Immersive Virtual Reality Medical Simulation: Autonomous Trauma Training Simulator

OPVSim: Applying a Graph-Based Methodology for VR Training in Guided Learning of Emergency Procedures in a Ship's Engineering Room

Virtual Reality (VR) can support effective and scalable training for procedures presented as step-by-step processes in machinery use, such as in an engineering room. Currently, many procedures are trained in closed experiences that do not allow for human errors or interaction with real subjects or machinery. Our goal is to address this gap by using VR training tools for guided procedural learning. To achieve this, we applied an existing methodology for designing such systems, called ProtoColVR, to develop a VR training simulation prototype for emergency procedures within an engineering room on a ship. The simulator, called OPVSim, employs end-to-end instruction, including a VR controls tutorial, step-by-step guided training based on graphs, offering different paths to the same goal, with feedback on correct and incorrect actions. We conducted a study with two groups of participants-cadets in training and experienced officers-to assess the effectiveness of the system developed using the described methodology. The study results reveal positive trends, including increased knowledge scores after using the simulator, and favorable outcomes for the prototype in terms of usability, presence, and workload. We discuss our findings, limitations, and the implications for designing VR training systems for guided procedural learning.

Immersive Virtual Reality Versus Mannequin-based Simulation Training for Trauma Resuscitation: A Randomized Controlled Noninferiority Trial

INTRODUCTION

Despite its high potential, the effect of immersive virtual reality simulation (VRS) in trauma resuscitation training has not been studied. The aim of this study was to test the hypothesis that VRS is non-inferior to mannequin-based simulation (MBS) in trauma resuscitation training.

METHODS

In a single-center, randomized controlled noninferiority trial, we compared individual training with an immersive virtual reality Trauma Simulator to live MBS training in a facilitated group. The primary outcome was the Trauma Score (ranging from 55 to 177) during the MBS assessment. The secondary outcomes were the Trauma Score VRS assessment, System Usability Scale (SUS) (ranging from 0 to 100), and Simulation Sickness Questionnaire (SSQ) (ranging from 0 to 235.62).

RESULTS

A total of 38 participants were enrolled in the study. The mean Trauma Score in MBS assessment was 163.2 (SD 7.9) for the control group and 163.1 (SD 13.8) for the intervention group; the difference of means 0.1 (95% confidence interval: -7.3, 7.5; P = .977). The mean Trauma Score in VRS assessment was 134.2 (SD 24.4) for control group and 158.4 (SD 17.6) for intervention group; the difference of means 24.2 (95% confidence interval: 10.1, 38.3; P = .001). The mean SUS of Trauma Simulator was 74.4 (SD 10.5). The median SSQ Total Severity score was 3.7 (IQR 0-18.7).

CONCLUSIONS

This study showed that VRS led to noninferior effects on trauma resuscitation skills to MBS. Trauma Simulator had good usability, was well received by the participants, and had minimal adverse effects.

Virtual Reality Versus Simulation in the Management of Trauma Based Scenarios-A Systematic Review

Introduction

Simulation allows trainees to practice skills safely. It is the current gold standard method of teaching. More recently, novel methods such as virtual reality and augmented reality are being explored as possible alternative methods.

Aims

To evaluate the current evidence pertaining to simulation and virtual reality as methods of teaching in teaching trauma management.

Methods

Medline and Embase (via Ovid interface) were used to search for articles up to April 2023. A combination of the following MeSH terms were employed in the primary search string - "virtual reality," "simulation," "surgery," "trauma," and "medical education."

Results

3815 studies were initially identified. After de-duplication, 2648 articles were screened using Covidence. Forty articles underwent full text review. Thirteen studies were included in the final review with a pooled total of 489 participants. Significant heterogeneity exists in the range of participants, scenarios and parameters assessed. The overall self-reported perception of VR as a teaching modality is positive and is well accepted however objective assessment and validation is needed.

Conclusion

VR can be useful for training and evaluation of trauma-based scenarios. It is a useful adjunct but is unlikely to replace simulation at present. More robust and replicable studies with larger sample sizes are needed to evaluate the long-term integration of virtual reality and augmented reality into the medical and surgical teaching curriculum.

The Trauma Training Score: A Novel and Objective Method for Performance Evaluation

BACKGROUND

Assessing proficiency in the initial management of a traumatically injured patient is challenging. Previously developed scoring tools frequently looked to evaluate single domains of a trauma leader or team's performance. An updated multi-domain scoring tool is needed to evaluate individual and group performance in the initial phases of trauma resuscitation.

METHODS

 The modified Delphi technique was used to improve and obtain consensus on a multi-domain trauma training score (TTS). Subject matter experts (SMEs) in trauma across the United States were contacted electronically to consider voluntary participation in this study. Elective participants electronically received and commented on statements related to the 10 separate domains of a proposed TTS. These statements were evaluated using a 5-point Likert scale ranging from "Strongly Agree" to "Strongly Disagree". Feedback from the SMEs was used to modify each domain that did not receive consensus, and repeat iterations were performed until 80% or greater consensus was achieved. Internal consistency was measured using Cronbach's-ɑ, with a goal of greater than 0.8.

RESULTS

Twenty-eight SMEs elected to participate in the modified Delphi process representing emergency medicine, trauma surgery, and critical care. Consensus was achieved when 80% or greater of the SMEs responded with a 4 or a 5 to each statement. Four total rounds of review and modification were required to achieve consensus on all statements. Cronbach's-ɑ for each round was greater than 0.85.

DISCUSSION

 A unifying standardized outcome for measuring performance in the initial phases of trauma resuscitation is needed. The TTS developed in this study used expert consensus to provide a multi-domain means of evaluating trauma practitioners of all levels in both live and simulated patients.

Virtual reality simulation to enhance advanced trauma life support trainings - a randomized controlled trial

BACKGROUND

Advanced Trauma Life Support (ATLS) is the gold standard of initial assessment of trauma patients and therefore a widely used training program for medical professionals. Practical application of the knowledge taught can be challenging for medical students and inexperienced clinicians. Simulation-based training, including virtual reality (VR), has proven to be a valuable adjunct to real-world experiences in trauma education. Previous studies have demonstrated the effectiveness of VR simulations for surgical and technical skills training. However, there is limited evidence on VR simulation training specifically for trauma education, particularly within the ATLS curriculum. The purpose of this pilot study is to evaluate the feasibility, effectiveness, and acceptance of using a fully immersive VR trauma simulation to prepare medical students for the ATLS course.

METHODS

This was a prospective randomised controlled pilot study on a convenience sample of advanced medical students (n = 56; intervention group with adjunct training using a commercially available semi-automated trauma VR simulation, n = 28, vs control group, n = 28) taking part in the ATLS course of the Military Physician Officer School. Feasibility was assessed by evaluating factors related to technical factors of the VR training (e.g. rate of interruptions and premature termination). Objective and subjective effectiveness was assessed using confidence ratings at four pre-specified points in the curriculum, validated surveys, clinical scenario scores, multiple choice knowledge tests, and ATLS final clinical scenario and course pass rates. Acceptance was measured using validated instruments to assess variables of media use (Technology acceptance, usability, presence and immersion, workload, and user satisfaction).

RESULTS

The feasibility assessment demonstrated that only one premature termination occurred and that all remaining participants in the intervention group correctly stabilised the patient. No significant differences between the two groups in terms of objective effectiveness were observed (p = 0.832 and p = 0.237 for the pretest and final knowledge test, respectively; p = 0.485 for the pass rates for the final clinical scenario on the first attempt; all participants passed the ATLS course). In terms of subjective effectiveness, the authors found significantly improved confidence post-VR intervention (p < .001) in providing emergency care using the ATLS principles. Perceived usefulness in the TEI was stated with a mean of 4 (SD 0.8; range 0-5). Overall acceptance and usability of the VR simulation was rated as positive (System Usability Scale total score mean 79.4 (SD 11.3, range 0-100).

CONCLUSIONS

The findings of this prospective pilot study indicate the potential of using VR trauma simulations as a feasible and acceptable supplementary tool for the ATLS training course. Where objective effectiveness regarding test and scenario scores remained unchanged, subjective effectiveness demonstrated improvement. Future research should focus on identifying specific scenarios and domains where VR can outperform or enhance traditional learning methods in trauma simulation.

ProtoColVR: Requirements Gathering and Collaborative Rapid Prototyping of VR Training Simulators for Multidisciplinary Teams

We present ProtoColVR, a methodology and a plugin designed for gathering requirements and collaborative rapid prototyping of virtual reality training simulators. Our methodology outlines the utilization of current technologies, the involvement of stakeholders during design and development, and the implementation of simulator creation through multiple iterations. We incorporate open-source tools and freely available environments like Twine and Unity to establish a reference implementation for requirements gathering and rapid prototyping. ProtoColVR is the outcome of our collaboration with a hospital and our Navy, and it has undergone testing in a development Jam. From these tests, we have gained valuable insights, including the ability to create functional prototypes within multidisciplinary teams, enhance communication among different roles, and streamline requirements gathering while improving our understanding of the virtualized environment.

Educational effects of and satisfaction with mixed-reality-based major trauma care simulator: A preliminary evaluation

Mixed reality (MR) is a hybrid system that projects virtual elements into reality. MR technology provides immersive learning using various real-world tools. However, studies on educational programs using MR are scarce. This study aimed to investigate the educational effects of and satisfaction with an MR-based trauma decision-making simulator. A total 40 of trainees self-selected to participate in this study. All of them participated in the MR trauma simulator for approximately 30 minutes and conducted voluntary learning without any external help. Declarative knowledge, measured using 20 multiple-choice questions, was assessed before and after MR trauma training. To confirm the educational effect, test scores before and after MR trauma training were compared using a paired t-test. Student satisfaction after training was measured using a ten-item questionnaire rated on a five-point Likert scale. A pretest-posttest comparison yielded a significant increase in declarative knowledge. The percentage of correct answers to multiple choice questions increased (from a mean of 42.3, SD 12.4-54.8, SD 13) after the MR-based trauma assessment and treatment training (P < .001). Of the participants, 79.45% were satisfied with the overall experience of using the MR simulator. This study demonstrated a meaningful educational effect of the MR-based trauma training system even after a short training time.

Practicing Emergency Medicine in the Metaverse: A Novel Mixed Reality Casualty Care Training Platform

BACKGROUND

Current casualty care training modalities present several challenges, including limited simulation facilities, instructor dependence, lack of standardization, documentation of trainees' performance and training personalization. The study presents the design, development and preliminary evaluation of a novel hybrid training platform to address these challenges.

METHODS

A mixed reality platform was chosen and developed to address field operators' requirements. The platform is easy to operate and can be set up by laypeople within 20-min in multiple environments. Individual-level training documentation is generated autonomously following each session, evaluating 30 aspects of performance. From this, a unique aggregated dataset emerges as a substrate for executives' dashboards and intelligent planning of future sessions.

RESULTS

An evaluation process took part using simulator-based training in different stages along the project using a questionnaire (Likert-scale based). Fifty military physicians took part in an identical head injury scenario requiring airway management by endotracheal intubation and were immediately surveyed.

CONCLUSION

TrauMR is an agile hybrid training that harbors the potential to address many of the emerging challenges of training for prehospital care in combat and civilian environments.

[Simulators and other tools in orthopedic-trauma surgery training]

INTRODUCTION

The classic paradigm of "learning on the patient in the operating room" is more and more in conflict with the growing requirements of cost-efficient work and patient safety. With the technology available today for simulator systems, the accessibility of digital tools and the development of a metaverse as a digital meeting place result in various application scenarios and alternatives to classic orthopedic training.

SIMULATORS

First VR-desktop simulations in orthopedics and traumatology were developed more than 20 years ago. VR-desktop simulators consist of a computer with a video screen and a joint model. Different instruments can be paired with this system and allow haptic feedback. With innovative software, numerous training programs can be selected, and the user receives precise feedback on their performance. Immersive VR simulators have also played an increasingly important role in recent years.

OTHER DIGITAL TOOLS

The use of digital media such as audio and video podcasts as learning and information sources increased in the context of COVID-19. There is also an increasing number of orthopedic and trauma surgery topics on social media platforms. In all fields, however, there is a risk of the spread of misinformation. A quality standard must be maintained.

EFFECTIVENESS AND UTILITY OF THE TRAINING

In order to evaluate simulators and their value as a training tool, it is important to comply with various validity criteria. Transfer validity plays an essential role for clinical application. Various studies demonstrate that the skills learned on simulators can also be successfully transferred to real clinical scenarios.

DISCUSSION

A lack of availability, costs and high effort are limitations of classic training methods. In contrast, there are versatile use cases of VR-based simulations that are individually adapted to the trainees and cannot endanger patients. The still high acquisition costs, technical obstacles and the not yet widespread availability are limiting factors. The metaverse still offers unimaginable possibilities today to transfer VR-based applications to experimental learning methods.

IMPLEMENTATION OF A DYNAMIC AND EXTENSIBLE MECHANICAL VENTILATOR MODEL FOR REAL-TIME PHYSIOLOGICAL SIMULATION

We have designed and implemented a generic virtual mechanical ventilator model into the open-source Pulse Physiology Engine for real-time medical simulation. The universal data model is uniquely designed to apply all modes of ventilation and allow for modification of the fluid mechanics circuit parameters. The ventilator methodology provides a connection to the existing Pulse respiratory system for spontaneous breathing and gas/aerosol substance transport. The existing Pulse Explorer application was extended to include a new ventilator monitor screen with variable modes and settings and a dynamic output display. Proper functionality was validated by simulating the same patient pathophysiology and ventilator settings virtually in Pulse as a physical lung simulator and ventilator setup.

Augmented reality for teaching anatomy

Successive waves of the coronavirus (COVID-19) pandemic lockdowns resulted in significant reduction in face-to-face teaching, with an adverse effect especially on sectors requiring direct skill acquisition. Despite the fact that augmented reality (AR) presents an equitable, cost-effective solution which reduces crowding in the confined spaces of the dissection theater, the benefits of AR-supported undergraduate medical education have been poorly investigated. We conducted a validated survey to explore the value of AR in the dissection theater and assess its impact from the learner's perspective. Further to a validated pilot (n = 30), a larger scale study (n = 130) was conducted to assess the introduction of AR across three different learning domains: retaining anatomy detail, perception of spatial anatomical relations, and speed of learning. A response rate of 85.4% was reported. Our results suggest that the use of AR technology leads to a significant enhancement of spatial relations, faster detailed material assimilation and assistance in understanding of key concepts. In addition, most participants opt to recommend AR as a valuable tool in the learning process. In view of the proposed added value of AR technology in various teaching aspects, we recommend that AR should be introduced as a standard practice in both pre- and postgraduate medical curricula and suggest further research regarding the use of this technology.

Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint

The COVID-19 pandemic caused widespread challenges and revealed vulnerabilities across global health care systems. In response, many health care providers turned to telehealth solutions, which have been widely embraced and are likely to become standard for modern care. Immersive extended reality (XR) technologies have the potential to enhance telehealth with greater acceptability, engagement, and presence. However, numerous technical, logistic, and clinical barriers remain to the incorporation of XR technology into telehealth practice. COVID-19 may accelerate the union of XR and telehealth as researchers explore novel solutions to close social distances. In this viewpoint, we highlight research demonstrations of XR telehealth during the COVID-19 pandemic and discuss future directions to make XR the next evolution of remote health care.