Training Effectiveness of a Wide Area Virtual Environment in Medical Simulation.

INTRODUCTION: The success of war fighters and medical personnel handling traumatic injuries largely depends on the quality of training they receive before deployment. The purpose of this study was to gauge the utility of a Wide Area Virtual Environment (WAVE) as a training adjunct by comparing and evaluating student performance, measuring sense of realism, and assessing the impact on student satisfaction with their training exposure in an immersive versus a field environment. METHODS: This comparative prospective cohort study examined the utility of a three-screen WAVE where subjects were immersed in the training environment with medical simulators. Standard field training commenced for the control group subjects. Medical skills, time to completion, and Team Strategies and Tools to Enhance Performance and Patient Safety objective metrics were assessed for each team (n = 94). In addition, self-efficacy questionnaires were collected for each subject (N = 470). RESULTS: Medical teams received poorer overall team scores (F1,186 = 0.756, P = 0.001), took longer to complete the scenario (F1,186 = 25.15, P = 0.001), and scored lower on The National Registry of Emergency Medical Technicians trauma assessment checklist (F1,186 = 1.13, P = 0.000) in the WAVE versus the field environment. Critical thinking and realism factors within the self-efficacy questionnaires scored higher in the WAVE versus the field [(F1,466 = 8.04, P = 0.005), (F1,465 = 18.57, P = 0.000), and (F1,466 = 53.24, P = 0.000), respectively]. CONCLUSIONS: Environmental and emotional stressors may negatively affect critical thinking and clinical skill performance of medical teams. However, by introducing more advanced simulation trainings with added stressors, students may be able to adapt and overcome barriers to performance found in high-stress environments.

Recollection of hypoxia symptoms between training events.

INTRODUCTION: The well-established technique of mask-off hypoxia training in a hypobaric training environment elicits symptoms that are correlated with in-flight symptoms reported by aircrew. Aircrew receive training on recognition of symptoms and response early in their flying career and accomplish refresher training on a 5-yr cycle. The symptoms reported after acute hypoxia represent cognitive and psychomotor impairment. The purpose of this study was to evaluate the correlation of symptoms experienced during hypoxia training and recall of symptoms S from the training sessions 5 yr previously. METHODS: A survey listing 18 symptoms of hypoxia and severity of condition was presented to 1123 aircrew attending refresher training at 10 U.S. Air Force Aerospace Physiology Training Units prior to and immediately following hypoxia training in the hypobaric chamber. RESULTS: The five symptoms most commonly reported following hypoxia training are: lightheaded/dizzy, dizziness, mental confusion, visual impairment, and tingling. The hypoxia symptom "lightheaded/dizzy" recorded the highest frequency of all 18 symptoms. Lightheaded/dizzy frequencies for both previous and current hypoxia training were 67.2% and 72.3%, respectively. This symptom remained consistent throughout all data analysis, retaining the highest frequency in all levels of severity (mild, moderate, and extreme) for both the previous hypoxia training and current hypoxia training. DISCUSSION: The similarity of symptoms recalled between hypoxia training events provides strong evidence that hypoxia training is an effective method of establishing recognized decrements that may influence performance in flight.