Objectives Simulation based medical education (SBME ) is expanding globally. Technology based education demands funding, equipment, faculty time and skill development. Our objective was to conduct feasibility testing of a prototype simulation based distance education system, using an international satellite communication link.

Methods This demonstration project aimed to identify technical feasibility and usability of a satellite communication system to project faculty expertise in SBME from the University of Hawaii (UH), in Honolulu, to the University of the Ryukyus (UR), in Okinawa, Japan. A trained UH facilitator controlled a simulator based at UR, and conducted three training scenarios and debriefing (20 minutes per scenario) for 5th year medical students (total n=7) at UR. Three cardiac case scenarios included; 1) Normal sinus rhythm, 2) Stable atrial fibrillation, and 3) Pulseless ventricular tachycardia. Principle learner objectives included; 1) initiating monitoring, oxygen, and IV access, 2) assessing vital signs, and 3) calling for help. Two simulation centers, SimTiki Simulation Center, (UH) and Okinawa Clinical Simulation Center, (UR) connected using a Japanese geostationary satellite system, WINDS (Kizuna), operated by the Japan Aerospace Exploration Agency (JAXA ), and managed by the National Institute of Information and Communications Technology (NICT). Applications included Laerdal SimMan3G software, and standard VTC (H.323) protocol. Usability heuristic and technology feasibility surveys were administered following the pilot SBME sessions.

Discussion Heuristic usability replies revealed opportunities for improvement; including bandwidth stabilization by optimizing network router configuration, incorporation of remote camera controls, and incorporation of direct manikin voice capability. This satellite based communication system has operational characteristics including image quality, transmission latency, and reliability which are adequate for development of a production model system for routine use. Conclusion We envision an ability to project a rich learning environment for practitioners and students in remote regions, where learners may participate in distance learning, during medical school rural health care rotations. This system has potential application in multi-site faculty training, clinical consultation, health care promotion, and for disaster and emergency crisis management communication. Some comments suggest student psychological engagement demands more facilitator skill or training when using distance learning than with face-to-face facilitation. Distance learning for remote isolated islands demonstrates good potential based on this pilot study of user acceptance and technical capability.

Simulation Based Distance Education with a Satellite System Communication Tool Gen Ouchi MD, Benjamin W Berg MD

Sim Tiki, John A.Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii

Okinawa Clinical Simulation Center University of the Ryukyus, JAPAN

Sim Tiki Simulation Center University of Hawaii, USA

Wideband Inter Networking engineering test and Demonstration Satellite (WINDS)

Results TECHNICAL: We demonstrated SBME remotely controlling a simulator through a

geosynchronous satellite link between University networks. Simultaneous TCP throughput of 2.11 Mbps was achieved UH to UR. UDP throughput was 1Mbps. Results of survey Q2 & Q3 indicated that sound and video quality problems were valued differently: students valued audio and faculty valued video preferentially. In open question format faculty noted low quality intermittent video, and no student noted video problems. Audio delay was noted to affect both teaching (faculty comments)/and learning (student comments).

USER ACCEPTANCE:

SBME mean feasibility score for future use (Q5) was 3.9 on a 5 point Likert scale[students (n=7), Facilitator (n=1), Faculty observers (n=7)]. Fig.1 shows Post-simulation survey results indicated good user acceptance. Faculty were more optimistic than students about potential future application of this methodology (Q5). Manikin control problems were not noted in free comments.

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Q1 Q2 Q3 Q4 Q5

Inst. Learner

Figure 1. Post-simulation survey

Satellite simulation system images

SimMan3G monitor controller

Q1.Do you feel difficulty to understand ? 1 2 3 4 5 no diffcult very difficult Q2. Do you feel naturalty in two-way conversation ? 1 2 3 4 5 natural unnatural Q3. How do you think image quality? 1 2 3 4 5 very clear very unclear Q4. How do you think SimMan reaction ? 1 2 3 4 5 natural unnatural Q5. Do you think distance simulation training is possible ? 1 2 3 4 5 impossible possible

Source: https://www.mededportal.org/icollaborative/resource/712