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A-Peterson INTED (2013) PDF
A-Peterson INTED (2013) PDF
Abstract
Technological advances, such as online courses and virtual simulations, are altering how we teach and learn. Online courses are becoming more common. These courses give professors a unique forum to engage students from around the world, and enable students to view and review lecture material multiple times. As an added bonus, pre-recording lecture material frees faculty time, enables increasing class size, and allows faculty to devote more energy toward productive group interactive curriculum. Online courses are ideally suited for many types of lecture-based curricula; however, they are not sufficient for curriculums that necessitate hands-on activities such as gross anatomy and surgery. We are currently working to rectify this conundrum by creating high-resolution simulations in the virtual world. Our goal is to utilize virtual environments to simulate visual and haptic scenarios necessary for hands-on activities. This work will advance current technologies by: creating realistic visualizations of surgery, programming surgical complications that can be incorporated into a surgical session or manipulated by an external viewer, create animations of the anatomy and the ability of the surgeon to manually manipulate different anatomical structures, and advance current haptic functions of virtual environments so that the surgeon has a full sensory experience (they can see, hear, feel, and experience a realistic surgical procedure). Simulations have been used extensively by commercial pilots and the military for training exercises. These simulations have greatly improved training efficacy in participants. We anticipate that virtual surgical simulations will have similar outcomes. Current endeavors and progress toward these goals in virtual reality environments by both our group and others throughout the world will be discussed. Keywords: Novel teaching technology, education technology development, computer assisted learning, distance learning, medical education.
INTRODUCTION
Optimization of learning is the ultimate goal of all educators. For years, didactic lectures have been the most common teaching method at universities world-wide. However technological advances are slowly changing the face of education. Online courses now allow students to participate in courses from disparate locations around the world. These courses are ideal for many types of lecture-based curricula; however, they are not sufficient for curricula that necessitate hands-on activities such as gross anatomy and surgery. To address this problem, researchers are creating high-resolution virtual surgical simulations. A virtual simulation uses computer graphics to create a world that responds to the users input (gesture, verbal command, etc.). Users are able to hone their motor skills, increase their ability to process information quickly, and explore information in a non-linear fashion. Because the learning experience is a model of a real world situation, students have a 1, 2 strong transfer of learning from the virtual experience to future real-life applications . During the last decade, the use of simulators for teaching and training has become standard. Unlike lecture based lessons, educators create active learning environments by which students are encouraged to actively think about information, make choices, and execute learning skills for defined physical tasks. Training simulators have been used extensively by commercial pilots and the military for training exercises, and have been
shown to dramatically increase both the cognitive and motor accuracy of the participants 3-8 and decrease errors. Initial surgical simulations have had similar outcomes . Unlike flight training, improved medical training has the potential to impact almost every human on the planet. The expertise of surgeons can be limited by their lack of access to physical training paradigms. Virtual reality based surgical simulations, hold significant promise for revolutionizing medical training. Successful implementation of virtual surgery in medical education will allow limitless practice sessions on a virtual body, enable students to experience the multi-variant nature of surgical procedures, allow surgical competency with both common and rare complications, and facilitate group and distance learning. Simulation training, in combination with live patient training, will enhance the acquisition of clinical skills, increase exposure to medical problems, and help to ensure uniformity of training experiences.
METHODS
The current paper is based on current virtual reality medical simulations under development in my laboratory and previous documented educational benefits of such technology. Ideology is derived from Pubmed searches for articles containing virtual reality, surgical simulation, medical education, learning, and virtual technologies. Based on the relevancy of the article, 150 articles were selected for analysis.
3 3.1
Although not fully implemented with current technologies, virtual surgical simulations will allow students and experts to interact world-wide. This will enable students to repeatedly test their proficiency, obtain assistance from global experts in various techniques, and become teachers to other students world-wide. Open sharing of perceived difficulties and successes will assist surgical skills acquisition globally, and may provide the impetus for novel surgical techniques into the future.
3.2
Simulation technologies have been used for years to improve the motor and cognitive function of users for specific, difficult tasks that are necessary for the preservation of human life. Flight simulations, for example, have been reported to dramatically increase the functionality of pilots and decrease errors. The use of flight simulations is thought to play a 22 significant role in decreasing deaths from 3214 (1972) to 703 (2011; ). Because of the noted increase in training efficacy, simulators were implemented by the Federal Aviation 23 Administration as a critical tool in pilot training . Like flight simulations, surgical simulators have been shown to dramatically increase the skill of surgeons, decrease the operational 12, 24-38 time, and decrease errors and post-operative complications . With these types of evidences, A Food and Drug Administration panel recently recommended the use of virtual reality simulation as an integral component of a training package for carotid artery 39 stenting . I expect that further government recommendations and regulations will be implemented in the future as these technologies advance.
instruments by manipulating objects within a box. More recently, full-scale human models such as Metiman (CAE Heathcare, Montreal, Canada) have been developed that enable individuals to practice basic medical procedures in real-life situations (e.g., CPR training, combat scenarios). Although these simulators have proven to have an impact on the learning and success of trainees, they are unable to mimic a full surgical procedure. Over the last decade, computerized surgical procedures have become popular. Numerous training videos have been created to familiarize individuals with specific surgical procedures. However, virtual surgeries are typically shown with idealistic clean anatomy that does not accurately depict a real surgery. Additionally, most of these types of programs are either non-interactive videos or limit user participation to accurate actions. Because some of the most memorable and useful learning occurs due to use mistakes, these programs offer limited teaching functionality. Within the last year, several groups have attempted to create interactive virtual surgeries. th One of the best examples was unveiled October 6 , 2012 by a group at University Hospital in Cleveland, OH. Their Surgical Rehearsal Platform utilizes CT/MRI scans from individual patients to recreate a surgical condition for the express purpose of practicing a surgical technique prior to live surgery. With only the relevant anatomy portrayed, the surgeons are able to plan and visualize their surgical approach for that specific patient. Although this is a huge step in the right direction, this platform does not allow for a realistic practice of surgical technique from the beginning of the surgery to the end. Therefore its primary function would be in assisting surgical practice in experienced surgeons.
Figure 1. Reconstruction of male human skeleton with forearm, biceps, and triceps muscles at different stages of animation. To create a virtual surgery, the 3D anatomy is transferred from a volume rendered state into the virtual world, and a virtual human is reconstructed. An example of a virtual human within a preliminary virtual suite is shown in Fig. 2. We will utilize custom fluid dynamic, virtual reality, and human computer interface software that has been created at Iowa State University to visualize anatomical structures during skin incisions, recreate bleeding, interface haptic and auditory feedback, and create a learning environment to maximally engage and evaluate student outcome measures.
Figure 2. Virtual male anatomy is shown reclining on a surgical table. The skin and muscles are transparent to better visualize bone and heart.
CONCLUSIONS
Researchers investigating the efficacy of virtual reality as a teaching tool have been impressed with the stunning visual and sensory effects that it is able to portray to users. With future development, it will become a powerful instructional tool for medical education or other subjects that require motor training. As technology advances, virtual simulations have the potential to benefit learning, design, analysis, and communication within the university setting. Because of its networking capabilities, the virtual environment will allow global teamwork with experts, and thus improve the quality of teaching, training, and research world-wide.
REFERENCES
[1] [2] Brudea, G.C., Coiffet, P. (2003). Virtual Reality Technology, 2 Inc., Hoboken, New Jersey.
nd
Klopfer, E., Osterweil, S., Groff, J., Haas J. (2009). The instructional power of digital games social networking simulations and how teachers can leverage them. The Edu. Arcade. http://education.mit.edu/papers/GamesSimsSocNets_EdArcade.pdf Helmreich, R.L. (1997). Managing human error in aviation. Sci. Am. 276, pp. 62-7. Leedom, D., Dimon, R. (1995). Improving team coordination: a case for behaviorbased training. Mil. Psych. 7, pp. 109-22. Holcomb, J.B., Dumire, R.D. (2002). Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training. J. Trauma, 52, pp. 1078-85. Wong, A.K. (2004). Full scale computer simulators in anesthesia training and evaluation. Can. J. Anaesth. 51, pp. 455-64. DeVita, M.A., Schaefer, J., Lutz, J., Wang, H., Dongilli, T. (2005). Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual. Saf. Health Care, 14, pp. 326-31. Moorthy, K., Munz, Y., Adams, S., Pandey, V., Darzi, A. (2005). A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre. Ann. Surg. 242, pp. 631-9. Fitts, P.M., Posner, M.I. (1967). Human performance. Belmont, CA: Brooks/Cole. Kopta, J.A. (1971). The development of motor skills in orthopedic education. Clin. Orthop. 75, pp. 80-5. Ericsson, K.A. (1996). The acquisition of expert performance: an introduction to some of the issues. In: Ericsson, K.A., ed. The road to excellence: the acquisition of expert performance in the arts and sciences, sports, and games. Mahwah, NJ: Lawrence Erlbaum Associates, pp. 1-50. Cox, M., Irby, D.M. (2006). Teaching Surgical SkillsChanges in the Wind. New Eng. J. Med. 355(25), pp. 2664-2669. Trent, S., Artiles, A., Englert, C. (1998). From deficit thinking to social constructivism: A review of theory, research, and practice in special education. Review of Research in Education, 23, pp. 277-307. Taffinder, N., Sutton, C., Fishwick, R.J., McManus, I.C., Darzi, A. (1998). Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomized controlled studies using the MIST VR laparoscopic simulator. Stud. Health Technol. Inform. 50, pp. 124- 30. Darzi, A., Mackay, S. (2001). Assessment of surgical competence. Qual. Health Care, 10(Suppl. 2), pp. ii64-ii69. Risucci, D., Cohen, J.A., Garbus, J.E., Goldstein, M., Cohen, M.G. (2001). The effects of practice and instruction on speed and accuracy during resident acquisition of simulated laparoscopic skills. Curr. Surg. 58, pp. 230-5. Mantovani, F., Gaggiolo, A., Castelnuovo, G., Riva, G. (2003). Virtual reality training for health-care professionals. CyberPsychology and Behavior, 6(4), 389-395. Winn, W., Hoffman, H., Hollander, A., Osberg, K., Rose, H., Char, P. (1997). The effect of student construction of virtual environments on the performance of high- and low-ability students. Paper presented at the meeting of the American Educational Research Association, Chicago, IL. Seitz, A. R., Dinse, H. R. (2007). A common framework for perceptual learning. Current Opinion in Neurobiology, 17(2), pp. 148153. Shams, L., Seitz, A. R. (2008). Benefits of multisensory learning. Trends in Cognitive Sciences, 12(11), pp. 411417. Sigrist, R., Rauter, G., Riener, R., Wolf, P. (2012). Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review. Psychon. Bull. Rev. [Epub ahead of print]. http://link.springer.com/article/10.3758%2Fs13423-012-0333-8
[6] [7]
[8]
[12] [13]
[14]
[15] [16]
[17] [18]
[22] [23]
PlaneCrashInfo.com. Causes of fatal accidents by decade (percentage). Available: www.planecrashinfo.com/cause.htm (accessed 2012 Oct 8). Federal Aviation Administration. (2012). National Simulator Program Simulator Implementation Procedures. Available: http://www.faa.gov/about/initiatives/nsp/sip (accessed 2012 Oct. 8). Scott, D.J., Bergen, .PC., Rege, R.V. (2000). Laparoscopic training on bench models: better and more cost effective than operating room experience? J. Am. Coll. Surg. 191, pp. 272-83. Wong, B.L.W., Ng, B.P, Clark, S.A. (2000). Assessing the effectiveness of animation and virtual reality in teaching operative dentistry. Journal of Dentistry: Educational Technology Section. Retrieved May 24, 204, from http://www1.elsevier.com/homepages/sab/jdentet/contents/wong2/wong2.html Seymour, N.E., Gallagher, A.G., Roman, S.A. (2002). Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann. Surg. 236, pp. 458-63. Wilhelm, D.M., Ogan, K., Roehaborn, C.G., Cadedder, J.A., Pearle, M.S. (2002). Assessment of basic endoscopic performance using a virtual reality simulator. Journal of the American College of Surgeons, 195(5), pp. 675-681. Imber, S., Shapira, G., Gordon, M., Judes, H., Metzger, Z. (2003). A virtual reality dental simulator predicts performance in an operative dentistry manikin course. European Journal of Dental Education, 7(4), pp. 160-163. Jeffries, P.R., Woolf, S., Linde, B. (2003). Technology-based vs. traditional instruction: A comparison of two methods for teaching the skill of performing a 12lead ECG. Nursing Education Perspectives, 24(2), pp. 70-74. Moorthy, K., Smith, S., Brown, T., Bann, S., Darzi, A. (2003). Evaluation of virtual reality bronchoscopy as a learning and assessment tool. International Journal of Thoracic Medicine, 70(2), pp. 195-199. Riva, G. (2003). Applications of virtual environments in medicine. Methods of Information in Medicine, 42, 524-534. Fried, G.M., Feldman, L.S., Vassiliou, M.C. (2004). Proving the value of simulation in laparoscopic surgery. Ann. Surg. 240, pp. 518-28. Grantcharov, T.P., Kristiansen, V.B., Bendix, J., Bardram, L., Rosenberg, J., FunchJensen, P. (2004). Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br. J. Surg. 91, pp. 146-50. Brindley, P.G., Jones, D.B., Grantcharav, T., Gara, C.G. (2009). Canadian Association of University Surgeons Annual Symposium. Surgical Simulation: the solution to safe training or a promise unfulfilled? J. Can. Chir., 55, pp. S200-S206. Chakravarthy, B., Haar, E., Bhat, S.S., McCoy, C.E., Denmark, T.K., Lotfipour, S. (2010). Simulation in medical school education: review for emergency medicine. Western Journal of Emergency Med. 12, pp. 461-466. McGaghie, W.C., Draycott, T.J. Dunn, W.F., Lopez, C.M., Stefanidis, D. (2011a). Evaluating the Impact of Simulation on Translational patient outcomes. Simul. Healthc. 6, pp. S42-S47. McGaghie, W.C., Issenberg, S.B., Cohen, E.R., Barsuk, J.H., Wayne, D.B. (2011b). Does Simulation-based Medical Education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad. Med. 86, pp. 676-711. Gallagher, A.G., Cates, C.U. (2004). Approval of virtual reality training for carotid stenting: what this means for procedural-based medicine. JAMA, 292, pp. 30243026.
[24]
[25]
[26]
[27]
[28]
[29]
[30]
[34]
[35]
[36]
[37]
[38]