Defining user needs for on-line surgical simulation tools and multi-media learning content for physiology

Leeds 24 August 2000Web-based Standard Educational Tools (WebSET) constitutes a two-year project, which is funded by the European Commission under the 5th Framework Programme, for innovative use of interactive Web technologies to provide low fidelity surgical simulators and educational tools for physiology teaching in schools and higher education. Four end-user partners within the WebSET-consortium have been working on a user requirements report to define the most appropriate applications for implementation into the training packages for surgeon-trainees and into the learning content and material for biology students. The final goal is to generate an open, collaborative multi-user environment across the World Wide Web for surgeons and students to access via a simple browser-enabled PC, anywhere and at anytime, whether supervised by a trainer or not.


The Department of Neurosurgery at Leeds General Infirmary, one of the clinical WebSET partners, has selected the ventricular catheterisation procedure for insertion into the surgical simulation package. This simulation is already up and running on the Web and accessible via multiple platforms but it still needs additional functional tools to enable vivid interaction from a remote trainer. The WebSET partners already have planned to introduce help and feedback modules, scenario models for untoward events, as well as video or multi-media clips. Ventricular catheterisation which basically consists of the introduction of an instrument into a body cavity or space, constitutes an essential skill which a junior surgeon has to learn early in his education. By means of Virtual Reality Modelling Language and Java, the simulation is fairly easy to model.

The procedure has been split into subtasks, that can be assessed separately. The simulation offers an overview of the procedure and is suited to teach 3D neuro-anatomy to undergraduate medical students. Trainees can download the simulation into a VRML capable browser and start performing the series of steps individually or interactively with a trainer at a remote location. The simulation has to be carried out repeatedly while the trainee is assessed for speed of response, number of mouse moves, accuracy, decision making and learning. It is also necessary to evaluate the simulation itself, by estimating its capacity to differentiate between trainer and trainee. Also the files should be easy downloadable and accessible for the trainee whereas the interactive software feedback needs to have sufficient speed.

In the end, it should be possible to compare the results of simulator-trainees with those of trainees who have not been practising with the simulation as both go on to perform the actual operation. The Neurosurgery Department in Leeds aims to have the ventricular catheterisation simulation accepted as an assessment procedure by the Royal College of Surgeons in England and their colleagues throughout Europe. The Imperial College School of Medicine at St. Mary's Hospital in London, which is the second clinical WebSET partner, has chosen the lumbar puncture procedure as a simulation model. Also in this case, the simulation is already available but will be extended with additional features. These will include a sensitive evaluation module for feedback to the teacher and trainee, a tutorial component to provide tailored instructions to unsupervised trainees, as well as a low fidelity haptic system with integrated calibration to simulate bone, ligament and skin.

The question has been raised among the technical WebSET partners whether an inexpensive force feedback mouse will provide sufficient adequate support and the requested added value in a learning environment. Indeed physically, the simulated haptic experience is not altogether comparable to the real one in the surgical task. Still the experimental design might offer some valuable clues for the assessment of low fidelity haptics in surgical simulators. As the third clinical project partner, the Medical School of the University Hospital in Athens has defined two other simulations for production. In this regard, the WebSET tools will be reused and even extended in the skin trauma stitching training module, aimed at medical students, and in the "Verres & Trocar Needle" laparoscopy simulation for young surgeons.

In turn, the Faculty of Computer and Information Science at the University of Ljubljana in Slovenia is responsible for the educational physiology tools within WebSET. In collaboration with the Slovenian Ministry of Education and Sport, and the Departments of Cardiovascular and Neurosurgery at the University Medical Centre, the learning material contents requirements have been described. The chosen topic for tool testing is cell physiology while the learning components are targeted to biology education at secondary school level. Students will have descriptions, illustrations, 2D and 3D animations, visualisations and simulations at their disposal, based on authorised biology textbooks. The learning material has to be functional and consistent. It has to provide the user with sufficient informative help options, interactive multi-media support for biological experiments, as well as an intuitive, transparent navigation.

Great importance is attached to the flexible reusability of the material, also for higher educational levels than secondary schools. The simulation tasks and environments have to challenge the student, allowing him to form and test hypotheses and gain a qualitative understanding of a physiology system. The tools should involve teachers by offering them the opportunity to set up demonstrations, exercises and enquiries. The sometimes involuntary choice of educationally equivalent 2D graphics instead of the richer 3D simulations largely depends on the often limited computer performance and bandwidth availability. As a powerful model for conceptual learning of natural sciences with virtual experiments, the University of Ljubljana team has proposed the JaCoB zero programming tool.

The JaCoB application provides an established pedagogic approach, suitable for a large variety of learning disciplines. The tool allows the user to quickly set up a model, which represents a physiological phenomenon, and observe the changes through modification of the parameters. Additionally, the team aims to expand the physiology learning components to surgical applications, including aorto-coronary venous bypass grafting (ACBG) and neuro-surgical procedures in sitting position. The WebSET partners also have established a priority list of user requirements in order to clearly identify which tools are mandatory, meaning that they are absolutely necessary to have the project succeeded. The remaining ones are highly desirable too but the nature of WebSET will not be put at stake, should they not be implemented.

For a complete description of the WebSET project, we refer to the article Virtual multi-user environment to provide surgical training and physiological education via the Web. More news on the ventricular catheterisation simulation, developed by a team of experts at the Manchester Visualization Centre and Leeds General Infirmary, is available in the article Do your own on-line surgery simulation.

Leslie Versweyveld

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