News & Press: Simulation Technologies

Bringing Learning to Life

Thursday, September 17, 2020  
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by Billie Paschal, SimGHOSTS Board member


Healthcare Simulation Week is here again!  For me, the best thing about a designated week recognizing the industry we serve is to see what others are doing. Taking a week to see how we are evolving as an industry is inspiring.  The theme for this year's Healthcare Simulation Week is "Bringing Learning to Life," so I want to share with you some of the ways that simulationists around the world are using technology to improve learning outcomes. I reviewed several recent journal articles for my inspiration and the three I chose are Augmented Reality Learning Environment for Basic Life Support and Defibrillation Training: Usability Study by Ingrassia PL, Mormando G, Giudici E, Strada F, Carfagna F, Lamberti F, Bottino A from the Journal of Medical Internet Research.  Neurological Assessment Using a Physical-Virtual Patient (PVP) by Gonzalez L, Daher S, Welch G. from the Simulation & Gaming journal. Lastly, Hybrid medical simulation – a systematic literature review by Brown, W.J., Tortorella, R.A.W. found in the Smart Learning Environments. 

The team at SIMNOVA in Italy are taking a typical Basic Life Support class to the next level using an augmented reality product they developed in conjunction with the Department of Computer Engineering of Politecnico di Torino and Logosnet’s e-REAL Immersive Simulation Labs in Switzerland. The focus of the article was the use of Microsoft's HoloLens technology and their Holo-BLSD program, which is used to create high definition holograms that immerse the learner in a realistic scenario while they demonstrate their BLS skills on a manikin.  This phase of their research is to investigate user acceptance and feasibility of AR as a tool for BLS learning. 

The typical approach to teaching BLS is in a classroom setting with skills practice and demonstrations but it lacks the stress and cognitive load that learners face in a more realistic scenario. To improve realism, the HOLO-BLSD scenarios link virtual objects to the manikin and environment. Using this technology, the learner can now assess scene safety and remove potential hazards, perform a responsiveness check on the patient, activate emergency medical services using a public phone booth and interacting with a simulated operator, asking a bystander to find and retrieve and AED and performing CPR on a manikin torso with a full body AR overlay. 

Users reported confidence in using the technology with minimal additional cognitive load or physical effort. Their experience was enjoyable and realistic and they agreed that the system was a beneficial training tool. The most significant downfall was a lack of peripheral view and the impact of ambient light on the quality of the holograms. 

Continuing the augmented reality theme but using an entirely different technology, Gonzalez et al. (2020) bring learning to life by adding a head and neck semi-transparent plastic shell with rear-projection augmentation to an existing manikin to teach neurological assessment. Their Physical-Virtual Patient (PVP) can display facial expressions and verbal responses to provide learner cues and respond to requests such as those made to a patient when performing a neurological assessment.  The PVP was created "in house" with Autodesk Maya and the unity gaming engine and LipSync pro-unity to provide an example of a smile, grimace, and even lip movement for speaking. The physical components of the system comprise  a 3D printed human head using a projector underneath the shell with pre-recorded verbal responses played through a speaker embedded in the head shell.  The shell was then placed over a Laerdal SimMom to offer a body for continued assessment and completion of objectives.  

The nursing students who participated in the study reported increased authenticity and engagement when compared to manikin only simulation. Those who completed the scenario using the PVP also demonstrated greater knowledge acquisition than those who used manikin only. 

The third paper is a systematic review of the usage of hybrid simulation experiences and it is worth reading just for the literature review, which to me was like taking a stroll in a museum  (a museum for a simulation nerd like myself, I am not sure it would be an excellent financial investment). I knew of some of the hybrid technologies, such as the tracheostomy overlay system (TOS), others I did not.  I had no idea that Standardized Patients (SP) were being implemented as early as 1963, making SP's older than most of those reading this blog (even me).  

A common theme identified in the review is that of improved learner-patient interaction in hybrid simulation when compared to manikin or task trainer simulation, attributed to the ability of standardized patients to speak and display non-verbal cues in response to learner actions. A study comparing Intravenous Catheter Insertion training using Avstick in hybrid simulation or manikin found that they were equally effective in improving student self-efficacy however the hybrid simulation was superior for student interaction with the patient. Wearable and embedded sensors and low-cost DIY wearable trainers were other hybrid technologies that were show to be effective.  

Our industry brings learning to life; it is what we do every day. As a profession, healthcare simulation technology specialists are united by their passion for bringing learning to life using their diverse skill set. These three articles demonstrate that you can bring learning to life with simple, inexpensive, DIY solutions or high-tech innovations. I hope that in reading this you have had an idea spark or recognized that you have developed a valuable way of bringing learning to life that is worth sharing. Something to ponder as you celebrate Healthcare Simulation Week and continue to do our thing, bringing learning to life.