Immersive distance simulation: Exploring the educational impact of stereoscopic extended reality (XR) video in remote learning environments.

What was the educational challenge?There is a growing need for healthcare simulation options when local expertise or resources are not available. To connect instructors with remote learners, current options for distance simulation are typically limited to videoconferencing on desktop computers or mobile devices, which may not fully capture the complexity of clinical scenarios.What was the solution?Extended reality (XR) technology may provide a more immersive and realistic distance healthcare simulation experience compared to traditional videoconferencing options. Unlike computer- or phone-based video calls, stereoscopic video in XR provides a sense of depth that may increase spatial understanding and engagement in distance simulation.How was the solution implemented?We investigated the impact of XR for synchronous distance simulation compared to traditional desktop-based videoconferencing in Emergency Medicine (EM) resident training for an obstetrical emergency. A randomized controlled experiment was conducted with half of the residents using XR and half using computers to participate in the simulation.What lessons were learned that are relevant to a wider global audience?There was an unanticipated interaction between postgraduate year and condition such that performance in the XR condition was superior for first year residents, while this was reversed for more experienced residents. This indicates that the benefits of XR might be dependent on participant characteristics, such as learner level.What are the next steps?We plan to extend this research to clarify characteristics of learners and tasks that are important determinants of differences in outcomes between stereoscopic XR versus traditional videoconference displays.

Understanding the Effects of Health Care Distance Simulation: A Systematic Review.

ABSTRACT: The use of distance simulation has rapidly expanded in recent years with the physical distance requirements of the COVID-19 pandemic. With this development, there has been a concurrent increase in research activities and publications on distance simulation. The authors conducted a systematic review of the peer-reviewed distance health care simulation literature. Data extraction and a risk-of-bias assessment were performed on selected articles. Review of the databases and gray literature reference lists identified 10,588 titles for review. Of those, 570 full-text articles were assessed, with 54 articles included in the final analysis. Most of these were published during the COVID-19 pandemic (2020-2022). None of the included studies examined an outcome higher than a Kirkpatrick level of 2. Most studies only examined low-level outcomes such as satisfaction with the simulation session. There was, however, a distinction in studies that were conducted in a learning environment where all participants were in different locations ("distance only") as compared with where some of the participants shared the same location ("mixed distance"). This review exclusively considered studies that focused solely on distance. More comparative studies exploring higher level outcomes are required to move the field forward.

Health Care Simulation in Person and at a Distance: A Systematic Review.

ABSTRACT: Distance simulation is a method of health care training in which the learners and facilitators are in different physical locations. Although methods of distance simulation have existed in health care for decades, this approach to education became much more prevalent during the COVID-19 pandemic. This systematic review studies a subset of distance simulation that includes combined in-person and distance simulation elements, identified here as "mixed- distance simulation." A review of the distance simulation literature identified 10,929 articles. Screened by inclusion and exclusion criteria, 34 articles were ultimately included in this review. The findings of this review present positive and negative aspects of mixed-distance simulation formats, a description of the most frequent configurations related to delivery, terminology challenges, as well as future directions including the need for faculty development, methodological rigor, and reporting details.

Comparing Capabilities of Simulation Modalities for Training Combat Casualty Care: Perspectives of Combat Medics.

INTRODUCTION: Combat casualty care requires learning a complex set of skills to treat patients in challenging situations, including resource scarce environments, multiple casualty incidents, and care under fire. To train the skills needed to respond efficiently and appropriately to these diverse conditions, instructors employ a wide array of simulation modalities. Simulation modalities for medical training include manikins, task trainers, standardized patient actors (i.e., role players), computer or extended reality simulations (e.g., virtual reality, augmented reality), cadavers, and live tissue training. Simulation modalities differ from one another in multiple attributes (e.g., realism, availability). The purpose of this study was to compare capabilities across simulation modalities for combat casualty care from the perspective of experienced military medics. MATERIALS AND METHODS: To provide a more complete understanding of the relative merits and limitations of modalities, military combat medics (N = 33) were surveyed on the capabilities of simulation modalities during a 5-day technical experimentation event where they observed medical simulations from industry developers. The survey asked them to rate each of eleven modalities on each of seven attributes. To elicit additional context for the strengths, limitations, and unique considerations of using each modality, we also collected open-ended comments to provide further insight on when and how to use specific simulation modalities. RESULTS: Results showed differences among the simulation modalities by attribute. Cadavers, role play, moulage, and live tissue all received high ratings on two or more attributes. However, there was no modality that was rated uniformly superior to the others. Instead, modalities appear to have unique strengths and limitations depending on the training context and objectives. For example, cadavers were seen as highly realistic, but not very reusable. CONCLUSIONS: The study furthers our understanding of simulation modalities for medical training by providing insight from combat medics on the benefits, limitations, and considerations for implementing different modalities depending on the training context. These results may be helpful to instructors in selecting modalities for their programs.

Assessing Usability of Untethered Head-Mounted Displays for Medical Education: A Within-Person Randomized Trial.

INTRODUCTION: Recent meta-analyses have found immersive technology to be effective for training, yet there is limited research on user experience with head-mounted displays (HMDs) in the medical domain. If emerging immersive displays do not meet usability standards in the context of healthcare simulation, the technology may cause frustration or hinder learning outcomes. This is the first experimental comparison of usability in commercial untethered, "all-in-one" HMDs for healthcare simulation. METHODS: The usability and comfort of three commercial untethered HMDs (Oculus Go, Oculus Quest, and Lenovo Mirage Solo) were tested using a randomized within-person design such that each headset was evaluated by all participants in a random sequence. During the experiment, participants (n = 9) interacted with a simulated healthcare environment in each headset and then responded to usability and comfort surveys. RESULTS: All of the HMDs were rated as having higher than average usability compared with an industry benchmark scale, the System Usability Scale. Only one of the headsets had a usability rating in the highest range, which was significantly higher than the lowest rated headset ( P = 0.047, Cohen d = 0.901). In addition, feelings of discomfort with the headsets were low, and comfort ratings did not differ significantly between headsets ( P > 0.05). CONCLUSIONS: Untethered HMDs had acceptable user experience ratings during a healthcare simulation task, but some headsets were rated higher on usability. Because usability is important for learner engagement and training outcomes, educators should confirm that immersive displays meet usability standards before implementation.

Establishing Measurement Equivalence Across Computer- and Paper-Based Tests of Spatial Cognition.

Objective The purpose of the present research is to establish measurement equivalence and test differences in reliability between computerized and pencil-and-paper-based tests of spatial cognition. Background Researchers have increasingly adopted computerized test formats, but few attempt to establish equivalence for computer-based and paper-based tests. The mixed results in the literature on the test mode effect, which occurs when performance differs as a function of test medium, highlight the need to test for, instead of assume, measurement equivalence. One domain that has been increasingly computerized and is thus in need of tests of measurement equivalence across test mode is spatial cognition. Method In the present study, 244 undergraduate students completed two measures of spatial ability (i.e., spatial visualization and cross-sectioning) in either computer- or paper-and-pencil-based format. Results Measurement equivalence was not supported across computer-based and paper-based formats for either spatial test. The results also indicated that test administration type affected the types of errors made on the spatial visualization task, which further highlights the conceptual differences between test mediums. Paper-based tests also demonstrated increased reliability when compared with computerized versions of the tests. Conclusion The results of the measurement equivalence tests caution against treating computer- and paper-based versions of spatial measures as equivalent. We encourage subsequent work to demonstrate test mode equivalence prior to the utilization of spatial measures because current evidence suggests they may not reliably capture the same construct. Application The assessment of test type differences may influence the medium in which spatial cognition tests are administered.

Greenhouse gas emissions from green waste composting windrow.

The process of composting is a source of greenhouse gases (GHG) that contribute to climate change. We monitored three field-scale green waste compost windrows over a one-year period to measure the seasonal variance of the GHG fluxes. The compost pile that experienced the wettest and coolest weather had the highest average CH4 emission of 254±76gCday-1 dry weight (DW) Mg-1 and lowest average N2O emission of 152±21mgNday-1 DW Mg-1compared to the other seasonal piles. The highest N2O emissions (342±41mgNday-1 DW Mg-1) came from the pile that underwent the driest and hottest weather. The compost windrow oxygen (O2) concentration and moisture content were the most consistent factors predicting N2O and CH4 emissions from all seasonal compost piles. Compared to N2O, CH4 was a higher contributor to the overall global warming potential (GWP) expressed as CO2 equivalents (CO2 eq.). Therefore, CH4 mitigation practices, such as increasing O2 concentration in the compost windrows through moisture control, feedstock changes to increase porosity, and windrow turning, may reduce the overall GWP of composting. Based on the results of the present study, statewide total GHG emissions of green waste composting were estimated at 789,000Mg of CO2 eq., representing 2.1% of total annual GHG emissions of the California agricultural sector and 0.18% of the total state emissions.

Self-reported craft expertise predicts maintenance of spatial ability in old age.

Three hundred and three female participants between the ages of 18 and 77 reported their experience in crafting (sewing, knitting, and crocheting) and completed a measure of spatial ability: The Paper Folding Test. To investigate the connection between spatial ability performance, age, and craft expertise, an ANOVA was conducted for the Paper Folding Test using two levels of crafting expertise (High and Low) and three age categories (younger adults: 18-39, middle-aged adults: 40-59, and older adults: 60-77). Performance on the spatial ability test declined with age as predicted from previous literature. However, there was a significant Age by Expertise interaction. No difference was found between High and Low craft expertise groups in younger adults (18-39), but there was a growing difference between expertise groups in middle-aged adults (40-59) and older adults (60-77). The results suggest that continued hands-on experience in spatial domains is a predictor of maintenance of spatial ability across the life span.