Preliminary evaluation of a virtual reality-based simulator for learning spinal anesthesia.

STUDY OBJECTIVE: To evaluate the influence of a simulation-based program on the initial performance of dural puncture by medical interns, and to refine the design of simulator-based teaching and competence assessment. DESIGN: Prospective interventional study. SETTING: Academic medical center. SUBJECTS: 27 medical interns inexperienced in the technique of spinal anesthesia or dural puncture and within 12 months of graduating from medical school, were randomly assigned to a conventional or a simulator-based teaching course of spinal anesthesia: 13 were recruited to the Conventional Group (CG) and 14 to the Simulator Group (SG). MEASUREMENTS: A SenseGraphic Immersive workbench and a modified Phantom desktop with shutter glasses were used to create a teaching environment. Outcomes of teaching were assessed in two phases within three weeks of the teaching course: Phase I consisted of a written examination followed by assessment on the simulator. A global rating scale and a task-specific checklist were used. Phase II (for those participants for whom a suitable opportunity arose to perform spinal anesthesia under supervision within three wks of the teaching course) consisted of structured observation of clinical performance of the procedure in the operating room. Participants were assessed by independent, study-blinded experts. Student's two-tailed impaired t-tests were used to compare the parametric outcomes (P < 0.05 was considered significant). MAIN RESULTS: All participants completed the written test successfully with no difference between groups. Ten participants from CG and 13 from SG completed the simulator-based testing performing similarly in terms of the global rating scale. Five participants in CG and 6 in SG proceeded to clinical testing. On the global rating scale, interns in SG scored higher than those in CG. They performed similarly according to the task-specific checklist. CONCLUSIONS: Overall, no difference was measured between those taught with traditional methods and those, by a simulator based program in regard to the performance of spinal anesthesia.

Virtual reality-based medical training and assessment: The multidisciplinary relationship between clinicians, educators and developers.

BACKGROUND: The current focus on patient safety and evidence-based medical education has led to an increased interest in utilising virtual reality (VR) for medical training. The development of VR-based systems require experts from different disciplines to collaborate with shared and agreed objectives throughout a system's development process. Both the development of technology as well as the incorporation and evaluation of relevant training have to be given the appropriate attention. AIM: The aim of this article is to illustrate how constructive relationships can be established between stakeholders to develop useful and usable VR-based medical training systems. METHODS: This article reports a case study of two research projects that developed and evaluated a VR-based training system for spinal anaesthesia. RESULTS: The case study illustrates how close relationships can be established by champion clinicians leading research in this area and by closely engaging clinicians and educators in iterative prototype design throughout a system's development process. CONCLUSION: Clinicians and educators have to strive to get more involved (ideally as champions of innovation) and actively guide the development of VR-based training and assessment systems. System developers have to strive to ensure that clinicians and educators are participating constructively in the developments of such systems.

Testing haptic sensations for spinal anesthesia.

BACKGROUND AND OBJECTIVES: Having identified key determinants of teaching and learning spinal anesthesia, it was necessary to characterize and render the haptic sensations (feeling of touch) associated with needle insertion in the lower back. The approach used is to match recreated sensations (eg, "pop" through skin or dura mater) with experts' perceptions of the equivalent clinical events. METHODS: The study was performed using a haptic device (Phantom Desktop) that simulated the tactile elements of predefined clinical events. Twenty-four experts (anesthetists) were invited to assess rendered versions of 3 basic sensations, which typically occur during the performance of spinal anesthesia with a 25-gauge pencil point needle: (1) touching different surfaces (skin, bone), (2) the "pop" sensations (skin, dura mater), and (3) the sensations associated with advancement of the spinal needle through particular tissues (subcutaneous tissue, ligaments, intrathecal space). The perceptions of each participant were recorded. The relationships between each rendered sensation and the corresponding participant's perception was modeled using standard random effects techniques. RESULTS: Experts seem to possess a specific haptic perception regarding most sensations. The coefficient of variation was less than 0.50 for all sensations with the exception of intrathecal space. However, there is considerable within-rater variation when experts are presented with the same haptic rendering on more than one occasion for bone surface, skin pop, dura pop, and subcutaneous tissue. CONCLUSIONS: The importance of this finding is that it demonstrates the feasibility of an "expert perception"-based approach to the design of medical simulators.

VR-based training and assessment in ultrasound-guided regional anesthesia: from error analysis to system design.

If VR-based medical training and assessment is to improve patient care and safety (i.e. a genuine health gain), it has to be based on clinically relevant measurement of performance. Metrics on errors are particularly useful for capturing and correcting undesired behaviors before they occur in the operating room. However, translating clinically relevant metrics and errors into meaningful system design is a challenging process. This paper discusses how an existing task and error analysis was translated into the system design of a VR-based training and assessment environment for Ultrasound Guided Regional Anesthesia (UGRA).