Training situational awareness for scrub nurses: Error recognition in a virtual operating room.

Virtual reality simulation provides interesting opportunities to train nurses in a safe environment. While the virtual operating room has proven to be a useful training tool for technical skills, it has been less studied for non-technical skills. This study aimed to assess "Error recognition in a virtual operating room", using a simulation scenario designed to improve situation awareness. Eighteen scrub-nurse students and 8 expert scrub-nurses took part in the experiment. They were immersed in a virtual operating room and reported any errors they observed. There were nineteen errors with various degrees of severity. Measures were retrieved from logs (number of errors, time for detection, movements) and from questionnaires (situation awareness, subjective workload, anxiety and user experience). The results showed that the participants who detected most errors had a higher level of situation awareness, detected high-risk errors faster and felt more immersed in the virtual operating room than those detecting fewer errors. They also felt the workload was lighter and experienced more satisfaction. Students explored the operating room more than experts did and detected more errors, especially those with moderate risk. Debriefings confirmed that virtual simulation is acceptable to trainees and motivates them. It also provides useful and original material for debriefings.

User-centered design of a multisensory power wheelchair simulator: towards training and rehabilitation applications.

Autonomy and social inclusion can reveal themselves everyday challenges for people experiencing mobility impairments. These people can benefit from technical aids such as power wheelchairs to access mobility and overcome social exclusion. However, power wheelchair driving is a challenging task which requires good visual, cognitive and visuo-spatial abilities. Besides, a power wheelchair can cause material damage or represent a danger of injury for others or oneself if not operated safely. Therefore, training and repeated practice are mandatory to acquire safe driving skills to obtain power wheelchair prescription from therapists. However, conventional training programs may reveal themselves insufficient for some people with severe impairments. In this context, Virtual Reality offers the opportunity to design innovative learning and training programs while providing realistic wheelchair driving experience within a virtual environment. In line with this, we propose a user-centered design of a multisensory power wheelchair simulator. This simulator addresses classical virtual experience drawbacks such as cybersickness and sense of presence by combining 3D visual rendering, haptic feedback and motion cues. It relies on a modular and versatile workflow enabling not only easy interfacing with any virtual display, but also with any user interface such as wheelchair controllers or feedback devices. This paper presents the design of the first implementation as well as its first commissioning through pretests. The first setup achieves consistent and realistic behavior.

Learning procedural skills with a virtual reality simulator: An acceptability study.

BACKGROUND: Virtual Reality (VR) simulation has recently been developed and has improved surgical training. Most VR simulators focus on learning technical skills and few on procedural skills. Studies that evaluated VR simulators focused on feasibility, reliability or easiness of use, but few of them used a specific acceptability measurement tool. OBJECTIVES: The aim of the study was to assess acceptability and usability of a new VR simulator for procedural skill training among scrub nurses, based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model. PARTICIPANTS: The simulator training system was tested with a convenience sample of 16 non-expert users and 13 expert scrub nurses from the neurosurgery department of a French University Hospital. METHODS: The scenario was designed to train scrub nurses in the preparation of the instrumentation table for a craniotomy in the operating room (OR). RESULTS: Acceptability of the VR simulator was demonstrated with no significant difference between expert scrub nurses and non-experts. There was no effect of age, gender or expertise. Workload, immersion and simulator sickness were also rated equally by all participants. Most participants stressed its pedagogical interest, fun and realism, but some of them also regretted its lack of visual comfort. CONCLUSION: This VR simulator designed to teach surgical procedures can be widely used as a tool in initial or vocational training.

Help! I Need a Remote Guide in My Mixed Reality Collaborative Environment.

The help of a remote expert in performing a maintenance task can be useful in many situations, and can save time as well as money. In this context, augmented reality (AR) technologies can improve remote guidance thanks to the direct overlay of 3D information onto the real world. Furthermore, virtual reality (VR) enables a remote expert to virtually share the place in which the physical maintenance is being carried out. In a traditional local collaboration, collaborators are face-to-face and are observing the same artifact, while being able to communicate verbally and use body language, such as gaze direction or facial expression. These interpersonal communication cues are usually limited in remote collaborative maintenance scenarios, in which the agent uses an AR setup while the remote expert uses VR. Providing users with adapted interaction and awareness features to compensate for the lack of essential communication signals is therefore a real challenge for remote MR collaboration. However, this context offers new opportunities for augmenting collaborative abilities, such as sharing an identical point of view, which is not possible in real life. Based on the current task of the maintenance procedure, such as navigation to the correct location or physical manipulation, the remote expert may choose to freely control his/her own viewpoint of the distant workspace, or instead may need to share the viewpoint of the agent in order to better understand the current situation. In this work, we first focus on the navigation task, which is essential to complete the diagnostic phase and to begin the maintenance task in the correct location. We then present a novel interaction paradigm, implemented in an early prototype, in which the guide can show the operator the manipulation gestures required to achieve a physical task that is necessary to perform the maintenance procedure. These concepts are evaluated, allowing us to provide guidelines for future systems targeting efficient remote collaboration in MR environments.

AR Feels "Softer" than VR: Haptic Perception of Stiffness in Augmented versus Virtual Reality.

Does it feel the same when you touch an object in Augmented Reality (AR) or in Virtual Reality (VR)? In this paper we study and compare the haptic perception of stiffness of a virtual object in two situations: (1) a purely virtual environment versus (2) a real and augmented environment. We have designed an experimental setup based on a Microsoft HoloLens and a haptic force-feedback device, enabling to press a virtual piston, and compare its stiffness successively in either Augmented Reality (the virtual piston is surrounded by several real objects all located inside a cardboard box) or in Virtual Reality (the same virtual piston is displayed in a fully virtual scene composed of the same other objects). We have conducted a psychophysical experiment with 12 participants. Our results show a surprising bias in perception between the two conditions. The virtual piston is on average perceived stiffer in the VR condition compared to the AR condition. For instance, when the piston had the same stiffness in AR and VR, participants would select the VR piston as the stiffer one in 60% of cases. This suggests a psychological effect as if objects in AR would feel "softer" than in pure VR. Taken together, our results open new perspectives on perception in AR versus VR, and pave the way to future studies aiming at characterizing potential perceptual biases.

Synthesis and Simulation of Surgical Process Models.

Virtual Reality for surgical training is mainly focused on technical surgical skills. We work on providing a novel approach to the use of Virtual Reality focusing on the procedural aspects. Our system relies on a specific work-flow generating a model of the procedure from real case surgery observation in the operating room. This article presents the different technologies created in the context of our project and their relations as other components of our workflow.

Exchange of avatars: toward a better perception and understanding.

The exchange of avatars, i.e. the actual fact of changing once avatar with another one, is a promising trend in multi-actor virtual environments. It provides new opportunities for users, such as controlling a different avatar for a specific action, retrieving knowledge belonging to a particular avatar, solving conflicts and deadlocks situations or even helping another user. Virtual Environments for Training are especially affected by this trend as a specific role derived from a scenario is usually assigned to a unique avatar. Despite the increasing use of avatar exchange, users' perception and understanding of this mechanism have not been studied. In this paper, we propose two complementary user-centered evaluations that aim at comparing several representations for the exchange of avatars; these are termed exchange metaphors. Our first experiment focuses on the perception of an exchange by a user who is not involved in the exchange, and the second experiment analyzes the perception of an exchange triggered by the user. Results show that the use of visual feedback globally aids better understanding of the exchange mechanism in both cases. Our first experiment suggests, however, that visual feedback is less efficient than a simple popup notification in terms of task duration. In addition, the second experiment shows that much simpler metaphors with no visual effect are generally preferred because of their efficiency.

Personified and multistate camera motions for first-person navigation in desktop virtual reality.

In this paper we introduce novel 'Camera Motions' (CMs) to improve the sensations related to locomotion in virtual environments (VE). Traditional Camera Motions are artificial oscillating motions applied to the subjective viewpoint when walking in the VE, and they are meant to evoke and reproduce the visual flow generated during a human walk. Our novel camera motions are: (1) multistate, (2) personified, and (3) they can take into account the topography of the virtual terrain. Being multistate, our CMs can account for different states of locomotion in VE namely: walking, but also running and sprinting. Being personified, our CMs can be adapted to avatar's physiology such as to its size, weight or training status. They can then take into account avatar's fatigue and recuperation for updating visual CMs accordingly. Last, our approach is adapted to the topography of the VE. Running over a strong positive slope would rapidly decrease the advance speed of the avatar, increase its energy loss, and eventually change the locomotion mode, influencing the visual feedback of the camera motions. Our new approach relies on a locomotion simulator partially inspired by human physiology and implemented for a real-time use in Desktop VR. We have conducted a series of experiments to evaluate the perception of our new CMs by naive participants. Results notably show that participants could discriminate and perceive transitions between the different locomotion modes, by relying exclusively on our CMs. They could also perceive some properties of the avatar being used and, overall, very well appreciated the new CMs techniques. Taken together, our results suggest that our new CMs could be introduced in Desktop VR applications involving first-person navigation, in order to enhance sensations of walking, running, and sprinting, with potentially different avatars and over uneven terrains, such as for: training, virtual visits or video games.

Using virtual reality to analyze links between handball thrower kinematics and goalkeeper's reactions.

This work investigates the design of a new method to evaluate the importance of visual elements taken into account by a handball goalkeeper facing a thrower. Virtual reality was used to design and reproduce standardised situations in a controlled environment. Under such conditions, it was possible to isolate for investigation one visual element in the thrower's gestures. The goalkeeper's movements were recorded in order to compare his reactions to two separate throws where only one visual element was modified. Our systems allowed us to measure and record the effects of small changes in the thrower's movements. With the numerical values we obtained from our results we were able to come up with a scale of significance for each isolated element. These preliminary results look promising for neuroscience, allowing us to better understand the strategies used in duel situations.