Sakti Srivastava

Design, Development, and Evaluation of an Online Virtual Emergency Department for Training Trauma Teams

Background: Training interdisciplinary trauma teams to work effectively together using simulation technology has led to a reduction in medical errors in emergency department, operating room, and delivery room contexts. High-fidelity patient simulators (PSs)—the predominant method for training healthcare teams—are expensive to develop and implement and require that trainees be present in the same place at the same time. In contrast, online computer-based simulators are more cost effective and allow simultaneous participation by students in different locations and time zones. In this pilot study, the researchers created an online virtual emergency department (Virtual ED) for team training in crisis management, and compared the effectiveness of the Virtual ED with the PS. We hypothesized that there would be no difference in learning outcomes for graduating medical students trained with each method. Methods: In this pilot study, we used a pretest-posttest control group, experimental design in which 30 subjects were randomly assigned to either the Virtual ED or the PS system. In the Virtual ED each subject logged into the online environment and took the role of a team member. Four-person teams worked together in the Virtual ED, communicating in real time with live voice over Internet protocol, to manage computer-controlled patients who exhibited signs and symptoms of physical trauma. Each subject had the opportunity to be the team leader. The subjects’ leadership behavior as demonstrated in both a pretest case and a posttest case was assessed by 3 raters, using a behaviorally anchored scale. In the PS environment, 4-person teams followed the same research protocol, using the same clinical scenarios in a Simulation Center. Guided by the Emergency Medicine Crisis Resource Management curriculum, both the Virtual ED and the PS groups applied the basic principles of team leadership and trauma management (Advanced Trauma Life Support) to manage 6 trauma cases—a pretest case, 4 training cases, and a posttest case. The subjects in each group were assessed individually with the same simulation method that they used for the training cases. Results: Subjects who used either the Virtual ED or the PS showed significant improvement in performance between pretest and posttest cases (P < 0.05). In addition, there was no significant difference in subjects’ performance between the 2 types of simulation, suggesting that the online Virtual ED may be as effective for learning team skills as the PS, the method widely used in Simulation Centers. Data on usability and attitudes toward both simulation methods as learning tools were equally positive. Discussion: This study shows the potential value of using virtual learning environments for developing medical students’ and resident physicians’ team leadership and crisis management skills.

Evaluation of a surgical simulator for learning clinical anatomy.

Background  New techniques in imaging and surgery have made 3‐dimensional anatomical knowledge an increasingly important goal of medical education. This study compared the efficacy of 2 supplemental, self‐study methods for learning shoulder joint anatomy to determine which method provides for greater transfer of learning to the clinical setting.

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.

Interactive simulation of the human hand

This paper presents techniques for simulating the motion of a human hand on a computer graphics display. This simulation is based on a generic 3D model of the human hand in which the bone structure is described as an articulated linkage. Soft tissue around the bones is represented using mass-spring meshes. A predictor-corrector method, including the treatment of incompressibility and collision constraints, is used to compute soft-tissue deformation while bones are moving. Tendons responsible for the movement of the fingers are not explicitly represented as distinct objects, but their mechanical effect on the bone structure (application of forces) is included in our model. The implemented software simulates a human hand, including bone movement, soft-tissue deformation, and collision handling, at interactive rates on a PC. This software may be used as a tool to teach anatomy or simulate surgical operations.

Production of a Multisource, Real-Time, Interactive Lesson in Anatomy and Surgery: Corn Demonstration

During Internet2s 2002 Fall Member Meeting in Los Angeles, the California Orthopaedic Research Network (CORN) demonstrated a unique distributed learning environment that sought to enrich medical student understanding of hand anatomy and surgery. Live, streaming video of an orthopedic surgical procedure at UCLA Medical Center was combined with related stereoscopic “virtual hand” images from Stanford, to teach participants at a third location. Medical students, anatomists, and surgeons at these remote but connected sites valued the simultaneous real-time interactions among the different venues. A number of technical issues were resolved during this exercise. This article describes the process of arranging such a demonstration and summarizes the lessons learned from our experience so that this innovative pedagogical approach can be successfully adopted on a broader scale.

Simulated learning environments in anatomy and surgery delivered via the next generation internet.

The Next Generation Internet (NGI) will provide high bandwidth, guaranteed Quality of Service, collaboration and security, features that are not available in todays Internet. Applications that take advantage of these features will need to build them into their pedagogic requirements. We present the Anatomy Workbench and the Surgery Workbench, two applications that require most of these features of the NGI. We used pedagogic need and NGI features to define a set of applications that would be difficult to operate on the current Internet, and that would require the features of the NGI. These applications require rich graphics and visualization, and extensive haptic interaction with biomechanical models that represent bony and soft tissue. We are in the process of implementing these applications, and some examples are presented here. An additional feature that we required was that the applications be scalable such that they could run on either on a low-end desktop device with minimal manipulation tools or on a fully outfitted high-end graphic computer with a realistic set of surgical tools. The Anatomy and Surgery Workbenches will be used to test the features of the NGI, and to show the importance of these new features for innovative educational applications.

An augmented reality tool for learning spatial anatomy on mobile devices: Learning Spatial Anatomy on Mobile Devices

Augmented Realty (AR) offers a novel method of blending virtual and real anatomy for intuitive spatial learning. Our first aim in the study was to create a prototype AR tool for mobile devices. Our second aim was to complete a technical evaluation of our prototype AR tool focused on measuring the systems ability to accurately render digital content in the real world. We imported Computed Tomography (CT) data derived virtual surface models into a 3D Unity engine environment and implemented an AR algorithm to display these on mobile devices. We investigated the accuracy of the virtual renderings by comparing a physical cube with an identical virtual cube for dimensional accuracy. Our comparative study confirms that our AR tool renders 3D virtual objects with a high level of accuracy as evidenced by the degree of similarity between measurements of the dimensions of a virtual object (a cube) and the corresponding physical object. We developed an inexpensive and user‐friendly prototype AR tool for mobile devices that creates highly accurate renderings. This prototype demonstrates an intuitive, portable, and integrated interface for spatial interaction with virtual anatomical specimens. Integrating this AR tool with a library of CT derived surface models provides a platform for spatial learning in the anatomy curriculum. The segmentation methodology implemented to optimize human CT data for mobile viewing can be extended to include anatomical variations and pathologies. The ability of this inexpensive educational platform to deliver a library of interactive, 3D models to students worldwide demonstrates its utility as a supplemental teaching tool that could greatly benefit anatomical instruction. Clin. Anat. 30:736–741, 2017.

Spatial and Visual Reasoning: Do These Abilities Improve in First-Year Veterinary Medical Students Exposed to an Integrated Curriculum?

Spatial visualization ability refers to the human cognitive ability to form, retrieve, and manipulate mental models of spatial nature. Visual reasoning ability has been linked to spatial ability. There is currently limited information about how entry-level spatial and visual reasoning abilities may predict veterinary anatomy performance or may be enhanced with progression through the veterinary anatomy content in an integrated curriculum. The present study made use of two tests that measure spatial ability and one test that measures visual reasoning ability in veterinary students: Guays Visualization of Views Test, adapted version (GVVT), the Mental Rotations Test (MRT), and Ravens Advanced Progressive Matrices Test, short form (RavenT). The tests were given to the entering class of veterinary students during their orientation week and at week 32 in the veterinary medical curriculum. Mean score on the MRT significantly increased from 15.2 to 20.1, and on the RavenT significantly increased from 7.5 to 8.8. When females only were evaluated, results were similar to the total class outcome; however, all three tests showed significant increases in mean scores. A positive correlation between the pre- and post-test scores was found for all three tests. The present results should be considered preliminary at best for associating anatomic learning in an integrated curriculum with spatial and visual reasoning abilities. Other components of the curriculum, for instance histology or physiology, could also influence the improved spatial visualization and visual reasoning test scores at week 32.

Can Anyone Make a Smart Device?: Evaluating the Usability of a Prototyping Toolkit for Creative Computing

Can anyone make a smart device? Affordable sensors, actuators and novice microcomputer toolkits are the building blocks of the field we refer to as Creative Computing. With the growing maker movement, more tools are becoming available to novices, but there is little research into the usability evaluation of these toolkits. In this chapter, we discuss the importance of closing the gap between idea and prototype, the need for systematically evaluating the usability of novice toolkits, and a strategy for doing so. Specifically, the chapter presents the Tiny Device Test, a method for evaluating the usability of novice electronics toolkits. Using a standard set of building challenges based on common household electronics, we discuss methods for evaluating the Bloctopus toolkit, which was designed for novice electronics prototyping with low-resolution materials. This work aims to contribute to the idea of “making simple things simple, and complex things possible,” with prototyping toolkits of the future.

Collaborative networked virtual surgical simulators cnvss implementing hybrid client-server architecture: Factors affecting collaborative performance

Currently, surgical skills teaching in medical schools and hospitals is changing, requiring the development of new tools to focus on (i) the importance of the mentor’s role, (ii) teamwork skills training, and (iii) remote training support. Collaborative Networked Virtual Surgical Simulators (CNVSS) allow collaborative training of surgical procedures where remotely located users with different surgical roles can take part in the training session. To provide successful training involving good collaborative performance, CNVSS should guarantee synchronicity in time of the surgical scene viewed by each user and a quick response time which are affected by factors such as users’ machine capabilities and network conditions. To the best of our knowledge, the impact of these factors on the performance of CNVSS implementing hybrid client–server architecture has not been evaluated. In this paper the development of a CNVSS implementing a hybrid client–server architecture and two statistical designs of experiments (DOE) is described by using (i) a fractional factorial DOE and (ii) a central composite DOE, to determine the most influential factors and how these factors affect the collaboration in a CNVSS. From the results obtained, it was concluded that packet loss, bandwidth, and delay have a larger effect on the consistency of the shared virtual environment, whereas bandwidth, server machine capabilities, and delay and interaction between factors bandwidth and packet loss have a larger effect on the time difference and number of errors of the collaborative task.