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UVA SOM Clinical Connections Use of Simulation in Medical Education: A Physical Simulator for Traini

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Title: UVA SOM Clinical Connections Use of Simulation in Medical Education: A Physical Simulator for Traini


1
UVA SOM Clinical ConnectionsUse of Simulation
in Medical EducationA Physical Simulator for
Training of Clinical Palpation Skills in
Examination of the Prostate April 24, 2008
  • Gregory Gerling, PhD, Systems Engineering
  • Marcus Martin, MD, School of Medicine
  • Reba Moyer Childress, FNP-C, School of Nursing
  • Graduate and Undergraduate Researchers
  • Isabelle Rivest, Computer Science
  • Sarah Rigsbee, Systems Engineering
  • Miki Wang , Systems Engineering
  • Angie Lee, Systems Engineering

2
Objectives
  • Define Simulation
  • Identify Levels of Simulation
  • Identify Simulation Technologies being developed
    at UVa
  • Identify how Simulation Technologies can enhance
    Student Education

3
Simulation Defined
  • A device, event or situation made to resemble
    clinical practice as authentically as possible
    to
  • Teach theory
  • Assess progress
  • Integrate technology
  • Develop problem-solving and clinical reasoning
    skills

4
  • Resusci Anne (1960)

5
Simulation Levels
  • Low-Fidelity
  • (Use of Oranges
  • to teach Injections)
  • Intermediate-Fidelity
  • (e.g. Static Mannequins)
  • High-Fidelity
  • (e.g., Clinical Labs VR)

6
Simulations asTeaching Strategies
  • Tie concepts together
  • Portray the "big picture"
  • Simulate clinical situations
  • Increase student confidence in skills prior to
    clinical experience
  • Teach core to complex skills

7
Simulation TechnologiesBeing Developed at UVa
  • Chest Tube Insertion Simulator
  • Breast Examination Simulator
  • Virginia Prostate Examination Simulator (VPES)

8
Chest TubeInsertion Simulator
  • Capstone Project
  • 4th Year Systems Engineering Students
  • 4th Year Computer Science Students
  • School of Medicine
  • School of Nursing

9
VR Virtual Reality Simulator
  • 3D View Of Patient
  • Force Feedback Touch Interface Device
  • Safe Environment
  • Repeat Practice
  • Cognitive
  • Manipulative
  • Tailors To Individual Practice Needs
  • Objective Performance Measures
  • Sequenced Steps
  • Instructions
  • Feedback

10
Multiple Programming Languages
  • Interface With Force Feedback Device
  • Render Virtual Environments
  • Examples
  • Chest Incision
  • Pleural Space Penetration
  • Automatic Transition To Subsequent Steps

11
Software
  • Graphics/Meshes
  • 3D Nodes for Skin Incision
  • Animation
  • Movement of Scalpel/Kelly Clamp
  • Chest Depression
  • Skin Separation
  • Bleeding

12
PC Workstation
  • Monitor One
  • Patient Demographics
  • Patient Vital Signs
  • Patient X-Ray
  • Monitor Two
  • Virtual OR
  • 3D patient
  • Tasks/Instructions

13
Chest Tube Insertion TrainingUsing Virtual
Reality and Force Feedback
Post - Performance Report
14
Breast Cancer Simulator
15
Motivation
  • 235,000 New Cases Of Prostate Cancer Per Year
  • 27,000 Deaths Annually
  • 100 Five Year Survival Rate With Early Detection

16
Detection Methods
  • Prostate Specific Antigen (PSA)
  • Digital Rectal Exam (DRE)

17
PSA Elevation
  • BPH
  • Infection
  • Irritation
  • Recent Ejaculation
  • After DRE
  • Cancer

18
False Positive/False Negative
  • Nearly 30 Men With Increased PSA
  • No Cancer
  • Nearly 30 Men With Cancer
  • Normal PSA

19
DRE
  • Detects 17 Tumors Missed By PSA
  • 17-34 Positive Predictive Value

20
DRE and PSA
  • 50 PPV Together

21
Other Detection Methods
  • Ultrasound
  • CT Scan
  • Prostate Biopsy

22
Prostate Disease and Training
Nasco 1 Static with Torso
Nasco 2 Static without Torso
23
VPES Components
  • Torso
  • Hollow With PVC Piping Frame
  • Skin Pigmented Silicone- Elastomer
  • Rectal Wall Silicone Elastomer
  • Prostate Silicone
  • Multiple Water Fillable Balloons
  • Flexiforce Sensors
  • Rotating Track
  • Scenario Control Box
  • Computer Data Display
  • Balloon Filing/Monitoring Box
  • Data Amplification/Filtering Box

24
Feedback
  • Technique Feedback (Flexiform Sensors
  • Finger Location
  • Applied Magnitude Of Pressure
  • Performance Feedback (Balloon Pressure Transducer
  • Tumor Palpation
  • Tumor Location
  • Augmented Feedback
  • Balloon/Tumor Pulsation
  • Pedagogical Alternative
  • Non-natural

25
Virginia Prostate Examination Simulator (VPES)
  • Computerized and Physical (hybrid)
  • Prostates Attached To Track
  • Accurate Size, Stiffness, Disease State
  • Embedded 4-6 Balloons and 4 Sensors

26
User Interface Feedback
27
Data Analysis
four main patterns (U, V, L and line)
  • 3 Factors (at present)
  • Local Finger Movement
  • Global Finger Movement
  • Average Finger Pressure

28
VPES Main Advantages
  • Greater Number of Scenarios (100 Compared To
    4-6)
  • Scenarios Cover All Diseases (Bph, Prostatitis
    and Cancer)
  • Feedback In Both Immediate and Debriefing Forms
  • Study of 34 Medical and 3 Nurse Practitioner
    Students Indicates Training With VPES May Improve
    Performance

29
Publications Acknowledgements
  • Journal Papers
  • Gerling G.J., Rigsbee, S., Moyer Childress, R.
    and Martin, M. L., The Design and Evaluation of
    a Computerized Physical Simulator for Training
    Clinical Prostate Palpation Skills (submitted to
    IEEE Transactions on Systems, Man, Cybernetics,
    Part A)
  • Gerling, G.J., Martin, M.L., Moyer Childress, R.,
    Learner-centered simulation to train the digital
    rectal exam combining self-directed and active
    learning with instructor validation (draft in
    preparation for Academic Medicine)
  • Conference Papers
  • Rigsbee, S., Gerling G.J., Moyer Childress, R.
    and Martin, M. L., A Computerized Physical
    Simulator for Training Clinical Prostate
    Palpation Skills (IEEE Systems, Man and
    Cybernetics Conference, 2007, Montreal, Canada,
    pp. 2223-2227)
  • Raja, N.S., Schleser, J.A., Norman, W.P., Myzie,
    C.D., Gerling, G.J., and Martin, M. L.,
    Simulation Framework for Training Chest Tube
    Insertion Using Force Feedback Virtual Reality
    Devices (IEEE Systems, Man and Cybernetics
    Conference, 2007, Montreal, Canada, pp.
    2261-2266)
  • Wang, M., Gerling, G.J., Moyer Childress, R., and
    Martin M.L. Characterizing Finger Palpation in
    the Detection of Prostate Cancers and
    Abnormalities (accepted for Human Factors and
    Ergonomics Society, 2008, New York City, NY)
  • Moyer Childress, R.M., Gerling G.J, Martin, M.L,
    and Rigsbee, S. A Physical Simulator for
    Training Clinical Palpation Skills in Exams of
    the Prostate Gland (The 18th International
    Nursing Research Congress Focusing on
    Evidence-Based Practice Vienna, 2007)
  • Cline, B.C., Badejo, A.O., Rivest, I.I., Scanlon,
    J.R., Taylor, W.C., and Gerling, G.J. Human
    Performance Metrics for a Virtual Reality
    Simulator to Train Chest Tube Insertion (SIEDS
    Conference, Charlottesville, VA, 2008)
  • Provisional US patent
  • 2007, A computerized physical simulator for
    training clinical prostate palpation skills

30
Simulation Resources
  • Practical Health Care Simulations
  • (2004) Loyd, Lake, Grenberg
  • Simulation in Nursing Education From
    Conceptualization to Evaluation
  • (2007) Jeffries, P.R.
  • (NLN/Laerdal Research Teams Book)

31
Questions?
  • mlm8n_at_eservices.virginia.edu
  • gregory-gerling_at_virginia.edu
  • reba_at_virginia.edu
  • Thank you!

32
VPES Demonstration
2 abnormalities selected (red)
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