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Foronda CL, Gonzalez L, Meese MM, Slamon N, Baluyot M, Lee J, Aebersold M. A Comparison of Virtual Reality to Traditional Simulation in Health Professions Education: A Systematic Review. Simul Healthc 2024; 19:S90-S97. [PMID: 37651101 DOI: 10.1097/sih.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
ABSTRACT With the increasing availability of virtual reality (VR) and its lower overall costs of use, the objective of this review was to compare VR to traditional simulation in terms of learning outcomes. Studies were included if they met the following criteria: ( a ) research study (of any design), ( b ) focused on learners in health professions, and ( c ) compared VR with traditional simulation. Studies were excluded for the following reasons: ( a ) not a research study, ( b ) focused on learners outside health professions, ( c ) used screen-based or computer-based simulation, ( d ) used a task trainer, and ( e ) did not involve a comparison of VR to traditional simulation. The searches were run on November 11 and 12, 2021, in CINAHL via EBSCO, Ovid Embase, ERIC via EBSCO, IEEE Xplore, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the review. A team of researchers applied Kirkpatrick's Levels, Melnyk's Levels of Evidence, and Critical Appraisal Skills Programme guidelines to assess the level of evidence and look for bias. Fifteen studies were reviewed including 11 randomized controlled trials. The lead researcher synthesized the study results into 3 categories: (1) traditional simulation performed better, (2) VR performed better, and (3) comparable outcomes. There is insufficient evidence to endorse one form of simulation (VR or traditional) as more effective at this time. The body of evidence contained too few studies to draw meaningful conclusions to answer the guiding question. The studies covered a large range of modalities, learner groups, and healthcare topics, preventing a meta-analysis. Based on the literature and experience, we recommend that VR experiences be proctored, include debriefing, have a backup plan for cybersickness or myopia, and have time and costs documented. Use of VR is likely to expand; thus, research is needed to inform the best contexts and applications.
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Affiliation(s)
- Cynthia L Foronda
- From the University of Miami School of Nursing and Health Studies, Coral Gables, FL (C.L.F.); Clinical Learning Resources, Sentinel U, Waterbury, CT (L.G.); Department of Anesthesiology and Perioperative Medicine, UAB Medicine, University of Alabama at Birmingham, Birmingham, AL (M.M.M.); The Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA (N.S.); Nemours/duPont Hospital for Children, Wilmington, DE (N.S.); Divisions of Pediatric Emergency Medicine and Simulation, Department of Emergency Medicine, Riley Hospital for Children/Indiana University Health, Indianapolis, IN (M.B.); School of Nursing and Health Studies, University of Miami, Coral Gables (J.L.); and University of Michigan School of Nursing, Ann Arbor, MI (M.A.)
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Kanschik D, Bruno RR, Wolff G, Kelm M, Jung C. Virtual and augmented reality in intensive care medicine: a systematic review. Ann Intensive Care 2023; 13:81. [PMID: 37695464 PMCID: PMC10495307 DOI: 10.1186/s13613-023-01176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Virtual reality (VR) and augmented reality (AR) are rapidly developing technologies that offer a wide range of applications and enable users to experience digitally rendered content in both physical and virtual space. Although the number of studies about the different use of VR and AR increases year by year, a systematic overview of the applications of these innovative technologies in intensive care medicine is lacking. The aim of this systematic review was to provide a detailed summary of how VR and AR are currently being used in various areas of intensive care medicine. METHODS We systematically searched PubMed until 1st March 2023 to identify the currently existing evidence for different applications of VR and AR for both health care providers in the intensive care unit and children or adults, who were in an intensive care unit because of a critical illness. RESULTS After screening the literature, a total of 59 studies were included. Of note, a substantial number of publications consists of case reports, study plans or are lacking a control group. Furthermore, study designs are seldom comparable. However, there have been a variety of use cases for VR and AR that researchers have explored. They can help intensive care unit (ICU) personnel train, plan, and perform difficult procedures such as cardiopulmonary resuscitation, vascular punctures, endotracheal intubation or percutaneous dilatational tracheostomy. Patients might benefit from VR during invasive interventions and ICU stay by alleviating stress or pain. Furthermore, it enables contact with relatives and can also assist patients in their rehabilitation programs. CONCLUSION Both, VR and AR, offer multiple possibilities to improve current care, both from the perspective of the healthcare professional and the patient. It can be assumed that VR and AR will develop further and their application in health care will increase.
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Affiliation(s)
- Dominika Kanschik
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Georg Wolff
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany
- Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty, Heinrich-Heine University, Duesseldorf, Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany.
- Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty, Heinrich-Heine University, Duesseldorf, Duesseldorf, Germany.
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Donovan CM. Augmented Reality Integration in Manikin-Based Simulations: Bringing Basic Science to the Critical Care Bedside with Limited Augmented Reality Resources. Med Sci Educ 2023; 33:829-833. [PMID: 37546210 PMCID: PMC10403467 DOI: 10.1007/s40670-023-01821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/08/2023]
Abstract
Immersive simulation and augmented reality (AR) are powerful educational tools in high-risk medical professions. Basic science AR, such as anatomic holograms, are gaining popularity. Many educators want to adopt AR and integrate basic science review in high-risk clinical decision-making but cannot afford it. In this project, we designed three AR integrated manikin-based simulations (ARI-MBS) by combining critical care scenarios with commercially available AR programs. Using a single headset and limited equipment, we technically integrated AR into MBS in a way that both students and faculty found rewarding. We present our design, so that others may replicate it. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01821-z.
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Affiliation(s)
- Colleen M. Donovan
- Department of Emergency Medicine, Rutgers-RWJMS, New Brunswick, NJ USA
- Department of Pharmacy Practice & Administration, Rutgers-EMSOP, Piscataway, USA
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Dinh A, Tseng E, Yin AL, Estrin D, Greenwald P, Fortenko A. Perceptions of Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers (Preprint). JMIR Form Res 2022; 7:e45211. [PMID: 36976628 PMCID: PMC10131657 DOI: 10.2196/45211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR's implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. OBJECTIVE This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. METHODS Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR's potential in remote health care. Interviews were transcribed and analyzed via thematic coding. RESULTS Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR's adoption. CONCLUSIONS AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine.
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Affiliation(s)
- Alana Dinh
- Medical College, Weill Cornell Medicine, New York, NY, United States
| | - Emily Tseng
- Department of Information Science, Cornell Tech, New York, NY, United States
| | - Andrew Lukas Yin
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Deborah Estrin
- Department of Computer Science, Cornell Tech, New York, NY, United States
| | - Peter Greenwald
- Emergency Medicine, NewYork-Presbyterian Hospital, New York, NY, United States
| | - Alexander Fortenko
- Emergency Medicine, NewYork-Presbyterian Hospital, New York, NY, United States
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Lateef F, Peckler B, Saindon E, Chandra S, Sardesai I, Rahman MAA, Krishnan SV, Wahid Ali AA, Goncalves RV, Galwankar S. The Art of Sim-Making: What to Learn from Film-Making. J Emerg Trauma Shock 2022; 15:3-11. [PMID: 35431474 PMCID: PMC9006725 DOI: 10.4103/jets.jets_153_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022] Open
Abstract
The components of each stage have similarities as well as differences, which make each unique in its own right. As the film-making and the movie industry may have much we can learn from, some of these will be covered under the different sections of the paper, for example, "Writing Powerful Narratives," depiction of emotional elements, specific industry-driven developments as well as the "cultural considerations" in both. For medical simulation and simulation-based education, the corresponding stages are as follows: DevelopmentPreproductionProductionPostproduction andDistribution. The art of sim-making has many similarities to that of film-making. In fact, there is potentially much to be learnt from the film-making process in cinematography and storytelling. Both film-making and sim-making can be seen from the artistic perspective as starting with a large piece of blank, white sheet of paper, which will need to be colored by the "artists" and personnel involved; in the former, to come up with the film and for the latter, to engage learners and ensure learning takes place, which is then translated into action for patients in the actual clinical care areas. Both entities have to go through a series of systematic stages. For film-making, the stages are as follows: Identification of problems and needs analysisSetting objectives, based on educational strategiesImplementation of the simulation activityDebriefing and evaluation, as well asFine-tuning for future use and archiving of scenarios/cases.
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Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Professor, Duke NUS Graduate Medical School, Yong Loo Lin School of Medicine, National University of Singapore and Lee Kong Chian Medical School, Nanyang Technological University, SingHealth Duke NUS Institute of Medical Simulation, Singapore.,Director, SingHealth Duke NUS Institute of Medical Simulation, Singapore
| | - Brad Peckler
- Department of Emergency Medicine, Simulation and Skills Centre, Wellington Hospital, Wellington, New Zealand
| | - Eric Saindon
- Head of Visual Effects, Weta Digital, Wellington, New Zealand
| | - Shruti Chandra
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,Director, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,Program Director, Digital Health and Telehealth Education, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Indrani Sardesai
- Department of Emergency Medicine, Queen Elizabeth Hospital, Gateshead, United Kingdom, Europe
| | | | - S Vimal Krishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Afrah Abdul Wahid Ali
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rose V Goncalves
- Department of Clinical Sciences, Florida State University College of Medicine, Emergency Medicine Residency at Sarasota Memorial Hospital, Sarasota, Florida, USA
| | - Sagar Galwankar
- Director for Research, The Florida State University Emergency Medicine Residency Program, Sarasota Memorial Hospital, Sarasota, Florida, USA
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Toto RL, Vorel ES, Tay KYE, Good GL, Berdinka JM, Peled A, Leary M, Chang TP, Weiss AK, Balamuth FB. Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial. JMIR Med Educ 2021; 7:e29899. [PMID: 34612836 PMCID: PMC8529461 DOI: 10.2196/29899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education. OBJECTIVE In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps. METHODS We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants' time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups. RESULTS We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient's perfusion. CONCLUSIONS We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants' awareness of abnormal perfusion.
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Affiliation(s)
- Regina L Toto
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ethan S Vorel
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Khoon-Yen E Tay
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Grace L Good
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Adam Peled
- BrickSimple, LLC, Doylestown, PA, United States
| | - Marion Leary
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Todd P Chang
- Division of Emergency Medicine & Transport, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Anna K Weiss
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Frances B Balamuth
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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