Simulated Medical Learning Environments on the Internet

Learning anatomy and surgical procedures requires both a conceptual understanding of three-dimensional anatomy and a hands-on manipulation of tools and tissue. Such virtual resources are not available widely, are expensive, and may be culturally disallowed. Simulation technology, using high-performance computers and graphics, permits realistic real-time display of anatomy. Haptics technology supports the ability to probe and feel this virtual anatomy through the use of virtual tools. The Internet permits world-wide access to resources. We have brought together high-performance servers and high-bandwidth communication using the Next Generation Internet and complex bimanual haptics to simulate a tool-based learning environment for wide use. This article presents the technologic basis of this environment and some evaluation of its use in the gross anatomy course at Stanford University.Media-rich learning experiences are widely available on the web. Medical schools and other health care organizations maintain extensive websites for learning, reference, and assessment. Continuing medical education on the Internet is one of the most commonly available and widely used services for health care practitioners. These media-based learning environments, though widely available, represent a passive medium of information retrieval by clicking a mouse.We have been investigating the next generation of Internet-based learning technologies: simulation-oriented learning environments that support interaction, collaboration, and active learning. The topics of learning are anatomy and basic surgical manipulations. To support these topics, we have developed three-dimensional visualizations of anatomy and have enriched these anatomical models with biomechanical tissue properties of elasticity and viscosity such that the learner can use appropriate force-feedback tools to feel tissues at the same time that they visualize them. Access to and interaction with these simulation environments have required that we push the envelope of current Internet capabilities, and that we investigate the role of network bandwidth and latency in the performance of these applications. A preliminary version of this work was presented at MedInfo, 2001.¹