Simulation for team training and assessment: case studies of online training with virtual worlds
Individuals in clinical training programs concerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and frequently repetitive. The widely substituted alternative for real patients—high-fidelity, manikin-based simulators (human patient simulator)—are expensive and require trainees to be in the same place at the same time, whereas online computer-based simulations, or virtual worlds, allow simultaneous participation from different locations. Here we present three virtual world studies for team training and assessment in acute-care medicine: (1) training emergency department (ED) teams to manage individual trauma cases; (2) prehospital and in-hospital disaster preparedness training; (3) training ED and hospital staff to manage mass casualties after chemical, biological, radiological, nuclear, or explosive incidents. The research team created realistic virtual victims of trauma (6 cases), nerve toxin exposure (10 cases), and blast trauma (10 cases); the latter two groups were supported by rules-based, pathophysiologic models of asphyxia and hypovolemia. Evaluation of these virtual world simulation exercises shows that trainees find them to be adequately realistic to ‘‘suspend disbelief,’’ and they quickly learn to use Internet voice communication and user interface to navigate their online character/avatar to work effectively in a critical care team. Our findings demonstrate that these virtual ED environments fulfill their promise of providing repeated practice opportunities in dispersed locations with uncommon, life-threatening trauma cases in a safe, reproducible, flexible setting.
Simulation of scenarios
- Creation of virtual reality learning environments through software.- Surveys and focus groups discussions
Subject to each of the studies:E.g. 3rd Study: 5-point Likert-scale ratings to show confidence in ability to respond to a CBRNE incident (before and after trainings).
1st Study: Training sessions conducted with students/interns randomly assigned either to human-patient simulator (HPS) or to a virtual world (VW). Additionally, trainees were given pretest and posttest cases, where experienced clinicians observed the performance and assigned scores.2nd Study:Teams were composed of experienced paramedics, EMT team members, and ED physicians. Satisfaction survey completed in the end of the sessions + focus group discussion.3rd Study:Participants were physicians and nurses, who were evaluated on 2 different groups with debriefing sessions and surveys + open discussion.
Through surveys and debriefing sessions.
Three virtual world studies for team training and assessment in acute-care medicine are presented:Training emergency department (ED) teamsPrehospital and in-hospital disaster preparedness trainingTraining ED and hospital staff to manage mass casualties
The authors recognize that these studies concern team training in emergency medicine and are not for surgical teams; however, they assert that the virtual world concepts and methods are applicable to both.The key technology issue is identifying and using a software platform onto which an application can easily be built.
Advantages of using virtual worlds training were concluded to be: The exact layout and location of resources of specific EDs can be replicated.Trainees do not have to be present at the same location to play their avatar roles.Drills can be conducted at any time of day or night to accommodate trainees’ schedules.A variety of patient scenarios and conditions can be modeled to simulate individual patient cases or multiple victims in complex clinical situations.Dangerous and/or infrequently occurring situations can be presented.Scenarios can be run more than once during a short period of time, allowing trainees to learn from their mistakes.Trainees’ performance during the simulation can be captured for playback and assessment after the event
Evaluation of these virtual world simulation exercises shows that trainees find them to be adequately realistic to ‘‘suspend disbelief,’’ and they quickly learn to use Internet voice communication and user interface to navigate their online character/avatar to work effectively in a critical care team.1st Study: Training sessions conducted with students/interns randomly assigned either to human-patient simulator (HPS) or to a virtual world (VW) for trauma cases simulations. 2nd Study:3D virtual simulation of 2 worlds for the rapid response to a chemical, biologic, radiologic, nuclear, or highly explosive (CBRNE) incident.3rd Study:Creation of a 3D virtual world replica of the Stanford emergency department for training hospital staff to assess and manage mass casualties after a CBRNE incident.
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