The Effect of Hyper-Realistic Trauma Training on Emotional Intelligence in Second Year Military Medical Students

Using Full Dive Virtual Reality to Operationalize Warfighter Resilience: From Proof of Concept and Usability of Hardware and Software to Upcoming Integrated Psychological Skills Training

INTRODUCTION

Modern warfare operations are volatile, highly complex environments, placing immense physiological, psychological, and cognitive demands on the warfighter. To maximize cognitive performance and warfighter resilience and readiness, training must address psychological stress to enhance performance. Resilience in the face of adversity is fundamentally rooted in an individual's psychophysiological stress response and optimized through decreased susceptibility to the negative impact of trauma exposure. The current project aims to optimize warfighter expertise, resilience, adaptability, and performance by utilizing a validated Full Dive Virtual Reality (FDVR) training platform to provide high-fidelity, safe, and scalable, controlled stress exposure in highly realistic simulated training scenarios with the most advanced, immersive technology available.

MATERIALS AND METHODS

Following Institutional Review Board approval and consent, 2 operators were fitted with high-fidelity virtual reality headsets with hand and eye tracking, full-body haptic feedback suits, a 360° omnidirectional treadmill, and Food and Drug Administration (FDA) cleared biometric monitors. Following acclimation, operators were placed in an industrial fire scenario and instructed to respond as a firefighter and paramedic, to search for and resuscitate any casualties, extinguish the fire, and exfiltrate safely. Following initial acclimation and after each demonstration (n = 2), 3 semistructured interviews asked operators their perceptions and experiences related to FDVR, focusing on usability, feasibility, and safety. Biometric data were continuously recorded using the Caretaker Medical VitalStream.

RESULTS

Proof-of-concept (POC) testing proved that the FDVR training platform is usable, safe, and feasible. It creates an immersive environment with physiological responses to mimic realistic Mass Casualty Events (MCEs). Using a case study approach, transcript data were analyzed using thematic analysis. Three major themes emerged: Sensory deficits reduced realism, but sensory feedback improved fidelity, vestibular discord affected the virtual reality experience but only when the system did not respond naturally to operator movement after acclimation, and movement accommodations were made by operators to enhance usability, especially for fine motor movements. Biometric data analysis correlated timestamps from the VitalStream unit with operator responses to stress-inducing events (i.e., explosions, fires, and a deceased victim). Both operators exhibited significant physiological responses, including elevated heart rate, systolic blood pressure, and mean arterial pressure, particularly following explosions, encountering fire, and encountering the deceased victim within the training environment.

CONCLUSIONS

The FDVR training platform overcomes the obstacles of in-person simulation training and provides the closest to real-life experience available. It will allow warfighters to train with their teams in immersive environments that replicate the conditions in which they are expected to perform their duties. The POC demonstrated that physiological responses can be mapped to scenario events to allow tracking of stress responses, cognitive load, as well as performance, and decision-making of the warfighter. The POC only involved 2 operators, but served to prove that the platform was safe and effective. Future testing plans to include 200 warfighters in operational teams of 10 to 12 to further validate the training effectiveness of the FDVR platform.

A distinct immune cytokine profile is associated with morning cortisol and repeated stress

OBJECTIVE

The objective of this study was to investigate possible immune cytokine trends throughout a week-long surgical simulation mass-casualty training session in order to determine the effects of stress inoculation on the immune system.

METHODS

Thirty-seven military medical students participated in a hyper-realistic surgical simulation training event conducted at Strategic Operations site in San Diego, California. Salivary samples were collected every morning of the stress training exercise for 4 consecutive days. Cortisol, along with a panel of 42 immune cytokines, was measured using multiplex enzyme-linked immunosorbent assays from Eve Technologies. The determined concentrations were averaged and plotted on a scatter plot, and then points were fit to a second-order polynomial trendline of best fit to measure.

RESULTS

The cytokines epidermal growth factor, growth-related oncogene-α, interleukin (IL)-1α, and platelet-derived growth factor-AA followed a noted pattern of cortisol decrease throughout the week. In addition, cytokines IL-27, granulocyte colony stimulating factor, IL-10, and IL-13 demonstrated a late peak, followed by a return to baseline at the conclusion of training. Finally, the cytokine monocyte chemoattractant protein-1 displayed a decline throughout the week followed by an increase on the last day of stress training.

CONCLUSIONS

Altogether, these results help to identify important biomarkers that may help to improve long-term stress adaptation and prevent post-traumatic stress disorder following exposure to repeated stress.

Outcomes of Emotional Intelligence Training for Surgeons in a Real-World Setting: a Mixed Methods Study

OBJECTIVE

The objective was to assess, improve and re-assess Emotional Intelligence (EI) in a group of junior and senior surgeons in a real-world setting.

DESIGN

This was a mixed methods study. An EI education program was delivered through a series of webinars. The program drew from the central concepts of emotional intelligence: Motivation, empathy, social skills, self-knowledge, and self-control. There was also a component of professional development. EI assessment was performed pre- and post-intervention using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and a series of targeted questions. Qualitative assessment was performed by means of structured interviews examining uptake in techniques, understanding of EI, and its effect on personal and professional life.

SETTING

The Australia and New Zealand Training Board in Colorectal Surgery administers a 2-year bi-national training program in teaching hospitals in Australia and New Zealand and runs a series of educational webinars throughout the training program. The "EI series" was part of this educational program.

PARTICIPANTS

Webinars were attended by 35 junior surgeons and 8 senior surgeons RESULTS: Self-perceived knowledge and use of EI increased from a mean of 3.6 to 6.5 (p<0.0001). There was a significant difference between experiential (94) and strategic (101) scores (p=0.005). There was a nonsignificant improvement (98.04-100.6, p=0.16), in the pre-post MSCEIT among the junior surgeons and no change for senior surgeons. Seventy-eight percent (25/32) of surgeons interviewed reported using any new EI strategies. Seventy-five percent actively stopped and considered what other people in a clinical scenario may be thinking; 78% commenced metacognition; 81% practiced the process of self-regulation; 66% had begun to recognise and use emotions as data; and, 47% had actively practiced the process of self-distancing CONCLUSION: This study demonstrated the feasibility and utility of delivering EI training in an online format to a group of time-poor surgeons in a real-world setting.

A Mixed Methods Investigation on the Relationship Between Perceived Self-Regard, Self-Efficacy, and Commitment to Serve Among Military Medical Students

INTRODUCTION

Routinely faced with potentially traumatizing situations, resilience is critical for military physicians. However, related studies are limited in scope. The current study distinctively combines hyper-realistic immersion training for military medical students with emotional intelligence and hardiness measures. With self-reflection shown to improve performance, qualitative inquiry was concurrently conducted in a mixed methodology approach to provide a uniquely comprehensive perspective on the resilience training needs of this population.

MATERIALS AND METHODS

Thirty-four osteopathic military medical students participated in a week-long training simulating real-life combat and mass casualty events. The Emotional Quotient-Inventory 2.0 (EQ-i 2.0) and Hardiness Resilience Gauge were administered as pre- and post-test measures. Paired t-tests were used to determine statistically significant gains, and a multiple case study analysis of a six-student focus group allowed for the synchronization of quantitative and qualitative data. Institutional Review Board approval for the study was obtained through Rocky Vista University with a reciprocal agreement with Touro University California's Institutional Review Board. All students participating in the study received written informed consent.

RESULTS

Qualitative findings for this study aligned with this current year's findings of statistically significant results in the improvement of the Overall EQ-i and Overall Hardiness. Qualitative responses thematically analyzed demonstrated environmental realism, adaptation, increased awareness, and positive interpersonal and clinical outlook. Notable increases occurred in all EQ-i domains except Decision-Making and Stress Tolerance. The Self-Perception domain saw significant increases in Self-Regard and Emotional Self-Awareness while Well-Being and Optimism simultaneously improved.

CONCLUSION

This unique pilot study showed that quantitative and qualitative results aligned, supporting the finding that a safe trauma-related training environment can improve the confidence and resilience in military medical students. The goal of this training was to promote resilience and mitigate trauma. Results demonstrate improved self-efficacy and enhanced commitment. Increases in self-awareness and confidence made participants more inclined to see their worth and strengthened their sense of duty as described in their qualitative responses. Pervasive gains suggest that the training aligned well with its purpose, and the methods employed enhanced participant experience. Long-term follow-up studies are needed to assess outcome sustainability.

A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues

Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.

Emotional intelligence in undergraduate medical students: a scoping review

PURPOSE

To perform a scoping review to determine what is known about emotional intelligence (EI) in undergraduate medical education (UME). Two main questions were asked: A. What medical student characteristics are associated with EI? Are there correlations with demographic or other factors? B. What research studies have been done on EI in UME? For example, is there evidence EI changes over time as a result of personal experiences? Should EI be used as an admission criterion? Can EI improve as a result of experiences or deliberate interventions?

METHOD

The authors searched four databases (PubMed, PsycInfo, Education Resources Information Center, and Web of Science) for all papers published up to and including December 2020. Two reviewers independently screened articles to determine if they met inclusion criteria. All authors extracted and analyzed data.

RESULTS

A set of 1520 papers on the topic of emotional intelligence was identified, with 119 papers meeting inclusion criteria. Most studies were done at international locations with only 17 done at US medical schools. Seventy-five were cohort or cross-sectional studies. Study populations were mixed among the studies, with year of medical study, inclusion of other healthcare students, and participation rates among the inter-study differences noted.

CONCLUSIONS

Numerous gaps in the literature on EI exist with several points being clear: (1) there is disagreement on the definition of EI, (2) it is undetermined whether EI is a trait or an ability, and (3) there is marked variability among the instruments used to measure EI. It is also becoming apparent that using EI determination may be helpful as a component of the admission process, higher EI is likely related to improved clinical reasoning, and higher EI contributes to more effective stress management.

Burnout assessment at a college of pharmacy, college of optometry, and school of physician assistant studies

INTRODUCTION

There is limited research on burnout among students and faculty of health professions programs. This study was designed to assess burnout among students and faculty at a college of pharmacy (COP), college of optometry (COO), and school of physician assistant studies (SPAS).

METHODS

The Professional Quality of Life Scale (ProQOL) was distributed to faculty and students at Marshall B Ketchum University (MBKU) COP, COO, and SPAS. Scores for burnout, compassion satisfaction, and secondary traumatic stress were compared between programs, faculty, and students.

RESULTS

Median secondary traumatic stress scores were statistically higher for respondents (students and faculty) in the SPAS (24 [interquartile range (IQR) 17-27]) vs. respondents in the COP (20 [IQR 18-26]) and COO (19 [IQR 16-22]). Faculty had statistically higher median compassion satisfaction scores (41 [IQR 34-44]) vs. students (36 [IQR 32-40]), while students had statistically higher median burnout scale scores compared to faculty (27 [IQR 23-32] vs. 21 [IQR 17-26]). There was no difference in secondary traumatic stress between students and faculty, and there were no differences in compassion satisfaction or burnout between programs.

CONCLUSIONS

This study demonstrated that students in the COP, COO, and SPAS had higher burnout scores when compared to faculty at the study institution. These results suggest that efforts to address burnout should first focus on students. SPAS students and faculty may require specific efforts to address secondary trauma.