dev-kahol amia 2009 workshop

© 2009, Dev AMIA 2009 Workshop1 of 46

Virtual Environments forTraining in Healthcare

(Plaza A, Hilton, San Francisco)

Parvati Dev, PhD, Innovation in Learning Inc, Los Altos Hills, CA

Kanav Kahol, PhD, Arizona State University, Tempe, AZ

(sponsored by the Education Working Group)

AMIA’2009 Workshop #09


Today’s Program

• Overview of virtual worlds, from Flash to immersive 3D

• Teaching clinical procedures and team work in virtual

worlds

• Teaching business processes in virtual environments

• Using virtual worlds to capture activities in real worlds

• Discussion and Brainstorming


Getting together


Sharing information - collaboration

QuickTime™ and a decompressor

are needed to see this picture.


Social


Fun ! -- Extends real life(World of Warcraft)


Why?

• The space feels real, its three-dimensional– I know how to move and find things

• Though I wish it was easier to navigate !

• I feel the others are really present• It is quite easy to share and collaborate

– Wish it was easier to bring in my simulations and programs– Powerpoints and spreadsheets are not enough– But I like that my documents can be left behind for next time

• Voice is good• Often the technology does not work


MD Kiosk Virtual Health Island (Second Life)

http://www.youtube.com/watch?v=U3Szet7MJEM&feature=related


Medical Centers

Ann Myers Medical Center

http://www.youtube.com/watch?v=QnTzgon-Wto&feature=related

National Health Service Polyclinic, UK

http://secondhealth.wordpress.com/


Medical Centers

Stanford University Emergency Department

http://summit.stanford.edu/research/VEDII.html


http://vw.ddns.uark.edu/index.php?page=overview

Healthcare Logistics (U Arkansas)


Virtual Patients for Virtual Worlds


Virtual Surgeon Open Heart Game

http://www.youtube.com/watch?v=8SAder8uMro&feature=related


Related medical information- cleft palate 3D surgical model


Virtual World Platforms

Virtual World PlatformVirtual World Platform

Virtual PatientsVirtual Patients

3D BuildingClinic

3D BuildingClinic

Medical Objects with

behaviors

Medical Objects with

behaviors

Virtual World server


ClientClient

Scenarios based on CurriculumScenarios based on Curriculum

Tracking and Performance Assessment

Tracking and Performance Assessment

User Authentication and Performance

Database


Database

ClientClient





ClientClient


Database


Database

ClientClient

CLIENT:

• Renders 3D world, avatars

• GUI for interaction

• Code for ‘behaviors’ of objects

• May have application support (ppt etc)

SERVER:

• Has copy of world for download on login

• Maintains status of each avatar and object

• Sends/receives status updates to/from all clients

•Supports application sharing fromany client

MULTIPLE SERVERS:

•There may be additional servers for media e.g. VOIP, video





ClientClient


Database


Database

ClientClient

CLIENT:

• Forterra client (download)

• Second Life client (download)

• Qwaq/Teleplace (download)

• Sun, Sirikata, …

• Metaplace (in browser, Flash)

• Unity3D (in browser, plugin)

• Unisfair (in browser, Flash?)

• Whyville (in browser, Java)

SERVER:

• Forterra server (hosted)

• Second Life server (hosted)

• Qwaq/Teleplace (hosted)

•Sun, Sirikata, … (you host)

• Metaplace server (hosted, Flash)

• Unity3D server (hosted)

• Unisfair (hosted)

• Whyville (hosted)

Tixeo


Faux 3D + video/voice


Lesson Plans ?

Collaborators:

Stanford University and Hospital

Forterra Systems

Innovation in Learning Inc


A Medical Virtual World


Subject Matter Experts

DevelopContent

DevelopBehaviors

IntegrateAnalysis &

DesignEvaluate

DevelopCurriculum

Analysis with SMEs determines high-value curriculum


Example Scenario Timeline

Incident Command

Victims

Out of Hospital First Responders

Bystanders

911 Calls Madefrom Scene

Specify Safety &Evacuation Areas

Complete HazardAssessment

Manage Mediaat Scene

Hospital AlertSystem Activated

GeneralNotifications Made

ICS CommandSetup Complete

ICS Setupat Event

MCI PlanActivated

Hot / Warm / ColdZones Established

VictimsTriaged

Manage On SceneBystanders

VictimTransportation

Fire - 1st

Assignment ArrivesPolice Setup andEnforce Perimeter

Triage AreaSetup

TreatImmediates

Able VictimsSelf-Extricate

Able VictimsSelf Transport

to Hospitals

Victims Moved toHospital

BystandersArrive

Media CrewsArrive

Protective ActionsTaken

Overall Timeline: Out-of-Hospital Scenario - Detonation of Radioactive Dirty Bomb


Pre-Hospital Curriculum

Emergency Preparedness – Pre-hospital

Decontaminate at Scene

Triage, Decontamination, and Transport Set the Stage

for In-Hospital Treatment

Triage at the scene Transport to hospital


In-Hospital Curriculum

• Users are emergency physicians and nurses

• Present the stresses and challenges of a disaster – task loading

• Teams can succeed or fail to save patients

• Team coordination, communication, and leadership are key

. Patient avatars live or die in this persistent virtual world

Emergency Preparedness – In-hospital to Emergency Department


High School CPR Preparedness

• Students practice decision making

• When should CPR be given

• What actions besides CPR are needed


Curricula for Virtual Worlds

• Start by identifying the task(s) to be learned/practiced – the learning goal(s)

• Deconstruct the task into parts;• Identify the desired behaviors and attitudes

– the KSAs;• Set the context/situation in which these behaviors and attitudes will

be elicited;• Specify the desired actions of the trainees as well as the “supporting

roles”;• Elaborate on the basic scenario with more complex ones.


Deconstruct the tasks

Is victim breathing?

Victim collapses…

Check for airway obstruction.

Open airway: head tilt, chin lift.

Call 9-1-1

Look, listen, feel for breathing.

Give one rescue breath.

Give 30 chest compressions.

Continue until EMT arrives.

Clear airway.

Check for responsiveness.

Is victim breathing?

Victim collapses…

Check for airway obstruction.

Open airway: head tilt, chin lift.

Call 9-1-1

Look, listen, feel for breathing.

Give one rescue breath.

Give 30 chest compressions.

Continue until EMT arrives.

Clear airway.

Check for responsiveness.


Place tasks in a Scenario


Example Scenario Timeline


Score Sheet for Performance

CPR Performance Checklist

Performance Checklist for Scoring CPR recordings

Instructions: Yes/NoStudent gets one point for each of the following done correctly, and in the correct sequence.Some items qualify for .5 point.

1 Student responds to the collapse quickly (time between victim collapsing and student volunteering to do CPR is less than…5?...seconds.)

2 Student asks someone to "go call 911" (should be asking by name or by clothing, etc.) (half point if student does NOT say-and come back and tell me what happened…some type of request to 'report back')CPR Sequence of actions:

3 Student "checks for responsiveness" ("Are you OK?")4 Student "checks airway" for obstruction.5 Student "opens airway" by clicking "Head tilt, chin lift" button6 Student "checks for breathing" by leaning head over and "Look, Listen, Feel"7 Student "gives 2 rescue breaths" (half credit if student gives one rescue breath) 8 Student "gives 15 chest compressions" (half credit if student gives 30 chest compressions 9 Student loses a point if they stop CPR before someone else offers to help)

either another student/bystander or the EMT arrives

Total Score


Teaching business processes


Tabletop Exercises

These are broadly intended to:• Validate plans and policies

• Promote team-building

• Achieve consensus

• Provide exposure to the decision-making process during an emergency

• Provide pre-event training and practice for operations or exercises

• Provide an opportunity to practice skills and improve individual performance under varying degrees of stress.


Incident Command Training

COMMAND STAFF• Incident Commander• Operations Chief• Logistics Chief• Planning Chief• Administration

(Finance) Chief• Security Chief

Dispensing antibiotic for Anthrax emergency

Fire on ship

http://www.commandsim.com/fireworld2007/startHere.html


Virtual oil rigs for emergency training

http://www.youtube.com/watch?v=uzr5UbdAuwQ


Building a virtual oil refinery


Collaborative Business Intelligence

• Business Intelligence – A process of information collection, mining, analysis, decision making– Small number of experts– Weeks to months

• Collaborative Business Intelligence– For example - Data center for hospital system has heating problem– Problem resolution needs many stakeholders– Need to move from strategic decision-making to operational decision-

making– Need real-time data, which is distributed, and requires multiple experts– Use document sharing, blogs, wikis, email, instant messaging,

conferencing, Webex, application sharing– Virtual worlds– The virtual collaboration platform provides mechanisms to capture user

decisions recorded in the virtual world and re-associate them with specific events, models and business processes


Links

3-D real-virtual worlds in health and healthcare, Maged N Kamel Bouloshttp://www.slideshare.net/sl.medic/3d-realvirtual-worlds-for-health-and-healthcare

Second Health (National Health Service in Second Life)http://secondhealth.wordpress.com/http://www.youtube.com/watch?gl=GB&hl=en-GB&v=Qtn5wcDA0isand numerous other videos

Imperial College, London:Ten weeks of activities to understand social networks, gaming and virtual worlds

(Second Life)http://learning20atimperial.wordpress.com/http://www.slideshare.net/learning20/2009-virtual-worlds-and-second-life

Podcasting in Plain English from CommonCrafthttp://www.youtube.com/watch?v=y-MSL42NV3c

Twitter in plain Englishhttp://www.youtube.com/watch?v=ddO9idmax0o

Social Networking in Plain Englishhttp://www.youtube.com/watch?v=6a_KF7TYKVc

Daden, a virtual worlds consulting company inUKhttp://www.daden.co.uk/pages/knowledge.html

has a number of interesting white papers

Heart Murmur Sim by Jeremy Kemp (San Jose State College)http://www.youtube.com/watch?v=xJY2Iwbzop4&feature=related

Ann Myers Medical Center (Second Life)http://www.youtube.com/watch?v=QnTzgon-Wto&feature=related

MD Kiosk on Virtual Health Islandhttp://www.youtube.com/watch?v=U3Szet7MJEM&feature=related

Emergency Preparedness simulationshttp://www.youtube.com/watch?v=3lanlNxY-2E&feature=relatedhttp://www.youtube.com/watch?v=RwQlHNlpVcE&feature=related

Virtual Patienthttp://www.youtube.com/watch?v=TU-TRXdSN7s&feature=related

New York Universityhttp://www.youtube.com/watch?v=K546pruIa0A&NR=1&feature=fvwp

Stanford Universityhttp://www.youtube.com/watch?v=TkuLAOzL0zU&NR=1

MUVERShttp://www.youtube.com/watch?v=NxwUMs4VCag&feature=related

Univ Texas and Breakaway

Virtual Surgeon Open Heart Gamehttp://www.youtube.com/watch?v=8SAder8uMro&feature=related

Virtual World Platforms (not exhaustive)http://www.forterrainc.com/http://www.secondlife.com/ and http://www.secondlifegrid.net/http://www.multiverse.net/http://www.metaplace.com/http://www.vastpark.com/http://www.unity3d.comhttp://www.sirikata.com/http://www.teleplace.com/ previously QwaqSun Wonderlandhttp://wiki.java.net/bin/view/Javadesktop/ProjectWonderland#Content_Creation

Learningwhyville.net


Links to our movies

Virtual Emergency Department (VEDII) - Users

Virtual Emergency Department (VEDII) Interface - GUI

Virtual Emergency Department (VEDII) - entire video (2:11 min)

http://www.youtube.com/watch?v=zUb2Z8ZTl6g

http://www.youtube.com/watch?v=6FEdUndV1Aw

http://www.youtube.com/watch?v=7KfO4vjf_II


Thank you !

[email protected]


Abstract: AMIA’2009

ABSTRACTVirtual Environments for Training in Healthcare

Parvati Dev, PhD, Innovation in Learning Inc, Los Altos Hills, CAKanav Kahol, PhD, Arizona State University, Tempe, AZ

(sponsored by the Education Working Group)

AbstractThree-dimensional virtual environments are the basis of highly popular online multi-person video games (World of Warcraft, Neverwinter Nights). The same technology has been used by educators to construct virtual learning environments for education in business, humanities, libraries, military, and healthcare. Some environments, such as those in Second Life, are exploratory, with structure provided through organized meetings and presentations ‘in-world’. Other environments resemble videogames, with sequential levels of play, providing a structured progress through the learning material, albeit in a game-like format. This workshop invites informatics educators and practitioners to participate in discussing current and potential uses of 3D virtual environments for learning and work in healthcare. Selected presentations on the topic will seed the discussion in the workshop.

Structure of Workshop:The workshop will open with short presentations on different healthcare training applications that use virtual environments.

ｷｷ Short overview of virtual worlds, from Flash to immersive 3D ｷｷ Examples of coursework in virtual worlds ｷｷ Teaching clinical procedures and team work in virtual worlds ｷｷ Teaching business processes in virtual environments ｷｷ Using virtual worlds to capture activities in real worlds

We will then move to an open brainstorming session where we list ideas for potential new applications. Small groups will each choose an idea to elaborate. Groups will come back to present their results.

Education goals:ｷｷｷ What are virtual environments for learning ｷｷｷ Technologies underlying these virtual environmentsｷｷｷ Current uses of virtual environments

Who should attend: Educators and researchers; physicians, nurses, and other healthcare professionals; hospital administrators; computer scientists, system developers, and programmers.

dev-kahol amia 2009 workshop

Health & Medicine