Hanna Maurin Söderholm

The impact of contextualization on immersion in healthcare simulation

BackgroundThe aim of this paper is to explore how contextualization of a healthcare simulation scenarios impacts immersion, by using a novel objective instrument, the Immersion Score Rating Instrument. This instrument consists of 10 triggers that indicate reduced or enhanced immersion among participants in a simulation scenario. Triggers refer to events such as jumps in time or space (sign of reduced immersion) and natural interaction with the manikin (sign of enhanced immersion) and can be used to calculate an immersion score.MethodsAn experiment using a randomized controlled crossover design was conducted to compare immersion between two simulation training conditions for prehospital care: one basic and one contextualized. The Immersion Score Rating Instrument was used to compare the total immersion score for the whole scenario, the immersion score for individual mission phases, and to analyze differences in trigger occurrences. A paired t test was used to test for significance.ResultsThe comparison shows that the overall immersion score for the simulation was higher in the contextualized condition. The average immersion score was 2.17 (sd = 1.67) in the contextualized condition and −0.77 (sd = 2.01) in the basic condition (p < .001). The immersion score was significantly higher in the contextualized condition in five out of six mission phases. Events that might be disruptive for the simulation participants’ immersion, such as interventions of the instructor and illogical jumps in time or space, are present to a higher degree in the basic scenario condition; while events that signal enhanced immersion, such as natural interaction with the manikin, are more frequently observed in the contextualized condition.ConclusionsThe results suggest that contextualization of simulation training with respect to increased equipment and environmental fidelity as well as functional task alignment might affect immersion positively and thus contribute to an improved training experience.

Measuring participants’ immersion in healthcare simulation: the development of an instrument

BackgroundImmersion is important for simulation-based education; however, questionnaire-based instruments to measure immersion have some limitations. The aim of the present work is to develop a new instrument to measure immersion among participants in healthcare simulation scenarios.MethodsThe instrument was developed in four phases: trigger identification, content validity scores, inter-rater reliability analysis and comparison with an existing immersion measure instrument. A modified Delphi process was used to develop the instrument and to establish validity and reliability. The expert panel consisted of 10 researchers. All the researchers in the team had previous experience of simulation in the health and/or fire and rescue services as researchers and/or educators and simulation designers. To identify triggers, the panel members independently screened video recordings from simulation scenarios. Here, a trigger is an event in a simulation that is considered a sign of reduced or enhanced immersion among simulation participants.ResultsThe result consists of the Immersion Score Rating Instrument (ISRI). It contains 10 triggers, of which seven indicate reduced and three enhanced immersion. When using ISRI, a rater identifies trigger occurrences and assigns them strength between 1 and 3. The content validity analysis shows that all the 10 triggers meet an acceptable content validity index for items (I-CVI) standard. The inter-rater reliability (IRR) among raters was assessed using a two-way mixed, consistency, average-measures intra-class correlation (ICC). The ICC for the difference between weighted positive and negative triggers was 0.92, which indicates that the raters are in agreement. Comparison with results from an immersion questionnaire mirrors the ISRI results.ConclusionsIn conclusion, we present a novel and non-intrusive instrument for identifying and rating the level of immersion among participants in healthcare simulation scenarios.

Combining Work Process Models to Identify Training Needs in the Prehospital Care Process

The prehospital process is complex and covers a wide range of locations, healthcare personnel, technologies and competences. Enabling high quality holistic training is hence a challenge. Process models are efficient tools for representing reality, but no single modeling approach can cover the complexity of prehospital care. In our research, we have investigated the possibility to combine various process modeling techniques in order to identify training components and as many perspectives of the prehospital process as possible. Results show that combining different approaches and adapting them based on the need at hand is a successful strategy for enabling an of the prehospital care process from multiple perspectives, including identification of holistic, realistic and engaging training components. Future work can utilize our results to build training scenarios that can be implemented in training using for example simulation.

Enhancing Immersion with Contextualized Scenarios: Role-Playing in Prehospital Care Training

This paper discusses the method used in a field experiment with 12 paramedic teams (n=24) exploring how they perceive a novel training approach. Much simulation-based training in prehospital care is decontextualized, meaning that medical care is trained without taking other characteristics of prehospital care into account. In this paper we suggest how a richer setting (contextualization), which includes more of the complicating aspects of prehospital care, can be introduced and evaluated in prehospital training.

Designing Simulation-Based Training for Prehospital Emergency Care: Participation from a Participant Perspective

Simulation-based training for prehospital emergency care is characterized by high degrees of complexity. Thorough knowledge of both the work and the setting is crucial and it is therefore important to involve both end-users and other stakeholders during the whole design process. This paper investigates a design process by focusing on how project participants experience the work process and participation of a multi-disciplinary, research-practitioner design team. This case study focuses on the work within a development project of a new prehospital emergency training facility. Open-ended interviews were conducted with the project participants halfway through the project. Strikingly, the results show that while there are problems and tensions that potentially could overturn the project, all participants express strong satisfaction with their participation in the project. This implies that the accumulated positive experiences are so strong that they overshadow tensions and problems that under other circumstances could have caused a project breakdown.

Breaking Out of the Bubble Putting Simulation Into Context to Increase Immersion and Performance

Objective. Simulation based training with full-size mannequins is a prominent means of training within the healthcare sector. Prehospital missions include all parts of the healthcare process which take place before a patient is handed over to the receiving hospital. This implies that the context for prehospital care is varied and potentially challenging or dangerous in several ways. In this article we present a study which explores immersion and performance by emergency medical services (EMS) professionals in in a training situation which takes the specifics of prehospital interventions into account. Methods. The study was carried out as a field experiment at an ambulance unit. The experiment was designed to compare the differences between two types of medical scenarios: basic and contextualized. We analyzed the levels of immersion throughout the scenarios and then team performance was evaluated by independent experts. Both analyses were made by observing video recordings from multiple camera angles with a custom made analysis tool. Results. Our results show that the contextualization of a medical scenario increases both immersion as measured by the Immersion Score Rating Instrument (ISRI) and team performance as measured by the Global Rating Scale (GRS). The overall ISRI score was higher in the contextualized condition as compared to the basic condition, with an average team wise difference of 2.94 (sd = 1.45). This difference is significant using a paired, two-tailed t-test (p<.001). The GRS score was higher for overall clinical performance in the contextualized scenario with an average team wise difference of 0.83 (sd = 0.83, p=.005). Conclusions. Full-size mannequin simulation based training for EMS professionals may be enhanced by contextualizing the medical scenarios. The main benefits are that the contextualized scenarios better take prehospital medical challenges into account and allow participants to perform better.

Spontaneous reactions to an anti-piracy initiative: A Youtube clip micro analysis

In this case study we analyzed the traces of spontaneous reactions of Youtube users when confronted with the short clip ’You wouldn’t Steal a Car’, that was used by the Motion Picture Association of America (MPAA) to influence people not to download copyrighted material from the Internet. This film has become an important cultural icon, which to a certain degree has shaped a whole generation of film viewers. The aim of this study was to provide an example of how anti piracy initiatives are received and understood by the receivers of the message. This was performed by collecting and analyzing the users spontaneous reactions as entered as comments on the Youtube page for the clip by qualitatively categorizing the contents using a bottom up approach. The results suggest that people practicing Internet-based culture consumption (IBCC) do this in more nuanced ways than is assumed in the film, where they are polarized as either “common thieves” or “good citizens”.

“You guys who download stuff illegally, don’t you ever feel guilty?”: Initial analysis of changes in practices and values among Swedish illegal file sharers 2007-2012

The study reports on the practices of illegal file sharing in Sweden during the period 2007-2012. More than 1.000 posts in response to the question “You guys who download stuff illegally, don’t you ever feel guilty?” where analyzed with regard to the respondents’ expressed senses of guilt, whether file sharing was right or wrong, if they buy media, together with dimensions of stakeholders and media genres. Preliminary results suggest that no changes in feelings of guilt were detected during the time period. However, more posts report to now buy media, while at there at the same time seem to be an increase in posts expressing file sharing, despite its current illegal status, is a right thing to do. A qualitative analysis is needed to further understand the complexity of current changes in file sharers justifications for what content to acquire through illegal file sharing, what they choose to pay for – and why.