State of the art of virtual reality simulation in anesthesia

Using Virtual Reality to teach ultrasound-guided needling skills for regional anaesthesia: A randomised controlled trial

STUDY OBJECTIVE

We previously designed and validated a virtual reality-based simulator to help train novices in ultrasound-guided needling skills necessary for safe and competent ultrasound-guided regional anaesthesia. This study was designed to compare the performance and error rates of novices trained by a human faculty aided with the assistance of this virtual reality simulator (virtual reality-assisted training), versus novices trained wholly by humans (conventional training).

DESIGN, SETTING, AND PARTICIPANTS

In this single centre, randomised controlled study, we used a standardised teaching protocol, rigorous blinding, iterative training of assessors, and validated global rating scale and composite error score checklists to assess skills learning of novice participants.

MAIN RESULTS

We recruited 45 novices and scored 270 assessments of performance and error rates. Inter-rater correlation coefficient of reliability of scoring between assessors for the global rating scale was 0.84 (95%CI 0.68-0.92) and for the composite error score checklist was 0.87 (95%CI 0.73-0.93). After adjustment for age, sex, Depression, Anxiety and Stress-21, and baseline score, there was no statistical difference for virtual reality-assisted training compared to conventional training in final global rating score (average treatment effect -3.30 (95%CI-13.07-6.48), p = 0.51) or in the final composite error score (average treatment effect 1.14 (95%CI -0.60-2.88), p = 0.20). Realism in the virtual reality simulator was similar to real-life when measured by the Presence Questionnaire, all components p > 0.79; and task workload assessed by the NASA-Task Load Index was not statistically different between groups, average treatment effect 5.02 (95%CI -3.51-13.54), p = 0.25. Results were achieved in the virtual reality-assisted group with half the human faculty involvement.

CONCLUSION

Novices trained using a hybrid, virtual reality-assisted teaching program showed no superiority to novices trained using a conventional teaching program, but with less burden on teaching resources.

Virtual Reality Training for Central Venous Catheter Placement: An Interventional Feasibility Study Incorporating Virtual Reality Into a Standard Training Curriculum of Novice Trainees

OBJECTIVES

This study assess the feasibility of integrating virtual reality (VR) simulation into the central venous catheter (CVC) placement training curriculum.

DESIGN

The study consists of 3 parts: (1) Evaluating current manikin-based training for CVC placement through surveys for senior first-year anesthesia residents and cardiac anesthesia faculty who supervise resident performing the procedure; (2) Interventional study training novice trainees with VR simulator and assessing their reaction satisfaction; and (3) pilot study integrating VR training sessions into CVC training curriculum for first-year anesthesia residents.

SETTING

Conducted at a single academic-affiliated medical center from December 2022 to August 2023.

PARTICIPANTS

Junior first-year anesthesia residents.

INTERVENTIONS

VR training sessions for CVC placements using the Vantari VR system.

MEASUREMENTS AND MAIN RESULTS

Primary outcome: novice trainees' satisfaction with VR training for CVC procedure. Satisfaction of resident and faculty with standard manikin-based training was also collected. Faculty expressed concerns about residents' confidence and perceived knowledge in performing CVC placement independently. Novice trainees showed high satisfaction and perceived usefulness with VR training, particularly in understanding procedural steps and developing spatial awareness. Pilot integration of VR training into the curriculum demonstrated comparable training times and emphasized structured stepwise training modules to ensure completion of vital procedural steps.

CONCLUSIONS

This study underscores the potential of VR simulation as a complementary training tool for CVC placement rather than a substitution of standard manikin training. VR is offering immersive experiences and addressing limitations of traditional manikin-based training methods. The integration of VR into training curricula warrants further exploration to optimize procedural proficiency and patient safety in clinical practice.

Validation of a novel, low-fidelity virtual reality simulator and an artificial intelligence assessment approach for peg transfer laparoscopic training

Simulators are widely used in medical education, but objective and automatic assessment is not feasible with low-fidelity simulators, which can be solved with artificial intelligence (AI) and virtual reality (VR) solutions. The effectiveness of a custom-made VR simulator and an AI-based evaluator of a laparoscopic peg transfer exercise was investigated. Sixty medical students were involved in a single-blinded randomised controlled study to compare the VR simulator with the traditional box trainer. A total of 240 peg transfer exercises from the Fundamentals of Laparoscopic Surgery programme were analysed. The experts and AI-based software used the same criteria for evaluation. The algorithm detected pitfalls and measured exercise duration. Skill improvement showed no significant difference between the VR and control groups. The AI-based evaluator exhibited 95% agreement with the manual assessment. The average difference between the exercise durations measured by the two evaluation methods was 2.61 s. The duration of the algorithmic assessment was 59.47 s faster than the manual assessment. The VR simulator was an effective alternative practice compared with the training box simulator. The AI-based evaluation produced similar results compared with the manual assessment, and it could significantly reduce the evaluation time. AI and VR could improve the effectiveness of basic laparoscopic training.

The utility of virtual reality and manikin crisis scenario simulations for anaesthesia trainee education: a randomised crossover pilot study

Simulation education for anaesthesia trainees is essential to build clinical skills and virtual reality can provide a reproducible, high-fidelity intra-operative training environment. Compared to in-situ manikin-based simulation, this modality has yet to be thoroughly evaluated. Twenty-six second post-graduate year anaesthesiology residents were randomly divided into two groups and participated in both virtual reality and manikin crisis scenarios at sessions six months apart. The exposure order was group A virtual reality followed by manikin and group B manikin followed by virtual reality. Clinical assessments were performed using a standardised checklist. Knowledge assessments were conducted. National Aeronautics and Space Administration Task Load Index and System Usability Scale scores were collected immediately after participation. Clinical scores between groups A and B were not significantly different. Group A had improved post-simulation knowledge scores after both sessions. Task load index scores were lower in mental demand for virtual reality. System usability scores showed less ease of use and more need for support in virtual reality.

Comparing the stress response using heart rate variability during real and simulated crises: a pilot study

Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant's heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N-N interval (SDNN), Root mean square standard deviation of the N-N interval (RMSSD), Percentage of successive R-R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.

Monitoring and evaluation of anesthesia depth status data based on neuroscience

Monitoring and analysis of anesthesia depth status data refers to evaluating the anesthesia depth status of patients during the surgical process by monitoring their physiological index data, and conducting analysis and judgment. The depth of anesthesia is crucial for the safety and success of the surgical process. By monitoring the state of anesthesia depth, abnormal conditions of patients can be detected in a timely manner and corresponding measures can be taken to prevent accidents from occurring. Traditional anesthesia monitoring methods currently include computer tomography, electrocardiogram, respiratory monitoring, etc. In this regard, traditional physiological indicator monitoring methods have certain limitations and cannot directly reflect the patient's neural activity status. The monitoring and analysis methods based on neuroscience can obtain more information from the level of brain neural activity.

PURPOSE

In this article, the monitoring and analysis of anesthesia depth status data would be studied through neuroscience.

METHODS

Through a controlled experiment, the monitoring accuracy of traditional anesthesia status monitoring algorithm and neuroscience-based anesthesia status monitoring algorithm was studied, and the information entropy and oxygen saturation of electroencephalogram signals in patients with different anesthesia depth were explored.

RESULTS

The experiment proved that the average monitoring accuracy of the traditional anesthesia state monitoring algorithm in patients' blood drug concentration and oxygen saturation reached 95.55 and 95.00%, respectively. In contrast, the anesthesia state monitoring algorithm based on neuroscience performs better, with the average monitoring accuracy of drug concentration and oxygen saturation reaching 98.00 and 97.09%, respectively. This experimental result fully proved that the monitoring performance of anesthesia state monitoring algorithms based on neuroscience is better.

CONCLUSION

The experiment proved the powerful monitoring ability of the anesthesia state monitoring algorithm based on neuroscience used in this article, and explained the changing trend of brain nerve signals and oxygen saturation of patients with different anesthesia depth states, which provided a new research method for the monitoring and analysis technology of anesthesia depth state data.

[Virtual reality in teaching of psychiatry and psychotherapy at medical school]

Hintergrund

Ausbildung und Lehre müssen sich den Gegebenheiten insbesondere in Corona-Zeiten anpassen, zumal neue digitale Technologien zur Verfügung stehen. Ärztliche Interaktions- und Explorationstechniken sind die wichtigsten Werkzeuge, die Medizinstudierende im Fach Psychiatrie und Psychotherapie zu erwerben haben.

Ziel der Arbeit

Avatare in virtueller Realität (VR) können grundsätzlich alle Krankheitsbilder in unterschiedlichen Schweregraden zu jeder Zeit repräsentieren.

Material und Methoden

Im Bochumer Avatar-Explorationsprojekt (AVEX) treten Studierende in den Dialog mit „psychisch kranken“ Avataren und versuchen, unter Anleitung und Supervision Diagnose, Differenzialdiagnose und Behandlungsempfehlungen zu erarbeiten.

Ergebnisse und Diskussion

Dadurch können die Studierenden auch seltene oder schwere psychiatrische Krankheitsbilder durch VR vermittelt kennenlernen. Dieser Übersichtsartikel stellt erste Erfahrungen insbesondere in Aufbau und Entwicklung sowie bez. der technologischen Herausforderungen dar.