Multiplayer virtual worlds are very suited for training medical teams. We develop customized medical spaces, such as an emergency department, with patients, beds, ambulances, medications, and other monitoring and treatment devices. We also present the results of a study on the efficacy of such environments for learning.
Multi-player virtual worlds are well-suited to training teams to work together.
There are many types of virtual worlds but they all share most of the above characteristics.
This is my first attempt entering a popular virtual world, Second Life. It is a vast, three-dimensional space, with many very realistic landscapes and some fantastically unrealistic spaces.
Many universities and companies have developed spaces in Second Life for meetings and presentations.
An unusual medical use is to present experiences that are very difficult to present in real life. The University of California, Davis, has developed a space where you can experience a variety of visual and auditory hallucinations. Here my avatar believes that she is walking down a hallway but …
… in the next instant, the floor appears to disappear. I am walking on air, a common hallucination. In my schizophrenic hallucination, I step very carefully on the stepping stones because I my experience says that the hallway is now a dangerous space.
These news items indicate the many companies that opened virtual offices in spaces such as Second Life. Actually the situation has changed somewhat since this slide was made in 2007. Now, in late 2008, many companies have become more cautious about their business expectations in virtual worlds. Universities and other learning organizations, on the other hand, continue to adopt virtual worlds as important new learning environments.
My research group at Stanford University, SUMMIT, partnered with Forterra Systems to create a 3D medical space using their multiplayer virtual world engine, OLIVE, to create a Virtual Emergency Department. The simulaton was used to train for mass casualty emergencies including chemical exposures that required decontamination using the ‘decon’ tent seen here outside the VED.
The VED includes the road and parking area outside, so ambulances can pull up and discharge patients. In the mass casualty scenario, numerous ambulances arrive, creating a scene of urgency and chaos that requires skilful management of medical resources and teams. It should be noted that each of the people seen in this picture is an ‘avatar’, managed by a different real person, who may be physically located anywhere in the world.
In a mass casualty, the arriving patients are ‘triaged’, that is, they udergo rapid diagnosis, outside the Emergency Department. Those determined to be ‘Immediate’ are sent to the Emergency Department beds for treatment by a team of doctors and nurses (each played by a real resident or nurse). ‘Minor’ and ‘Delayed’ do not need treatment right away and are sent to holding areas.
<number>
This is a view of the inside of the Emergency Department. The 3D space is developed from photos of a real Emergency Department.
Each ‘Immediate’ patient is managed by a medical team. Part of the learning objective is for the team to learn communication, leadership, followership, correct treatment protocol, and the ability to prioritize.The devices on the headboard and by the side of the bed are all active and allow the team to mange the patient medically.
The user interface supports examination of the patient, application of physical treatments such as cleaning a wound and applying compression bandages, administration of medications, and supplying blood or a saline drip. Themonitor gives the minute-by-minute health status of the patient.
<number>
We developed a different 3D world to teach high school students the decision making surrounding the use of CPR (cardio-pulmonary resuscitation). The link connects to a brief movie about this virtual world.
Before we embarked on extensive development of virtual worlds, we studied the efficacy of one of our early virtual worlds in 2004. This one was built on Adobe Systems’ Atmosphere engine, which is no longer available. We used that world to compare the learning in the virtual world with that using the current gold standard, the physical manikin.
Ten trauma situations were developed.
The patient’s vital signs were shown in the text box in the upper left (not on a simulated monitor). Treatment was via menu selections.
The team around the bed included Learners and Role Players. The role players played supporting roles in the team, while the learners took the role of the lead physician and the supporting physician. A Facilitator observed the performance of the team members in the virtual world and could, if necessary issue comments, suggestions or instructions.All team members wore headsets with microphones, allowing them to sit in different rooms but to be virtually in a common space, around the patient’s bed.
All team members knew the learning objectives of the exercise, the ability to follow the principles of appropriate resource management while providing correct medical management of the patient’s condition.
Each learning session consisted of one of the trauma scenarios, followed by a debrief session with the facilitator. During the debrief, the facilitator led a non-judgmental discussion about the actions taken during the scenario, with the learners discussing their thoughts, concerns and opinions, Typically, most of the learning takes place during this discussion rather than during the scenario itself.
The full study consisted of a training session, where the interface and goals were taught. Then the team went through 6 scenarios. The first and last were test scenarios. There was no debrief after these test scenarios. The middle four scenarios were learning scenarios, with debrief sessions. The performance was scored in all six scenarios.
Meanwhile, a ‘control’ team underwent the same scenarios but using a physical manikin instead of a virtual world. In this situation, the physical manikin is in a physical simulated operating room. The team works around the real bed. The manikin is realistic in that it has a pulse, breathes, and can have its vital signs measured. Air, blood, fluids and medication can be administered. The experience is close to that os working with a real patient.
The two groups were termed the HPS group (Human Patient Simulator, or the physical manikin) and the VED group (the Virtual Emergency Department). The pre-test and post-test performance was measured for both the groups. The results are graphed above. Two conclusions can be drawn. First, in both the HPS and VED groups, learning occurs, as shown by the improved performance during the post-test compared to the pre-test. Second, both HPS and VED groups show similar improvement from pre- to post-test, indicating that the virtual environment has resulted in learning comparable to that with the gold standard, the physical manikin. This key result encouraged us to continue our development of virtual learning environments,and we will continue to test the efficacy of these new learning environments.
From this somewhat stylized study, we can derive a range of conclusions and possible future directions.