A Virtual Reality Simulation Curriculum for Intravenous Cannulation Training

Objectives: Although virtual reality (VR) simulators play an important role in modern medical training, their efficacy is not often evaluated using learning curves. In this study, the learning curves of novice and intermediate users were elicited during a VR simulation–based curriculum for intravenous (IV) cannulation. Methods: This was a prospective observational study of subjects undergoing training using a VR model of IV cannulation. Participants were divided into two groups: novices (third‐year medical students with no prior practical experience in IV catheterization) and intermediates (recent graduates with limited experience). Performance was measured with two endpoints: time to completion and errors committed. Errors were categorized as critical or noncritical. Learning curves (error score and time completion vs. session number) were analyzed using the Friedman’s test. Performance before and after training was compared using the Kruskal‐Wallis test. The Spearman rank correlation coefficient (r_s) was used to determine the correlation between time completion and error score estimates. The number of attempts required to complete the training phase was also measured and compared between the two groups. Results: Thirty subjects were enrolled: 17 in the novice group and 13 in the intermediate group. Learning curve plateaus of intermediates were reached in the sixth case scenario (session), whereas novices reached a plateau in the eighth session. Performance comparison of time to completion and errors showed significant improvement for both groups. Less time and fewer attempts were required by all trainees to complete a scenario while progressing through the curriculum. The overall number of IV cannulation attempts of novices was significantly higher than that of the intermediates throughout the course. Conclusions: Significant learning curves for novice and intermediate students were demonstrated after following the VR simulation–based curriculum. Competencies acquired during this educational course may provide an important advantage for training prior to actual clinical practice. ACADEMIC EMERGENCY MEDICINE 2010; 17:1142–1145 © 2010 by the Society for Academic Emergency Medicine     

Virtual Reality and Simulation: Training the Future Emergency Physician

The traditional system of clinical education in emergency medicine relies on practicing diagnostic, therapeutic, and procedural skills on live patients. The ethical, financial, and practical weaknesses of this system are well recognized, but the alternatives that have been explored to date have shown even greater flaws. However, ongoing progress in the area of virtual reality and computer-enhanced simulation is now providing educational applications that show tremendous promise in overcoming most of the deficiencies associated with live-patient training. It will be important for academic emergency physicians to become more involved with this technology to ensure that our educational system benefits optimally.     

The Effect of Virtual Reality and Buzzy on First Insertion Success,Procedure-Related Fear,Anxiety, and Pain in Children during Intravenous Insertion in the Pediatric Emergency Unit: A Randomized Controlled Trial

IntroductionDistraction methods such as virtual reality and cold vibration device are recommended during intravenous interventions. Few studies have focused on the impact of nonpharmacological interventions on intravenous insertion success.MethodsA randomized controlled study evaluated effect of virtual reality and cold vibration device application on first-attempt intravenous insertion success and procedure-related pain, fear, and anxiety during intravenous insertion in children. Children aged 4 to 10 years (N = 150) undergoing peripheral intravenous catheterization insertion in the pediatric emergency department were randomized to 1 of 3 groups: virtual reality, cold vibration (Buzzy), and control group. Distraction technique of talking and asking questions of children was used in control group. Primary outcome was first-attempt intravenous insertion success; secondary outcomes were procedure-related pain, fear, and anxiety. Study data were collected using Difficult Intravenous Access score, Emotional Appearance Scale for Children, Wong-Baker Faces Pain Rating Scale, Color Analog Scale, Children's Anxiety Meter-State, and Child Fear Scale. Data were analyzed using chi-square test, Fisher exact test, and Kruskal–Wallis test.ResultsThere were no significant differences in first-attempt intravenous insertion success rates (virtual reality = 47.2%, Buzzy® = 50%, control = 46.9%), preprocedural emotional appearance scores, and procedure-related pain and anxiety scores. There was no difference between groups for vital signs before, during, and at fifth minute of procedure.DiscussionVirtual reality and Buzzy may decrease procedure-related fear in children during intravenous insertion. This research has shown that pediatric emergency nurses can reduce pain and anxiety by talking to children, and simple distractions such as asking questions are as effective as more technological ones.     

Learning in 360 Degrees: A Pilot Study on the Use of Virtual Reality for Radiation Therapy Patient Education

BackgroundPatient education for external beam radiation therapy (EBRT) is traditionally delivered in verbal and/or written form, which may not provide a full picture of the complex, technical aspects of treatment. The purpose of this pilot study was to create and evaluate a prototype 360-degree virtual reality (VR) video outlining the technical aspects of EBRT to the pelvis as a supplement to traditional education methods.Materials and MethodsA prototype VR video was filmed to simulate the delivery of one fraction of image-guided EBRT to the pelvis. Patients having a radical course of image-guided EBRT to the pelvis were approached while on active treatment to participate in focus groups evaluating the prototype VR video. Focus group discussions were recorded, transcribed, and subjected to thematic analysis.ResultsAll patients were accrued from a single academic cancer centre in a large metropolitan area. In total, seven patients were enrolled to participate in the focus groups. Thematic analysis revealed 71% of participants felt the traditional patient education met their needs. However, 86% mentioned the education did not fully capture the treatment experience. Participants identified potential benefits of VR could include an increased understanding of the treatment process, specifically the spatial and acoustic aspects of treatment, as well as the potential to reduce anxiety in new patients. Timing was also important, with 86% of participants recommending VR video viewing before the first day of treatment. Participants provided feedback such as including two-dimensional elements in the VR video and other changes which could potentially make the viewing experience more realistic.ConclusionsTraditional teaching methods are seen as satisfactory by patients at our institution, but it is recognized that there is a gap in current education methods. An immersive VR education tool has the potential to enhance standard patient education, increasing understanding of treatment and decreasing anxiety.     

A Review of Training Research and Virtual Reality Simulators for the da Vinci Surgical System

Phenomenon: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators. Approach: This review draws from published research to propose a core technical skill set for using the da Vinci surgeon console. Publications on three commercial simulators were used to evaluate the simulators’ content addressing these skills and associated metrics. Findings: An analysis of published research suggests that a core technical skill set for operating the surgeon console includes bimanual wristed manipulation, camera control, master clutching to manage hand position, use of third instrument arm, activating energy sources, appropriate depth perception, and awareness of forces applied by instruments. Validity studies of three commercial virtual reality simulators for robot-assisted surgery suggest that all three have comparable content and metrics. However, none have comprehensive content and metrics for all core skills. Insights: Virtual reality simulation remains a promising tool to support skill training for robot-assisted surgery, yet existing commercial simulator content is inadequate for performing and assessing a comprehensive basic skill set. The results of this evaluation help identify opportunities and challenges that exist for future developments in virtual reality simulation for robot-assisted surgery. Specifically, the inclusion of educational experts in the development cycle alongside clinical and technological experts is recommended.     

虚拟现实技术在老年康复医学中的应用研究进展

人口老龄化使社会对老年康复医疗服务的需求迅速增长。虚拟现实技术在康复过程中为训练者提供了有意义的任务性训练与感觉回馈,推动了从被动康复到主动康复的模式转变,特别在老年康复医学领域具有很大的临床应用潜力。本文就虚拟现实技术的概念、作用机制及其在国内外老年康复医学领域的应用研究进展进行综述。     

虚拟现实训练系统在康复医学教育中的应用

目的探讨虚拟现实训练系统在康复治疗学本科临床教学的应用价值。方法 26名本科康复治疗学专业实习生,在物理治疗临床教学中分为两组。研究组(n=14)采用先虚拟现实教学后传统教学的方式,对照组(n=12)采用传统教学的方式。学习结束后进行学生自我评价和物理治疗操作考试。结果研究组在提升训练目的性和趣味性、提高学习主动性和积极性、提高临床能力等方面优于对照组。理论考试成绩两组无显著性差异,操作考试成绩研究组优于对照组(P0.05)。结论引入虚拟现实系统可提高物理治疗学教学效果。     

虚拟现实技术对老年人平衡功能康复效果的Meta分析

目的 系统评价虚拟现实技术对老年人平衡功能康复的有效性。 方法 从中国知网、万方数据、中国生物医学文献数据库、维普、Web of Science、PubMed、Clinical Science、EMBASE、Science Direct、Medline、Cohrane Library对照实验中心注册数据库和谷歌学术,检索2009年至2019年虚拟现实平衡康复训练与常规康复训练对照治疗老年人平衡功能障碍的临床随机对照试验,筛选文献、提取资料并评价纳入研究的偏倚风险,运用RevMan软件进行Meta分析。 结果 最终纳入20项临床随机对照试验。对所有年龄段老年人,Berg平衡量表(BBS)评分有显著性差异(WMD = 2.33, 95%CI 0.88~3.78);对 < 75岁老年人,BBS评分有显著性差异(WMD = 2.59, 95%CI 0.22~4.97);对 > 75岁老年人,BBS评分有显著性差异(WMD = 2.69,95%CI 1.82~3.57)。对所有年龄段老年人,计时起立-行走试验(TUGT)时间有显著性差异(WMD = -0.96, 95%CI -1.65~-0.28);对 < 75岁老年人,TUGT时间有显著性差异(WMD = -1.06, 95%CI -1.98~-0.15);对 > 75岁老年人,TUGT时间无显著性差异(WMD = -0.81, 95%CI -1.98~0.37)。 结论 虚拟现实平衡功能训练能有效促进老年人平衡及步行功能康复。