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Anlimah F, Gopaldasani V, MacPhail C, Davies B. A systematic review of the effectiveness of dust control measures adopted to reduce workplace exposure. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:54407-54428. [PMID: 36964805 PMCID: PMC10121514 DOI: 10.1007/s11356-023-26321-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
The recent increase in silicosis cases in several countries casts doubt on dust control practices and their effectiveness in preventing respirable crystalline silica (RCS) exposure. Apart from silicosis, RCS may lead to other illnesses, health-related quality of life losses for workers and their families, and economic losses for companies. Thus, this systematic literature review examined the effectiveness of interventions employed to prevent exposure to RCS and increase the use of dust control measures. The review used keywords related to dust control interventions to search seven databases. Search results were screened and extracted for synthesis. The narrative synthesis showed the extent of research investment in China. In several designs and combinations, the interventions utilized water, surfactant, foam, and air currents to reduce dust exposure. These interventions offer varying degrees of dust control effectiveness against RCS and respirable dust. Although evidence indicates that interventions significantly decrease dust concentration levels, the control measures in place may not effectively prevent workplace overexposure to RCS. The review found that education and training interventions are employed to improve dust controls and respiratory protective equipment (RPE) use. Also, marketing strategies promote the use of RPE. These interventions can increase the frequency of use of RPE and the adoption of best practice dust control measures. Interventions increase knowledge, awareness, and attitudes about RPE usage and generate positive perceptions while reducing misconceptions. However, the benefits obtained from an intervention may diminish after its implementation, indicating that the interventions may not continually motivate workers to adopt control measures or use RPE.
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Affiliation(s)
- Frederick Anlimah
- Faculty of the Arts, Social Sciences and Humanities, School of Health and Society, Centre for Occupational Public and Environmental Research in Safety and Health (COPERSH), University of Wollongong, Building 29, Wollongong, NSW 2522 Australia
| | - Vinod Gopaldasani
- Faculty of the Arts, Social Sciences and Humanities, School of Health and Society, Centre for Occupational Public and Environmental Research in Safety and Health (COPERSH), University of Wollongong, Building 29, Room 124, Wollongong, NSW 2522 Australia
| | - Catherine MacPhail
- Faculty of the Arts, Social Sciences and Humanities, School of Health and Society, University of Wollongong, Building 29, Room 242, Wollongong, NSW 2522 Australia
| | - Brian Davies
- Faculty of the Arts, Social Sciences and Humanities, School of Health and Society, Centre for Occupational Public and Environmental Research in Safety and Health (COPERSH), University of Wollongong, Building 29, Room 116, Wollongong, NSW 2522 Australia
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Balaguer M, Pinquier J, Farinas J, Woisard V. Development of a holistic communication score (HoCoS) in patients treated for oral or oropharyngeal cancer: Preliminary validation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:39-51. [PMID: 36043497 PMCID: PMC10087239 DOI: 10.1111/1460-6984.12766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In head and neck cancer, many tools exist to measure speech impairment, but few evaluate the impact on communication abilities. Some self-administered questionnaires are available to assess general activity limitations including communication. Others are not validated in oncology. These different tools result in scores that does not provide an accurate measure of the communication limitations perceived by the patients. AIM To develop a holistic score measuring the functional impact of speech disorders on communication in patients treated for oral or oropharyngeal cancer, in two steps: its construction and its validation. METHODS & PROCEDURES Patients treated for oral/oropharyngeal cancer filled six self-questionnaires: two about communicative dynamics (ECVB and DIP), two assessing speech function (PHI and CHI) and two relating to quality of life (EORTC QLQ-C30 and EORTC QLQ-H&N35). A total of 174 items were initially collected. A dimensionality reduction methodology was then applied. Face validity analysis led to eliminate non-relevant items by surveying a panel of nine experts from communication-related disciplines (linguistics, medicine, speech pathology, computer science). Construct validity analysis led to eliminate redundant and insufficiently variable items. Finally, the holistic communication score was elaborated by principal component factor and validated using cross-validation and latent profile analysis. OUTCOMES & RESULTS A total of 25 patients filled the questionnaires (median age = 67 years, EIQ = 12; 15 men, 10 women; oral cavity = 14, oropharynx = 10, two locations = 1). After face validity analysis, 44 items were retained (κ > 0.80). Four additional items were excluded because of a very high correlation (r > 0.90) with other items presenting a better dispersion. A total of 40 items were finally included in the factor analysis. A post-analysis score prediction was performed (mean = 100; SD = 10). A total of 24 items are finally retained for the construction of the holistic communication score (HoCoS): 19 items from questionnaires assessing communicative dynamics (13 from the ECVB and six from the DIP), four items from a perceived speech impairment questionnaire (PHI) and one from a quality-of-life questionnaire (EORTC QLQ-H&N35). The reliability is good (five-fold cross-validation: rs = 0.91) and the complementary latent profile analysis shows a good validity of the HoCoS, clustering subjects by level of communication performance. CONCLUSIONS & IMPLICATIONS A global score allowing a measure of the impact of the speech disorder on communication was developed. It fills the lack of this type of score in head and neck oncology and allows the better understanding of the functional and psychosocial consequences of the pathology in the patients' follow-up. WHAT THIS PAPER ADDS What is already known on the subject Because of their anatomical location, head and neck cancer degrades the speech abilities. Few tools currently allow the assessment of the impact of the speech disorder on communication abilities. In ENT oncology, self-administered questionnaires are available to assess activity limitations and participation restrictions (International Classification of Functioning (ICF)-WHO). Other tools from the field of neurology allow an evaluation of communication dynamics. But these different tools, constructed by items, give global additive or averaged scores. This implies an identical weighting of each item, resulting in global scores that are not very representative of the communication limitations really perceived by the patients. What this paper adds to existing knowledge A new global holistic score allowing a measurement of the impact of speech impairment on communication after treatment of oral or oropharyngeal cancer has been developed. The methodology of its construction allows a better reflection of the symptomatological, pragmatic and psychosocial elements leading to a degradation of communication abilities. What are the potential or actual clinical implications of this work? The developed HoCoS score fills the gap in the absence of this type of tool in head and neck oncology. It may allow a better understanding of the factors involved in the functional and psychosocial limitations of these patients, and better customize their follow-up.
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Affiliation(s)
- Mathieu Balaguer
- IRITUniversité de Toulouse, CNRS, Toulouse INP, UT3ToulouseFrance
- Hôpital LarreyHôpitaux de ToulouseToulouseFrance
| | - Julien Pinquier
- IRITUniversité de Toulouse, CNRS, Toulouse INP, UT3ToulouseFrance
| | - Jérôme Farinas
- IRITUniversité de Toulouse, CNRS, Toulouse INP, UT3ToulouseFrance
| | - Virginie Woisard
- Hôpital LarreyHôpitaux de ToulouseToulouseFrance
- Laboratoire de Neuro‐Psycho‐Linguistique LNPLUniversité Toulouse IIToulouseFrance
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Tienkamp TB, van Son RJJH, Halpern BM. Objective speech outcomes after surgical treatment for oral cancer: An acoustic analysis of a spontaneous speech corpus containing 32.850 tokens. JOURNAL OF COMMUNICATION DISORDERS 2023; 101:106292. [PMID: 36521253 DOI: 10.1016/j.jcomdis.2022.106292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Surgical treatment for oral cancer leads to lasting changes of the vocal tract and individuals treated for oral cancer (ITOC) often experience speech problems. The purpose of this study was to analyse the acoustic properties of the spontaneous speech of individuals who were surgically treated for oral cancer. It was investigated (1) how key spectral measures of articulation change post-treatment; (2) whether changes are more related to target manner or place of articulation; and (3) how spectral measures develop at various time points following treatment. METHOD A corpus consisting of 32.850 tokens was constructed by manually segmenting the speech of five (four female - one male) American English speaking ITOC. General acoustic characteristics (duration and spectral tilt), plosives (burst frequency), fricatives (centre of gravity and spectral skewness), and vowels (F1 and F2) were analysed using linear mixed effects regression and compared to control speech. Moreover, a within speaker analysis was performed for speakers with multiple recordings. RESULTS Manner of articulation is more predictive of post-treatment changes than place of articulation. Compared to controls, ITOC produced the fricatives /f, v, θ, ð, s, z, ʃ, ʒ/ with a lower centre of gravity while no differences were found for plosives and vowels. Longitudinal analyses show high within-speaker variation, but general improvements one-year post-treatment. CONCLUSIONS Surgical oral cancer treatment changes the spectral properties of speech. Fricatives with varying manner of articulations were distorted, suggesting that manner of articulation is more predictive than place of articulation in identifying general problem areas for ITOC.
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Affiliation(s)
- Thomas B Tienkamp
- Center for Language and Cognition Groningen, University of Groningen, Oude Kijk in 't Jatstraat 26, 9712 EK, Groningen, The Netherlands.
| | - Rob J J H van Son
- Amsterdam Center for Language and Communication, University of Amsterdam, Spuistraat 134, 1012 VB Amsterdam, The Netherlands; Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Bence Mark Halpern
- Amsterdam Center for Language and Communication, University of Amsterdam, Spuistraat 134, 1012 VB Amsterdam, The Netherlands; Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands; Multimedia Computing Group, Delft University of Technology, Mekelweg 4, 2628 CD, Delft, The Netherlands
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Marczyk A, O'Brien B, Tremblay P, Woisard V, Ghio A. Correlates of vowel clarity in the spectrotemporal modulation domain: Application to speech impairment evaluation. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:2675. [PMID: 36456260 DOI: 10.1121/10.0015024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/13/2022] [Indexed: 06/17/2023]
Abstract
This article reports on vowel clarity metrics based on spectrotemporal modulations of speech signals. Motivated by previous findings on the relevance of modulation-based metrics for speech intelligibility assessment and pathology classification, the current study used factor analysis to identify regions within a bi-dimensional modulation space, the magnitude power spectrum, as in Elliott and Theunissen [(2009). PLoS Comput. Biol. 5(3), e1000302] by relating them to a set of conventional acoustic metrics of vowel space area and vowel distinctiveness. Two indices based on the energy ratio between high and low modulation rates across temporal and spectral dimensions of the modulation space emerged from the analyses. These indices served as input for measurements of central tendency and classification analyses that aimed to identify vowel-related speech impairments in French native speakers with head and neck cancer (HNC) and Parkinson dysarthria (PD). Following the analysis, vowel-related speech impairment was identified in HNC speakers, but not in PD. These results were consistent with findings based on subjective evaluations of speech intelligibility. The findings reported are consistent with previous studies indicating that impaired speech is associated with attenuation in energy in higher spectrotemporal modulation bands.
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Affiliation(s)
- Anna Marczyk
- Aix-Marseille Université, CNRS, LPL, UMR 7309, Aix-en-Provence, France
| | - Benjamin O'Brien
- Aix-Marseille Université, CNRS, LPL, UMR 7309, Aix-en-Provence, France
| | - Pascale Tremblay
- Universite Laval, Faculte de Medecine, Departement de Readaptation, Quebec City, Quebec G1V 0A6, Canada
| | | | - Alain Ghio
- Aix-Marseille Université, CNRS, LPL, UMR 7309, Aix-en-Provence, France
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Woisard V, Balaguer M, Fredouille C, Farinas J, Ghio A, Lalain M, Puech M, Astesano C, Pinquier J, Lepage B. Construction of an automatic score for the evaluation of speech disorders among patients treated for a cancer of the oral cavity or the oropharynx: The Carcinologic Speech Severity Index. Head Neck 2021; 44:71-88. [PMID: 34729847 DOI: 10.1002/hed.26903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 08/15/2021] [Accepted: 10/05/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Speech disorders impact quality of life for patients treated with oral cavity and oropharynx cancers. However, there is a lack of uniform and applicable methods for measuring the impact on speech production after treatment in this tumor location. OBJECTIVE The objective of this work is to (1) model an automatic severity index of speech applicable in clinical practice, that is equivalent or superior to a severity score obtained by human listeners, via several acoustics parameters extracted (a) directly from speech signal and (b) resulting from speech processing and (2) derive an automatic speech intelligibility classification (i.e., mild, moderate, severe) to predict speech disability and handicap by combining the listener comprehension score with self-reported quality of life related to speech. METHODS Eighty-seven patients treated for cancer of the oral cavity or the oropharynx and 35 controls performed different tasks of speech production and completed questionnaires on speech-related quality of life. The audio recordings were then evaluated by human perception and automatic speech processing. Then, a score was developed through a classic logistic regression model allowing description of the severity of patients' speech disorders. RESULTS Among the group of parameters subject to extraction from automatic processing of the speech signal, six were retained, producing a correlation at 0.87 with the perceptual reference score, 0.77 with the comprehension score, and 0.5 with speech-related quality of life. The parameters that contributed the most are based on automatic speech recognition systems. These are mainly the automatic average normalized likelihood score on a text reading task and the score of cumulative rankings on pseudowords. The reduced automatic YC2SI is modeled in this way: YC2SIp = 11.48726 + (1.52926 × Xaveraged normalized likelihood reading ) + (-1.94e-06 × Xscore of cumulative ranks pseudowords ). CONCLUSION Automatic processing of speech makes it possible to arrive at valid, reliable, and reproducible parameters able to serve as references in the framework of follow-up of patients treated for cancer of the oral cavity or the oropharynx.
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Affiliation(s)
- Virginie Woisard
- ENT Department, University Hospital of Toulouse, Toulouse, France.,Oncorehabilation Unit, University Institute of Cancer of Toulouse Oncopole, Toulouse, France.,Laboratoire Octogone-Lordat, Jean Jaures University Toulouse II, Toulouse, France
| | - Mathieu Balaguer
- ENT Department, University Hospital of Toulouse, Toulouse, France.,Institut de Recherche en Informatique de Toulouse, CNRS, Paul Sabatier University Toulouse III, Toulouse, France
| | - Corinne Fredouille
- Laboratoire d'Informatique d'Avignon, Avignon University, Avignon, France
| | - Jérôme Farinas
- Oncorehabilation Unit, University Institute of Cancer of Toulouse Oncopole, Toulouse, France
| | - Alain Ghio
- Laboratoire Parole et Langage, Aix-Marseille University, Marseille, France
| | - Muriel Lalain
- Laboratoire Parole et Langage, Aix-Marseille University, Marseille, France
| | - Michèle Puech
- ENT Department, University Hospital of Toulouse, Toulouse, France.,Oncorehabilation Unit, University Institute of Cancer of Toulouse Oncopole, Toulouse, France
| | - Corine Astesano
- Laboratoire Octogone-Lordat, Jean Jaures University Toulouse II, Toulouse, France
| | - Julien Pinquier
- Oncorehabilation Unit, University Institute of Cancer of Toulouse Oncopole, Toulouse, France
| | - Benoît Lepage
- ENT Department, University Hospital of Toulouse, Toulouse, France.,USMR, Université Paul Sabatier Toulouse III, Toulouse, France
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Xiao Y, Wang T, Deng W, Yang L, Zeng B, Lao X, Zhang S, Liu X, Ouyang D, Liao G, Liang Y. Data mining of an acoustic biomarker in tongue cancers and its clinical validation. Cancer Med 2021; 10:3822-3835. [PMID: 33938165 PMCID: PMC8178493 DOI: 10.1002/cam4.3872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/30/2021] [Accepted: 03/14/2021] [Indexed: 11/08/2022] Open
Abstract
The promise of speech disorders as biomarkers in clinical examination has been identified in a broad spectrum of neurodegenerative diseases. However, to the best of our knowledge, a validated acoustic marker with established discriminative and evaluative properties has not yet been developed for oral tongue cancers. Here we cross-sectionally collected a screening dataset that included acoustic parameters extracted from 3 sustained vowels /ɑ/, /i/, /u/ and binary perceptual outcomes from 12 consonant-vowel syllables. We used a support vector machine with linear kernel function within this dataset to identify the formant centralization ratio (FCR) as a dominant predictor of different perceptual outcomes across gender and syllable. The Acoustic analysis, Perceptual evaluation and Quality of Life assessment (APeQoL) was used to validate the FCR in 33 patients with primary resectable oral tongue cancers. Measurements were taken before (pre-op) and four to six weeks after (post-op) surgery. The speech handicap index (SHI), a speech-specific questionnaire, was also administrated at these time points. Pre-op correlation analysis within the APeQoL revealed overall consistency and a strong correlation between FCR and SHI scores. FCRs also increased significantly with increasing T classification pre-operatively, especially for women. Longitudinally, the main effects of T classification, the extent of resection, and their interaction effects with time (pre-op vs. post-op) on FCRs were all significant. For pre-operative FCR, after merging the two datasets, a cut-off value of 0.970 produced an AUC of 0.861 (95% confidence interval: 0.785-0.938) for T3-4 patients. In sum, this study determined that FCR is an acoustic marker with the potential to detect disease and related speech function in oral tongue cancers. These are preliminary findings that need to be replicated in longitudinal studies and/or larger cohorts.
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Affiliation(s)
- Yudong Xiao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Tao Wang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Wei Deng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Le Yang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Bin Zeng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Xiaomei Lao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Sien Zhang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Xiangqi Liu
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Daiqiao Ouyang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Guiqing Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yujie Liang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
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ZHANG L, DENG S. Association of snps of aif-1 gene with susceptibility to oral cancer in chinese population. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.38520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Liqiong ZHANG
- Huazhong University of Science and Technology, China
| | - Shaolin DENG
- Huazhong University of Science and Technology, China
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Convolutional Neural Network Classifies Pathological Voice Change in Laryngeal Cancer with High Accuracy. J Clin Med 2020; 9:jcm9113415. [PMID: 33113785 PMCID: PMC7692693 DOI: 10.3390/jcm9113415] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Voice changes may be the earliest signs in laryngeal cancer. We investigated whether automated voice signal analysis can be used to distinguish patients with laryngeal cancer from healthy subjects. We extracted features using the software package for speech analysis in phonetics (PRAAT) and calculated the Mel-frequency cepstral coefficients (MFCCs) from voice samples of a vowel sound of /a:/. The proposed method was tested with six algorithms: support vector machine (SVM), extreme gradient boosting (XGBoost), light gradient boosted machine (LGBM), artificial neural network (ANN), one-dimensional convolutional neural network (1D-CNN) and two-dimensional convolutional neural network (2D-CNN). Their performances were evaluated in terms of accuracy, sensitivity, and specificity. The result was compared with human performance. A total of four volunteers, two of whom were trained laryngologists, rated the same files. The 1D-CNN showed the highest accuracy of 85% and sensitivity and sensitivity and specificity levels of 78% and 93%. The two laryngologists achieved accuracy of 69.9% but sensitivity levels of 44%. Automated analysis of voice signals could differentiate subjects with laryngeal cancer from those of healthy subjects with higher diagnostic properties than those performed by the four volunteers.
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Lee J, Kim H, Kim KH, Jung D, Jowsey T, Webster CS. Effective virtual patient simulators for medical communication training: A systematic review. MEDICAL EDUCATION 2020; 54:786-795. [PMID: 32162355 DOI: 10.1111/medu.14152] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
CONTEXT Despite the growing use of virtual patients (VPs) in medical education, few studies have explored the features and effectiveness of VP-based medical communication skills training. We undertook a systematic review to summarise the design and evaluation of VP-based medical communication skills training systems in order to identify features of successful cases. METHODS Following PRISMA guidelines, we searched four databases for studies published between 2006 and 2018. Using a refined classification scheme, we extracted data on instructional design (scenario and instructional intervention), technological design (modality and interaction), and evaluation (user experience, learning effectiveness and evaluator). We assessed the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and the QualSyst standard assessment criteria. RESULTS A total of 14 studies were included for review. Of these, 85.7% (n = 12) were quantitative and 71.4% (n = 10) involved undergraduate students. The most common VP training scenario was history taking followed by the delivery of bad news. Diverse instructional interventions, including tutorials, learning activities, and feedback, were embedded in the VPs. The first-person perspective animated within-screen size VP was a popular technological feature. Most evaluations concerned the reality of simulation (for user experience) and skill in expressing empathy (as a learning outcome). Of the eight comparative studies, half reported significant attitude or skill improvements in the VP group. The distinct features of VPs shown to be effective were well-designed instructional interventions (eg, a pre-activity with a protocol-informed tutorial), and post-activity (eg, debrief or reflection), scaffolding and human feedback, but not system feedback. CONCLUSIONS Evidence-based VP training can enable students to gain communication skills in a safe and affordable learning environment. Elaborate technology alone cannot guarantee effective learning, but evidence-based instructional interventions can facilitate its optimal use and bring about better learning outcomes.
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Affiliation(s)
- Jihyun Lee
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Hyungsin Kim
- Smart Experience Design, Graduate School of Techno Design, Kookmin University, Seoul, South Korea
| | - Kwan Hoon Kim
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Daeun Jung
- Educational Psychology and Learning Systems, Florida State University, Tallahassee, Florida, USA
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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