P=.02 for VFib/VTach). The pre-post comparison of performances of the groups showed that control (P=.017 for PEA, P=.01 for VFib/VTach) and persuasive (P=.02 for PEA, P=.048 for VFib/VTach) groups improved their performances significantly, whereas minimally persuasive group did not (P=.45 for PEA, P=.46 for VFib/VTach). Results also suggest that the benefit of persuasiveness is constrained by the potentially interruptive nature of these features. CONCLUSIONS: Our results indicate that the VR-based ACLS training with proper feedback components can provide a learning experience similar to face-to-face training, and therefore could serve as a more easily accessed supplementary training tool to the traditional ACLS training. Our findings also suggest that the degree of persuasive features in VR environments have to be designed considering the interruptive nature of the feedback elements.

Design and development of a virtual reality simulator for advanced cardiac life support training.

The use of virtual reality (VR) training tools for medical education could lead to improvements in the skills of clinicians while providing economic incentives for healthcare institutions. The use of VR tools can also mitigate some of the drawbacks currently associated with providing medical training in a traditional clinical environment such as scheduling conflicts and the need for specialized equipment (e.g., high-fidelity manikins). This paper presents the details of the framework and the development methodology associated with a VR-based training simulator for advanced cardiac life support, a time critical, team-based medical scenario. In addition, we also report the key findings of a usability study conducted to assess the efficacy of various features of this VR simulator through a postuse questionnaire administered to various care providers. The usability questionnaires were completed by two groups that used two different versions of the VR simulator. One version consisted of the VR trainer with it all its features and a minified version with certain immersive features disabled. We found an increase in usability scores from the minified group to the full VR group.

The validity of take-home surgical simulators to enhance resident technical skill proficiency.

BACKGROUND: It is unknown whether surgical residents who learn minimal-access surgery skills in an unstructured environment (ie, at home), will develop a technical skill set that rivals that of those trained in the more traditional, structured learning environment. METHODS: Seven surgery residents were provided structured learning through didactic and hands-on skills training sessions and consistent supervision throughout training. A second group of 7 residents participated in an unstructured learning curriculum of training without supervision. End points were determined at the end of training using a standardized simulator based on predetermined performance measures. RESULTS: Both groups achieved high task scores, with comparable scores on gesture proficiency, hand movement smoothness, instrument movement smoothness, errors, and time elapsed. There was no significant difference between group differences in final skills scores. CONCLUSIONS: Unstructured learning is equally effective in delivering quality skills training when compared with structured training.

Impact of fatigue on neurophysiologic measures of surgical residents.

BACKGROUND: To gain additional insight into the impact of fatigue on surgery resident proficiency, we set out to quantify its impact on behavioral and neurophysiologic measures. STUDY DESIGN: Simulations were first created using a visio-haptic joystick attached to a surgical instrument (tool) that allows realistic interactions. Before baseline (pre-call) and after call, 7 PGY1 surgery residents performed simulation tasks that required varying levels of psychomotor and cognitive skill. Residents completed 3 sessions per week for 4 weeks. Surgical proficiency was established using 5 metrics: hand movement smoothness; instrument movement smoothness; time to task completion; gesture level proficiency and cognitive errors. Data (percent change from baseline, pre-call) were analyzed using repeated measures ANOVA. While performing these tasks, the residents also wore an EEG cap (B-Alert; Advanced Brain Monitoring), the data from which provided second to second insight into the effects of workload, distraction, and attention on task performance. Mean (±SD) pre-call and post-call values for each were analyzed using repeated measures ANOVA. RESULTS: Residents experienced significant (p < 0.014) post-call erosions in surgical proficiency, punctuated by dramatic increases in cognitive errors. EEG-based attention scores showed a significant (p < 0.014) concomitant decrement of 40%; distraction/drowsiness scores increased by 91%; and workload score increased by 51%. CONCLUSIONS: Fatigue adversely affects PGY1 resident surgical proficiency and neurophysiologic performance.

Toward effective pediatric minimally invasive surgical simulation.

BACKGROUND/PURPOSE: Simulation is increasingly being recognized as an important tool in the training and evaluation of surgeons. Currently, there is no simulator that is specific to pediatric minimally invasive surgery (MIS). A fundamental technical difference between adult and pediatric MIS is the degree of motion scaling. Smaller instruments and areas of dissection under greater optical magnification require finer, more precise hand movements. We hypothesized that this can be used to detect differences in skills proficiency between pediatric and general surgeons. METHODS: We programmed a virtual reality simulation of intracorporeal suturing with modes that used motion scaling to mimic conditions of either adult or pediatric MIS. The participants consisted of pediatric and general surgeons who wore motion-sensing gloves. Metrics included time elapsed, penetration errors, tool movement smoothness, hand movement smoothness, and gesture level proficiency. RESULTS: For all measures, pediatric surgeons demonstrated superior proficiency on exercises conducted in pediatric conditions (P < .05). Performance in adult conditions was similar between the 2 groups. CONCLUSION: Pediatric surgeons possess unique skills compared with general surgeons that relate to the technical challenges they routinely face, reinforcing the need for a surgical simulator specific to pediatric MIS. This validates our simulator and the manipulation of motion scaling as a useful training tool.

Quantitative evaluation of retention of surgical skills learned in simulation.

BACKGROUND: While initial results suggest that simulation does promote learning, there is a dearth of studies that define the extent to which skills learned through simulation are retained. METHODS: Residents skills were measured upon completion of an initial simulation training (baseline scores) and then every month for 6 months. Analysis was also performed to identify the number of iterations of practice required to regain baseline scores. RESULTS: While skill scores did not deteriorate from baseline after the first 3 months (p = 0.61, p = 0.44, p = 0.2, respectively), all scores (except time elapsed) reflected significant deterioration from the fourth month onward (p < 0.05, p < 0.032, p < 0.02). However the number of practice sessions required to regain baseline scores was significantly less than that required to achieve the baseline skill set (p < 0.0003). CONCLUSIONS: Skills learned through simulation show significant deterioration over long periods of time, suggesting that periodic retraining of skills may be necessary to maintain surgical proficiency.

Effects of duty hours and time of day on surgery resident proficiency.

BACKGROUND: Night floats have evolved in the era of limited resident work hours. This study was designed to define the effect of restricted nighttime duty hours on the psychomotor and cognitive skills of surgery residents. METHODS: To quantify the effect of fatigue on the skills of residents on day-shift and night-float rotations, residents were asked to complete visuohaptic simulations before and after 12-hour duty periods and to rate their fatigue level with questionnaires. RESULTS: Both groups showed significant decrements in proficiency measures after their shifts compared with baseline. The night-float group showed more significant declines (P < .05) in all areas assessed than the day-shift group. The night-float group was significantly less proficient in cognitive tasks after their shifts compared with the day-shift group. CONCLUSIONS: The deterioration of surgical proficiency is to a degree dependent on the time of day during which call occurs, not solely on the length of call.