The Perceived Effectiveness of Various Forms of Feedback on the Acquisition of Technical Skills by Advanced Learners in Simulation-Based Health Professions Education.

Simulation-based health professions education (SBHPE) is a valuable approach for healthcare professionals to develop and refine technical skills in a safe environment. Feedback plays a crucial role in the acquisition of these skills, but little research has explored the effectiveness of augmented (knowledge of results (KR) and knowledge of performance (KP) versus intrinsic feedback types for advanced learners. Therefore, this study aimed to determine what type of feedback is perceived to be most effective by advanced learners when acquiring complex technical skills in SBHPE. The study followed the test and evaluated phases of the design-based research (DBR) framework. A total of 23 advanced care paramedics (ACPs) participated in the study and received feedback in the form of KR, KP, and intrinsic feedback while using the intraosseous (IO) access simulator. Participants completed a survey to evaluate their learning experience and rank the perceived effectiveness of each feedback type. The results of this study indicated that KP was perceived as the most effective type of feedback and KR was perceived as the least effective feedback, with intrinsic feedback being in the middle. This work provides insights into the use of augmented and intrinsic feedback for advanced learners in an SBHPE environment, but future work to assess the actual learning effects of these types of feedback is needed.

Defining the Nature of Augmented Feedback for Learning Intraosseous Access Skills in Simulation-Based Health Professions Education.

In the field of health professions education, acquiring technical skills involves three stages: 1) receiving instructions, 2) engaging in practice, and 3) receiving feedback. Simulation serves as a valuable tool that encompasses all three stages, enhancing the effectiveness of health professions education. This work focuses on feedback, which can be categorized as intrinsic (perceived by the learner through their senses) or augmented (provided by an external perspective). Augmented feedback can take the form of knowledge of results (information regarding the outcome) or knowledge of performance (information about the actions leading to the outcome). The overall objective of this work was to evaluate the perceived efficacy of these types of feedback in learning technical skills using a simulation, specifically an intraosseous access simulator, among advanced care paramedics. The primary focus of this article and the initial step towards achieving the aforementioned objective of this work was to determine the possible knowledge of results and knowledge of performance that paramedic facilitators could offer to advanced care paramedics during the use of an existing intraosseous access simulator. This research was conducted following the design-based research framework, employing a combination of design thinking and Delphi methods to generate a comprehensive list of augmented feedback, in both the form of knowledge of results and knowledge of performance, that can be provided to advanced care paramedics while learning intraosseous access skills through a simulator. The design thinking session was carried out to generate an initial inventory of augmented feedback, which was then refined through two rounds of Delphi consensus-building with paramedic experts. This process resulted in an eight-step list of feedback for knowledge of results and knowledge of performance that can be delivered to advanced care paramedics by paramedic facilitators using an intraosseous access simulator.

Development of Content for a Virtual Reality Simulation to Understand and Mitigate Moral Distress in Healthcare Workers.

Background In high-stakes situations, healthcare workers are prone to suffer moral injury, the psychological, social, and spiritual impact of events involving betrayal or transgression of one's own deeply held moral beliefs and values. As a result, this may negatively impact their capacity to provide adequate levels of care to patients. There is a lack of educational resources catered to help healthcare workers navigate ethical situations in clinical settings that may lead to or worsen moral distress. The aim of this report is to describe the methodology of development and resulting outcomes in the form of an educational resource that includes a virtual reality (VR) simulation to help healthcare workers understand and mitigate moral distress as a result of internal and external constraints at their workplaces. Methodology A study using a method outlining a set of constraint parameters, followed by ideation utilizing design thinking (DT), and concluding with a consensus-building exercise using Delphi methodology (DM) with a group of 13 experts in healthcare simulation, VR, psychiatry, psychology, and nursing. The constraints parameters included technology use (VR), use of experiential learning theory, and duration of the intervention (15 minutes). A DT process was performed to generate and expand on ideas on the scenario and intervention of a possible VR simulation which were funneled into a three-round DM to define the foundations of the VR simulation. Average, standard deviations, and free-text comments in the DM were used to assess the inclusion of the produced requirements. Finally, a focus group interview was conducted with the same experts to draft the VR simulation. Results Within the specified constraints, the DT process produced 33 ideas for the VR simulation scenario and intervention that served as a starting point to short-list the requirements in Round 1. In Rounds 1 to 2, 25 items were removed, needed revising, and/or were retained for the subsequent rounds, which resulted in eight items at the end of Round 2. Round 2 also required specialists to provide descriptions of potential scenarios and interventions, in which five were submitted. In Round 3, experts rated the descriptions as somewhat candidate to use in the final VR simulation, and the open feedback in this round proposed combining the elements from each of the descriptions. Using this data, a prototype of the VR simulation was developed by the project team together with VR designers. Conclusions This development demonstrated the feasibility of using the constraints-ideation-consensus approach to define the content of a possible VR simulation to serve as an educational resource for healthcare workers on how to understand and mitigate moral distress in the workplace. The methodology described in this development may be applied to the design of simulation training for other skills, thereby advancing healthcare training and the quality of care delivered to the greater society.

Hand VR Exergame for Occupational Health Care.

The widespread use and ubiquity of mobile computing technologies such as smartphones, tablets, laptops and portable gaming consoles has led to an increase in musculoskeletal disorders due to overuse, bad posture, repetitive movements, fixed postures and physical de-conditioning caused by low muscular demands while using (and over-using) these devices. In this paper we present the development of a hand motion-based virtual reality-based exergame for occupational health purposes that allows the user to perform simple exercises using a cost-effective non-invasive motion capture device to help overcome and prevent some of the muskoloskeletal problems associated with the over-use of keyboards and mobile devices.

Liver biomechanical model for virtual palpation.

Palpation is a diagnostic technique used for evaluating physical properties of abdominal tissues and organs. The emulation of this procedure using virtual simulators is challenging due to trades between realism and interactivity. In this paper a virtual palpation system of the liver is proposed using a polyhedral mesh with a first order viscoelastic model defined in terms of its biomechanical properties extracted from experimental data. The hepatic tissue model is approximated to large deformations leading to a realistic haptic response of the procedure.

Anthropomorphic passive mechanism for performing hand exercises.

Hand disabilities resulting from traumas, accidents and other causes impact how people carry on everyday tasks, thus, the importance of physical therapy. This process is characterized for performing repetitive sequences of motion with the guidance of a physical therapist, and in some cases, requires doing the therapy without attendance, which may lead to unsatisfactory results due to pain, unclear guides and poor feedback on their performance. This paper presents the development of a humanoid passive mechanism for hand exercising using its limbs for achieving flexion/extension, pronation/supination and radial/ulnar deviations. Preliminary tests show an interest in having similar devices for hand training associated as a leisure activity that could be used as a stress reliever that allows entertaining while training.

Human eye haptics-based multimedia.

Immersive and interactive multimedia applications offer complementary study tools in anatomy as users can explore 3D models while obtaining information about the organ, tissue or part being explored. Haptics increases the sense of interaction with virtual objects improving user experience in a more realistic manner. Common eye studying tools are books, illustrations, assembly models, and more recently these are being complemented with mobile apps whose 3D capabilities, computing power and customers are increasing. The goal of this project is to develop a complementary eye anatomy and pathology study tool using deformable models within a multimedia application, offering the students the opportunity for exploring the eye from up close and within with relevant information. Validation of the tool provided feedback on the potential of the development, along with suggestions on improving haptic feedback and navigation.

Kinect-based posture tracking for correcting positions during exercise.

The Kinect sensor has opened the path for developing numerous applications in several different areas. Medical and health applications are benefiting from the Kinect as it allows non-invasive body motion capture that can be used in motor rehabilitation and phobia treatment. A major advantage of the Kinect is that allows developing solutions that can be used at home or even the office thus, expanding the user freedom for interacting with complementary solutions to its physical activities without requiring any traveling. This paper present a Kinect-based posture tracking software for assisting the user in successfully match postures required in some exercises for strengthen body muscles. Unlike several video games available, this tool offers a user interface for customizing posture parameters, so it can be enhanced by healthcare professionals or by their guidance through the user.

3D liver volume reconstructed for palpation training.

Virtual Reality systems for medical procedures such as the palpation of different organs, requires fast, robust, accurate and reliable computational methods for providing realism during interaction with the 3D biological models. This paper presents the segmentation, reconstruction and palpation simulation of a healthy liver volume as a tool for training. The chosen method considers the mechanical characteristics and liver properties for correctly simulating palpation interactions, which results appropriate as a complementary tool for training medical students in familiarizing with the liver anatomy.

Video game interfaces for interactive lower and upper member therapy.

With recent advances in electronics and mechanics, a new trend in interaction is taking place changing how we interact with our environment, daily tasks and other people. Even though sensor based technologies and tracking systems have been around for several years, recently they have become affordable and used in several areas such as physical and mental rehabilitation, educational applications, physical exercises, and natural interactions, among others. This work presents the integration of two mainstream videogame interfaces as tools for developing an interactive lower and upper member therapy tool. The goal is to study the potential of these devices as complementing didactic elements for improving and following user performance during a series of exercises with virtual and real devices.

3DUI assisted lower and upper member therapy.

3DUIs are becoming very popular among researchers, developers and users as they allow more immersive and interactive experiences by taking advantage of the human dexterity. The features offered by these interfaces outside the gaming environment, have allowed the development of applications in the medical area by enhancing the user experience and aiding the therapy process in controlled and monitored environments. Using mainstream videogame 3DUIs based on inertial and image sensors available in the market, this work presents the development of a virtual environment and its navigation through lower member captured gestures for assisting motion during therapy.