Tele-training on human patient simulators in virtual space evokes real life stress

Ann Arbor 22 March 2001A physician may practise and train emergency procedures on a human patient simulator (HPS) till he can dream the subsequent actions in reversed order while he is asleep. This will still not accustom the surgeon to the various stress elements experienced in a working emergency department or operating room under real life circumstances. An incontrovertible fact that has been well understood by a team of doctors and researchers at the Virtual Reality Laboratory of the Engineering College at the University of Michigan. Here, the Virtual Reality-enhanced Medical Readiness Trainer (MRT) is being developed and brought to perfection, with the aim to fuse the state-of-the-art technologies of HPS and fully immersive VR to stage the reality of time limits, environmental distractions, fatigue, and nerve-wrecking situations in clinical medicine.

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The Medical Readiness Trainer allows medical students, senior clinicians, and multi-speciality medical teams to integrate the observation of clinical facts with the body of theoretical knowledge. This serves as the basis for appropriate diagnosis and treatment, therapy modifications depending on the progression of the disease, complications, or unexpected events. The HPS component consists of computer-operated, life-size manikins to reproduce all sorts of disease symptoms, allowing the execution of several procedures, and giving appropriate responses to drug administration. The latest HPS models are even capable of artificial bleeding. Improper or delayed implementation of the required intervention might cause the "death" of a simulator. Hence, the trainee is challenged to undertake action promptly, by searching immediate access to all the intellectual resources available.

In addition, the virtual reality component of the MRT recreates the physical setting of a trauma bay in an emergency room, an operating theatre, or the claustrophobic sick bay on board of a US Coast Guard Cutter or a Medevac helicopter. In this virtual scenery, diagnostic devices and vital sign monitors provide data to the trainee on the patient's condition. Floating VR billboards with Web-based information and educational tools like diagrams, anatomical cross sections, and medical paper abstracts can be called upon at any time. The use of immersive virtual reality Cave systems and video conferencing to set up distributed and shared virtual environments allows for highly flexible training contexts in which alternatively all kinds of different aspects related to a medical intervention can be focused, such as consistency or variability, repeatability and reproducibility, or a complete lack of predictable elements.

A third factor within the MRT concept is the potential of global networking, which facilitates the tele-training of individuals, teams, or even groups of teams, who are physically separated by large distances from the teaching expert. Initiatives such as the Next Generation Internet (NGI) or Internet 2 provide the pipeline to link medical teams from different nations in a virtual space of interconnected MRT units, in which all the international partners experience and interact with identical medical and environmental scenarios. Thus, the network permits sharing of educational experiences and learning to collaborate smoothly as a very large entity. This opens perspectives for a customised training of medical deployment teams to operate in multinational environments after disaster events or in humanitarian relief operations, that have been set up by the United Nations or non-governmental organisations.

Currently, the MRT team is occupied at improving the scenario contents with the "burned patient". Once integrated with the Cave environment this scenario will confront trainees with the extreme realism of practising the treatment of thermal injuries. The Virtual Reality airway management trainer constitutes another subject of ongoing design. This MRT component will help the trainee teach to manipulate a manikin's airway under the most abnormal conditions by means of a haptic tool. A third issue which needs to be solved is the design of gateway mechanisms to remotely control simulators having a different capacity because they are developed by manufacturing competitors, such as Medical Simulation Corp. and Medical Education Technologies Inc. The MRT team also intends to experiment with shifting from central to both mobile and remote multi-simulator control. For more details, please visit the illustrated Web site of the Medical Readiness Trainer.


Leslie Versweyveld

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