INSTITUTE OF MEDICINE/SOCIETY FOR SIMULATION
IN HEALTHCARE GAMING ARCADE AND SHOWCASE
Eric B. Bauman, Ph.D., R.N.
Society for Simulation in Healthcare
The Institute of Medicine (IOM) (now a division of the National Academies of Sciences, Engineering, and Medicine) invited the Society for Simulation in Healthcare (SSH) Serious Games and Virtual Environments Special Interest Group to facilitate an arcade and showcase on April 23 as part of the 2-day workshop Envisioning the Future of Health Professional Education. The IOM/SSH Gaming Arcade and Showcase was modeled after the Serious Games and Virtual Environments Arcade and Showcases at the International Meeting on Simulation in Healthcare (IMSH) that have taken place over the past 5 years. Twenty-six teams were on hand to demonstrate their games and virtual environments-based educational technology. A panel of judges led by Dr. Jeff Taekman from Duke University Medical Center reviewed all of the participants’ work. These judges included Dr. Taekman; Dr. Pamela Jeffries, George Washington University School of
Gaming Arcade and Showcase Judges (from left to right): Gerald Stapleton, Laura Magaña Valladares, Pamela Jeffries, and Jeff Taekman
Gaming Arcade and Showcase Presenters
Nursing and SSH Past President; Mr. Gerald Stapleton, University of Illinois at Chicago; and Dr. Laura Magaña Valladares, National Institute of Public Health, Mexico.
SSH awarded a Leading Innovator Award and a runner-up award. Geoffrey Miller, M.S., EMT-P, and Andrew Cross from Eastern Virginia Medical School received the Leading Innovator Award for their entry, Automated Intelligent Mentoring System (AIMS): Applying Game Technology to Advance Medical Education. The runner-up award was given to Joyce Flores representing Games that Work for their entry, Brush Up, a game to teach young children proper teeth-brushing technique. Miller and Cross presented AIMS to the Global Forum on Innovation in Health Professional Education, workshop participants, and webcast viewers at day two of the workshop (April 24). The video of their presentation as well as a highlights video of the gaming arcade is available on the workshop’s website, iom.nationalacademies.org/futureofhpe. The pictures, in digital form, are also available on the workshop’s website.
This appendix includes the abstracts for each of the games presented during the IOM/SSH Gaming Arcade and Showcase.
PROJECT MAGIC: MOBILE APPLICATION GUIDE
FOR INNOVATIVE CURRICULUM
Eric B. Bauman, Ph.D., R.N.1; David Pederson1; Reid Adams1; Brian Pelletier2; Greg Vaughan2; Bruce Kaplan, D.O., FACOI1; and Carmen Fuentealba3
1DeVry Medical International’s Institute for
Research and Clinical Strategy, New Jersey;
2Learning Games Network, Wisconsin;
3Ross University School of Veterinary Medicine, St. Kitts, West Indies
A suite of innovative mobile applications custom designed to enhance medical and veterinary education by supporting and reinforcing didactic content and preparing students for simulated and clinical learning experiences. The project elements were created collaboratively with teaching faculty and content experts to support their existing curricula.
The project includes the following games for medical and veterinary students:
- Bone Viewer 3D, an interactive, mobile three-dimensional (3D) game-based learning tool to prepare medical and veterinary students for core principles of anatomy
- Diagnose Me!, an interactive, mobile 3D game-based learning tool to prepare clinicians for OSCE (Objective Structured Clinical Examination) exams, including the USMLE (United States Medical Licensing Examination) step two clinical exam
- iAnesthesia, an interactive, mobile 3D game-based learning tool to prepare veterinary students for clinical experiences focusing on the delivery of anesthesia to multiple species
- Embryo Tempus, an interactive, mobile 3D game-based learning tool that provides a high-fidelity active learning experience to supplement and reinforce traditional embryology content found in medical and veterinary medicine curricula
Objective 1: Engage learners in a high-fidelity, 3D, interactive experience to support content found within the medical, veterinary medicine, and other health sciences curricula.
Objective 2: The applications leverage game mechanics to engage students in active learning.
Objective 3: Prepare students for clinical learning experiences and licencesure exams.
MIMIC TECHNOLOGIES ROBOTIC
SURGERY SIMULATION SUITE:
DV-TRAINER, MAESTRO, AND XPERIENCE TEAM TRAINER
Glenn Carstater, M.B.A.
Mimic Technologies, Washington
Innovation, Thought Leadership in Robotic Simulation
First installed as a prototype at Indiana University’s Department of Urology in 2007, the dV-Trainer is the original robotic surgery simulator. It remains the only stand-alone robotic simulator that has been independently validated in published studies. In addition, the Intuitive Surgical Skills Simulator for the da Vinci Si Surgical System is based on Mimic’s proprietary simulation technology, MSim. The combined dV-Trainer/Skills Simulator install base has grown to approximately 1,500 systems, making it the most widely adopted platform for robotic simulation.
Cost-Effective and Accessible Training
Built on a compact, portable hardware platform, the dV-Trainer provides access to training outside of the operating room, when and where it is most convenient. According to numerous independent validation studies, the dV-Trainer closely reproduces the look and feel of the da Vinci system.
State-of-the-Art Robotic Surgery Simulation Technology
Mimic’s proprietary MSim platform powers the exercises available on the dV-Trainer, providing the most realistic and lifelike simulation available. MSim is at the heart of Mimic’s mission of helping prepare surgeons to deliver better care. It also has allowed the dV-Trainer to extend the benefits of simulation to now include team training (Xperience Team Trainer) and procedure-specific content (Maestro AR).
Industry-Leading Metrics and Scoring System
For objective performance evaluation, dV-Trainer users benefit from MScore. Built in to the dV-Trainer, MScore incorporates experienced surgeon data to establish proficiency-based scoring baselines—an industry first and Mimic exclusive.
Advanced Curriculum Development and Sharing
The dV-Trainer comes with best-in-class administration tools for educators to create, import, and export customized training protocols. dV-Trainer curricula can be uploaded and shared on Mimic’s MShare, an online portal for collaboration, providing access to validated simulation curricula from top institutions.
Mimic’s dV-Trainer offers more than 65 exercises under four overall categories:
- da Vinci overview and basic skills training
- Surgeon console overview—Review basic da Vinci functionality, covering topics such as icons, ergonomics, and settings.
- EndoWrist manipulation—Develop EndoWrist dexterity when working with as many as three common da Vinci instruments.
- Camera and clutching—Improve camera control, and learn to use the clutch effectively; train while using different motion scaling settings.
- Troubleshooting—Understand common da Vinci error messages, and determine how to react to them.
- Advanced surgical skills training
- Needle control and needle driving—Develop skill when manipulating needles, including the ability to hand off and position needles for effective and accurate needle driving.
- Suturing and knot tying—Improve suturing and knot tying technique with a variety of geometries common to robotic surgery, now including tube anastomosis and tube closure.
- Energy and dissection—Learn to properly apply monopolar and bipolar energy; practice dissection and manage bleeding.
- Games—Enjoy competing with other surgeons while developing robotic surgical skills at the same time.
- Procedure-specific content
- Maestro AR (Augmented Reality)—Use virtual instruments and augmented 3D case video to advance clinical decision making and procedural knowledge; refine skills specific to the procedure.
- Team training
- Xperience Team Trainer—Enable the robotic surgeon and first assistant to train together with this optional component for the dV-Trainer.
MIMYCX—THE WORLD’S FIRST 3D, MULTIPLAYER, IPE GAME
John Damici, M.F.A.
Professions Quest, Virginia
The Professions Quest staff is developing and publishing this virtual, interprofessional and interactive multiplayer learning solution targeted toward health professions education institutions and health professions students. Professions Quest’s products and services represent a unique vehicle for interprofessional education, and will deliver increased interaction, collaboration, and knowledge among the health professions and health professions students.
Interprofessional education has long been regarded as the best way of reducing medical errors and improving the health care system, but achieving it in any kind of collaborative or meaningful way has been elusive. That is about to change thanks to an innovative learning tool called MIMYCX. This interactive learning platform uses video game technology to bring students from different health care professions together to solve real-world scenarios.
The goal of MIMYCX is to transform interprofessional education by developing multiplayer virtual team-based learning solutions that provide true multicollaborative critical thinking, scholarship, and problem-solving skills to produce a new generation of professionals. Each player, or player team, can access MIMYCX and all of their personal and game performance data on desktops or mobile devices anywhere in the world. Students can benchmark their performance in the game against other health professions students.
CYBER-BASED CLINICAL EXPERIENCE FOR PHYSICAL THERAPY
Marjorie Zielke, Ph.D.1; Gary Hardee, M.A.1;
and Sue Scherer, P.T., Ph.D.2
1University of Texas at Dallas; 2Regis University, Colorado
Clinicalvpt.com is a prototype game-based simulation developed to allow physical therapy students and faculty at Regis University’s RueckertHartman College for Health Professions an opportunity to experience and provide feedback on a virtual NIH Stroke Scale practice session. Participants can practice four Stroke Scale items (1a, b, c, and 2). Responses are scored and feedback is provided during and at the end of gameplay. Data about decisions made during gameplay are tracked and stored. Clinicalvpt.com is designed to address the shortage in clinical placements for health care
professions, which can contribute to a backlog of students waiting for placement and affect graduation rates.
A 4-year National Simulation Study by the National Council of State Boards of Nursing found that up to 50 percent simulation “was effectively substituted for traditional clinical experience in all core courses across the prelicensure nursing curriculum” (NCSBN, 2014). California, Colorado, and Florida state boards of nursing have allowed up to a 25 percent of clinical hours to be substituted by simulations, including virtual and game-based simulations. Clinicalvpt.com was first developed as a Web-based simulation and later as a virtual reality (VR) experience using an oculus head-mounted display. Both versions provide varying educational advantages. The Web-based simulation facilitates asynchronous, distance-education opportunities; the VR experience adds greater immersion by enveloping the student in a lifelike visual and auditory virtual environment. Both versions will be demonstrated.
The Web-based simulation was used in a small study at Regis. Students and faculty who tested clinicalvpt.com completed posttest surveys and discussed the experience during focus group sessions in order to provide feedback on the design. Students said they appreciated having an opportunity to work on their own in a simulation, which is usually offered only in a group setting. All students agreed or strongly agreed that the gaming experience was appealing to play through and was helpful. Students stated they would like to see higher-fidelity virtual patients with multiple and more complex conditions. They also wanted opportunities for more clinical tasks, to interact with virtual caregivers, and to practice with virtual medical equipment. All faculty agreed or strongly agreed that the interaction in the gaming experience was appropriate for the activity.
Project Objective 1: Assess student participants’ reactions to the effectiveness of the game-based educational simulation as a representation of a clinical experience.
Project Objective 2: Assess faculty participants’ reactions to the effectiveness of the game-based simulation as an educational tool and representation of clinical experience.
USING A GAME-BASED SIMULATION TO COMPLEMENT
FACE-TO-FACE MEDICAL EDUCATION
Marjorie Zielke, Ph.D.1; Gary Hardee, M.A.1;
and Dorothy Sendelbach, M.D.2
1University of Texas at Dallas;
2 University of Texas Southwestern Medical Center
UTTimePortal.com is an innovative use of virtual environments and game-based simulation designed to address the goals of the University of Texas (UT) System’s Transformation in Medical Education (TIME) initiative. TIME’s mission is to increase the effectiveness of medical education while shortening its duration. UTTimePortal was developed as an assessment framework for game-based simulations as a complement to face-to-face clinical training. It was introduced as an assigned task during one of the TIME initiative’s summer courses at the UT Southwestern Medical Center. The course introduces undergrad premed students to a communications curriculum that includes lectures on professionalism in medical interviewing and in electronic media behavior.
UTTimePortal focuses on two of the course’s teaching objectives: how to efficiently gather the essential portions of a medical history; and to understand the requirements for maintaining professionalism in electronic media. One simulation module allows students to practice active listening techniques with a virtual patient and his caregiver to gain information about seven attributes of his current medical complaint. A second module represents a potential online conversation in which the student is asked by friends on a simulated social site about the patient and the medical interview.
Students were assigned to play the two game-based simulations following face-to-face classroom lectures on the topics and, with the medical interview module, before practicing with a standardized patient. In addition to game play, students were asked to discuss the professor’s questions about each module on discussion boards. The professor selected the best posts and awarded stars worth points toward the team total. Statistically significant improvement in students’ self-reported knowledge of interviewing skills, active listening techniques, medical interviewing, and understanding the attributes of a patient’s illness indicates support for Research Question 1: Can a game-based simulation help improve knowledge and attitudinal measures?
Students (n = 49) responded that the simulation: (1) allowed them to practice active listening (89 percent agree/strongly agree); (2) prepared them for conducting a medical interview (85 percent agree/strongly agree); and (3) was an effective means to educate students in the program (85
percent agree/strongly agree). Student responses about accountability in professional electronic communications on social networking pages indicate that the game’s social media episode increased awareness of personal responsibility.
Survey data also indicates support for Research Question 2: Is a game-based simulation an effective module for enhancing classroom lectures? Overall, 81 percent either agreed or strongly agreed that they were satisfied with the gaming experience. Two-thirds perceived the combination of lectures, the gaming experience, and standardized patient interviews as the most effective method for learning how to conduct a medical interview.
Project Objective 1: Explore the use of a game-based simulation to help improve knowledge and attitudinal measures regarding medical interviewing skills and professionalism in social media use.
Project Objective 2: Assess the effectiveness of a game-based simulation as an education module for enhancing classroom lectures.
A GAME-BASED MASTERY APPROACH TO LEARNING
PHARMACOLOGY AND NURSING CLINICAL ROTATION PREP
Tim Harrington, Ed.D.1; and
Leila McKinney, D.N.P., M.S.N., APRN, NP-C2
1DeVry Education Group, Arizona;
2DeVry Education Group, Georgia
PharmaCollegē is a game-based learning tool designed by Chamberlain College of Nursing to prepare students for practical nursing experience on procedure and responsibility relating to medication administration, nursing protocol, and practice in patient care. PharmaCollegē solves many teaching and learning challenges presented in traditional pharmacology courses.
Project Objective 1: Increase patient safety measures while administering medications in a clinical environment by improving drug therapy knowledge, nursing protocol, and patient education.
Project Objective 2: Increase subject knowledge retention as demonstrated through improved scores and pass-rates on the national exams.
Dov Jacobson1; and Joyce Flores, RDH, M.S.D.H.2
1Games That Work, Georgia; 2Gene W. Hirschfeld School
of Dental Hygiene, Old Dominion University, Virginia
Brush Up is a game in which young children learn tooth brushing. The game provides immediate feedback from a Bluetooth-connected, sensor-enabled toothbrush. The new software-only version introduces a novel “Selfie Assessment.” Guided by cognitive science and formative tests, the development team designed specialized characters, music, vocabulary, and a system of challenges and rewards. Efficacy was measured in a rigorous study that included a 1-year follow-up.
Project Objective 1: Improve brushing behaviors in young children.
Project Objective 2: Even distribution of brushing time across all tooth surfaces.
Craig Knoche, M.S., M.B.A.
i-Human Patients, Inc., California
i-Human Patients, International Meeting for Simulation in Healthcare Conference Best in Show winners, is an interactive, cloud-based, multimedia-rich platform that simulates a complete patient encounter to development patient assessment and diagnostic reasoning skills.
Project Objective 1: This project/innovation was developed to augment and accelerate apprenticeship training for clerkship students and residents.
Project Objective 2: This project/innovation was developed to integrate basic science education into a clinical context.
VIRTUAL INFANT PATIENTS, FAMILIES, AND STAFF
COLLABORATION: SIMULATING SITUATIONAL MEDICAL
SCENARIOS WITH A VIRTUAL LIVING WORLD
Judy LeFlore, Ph.D., R.N., NNP-BC, CPNP-AC&PC, ANEF, FAAN;
and Patricia Thomas, Ph.D., R.N., NNP-BC, CNE
University of Texas at Arlington
Medical training simulations mirroring the immersive environment of commercial video games offer benefits superior to physical mannequins. We have developed a recursive platform for the development and visualization of sociocultural models in medical situations. The model integrates visualization, sound design, and behavioral/cultural modeling with recursive assessment tools to create a living world that is sensory and culturally realistic.
Project Objective 1: Inspire a vision for transforming education that leads to greater student success by incorporating technologies that are more consistent with student learning styles, as in using gaming technology in a virtual world for the delivery of content.
Project Objective 2: Evaluate student success and performance from use of the virtual world to provide meaningful evidence that this type of instructional modality is valid.
CAN GAME PLAY TEACH STUDENT NURSES HOW TO SAVE
LIVES: AN UNDERGRADUATE TRAINING PROPOSAL FOR
STUDENT NURSES IN PEDIATRIC RESPIRATORY DISEASES
WITH A LIVING WORLD GAMING CONSTRUCT
Judy LeFlore, Ph.D., R.N., NNP-BC, CPNP-AC&PC, ANEF, FAAN; Mindi Anderson, Ph.D., R.N., CPNP-PC, CNE, CHSE-A, ANEF; Kristine Nelson; and Patricia Thomas, Ph.D., R.N., NNP-BC, CNE University of Texas at Arlington
The academic environment tends to “abstract” clinical concepts by teaching them in the classroom and out of context. Immersive video game technology may be a powerful medium for delivering nursing content and offers a variety of benefits superior to physical mannequins or standardized patients. The purpose of the study was to compare pediatric respiratory content delivered through a virtual world to the standard “in the seat lecture.”
Project Objective 1: Assess whether learning pediatric respiratory content through a virtual world is equal to learning in a traditional lecture for knowledge acquisition, knowledge transfer, and accuracy and timeliness of decision making.
Project Objective 2: Are students who learn pediatric respiratory content through a virtual world more satisfied than students who learn through traditional lectures?
THE AUTOMATED INTELLIGENT MENTORING SYSTEM:
APPLYING GAME TECHNOLOGY TO
ADVANCE MEDICAL EDUCATION
Geoffrey Miller, M.S., EMT-P; and Andrew Cross
Eastern Virginia Medical School, Virginia
The Automated Intelligent Mentoring System (AIMS) seeks to improve individualized, objective performance feedback during skill acquisition by rigorously assessing, real-time 3D psychometric measurement of performed skills. AIMS enhances individualized objective performance measurement, deliberate and repetitive practice, and feedback necessary for skill acquisition. It also provides uniformity in training and competency assessments.
Medical procedures, if performed incorrectly, can have serious and sometimes fatal consequences. The importance of deliberate and repetitive practice and feedback are well recognized as key features of high-fidelity medical simulation that leads to effective learning, particularly in the acquisition of clinical procedural skills. To provide adequate opportunity, learners must have access to appropriate simulation devices, equipment, mentoring, expertise, feedback, and individualized time to acquire a designated skill to a defined level of competence.
Although this model is achievable it comes at a high cost, and limits adequate, individualized opportunity to achieve desired performance outcomes. As clinical demands increase on medical educators, their time to observe, mentor students, and provide corrective feedback is becoming limited. Further, faculty observations of clinical procedural skills mainly rely on subjective criteria regarding the actual precision of real-time human performance metrics. The objective measurement of these metrics is a “missing middle” both in terms of simulator(s) and faculties’ ability to provide feedback to aid in the acquisition or performance of procedural skills.
This project may substantially contribute to solving this training dilemma and provide new levels of human performance feedback and data related to clinical procedural skill acquisition and performance. AIMS was developed for teaching and rigorously assessing, real-time 3D psychometric
measurement of procedural clinical skills performed by both novice learners and highly skilled professionals. AIMS is able to provide professional instruction with individualized, autonomous feedback for the learner, while providing detailed performance analytics for the instructors to remotely analyze, react, and refactor their future instructional efforts.
Unlike current simulation training models that require onsite instructors and often one-on-one interaction between learner and instructor, this technology accomplishes the same outcome in a more cost-effective manner. It provides comprehensive, real-time interactive instruction including active audio and visual cues, and dynamic feedback to users. As such, it may help to decrease the cost of medical education, in particular the teaching and training of critical clinical procedures and may lead to superior quality, effectiveness, and efficiency of the learner’s education.
Project Objective 1: Develop a low-cost solution, focused on the measurement of human performance related to specific real-time, 3D psychometric measurements of clinical procedural skills.
Project Objective 2: Improve and increase opportunities for individual, independent, deliberate practice, with real-time, objective assessment and expert feedback for learners, and performance analytics for instructors.
COURSE FOR OPERATIONALLY RELEVANT PATIENT SAFETY
(CORPS), BASED ON TEAMSTEPPS: STRATEGIES AND TOOLS TO
ENHANCE PERFORMANCE AND PATIENT SAFETY, VERSION 2.0
V. Andrea Parodi, R.N., Ph.D.
Virginia Modeling Analysis and Simulation Center,
Old Dominion University, Virginia
This program provides an avatar-guided, computer-based Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) version 2.0 instructional approach that includes content knowledge and testing to appeal to personnel who prefer interactive learning versus didactic instruction. Real-world scenarios, encountered by military nurses, are incorporated. Scenarios demonstrate common safety and leadership issues experienced by military medical professionals. Program completion follows mastery of content materials reflected by the learner achieving 100 percent accuracy on all graded and timed exercises.
Project Objective 1: To provide the most up-to-date TeamSTEPPS training available to military members in a self-paced, interactive format to promote high-performance teamwork wherever care is rendered.
Project Objective 2: To create a means to have a graded TeamSTEPPS component added to any training curriculum for continuous reinforcement for improved efficiency and patient safety.
CPG-BASED TRAUMA GAMES
V. Andrea Parodi, R.N., Ph.D.; Hector Garcia, M.S.A.;
Bridget Giles, Ph.D.; and Tom Frost, M.S.
Virginia Modeling Analysis and Simulation Center,
Old Dominion University
This suite of interactive computer-based trauma games were designed to support predeployment and sustainment education and training needs for military Nurse Corps officers. The games are a part of a larger, uniquely innovative military nursing trauma curriculum program. The content supports the learner acquisition of the knowledge needed to safely provide care to catastrophically wounded warriors. The program uses evidence-based practices (EBPs) that emerged from the Joint Theater Trauma Registry (JTTR) data analysis, and Clinical Practice Guidelines (CPGs) developed and promulgated by the Institute for Surgical Research (ISR). Additional clinical guidance came from the military lessons learned and operational nursing “pearls of wisdom.” Recently deployed nurses were involved in all phases of this program’s development to better identify some major learning needs and to better reflect operationally influenced care delivery.
The suite of games spans trauma content from primary to secondary survey and can make a perfect mobile app, tablet-based content mentor/ refresher or a companion to the computer-based curriculum. The use of digital-based learning tools offers the benefits of malleability and agility, able to simulate diverse environments and modify scenarios rapidly thus allowing educators to present content rich materials across different services, roles, and disciplines.
The program uses Benner’s model for leveling performance criteria and trauma and teamwork content is fully integrated into the program and grading criteria. We abandoned traditional percentage based grading for the mastery-learning format (must correctly complete all elements before proceeding) and created a self-paced deliberative practice approach as a means to acquire content knowledge (McGaghie et al., 2010).
The learner can choose to explore various supplemental content in the curriculum or keep repeating the games to improve proficiency and speed, or not. Consequently, a highly knowledgeable “player” can actually refresh and validate current content knowledge very quickly while another learner may need repeated efforts to gain content mastery. The games use high-fidelity photos of actual equipment from Role 2 and Role 3 type in-
country surgical facilities so the learners also develop immediate product/ equipment recognition. Game presentation allows for free-choice selections unless order sequence is required, then it too is required in the game. Game score is the amount of time to game completion when completed straight through with all items done correctly. Low score “wins.” Multiple iterations are tracked, but not penalized. In trauma, “you must be right, right away”; therefore, the faster one is, the better the score.
Were only the games available now as a smartphone app, learners could start to “pre-learn” before a simulation scenario or reinforce already learned material in anticipation of its use while passing the time in a line. The content, when updated by small- and medium-sized enterprises, can also be easily “pushed” to subscribers with an alert that a new CPG or a modified CPG is now reflected in the content. This will significantly shorten the time to positive impact from the learning/knowledge update to the change in practice with potentially positive measurable outcomes for the patient and the enterprise.
These games are part of an avatar-guided, computer game-based program of trauma instruction for military nurses. The general project was funded through the Defense Medical Research and Development Program (DMRDP) with programmatic management by the Joint Program Committee-1 and direct project oversight by the Telemedicine & Advanced Research Center (TATRC), an agency of the U.S. Army Medical Research and Matériel Command, under contract award No. W81XWH-12-2-0026. The views, opinions, and findings contained in this presentation are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.
THE BACTERIONOMICON: A FANTASY WORLD OF MONSTERS
AND HEROES INSPIRED BY BACTERIA AND ANTIBIOTICS
Nerdcore Medical, Connecticut
The Bacterionomicon is a compendium of infectious bacteria and antibiotics presented in the style of a Dungeons & Dragons bestiary book, in order to use imagination, metaphor, and stories to aid learning and promote awareness about antibiotic misuse.
Project Objective 1: Aid learning and promote awareness about antibiotic misuse.
OCCAM’S RAZOR CARD GAME: SOCIAL STUDYING
FOR NURSES AND MEDICAL STUDENTS
Nerdcore Medical, Connecticut
Occam’s Razor is a card game designed to help medical students, nursing students, and health professionals practice diagnosing patients. It features 14 different diseases, from acute appendicitis to septic arthritis, and draws on two classic philosophical principles: Occam’s razor (the simplest explanation is to be preferred) and Hickam’s dictum (patients can have as many diseases as they please).
Project Objective 1: Assist medical students, nursing students, and health professionals with practice in diagnosing patients.
DEFENDERS OF SOMA:
A CARD GAME ABOUT ANTIBIOTIC RESISTANCE
Nerdcore Medical, Connecticut
In Defenders of Soma, one player attacks the citizens of Soma with infectious bacteria, while the other player tries to defend them with recommended antibiotics. The more a given antibiotic is used, the less useful it becomes, as bacteria gain greater resistance. The game is designed to be a strategically challenging game for a general audience while also depicting medically relevant therapeutic recommendations.
Project Objective 1: Provide entertainment for learners while promoting awareness of antibiotic resistance and the challenges of treating infectious disease.
Melanie Stegman, Ph.D.
Molecular Jig Games, Washington
Immune Defense teaches abstract, fundamental concepts in molecular biology, including diffusion, randomness, protein structure and function, cell differentiation, and cell behavior. These core abstract concepts are necessary for student success in science, technology, engineering, and math
FIGURE B-1 Players’ self-rated confidence after playing the molecular biology video game or an unrelated control game (10th to 12th grade student data).
NOTES: One day after playing the games, students were shown the diagram on the left and asked to agree or disagree with the following statement: I would be able to understand this diagram if I read it and thought about it. Answer choices: 1. I disagree definitely; 2. I disagree somewhat; 3. I am neutral; 4. I agree somewhat; 5. I agree definitely. The molecular biology game players gave more confident replies than their classmates who played the control game. Average scores were IA = 3.16 and Control = 2.50 Students T-Test p << 0.000. In other words, the molecular biology video game cut the number of negative replies by half. For more information, visit www.MolecularJig.com/research (accessed September 8, 2015).
SOURCE: Stegman, 2014. For more information, visit http://dx.doi.org/10.1039/C4FD00014E (accessed September 4, 2015).
career paths, but typically are not taught until the student is in high school. Immune Defense allows younger students to learn abstract concepts. It drives player confidence by providing a clear set of possible actions and new, interesting challenges. The elements of the human immune system (cells, veins, receptors, and signaling molecules) are the parts of the puzzle that the player can manipulate. Controlled experiments with 7th to 12th grade students demonstrate that players remember the names, appearance, and functions of cells and proteins. Additionally, players show confidence when presented with novel diagrams that look and sound similar to the game (see Figure B-1). Immune Defense is a 15–20-minute game for Web browsers. For more information, visit ImmuneDefenseGame.com (accessed August 21, 2015).
IMMERSIVE LEARNING ENVIRONMENTS AT DUKE
Jeffrey Taekman, M.D.; and Michael Steele, P.M.P.
Duke University Medical Center, North Carolina
Immersive Learning Environments at Duke (ILE@D) is an ecosystem of 3D, collaborative worlds accessible from any Internet-connected computer that provides an innovative, interactive “front-end” to distance education and assessment in the health professions. ILE@D maximizes face-to-face interactions between teachers and students through self-directed, team-based, and facilitator-led preparatory activities in the virtual environment.
The Pre-Deployment Anesthesia and Anaphylaxis Training System is a serious game designed to teach the cognitive skills of rapid sequence intubation and moderate sedation for nonanesthesia providers. This single-player, fully automated simulation enables clinicians to evaluate, sedate, and medically manage 10 patients each with a unique set of medical and contextual challenges. In each scenario, learners must review the patient’s background and physical exam to determine primary and secondary sedation plans and execute that plan to anesthetize the virtual patient. Even with a correct plan, patients can sometimes act in unexpected ways. Several challenges (e.g., anaphylaxis) allow the learner to practice critical thinking in emergency situations.
Postpartum hemorrhage is a devastating condition in both the United States and abroad and is the leading cause of maternal mortality in the developing world. ILE@D Hemorrhage is a 3D, multiplayer, instructor-facilitated virtual simulation designed to train teams of clinicians in the medical management of postpartum hemorrhage as well as effective teamwork and communication behaviors (TeamSTEPPS). Participants connect from anywhere, sharing the same virtual environment in real time. This software has been used locally in Duke Hospital and as a proof-of-concept for virtual training in both Australia and Uganda.
Stroke is a devastating condition. Door-to-needle time (the time from patient entry into the hospital to the time of definitive therapy) is a critical factor in minimizing morbidity and maximizing survival. With the advent of telemedicine and tele-stroke facilities, nurses in outlying hospitals who lack adequate opportunities to keep their neurological exams skills fresh often perform the initial neurological exam. Our stroke scenario walks learners through a mentored neurologic exam, offering opportunities for physicians and nurses to hone their neuro exam skills in a safe environment.
Combat Medic is a single or multiplayer fully automated simulation where learners practice the procedural skills of cricothyrotomy, tourniquet management, and needle decompression. In this acute care case, the virtual patient will crash quickly if the learner fails to make the correct decisions. A complete debrief system allows the learner to playback the case, review the virtual patient’s vitals throughout the case, and compare their decisions with that of an expert.
Handover allows learners to practice the skills of transferring a patient from the intensive care unit to the operating room. This single-player, fully automated simulation puts you in the director’s chair, controlling all of the providers as they perform the actions necessary to move a patient. This also includes managing information exchange between the two teams. A playback/rating/feedback system allows mentors to review and comment on the learner’s choices.
Come explore ILE@D today at simcenter.duke.edu. We would like to thank The Duke Endowment for the Nanaline Duke Trust for support of ILE@D.
INTERPROFESSIONAL TEAMWORK TRAINING
USING TEAMSTEPPS VIRTUAL TEAMS
Rachel Umoren, M.D., M.S.1; Linda Sweigart, M.S.N., APRN2;
Evalyn Gossett, M.S.N., R.N.3; Barbara Truman4; John Fillwalk2;
Patricia Scott, Ph.D., M.P.H., O.T.5; Kay Hodson Carlton, R.N., Ed.D.,
ANEF, FAAN2; Natalia Rybas, Ph.D.6; and Rohit Das, M.D., M.P.H.1
1Indiana University School of Medicine, Indianapolis, IN;
2Ball State University, Muncie, IN; 3Indiana University
Northwest, Gary, IN; 4Fusion Unlimited Networks, Casselberry,
FL; 5Indiana University School of Health & Rehabilitation
Sciences; 6Indiana University East, Richmond, IN
TeamSTEPPS is a validated approach to teaching teamwork with demonstrated effectiveness in improving teamwork and patient safety. This multisite project evaluated students’ recognition of TeamSTEPPS strategies and attitudes regarding interprofessional communication, mutual support, situation monitoring, and conflict resolution. TeamSTEPPS was developed as a national program for health professional team training. Though proven effective, it is challenging to implement the program simultaneously with interprofessional health care students due to varying learner schedules.
Virtual learning environments (VLEs) allow flexibility of scheduling and location. The 3D Unity VLE provides enhanced graphics and adaptability to a variety of user hardware devices. Evidence has revealed the successful deployment of VLEs for developing communication skills for medical and nursing students. Simulated patient care situations were created as immersive experiences involving a health care team in typical patient care situations. Embedding the learner in a virtual team allows for a single- or multiplayer experience with positive participant feedback and significant changes in teamwork attitudes.
Project Objective 1: Apply low-cost, high-access, virtual technologies for rapid deployment of teamwork training and refresher sessions for health professionals through TeamSTEPPS virtual teams.
Project Objective 2: Examine the impact of TeamSTEPPS virtual teams on health professional student knowledge and attitudes to teamwork and apply this knowledge to advance team training and interprofessional collaborative practice.
Methods and Findings
The study involved more than 200 nursing, medical, occupational therapy, physician assistant, and social work students. Students completed three 5-minute scenarios based on TeamSTEPPS materials. The student’s avatar interacted with the avatars of the virtual health care team members that modeled the use of the teamwork communication tools. Participants were immersed in the scenarios observing communication of health care team members in typical patient care situations and identified TeamSTEPPS strategies that were used or that would have prevented adverse outcomes had the strategy been used. The Teamwork Attitudes Questionnaire (T-TAQ) was used as a pre-post measure; the tool included five categories: leadership, communication, mutual support, situation monitoring, and team structure. Analysis of participants’ scores on the T-TAQ revealed significant positive changes across the categories with P < 0.05. Students recognized the utilized or appropriate TeamSTEPPS communication strategy for various points in the realistic clinical situations. Student feedback of the activity was positive.
Conclusions and Implications
This pedagogical strategy overcomes many barriers to interprofessional teamwork skill development. It is an initial step to replacing face-to-face training sessions of these vital skills for all health care professional students. With future work, we expect to demonstrate that the 3D Unity-based simulation experiences are effective for teaching the communication skills that are essential to patient safety.
A NOVEL COMPUTER SCREEN–BASED SIMULATOR
FOR DEFIBRILLATOR SKILLS TRAINING
Kathleen Ventre, M.D.1; Joshua Ferge2; and Anne Brenneman3
1University of Colorado, Aurora; 2University of Colorado, Boulder;
3Primary Children’s Hospital, Salt Lake City, Utah
Rapid, well-coordinated resuscitation is essential for optimal outcomes from shockable cardiac arrest rhythms, yet studies from laboratory and clinical environments have found that health care teams often have difficulty delivering timely defibrillation. Acute care providers undergo advanced life support retraining every 2 years, and have few opportunities to gain experience in managing arrest rhythms between refresher courses. While mannequin-based simulation can impart and fortify resuscitation
skills, it is difficult to scale this resource-intensive technique to satisfy health care providers’ need for frequent retraining. These conditions suggest a need for fresh, sustainable approaches to the development and maintenance of competency in defibrillator operation.
After building a prototype, we gathered data on our simulator’s usability from beta testers who operated it using a “think aloud” protocol. Using these data we iteratively refined our simulator’s user interface and functional capabilities. The simulator now includes three modes: an interactive overview of basic defibrillator controls and two case-based modes that allow users to experience the consequences of their decisions. Three “tutorial” cases guide the user through operating the defibrillator in the context of managing a clinical scenario, and three scored “assessment” cases require fluent defibrillator operation to treat specific cardiac dysrhythmias. To allow us to gain insight into users’ error patterns, the simulator records management decisions and outcomes from the assessment cases. We configured our simulator to be hosted in a server at our hospital and transfer records to a secure database. We plan to use the data to inform curricular changes and future versions of the simulator.
Bob Yayac, M.B.A.; and Jeffrey Zack, M.B.A.
DecisionSim Chadds Ford, Pennsylvania
DecisionSim is a cloud and mobile simulation platform that specifically focuses on cognitive skills by assessing and enhancing decision making. Adults can better recall, synthesize, and apply what they learn by learning in context, practicing the application of knowledge, and receiving
personalized feedback. DecisionSim allows the learner to practice decision making in real-world scenarios, see consequences, and receive personalized feedback.
Project Objective 1: Demonstrate how DecisionSim can help improve decision making.
Project Objective 2: Demonstrate how DecisionSim’s unique authoring tools allow educators to customize the learning experience.
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