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Hanke LI, Vradelis L, Boedecker C, Griesinger J, Demare T, Lindemann NR, Huettl F, Chheang V, Saalfeld P, Wachter N, Wollstädter J, Spranz M, Lang H, Hansen C, Huber T. Immersive virtual reality for interdisciplinary trauma management - initial evaluation of a training tool prototype. BMC MEDICAL EDUCATION 2024; 24:769. [PMID: 39026193 PMCID: PMC11264734 DOI: 10.1186/s12909-024-05764-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Emergency care of critically ill patients in the trauma room is an integral part of interdisciplinary work in hospitals. Live threatening injuries require swift diagnosis, prioritization, and treatment; thus, different medical specialties need to work together closely for optimal patient care. Training is essential to facilitate smooth performance. This study presents a training tool for familiarization with trauma room algorithms in immersive virtual reality (VR), and a first qualitative assessment. MATERIALS AND METHODS An interdisciplinary team conceptualized two scenarios and filmed these in the trauma room of the University Medical Center Mainz, Germany in 3D-360°. This video content was used to create an immersive VR experience. Participants of the Department of Anesthesiology were included in the study, questionnaires were obtained and eye movement was recorded. RESULTS 31 volunteers participated in the study, of which 10 (32,2%) had completed specialist training in anesthesiology. Participants reported a high rate of immersion (immersion(mean) = 6 out of 7) and low Visually Induced Motion Sickness (VIMS(mean) = 1,74 out of 20). Participants agreed that VR is a useful tool for medical education (mean = 1,26; 1 very useful, 7 not useful at all). Residents felt significantly more secure in the matter after training (p < 0,05), specialist showed no significant difference. DISCUSSION This study presents a novel tool for familiarization with trauma room procedures, which is especially helpful for less experienced residents. Training in VR was well accepted and may be a solution to enhance training in times of low resources for in person training.
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Affiliation(s)
- Laura Isabel Hanke
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Lukas Vradelis
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christian Boedecker
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jan Griesinger
- Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Tim Demare
- Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Nicola Raphaele Lindemann
- Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Florentine Huettl
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Vuthea Chheang
- Virtual and Augmented Reality Group, Faculty of Computer Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Patrick Saalfeld
- Virtual and Augmented Reality Group, Faculty of Computer Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Nicolas Wachter
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jochen Wollstädter
- Department of Orthopedics and Trauma Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Marike Spranz
- Department of Diagnostic and Interventional Radiology, University Medical Center Johannes Gutenberg-University, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christian Hansen
- Virtual and Augmented Reality Group, Faculty of Computer Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany.
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Tran M, Ahmad M, Patel K, Argyriou O, Davies A, Shalhoub J. Comparing virtual reality and simulation to teach the assessment and management of acute surgical scenarios: A pilot study. Health Sci Rep 2024; 7:e2245. [PMID: 38983682 PMCID: PMC11231037 DOI: 10.1002/hsr2.2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/25/2024] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
Background and Aims Traditional apprenticeship-based surgical training presents with challenges, especially in acute scenarios. Simulation provides the current standard of facilitating surgical training in a low-risk environment but is restricted by limited accessibility and high costs. Virtual reality (VR) offers immersive three-dimensional computer-generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin-based simulation. We hypothesised that VR would be as effective as mannequin-based simulation in performance outcomes. Methods This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin-based simulation. Participants completed questionnaires and a 15-min pneumothorax scenario. Quantitative metrics included overall score, time-to-critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants' likes and dislikes of their allocated simulation modality. Results VR participants scored significantly higher than mannequin-based simulation participants in overall scores (74.30% (SD ± 5.08%) vs. 59.75% (SD ± 10.14) (p = 0.04)), and technical skills aspects (77.20% (SD ± 8.01%) vs. 65.00% (SD ± 8.21%) (p = 0.01)). Mannequin-based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time-to-completion (p = 0.06). ABS scores increased for both study groups, though was only significant for VR participants (p ≤ 0.01). VR participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication-learning compared to mannequin-based simulation. Conclusion Both VR and mannequin-based simulation training are effective in training junior doctors in acute surgical scenarios but present different educational benefits. Future research should recruit a larger sample size for a full comparative randomised controlled trial.
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Affiliation(s)
- Mi‐Tra Tran
- Faculty of MedicineImperial College LondonLondonUK
- Department of Surgery and Cancer, Academic Section of Vascular SurgeryImperial College LondonLondonUK
| | - Manal Ahmad
- Department of Surgery and Cancer, Academic Section of Vascular SurgeryImperial College LondonLondonUK
- Imperial Vascular UnitImperial College Healthcare NHS TrustLondonUK
| | - Kirtan Patel
- Department of Surgery and Cancer, Academic Section of Vascular SurgeryImperial College LondonLondonUK
| | - Orestis Argyriou
- Department of General SurgeryImperial College Healthcare NHS TrustLondonUK
| | - Alun Davies
- Department of Surgery and Cancer, Academic Section of Vascular SurgeryImperial College LondonLondonUK
- Imperial Vascular UnitImperial College Healthcare NHS TrustLondonUK
| | - Joseph Shalhoub
- Department of Surgery and Cancer, Academic Section of Vascular SurgeryImperial College LondonLondonUK
- Imperial Vascular UnitImperial College Healthcare NHS TrustLondonUK
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Birrenbach T, Stuber R, Müller CE, Sutter PM, Hautz WE, Exadaktylos AK, Müller M, Wespi R, Sauter TC. Virtual reality simulation to enhance advanced trauma life support trainings - a randomized controlled trial. BMC MEDICAL EDUCATION 2024; 24:666. [PMID: 38886688 PMCID: PMC11184689 DOI: 10.1186/s12909-024-05645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Advanced Trauma Life Support (ATLS) is the gold standard of initial assessment of trauma patients and therefore a widely used training program for medical professionals. Practical application of the knowledge taught can be challenging for medical students and inexperienced clinicians. Simulation-based training, including virtual reality (VR), has proven to be a valuable adjunct to real-world experiences in trauma education. Previous studies have demonstrated the effectiveness of VR simulations for surgical and technical skills training. However, there is limited evidence on VR simulation training specifically for trauma education, particularly within the ATLS curriculum. The purpose of this pilot study is to evaluate the feasibility, effectiveness, and acceptance of using a fully immersive VR trauma simulation to prepare medical students for the ATLS course. METHODS This was a prospective randomised controlled pilot study on a convenience sample of advanced medical students (n = 56; intervention group with adjunct training using a commercially available semi-automated trauma VR simulation, n = 28, vs control group, n = 28) taking part in the ATLS course of the Military Physician Officer School. Feasibility was assessed by evaluating factors related to technical factors of the VR training (e.g. rate of interruptions and premature termination). Objective and subjective effectiveness was assessed using confidence ratings at four pre-specified points in the curriculum, validated surveys, clinical scenario scores, multiple choice knowledge tests, and ATLS final clinical scenario and course pass rates. Acceptance was measured using validated instruments to assess variables of media use (Technology acceptance, usability, presence and immersion, workload, and user satisfaction). RESULTS The feasibility assessment demonstrated that only one premature termination occurred and that all remaining participants in the intervention group correctly stabilised the patient. No significant differences between the two groups in terms of objective effectiveness were observed (p = 0.832 and p = 0.237 for the pretest and final knowledge test, respectively; p = 0.485 for the pass rates for the final clinical scenario on the first attempt; all participants passed the ATLS course). In terms of subjective effectiveness, the authors found significantly improved confidence post-VR intervention (p < .001) in providing emergency care using the ATLS principles. Perceived usefulness in the TEI was stated with a mean of 4 (SD 0.8; range 0-5). Overall acceptance and usability of the VR simulation was rated as positive (System Usability Scale total score mean 79.4 (SD 11.3, range 0-100). CONCLUSIONS The findings of this prospective pilot study indicate the potential of using VR trauma simulations as a feasible and acceptable supplementary tool for the ATLS training course. Where objective effectiveness regarding test and scenario scores remained unchanged, subjective effectiveness demonstrated improvement. Future research should focus on identifying specific scenarios and domains where VR can outperform or enhance traditional learning methods in trauma simulation.
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Affiliation(s)
- Tanja Birrenbach
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Freiburgstrasse 16C, CH-3010.
| | - Raphael Stuber
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Freiburgstrasse 16C, CH-3010
| | | | | | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Freiburgstrasse 16C, CH-3010
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Freiburgstrasse 16C, CH-3010
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Freiburgstrasse 16C, CH-3010
| | - Rafael Wespi
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Freiburgstrasse 16C, CH-3010
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Thomas Christian Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Freiburgstrasse 16C, CH-3010
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Thoolen SJJ, Kuypers MI. External Hemorrhage Control Techniques for Human Space Exploration: Lessons from the Battlefield. Wilderness Environ Med 2023; 34:231-242. [PMID: 36906432 DOI: 10.1016/j.wem.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/11/2023]
Abstract
The past few decades of military experience have brought major advances in the prehospital care of patients with trauma. A focus on early hemorrhage control with aggressive use of tourniquets and hemostatic gauze is now generally accepted. This narrative literature review aims to discuss external hemorrhage control and the applicability of military concepts in space exploration. In space, environmental hazards, spacesuit removal, and limited crew training could cause significant time delays in providing initial trauma care. Cardiovascular and hematological adaptations to the microgravity environment are likely to reduce the ability to compensate, and resources for advanced resuscitation are limited. Any unscheduled emergency evacuation requires a patient to don a spacesuit, involves exposure to high G-forces upon re-entry into Earth's atmosphere, and costs a significant amount of time until a definitive care facility is reached. As a result, early hemorrhage control in space is critical. Safe implementation of hemostatic dressings and tourniquets seems feasible, but adequate training will be essential, and tourniquets are preferably converted to other methods of hemostasis in case of a prolonged medical evacuation. Other emerging approaches such as early tranexamic acid administration and more advanced techniques have shown promising results as well. For future exploration missions to the Moon and Mars, when evacuation is not possible, we look into what training or assistance tools would be helpful in managing the bleed at the point of injury.
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Affiliation(s)
- Stijn J J Thoolen
- Neural Systems Group, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA; Centre for Human and Applied Physiological Sciences, King's College London, United Kingdom.
| | - Maybritt I Kuypers
- European Astronaut Centre, European Space Agency, Cologne, Germany; Department of Emergency Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands
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Trauma Quality Improvement and Team Education: How Can We Better Optimize Our Training? CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Tovar MA, Zebley JA, Higgins M, Herur-Raman A, Zwemer CH, Pierce AZ, Ranniger C, Sarani B, Phillips JP. Exposure to a Virtual Reality Mass-Casualty Simulation Elicits a Differential Sympathetic Response in Medical Trainees and Attending Physicians. Prehosp Disaster Med 2023; 38:1-9. [PMID: 36606324 PMCID: PMC9885434 DOI: 10.1017/s1049023x22002448] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Previous studies have demonstrated the use of virtual reality (VR) in mass-casualty incident (MCI) simulation; however, it is uncertain if VR simulations can be a substitute for in-person disaster training. Demonstrating that VR MCI scenarios can elicit the same desired stress response achieved in live-action exercises is a first step in showing non-inferiority. The primary objective of this study was to measure changes in sympathetic nervous system (SNS) response via a decrease in heart rate variability (HRV) in subjects participating in a VR MCI scenario. METHODS An MCI simulation was filmed with a 360º camera and shown to participants on a VR headset while simultaneously recording electrocardiography (EKG) and HRV activity. Baseline HRV was measured during a calm VR scenario immediately prior to exposure to the MCI scenarios, and SNS activation was captured as a decrease in HRV compared to baseline. Cognitive stress was measured using a validated questionnaire. Wilcoxon matched pairs signed rank analysis, Welch's t-test, and multivariate logistic regression were performed with statistical significance established at P <.05. RESULTS Thirty-five subjects were enrolled: eight attending physicians (two surgeons, six Emergency Medicine [EM] specialists); 13 residents (five Surgery, eight EM); and 14 medical students (six pre-clinical, eight clinical-year students). Sympathetic nervous system activation was observed in all groups during the MCI compared to baseline (P <.0001) and occurred independent of age, sex, years of experience, or prior MCI response experience. Overall, 23/35 subjects (65.7%) reported increased cognitive stress in the MCI (11/14 medical students, 9/13 residents, and 3/8 attendings). Resident and attending physicians had higher odds of discordance between SNS activation and cognitive stress compared to medical students (OR = 8.297; 95% CI, 1.408-64.60; P = .030). CONCLUSIONS Live-actor VR MCI simulation elicited a strong sympathetic response across all groups. Thus, VR MCI training has the potential to guide acquisition of confidence in disaster response.
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Affiliation(s)
- Matthew A. Tovar
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
| | - James A. Zebley
- Department of Surgery, George Washington University, Washington, DCUSA
| | - Mairead Higgins
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
| | - Aalap Herur-Raman
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
| | - Catherine H. Zwemer
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
| | - Ayal Z. Pierce
- Department of Emergency Medicine, George Washington University, Washington, DCUSA
| | - Claudia Ranniger
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
- Department of Emergency Medicine, George Washington University, Washington, DCUSA
| | - Babak Sarani
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
- Department of Surgery, George Washington University, Washington, DCUSA
- Department of Emergency Medicine, George Washington University, Washington, DCUSA
| | - James P. Phillips
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
- Department of Emergency Medicine, George Washington University, Washington, DCUSA
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Kiyozumi T, Ishigami N, Tatsushima D, Araki Y, Sekine Y, Saitoh D. Development of virtual reality content for learning Japan Prehospital Trauma Evaluation and Care initial assessment procedures. Acute Med Surg 2022; 9:e755. [PMID: 35572049 PMCID: PMC9077464 DOI: 10.1002/ams2.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
Aim The Japan Prehospital Trauma Evaluation and Care (JPTEC) is a standardized educational program for prehospital trauma care in Japan. The initial assessment in the JPTEC course comprises a training segment that includes a 30‐min session. Given the limited face‐to‐face training due to the coronavirus disease 2019, virtual reality (VR) content has become an alternative. However, creating VR content typically requires the assistance of expert technicians. We aimed to create VR content for the initial assessment segment of the JPTEC and verify its educational effectiveness. Methods We created VR content for learning the initial assessment of the JPTEC using our easy‐to‐use VR content creation system. The participants played the VR content for 15 min. The number of times they “cleared” (i.e., made a correct decision and completed the initial assessment) was recorded every 5 min. Then, a JPTEC‐certified instructor tested their practical skills through face‐to‐face simulation. Results The authors had no specialized skills and created the VR content in 2 days. Fourteen students used the material. They cleared the scenario 3 (3–4) times in the first 5 min in 15 min, 5 (4–5) times in the second 5 min, and 5 (5–5) times in the third 5 min (P < 0.05). All participants passed the practical evaluation. Conclusion A shorter VR training developed using our easy‐to‐use VR content creation system can replace the 30‐min JPTEC session on the initial assessment. This system allows for the free and easy creation of VR content.
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Affiliation(s)
- Tetsuro Kiyozumi
- Department of Defense Medicine National Defense Medical College Tokorozawa City Japan
- Department of Traumatology and Critical Care Medicine National Defense Medical College Tokorozawa City Japan
| | - Norio Ishigami
- Department of Defense Medicine National Defense Medical College Tokorozawa City Japan
| | - Daisuke Tatsushima
- Department of Defense Medicine National Defense Medical College Tokorozawa City Japan
| | - Yoshiyuki Araki
- Department of Defense Medicine National Defense Medical College Tokorozawa City Japan
| | - Yasumasa Sekine
- Department of Traumatology and Critical Care Medicine National Defense Medical College Tokorozawa City Japan
- Division of Traumatology, Research Institute National Defense Medical College Tokorozawa City Japan
| | - Daizoh Saitoh
- Department of Traumatology and Critical Care Medicine National Defense Medical College Tokorozawa City Japan
- Division of Traumatology, Research Institute National Defense Medical College Tokorozawa City Japan
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