Simulation for Combat Trauma Training: Lessons Learned from the Military Simulation Experience

1
Simulation for Combat Trauma Training Lessons
Learned from the Military Simulation Experience

• Howard R. Champion
• Gerald A. Higgins

2
Lessons from US Military

• Worlds Largest User of Simulators
• Ab Initio Training
• Training for Hypothetical Events
• Sustainment

3
The Military Simulation Experience

• Meta-Analysis of military simulation
• Literature reviewed
• Simulators reviewed
• Benefits of simulation training
• Cost effectiveness
• Transfer and training efficacy
• Guidelines and recommendations

4
Meta-Analysis of Military Simulation

• Quantitative and qualitative assessment of
  military simulation efforts, including
• Cost effectiveness
• Training efficacy
• Technology issues

5
Meta-Analysis of Military Simulation

• Literature Reviewed 117 relevant publications,
  from 1946 to 1999.
• Simulators Reviewed (in current use)
• 39 Land-based training simulators
• 33 Ship simulators
• 47 Flight simulators

6
Benefits of Simulator Training Cost
Effectiveness

• Simulators are extremely cost-effective training
  instruments.
• Flight simulators for military training can be
  operated at between 5 and 20 of the cost of
  operating the aircraft being simulated.

7
Benefits of Simulator Training Cost
Effectiveness
Cost Savings Realized with a Large, Multi-Service
Training Exercise
8
Benefits of Simulator Training Training Efficacy
9
Benefits of Simulator Training Training Efficacy

• Transfer-of-training efficacy can be assessed
  using measures such as the Transfer Effectiveness
  Ratio.
• The transference rate for a flight simulator is
  about 0.5 - that is, 60 minutes using a flight
  simulator is worth 30 minutes flying an airplane
  in terms of training efficacy.

10
Benefits of Simulator TrainingTraining Efficacy
Meta-Analysis Shows that Simulators are
Effective Training Instruments
11
The Military Simulation Experience

• Flight, vehicle, ship, gunnery simulation
• Effective for
• Mission rehearsal
• Skills training
• Predictive modeling
• Equipment design
• Strategic planning and coordination
• Budget of almost 2 billion per year

12
Guidelines from the Military ExperienceRecommend
ations for Combat Trauma Simulation
Training Integration is Important

• 1. Simulators must be integrated into a
  training plan to be effective. Without training
  integration, simulators will not be used by
  military personnel.
• Performance Assessment is Critical
• 2. Users must be clear about how their
  performance meets operational requirements.
  Accurate, quantitative performance measures are
  critical to simulator effectiveness.

13
Guidelines from the Military ExperienceRecommend
ations for Combat Trauma Simulation
Hybrid Technologies Provide the Best Training

• 3. Hybrid combinations of different simulation
  technologies, coupled with real world
  environments, provide the most effective training
  instruments.
• Fidelity is Important for User Acceptance
• 4. High user acceptance is critical for
  simulator-based training. Although simulator
  fidelity is not necessarily important for
  successful training, it is important for user
  acceptance.

14
Guidelines from the Military ExperienceRecommend
ations for Combat Trauma Simulation
Requirement for Flexible Delivery Platforms

• 5. The most effective training occurs during
  the first 10-25 times a student uses a simulator.
  Simulators also provide an ideal way for
  introducing new techniques and equipment to
  experienced users.
• 6. Part Task Trainers (PTT) are more effective
  than Whole Task Trainers (WTT) for training
  procedural skills.

The Importance of Part Task Trainers
15
Guidelines from the Military ExperienceRecommend
ations for Combat Trauma Simulation
The Importance of Virtual Environments

• Simulators are most useful for training cognitive
  and perceptual skills related to spatial tasks.
  VE simulation is ideal for training spatial tasks
  and situational awareness.
• Case Scenarios Enhance Training Effectiveness
• 8. Simulation training can be enhanced by
  providing the user with a library database of
  case studies, including virtual and live
  performance data from other users.

16
Simulators can provide negative training

• Taylor et al (1997) found that several personal
  computer-based simulators produced negative
  training effects
• Gil et al (2000) found that several commercial
  driving games degraded performance in actual
  driving skills among professional race drivers

17
Simulator fidelity is not always necessary for
effective training

• Lintern, Roscoe and Sivier (1990) showed that for
  actual landings in crosswinds, naive students
  trained in a simulator without crosswinds
  performed better than students trained with
  crosswinds in the simulator
• Moroney and Moroney (1998), showed that, for most
  tasks that have been studied, motion platforms do
  not provide any additional instructional
  advantage over static systems

18
Some IMIS Data (Effectiveness)

Conclusion IMIS simulator made generalist as
effective as specialist for targeted tasks.
19
The Thirds


20
Realizing The Thirds
A SYSTEMS APPROACH TO COMPETENCY

• Understand the fundamentals (topic/task/function)
• Business process analyses
• Task analyses
• Cognitive task analysis for each learning
  component
• Enable adaptive pedagogy (learner centricity)
• Design for portability reusability
• Verification validation of training efficacy
• Enable workplace cultural acceptance

21
Types of Medical Simulators Applications
Simulation
Planning Therapy
Training Systems
Device Design and Testing
22
Added Value Education Training in the Context
of

• ERROR
• EMERGENCIES

23
Causes of Surgical Error

• Operator
• Fatigue
• Stress
• Poor training
• Lacks experience
• Low innate ability

• Device
• Faulty design
• Poor usability
• Wrong material
• Wrong device
• Poor fit
• Broken
• Non-sterile

• Patient
• Variable size
• Variable pathology
• Age
• Anomalies
• Movement
• Lateralization

24
Medical Knowledge

• Doubles every 3 5 years
• Informatic Age of Medicine

25
Medical Simulation

• ? Cost
• ? Effectiveness
• ? Patient safety
• ? Error

26
Validation

• FACE VALIDITY
• Ability of simulator to accurately provide a
  training / testing environment

27
Validation

• CONTENT VALIDITY
• Degree to which simulators measure the Knowledge,
  Skills and Abilities (SKAs) of students

28
Validation

• PREDICTIVE VALIDITY
• Measurement of simulators precision in being
  able to predict whether the students will be
  successful in transferring learned skill to real
  world

29
Validation

• CONSTRUCT VALIDITY
• Measures whether the simulator, in both form and
  results, is consistent with the theory behind the
  simulation experience

30
Validation

• CONVERGENT VALIDITY
• Relates to degree in which simulation experience
  is similar to the experience of practical
  exercises on live animal or patient contact.

31
Importance of Curriculum