Journal articles: 'Virtual patient simulation'

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Nystrom, Daniel T., Douglas E. Paull, Ashley N. D. Meyer, and Hardeep Singh. "Virtual Patient Simulation." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 60, no. 1 (September 2016): 533–37. http://dx.doi.org/10.1177/1541931213601123.

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Medical diagnosis has begun to draw attention as a patient safety concern that is valid, yet difficult to study. In the current study, we implement a virtual patient simulation to assess different information sampling techniques practiced by a variety of health care providers including physicians, nurses, health technicians, and pharmacists who were tasked with diagnosing a virtual patient. Results suggest there are three different information sampling approaches used to arrive at a medical diagnosis: iteration, batch, and haste. In the iterative approach, clinicians sampled a series of hypothesis-generating sources of information (e.g., patient history, physical exam, etc.) that were immediately followed by a series of diagnostic tests (e.g., X-ray, EKG, etc.) and this process was repeated for 2-4 cycles before arriving at a diagnosis. In the batch approach, hypothesis-generating sources of information were sampled in a single series or “batch” that was then followed by a single series of diagnostic tests. In the haste approach, only a few sources of hypothesis-generating information were sampled before arriving at a medical diagnosis, and none of the information sampled was tested using diagnostic tests. Results suggest virtual patient simulation is a useful format to observe the emergence of clinicians’ diagnostic process and to collect a variety of measures and outcomes associated with medical diagnosis.

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Bond, William F., Teresa J. Lynch, Matthew J. Mischler, Jessica L. Fish, Jeremy S. McGarvey, Jason T. Taylor, Dipen M. Kumar, et al. "Virtual Standardized Patient Simulation." Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 14, no. 4 (August 2019): 241–50. http://dx.doi.org/10.1097/sih.0000000000000373.

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Waghale, Vedantika, Ujwalla Gawande, Gaurav Mahajan, and Shriram Kane. "Virtual Patient Simulation- an Effective Key Tool for Medical Students Enhancing Diagnostic Skills." ECS Transactions 107, no. 1 (April 24, 2022): 16191–97. http://dx.doi.org/10.1149/10701.16191ecst.

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Virtual technology advancements have made it easier to recreate reality using virtual or simulation-basedpatients shown on a digital screen.virtual clinical simulation is a computer-based representation of reality in which actual individuals interact with simulated systems. It's a simulation that puts players in the middle lane by putting their decision-making, motor control, and communication abilities to the test. Virtual patients are used in active and realistic clinical contexts spanning from hospital to outpatient clinics in clinical virtual simulation. Advances in digital and virtual technologies have made it simpler to replicate reality using virtual patients projected on a computer display.Early education is commonly dominated by the presenting of knowledge in a theoretical and science-oriented manner, with few links to clinical practise. Orientation toward specialised disciplines leads to information fragmentation, a mismatch of competencies to requirements, and a restricted holistic picture of the patient. As a result,Academics have been looking for techniques to make health professional education more interesting, achieve a higher audience, and be more efficient. Virtual patient simulations are now being taught at medical schools around the country. It's hard to estimate the global adoption rate, but early indications suggest that it's high and that demand is growing. Virtual patient simulations were used in 26 out of 108 responding medical schools in the United States and Canada, according to a study performed by Huang et al in 2005. In 2016, it was stated that the MedU virtual patient gathering was being used at 130 medical schools in those nations.

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Willaert, Willem I. M., Rajesh Aggarwal, Isabelle Van Herzeele, Nicholas J. Cheshire, and Frank E. Vermassen. "Recent Advancements in Medical Simulation: Patient-Specific Virtual Reality Simulation." World Journal of Surgery 36, no. 7 (April 25, 2012): 1703–12. http://dx.doi.org/10.1007/s00268-012-1489-0.

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Botezatu, Mihaela, Håkan Hult, Mesfin Kassaye Tessma, and Uno Fors. "Virtual patient simulation: Knowledge gain or knowledge loss?" Medical Teacher 32, no. 7 (July 2010): 562–68. http://dx.doi.org/10.3109/01421590903514630.

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Larkin, Amy, Stacey Hughes, Martin Warters, and Gwen Littman. "VASODILATORY SHOCK: CAN VIRTUAL PATIENT SIMULATION IMPROVE MANAGEMENT?" Chest 156, no. 4 (October 2019): A1006. http://dx.doi.org/10.1016/j.chest.2019.08.931.

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Parikh, Dhwani, and Marisa Kollmeier. "Guidelines and workflow for virtual simulation." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 49. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.049.

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49 Background: An important component of radiation treatment planning is the CT simulation which involves several steps including patient positioning, imaging in the treatment position, and placement of an isocenter, a point through which the central rays of the radiation beams pass. As radiation therapy is an important component of palliative treatment for metastatic cancer, some patients require multiple courses which may be temporally proximate. This creates a burden for patients who may be challenged with regard to mobility, distance, and logistics coordinating travel to the department. We sought a clinical workflow that maintains the integrity of the simulation process but allows the potential use of previously obtained treatment planning imaging to create a new treatment plan (i.e. virtual CT simulation). We present our workflow and experience here. Methods: A multidisciplinary group developed a virtual simulation workflow and identified critical criteria to safely and reliably proceed with virtual simulation. These included: time from initial CT simulation (< 14 days), adequacy of patient positioning and immobilization, as well as appropriate inclusion of the entire “virtual” planning treatment volume (PTV) and organs at risk (OARs) in the original scan. Specific virtual simulation care paths were created in treatment planning software (Aria®, Varian Medical Systems) for case tracking. A pilot was initiated to monitor the workflow for the first 10 patients and corrections to the workflow were made. Thereafter the program was randomly audited and the QA reporting system monitored for reported error events. Results: The virtual simulation workflow pilot was initiated in June 2020. Of the first 50 virtual simulation requests, 48 were approved (96%). Two cases were denied due to inadequate immobilization. There was only one event reported pertaining to set up uncertainty requiring clarification from physics. Conclusions: Given the success of the virtual simulation criteria and workflow we will continue this practice and will monitor the cases as well as RISQ events closely. Based on feedback we have received we will expand the window of time to request a virtual simulation from 14 days to 21 days after original simulation and will also allow for up to 3 virtual isocenters to be placed.

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Kim, Byeol, Warren Schwartz, Danny Catacora, and Monifa Vaughn-Cooke. "Virtual Reality Behavioral Therapy." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 60, no. 1 (September 2016): 356–60. http://dx.doi.org/10.1177/1541931213601081.

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Mental health and substance abuse patients face many challenges in receiving effective long-term outpatient behavioral therapies, including issues related to accessibility and personalized care. Mobile health technologies, particularly those integrating virtual reality (VR), are increasingly becoming more accessible and affordable, thus providing a potential avenue to deploy outpatient behavioral therapy. This paper proposes a method to address the aforementioned challenges by personalizing and validating VR simulation content for behavioral therapy. An initial demonstration will be performed for tobacco cessation, which is a critical public health treatment area for mental illness and substance abuse. The method empirically builds smoker personas from theoretically grounded survey content. The personas are then used to design and pilot VR simulation modules tailored to behavioral interventions, which will be tested in the patient population. The VR simulation will record a subject’s emotions and brain activities in real-time through subjective (surveys) and objective (neurophysiology) measures of emotional response. The overall goal of the study is to validate the VR content by demonstrating that significant differences are seen in emotional response when presenting content personalized for the patient.

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Mudunkotuwe, J., V. Mannali, J. Henry, J. Clift, and P. Strickland. "Digitised remote delivery of simulation in psychiatry during the pandemic and for the future." European Psychiatry 65, S1 (June 2022): S199. http://dx.doi.org/10.1192/j.eurpsy.2022.523.

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Introduction Surrey and Borders NHS Foundation Trust’s AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient simulation system, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents. During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ’out-of-body’ perspective, immersed in a customdesigned interactive virtual environment. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. During the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams. Objectives To evaluate the feedback from Doctors in training taking part on the education sessions. Methods We collected qualitiative and quanttaive infromation from participants after the teaching session. Results We received strongly positive reults in all parameters measured. the presenters will show a detailed breakdoen in the session. Conclusions The digitalised delivery of the virtual patient simulation, has been pivotal in limiting interruptions to communication skills training in mental health. Disclosure The NHS trust has co produced the simulation platform with a private software firm Xenadu Virtual Environments

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Niederer, S. A., Y. Aboelkassem, C. D. Cantwell, C. Corrado, S. Coveney, E. M. Cherry, T. Delhaas, et al. "Creation and application of virtual patient cohorts of heart models." Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences 378, no. 2173 (May 25, 2020): 20190558. http://dx.doi.org/10.1098/rsta.2019.0558.

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Patient-specific cardiac models are now being used to guide therapies. The increased use of patient-specific cardiac simulations in clinical care will give rise to the development of virtual cohorts of cardiac models. These cohorts will allow cardiac simulations to capture and quantify inter-patient variability. However, the development of virtual cohorts of cardiac models will require the transformation of cardiac modelling from small numbers of bespoke models to robust and rapid workflows that can create large numbers of models. In this review, we describe the state of the art in virtual cohorts of cardiac models, the process of creating virtual cohorts of cardiac models, and how to generate the individual cohort member models, followed by a discussion of the potential and future applications of virtual cohorts of cardiac models. This article is part of the theme issue ‘Uncertainty quantification in cardiac and cardiovascular modelling and simulation’.

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Dyachenko, E. V. "Simulated Patient or Patient-Robot in Teaching Doctors Professional Communication — Unity of Opposites." Virtual Technologies in Medicine 1, no. 3 (September 17, 2021): 137–38. http://dx.doi.org/10.46594/2687-0037_2021_3_1343.

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Research shows that bedside communication training (in the workplace) is more effective if trainees have mastered the doctor-patient simulation cycle. The technologies are different: virtual and simulated patients, robotic patients. What learning tasks can they solved? Is it possible to effectively train doctors in professional communication with the involvement of virtual patients and robotic patients?

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Franc-Law, Jeffrey M., Michael Bullard, and F. Della Corte. "Simulation of a Hospital Disaster Plan: A Virtual, Live Exercise." Prehospital and Disaster Medicine 23, no. 4 (August 2008): 346–53. http://dx.doi.org/10.1017/s1049023x00005999.

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AbstractIntroduction:Currently, there is no widely available method to evaluate an emergency department disaster plan. Creation of a standardized patient data- base and the use of a virtual, live exercise may lead to a standardized and reproducible method that can be used to evaluate a disaster plan.Purpose:A virtual, live exercise was designed with the primary objective of evaluating a hospital's emergency department disaster plan. Education and training of participants was a secondary goal.Methods:A database (disastermed.ca) of histories, physical examination findings, and laboratory results for 136 simulated patients was created using information derived from actual patient encounters.The patient database was used to perform a virtual, live exercise using a training version of the emergency department's information system software.Results:Several solutions to increase patient flow were demonstrated during the exercise. Conducting the exercise helped identify several faults in the hospital disaster plan, including outlining the important rate-limiting step. In addition, a significant degree of under-triage was demonstrated. Estimates of multiple markers of patient flow were identified and compared to Canadian guidelines. Most participants reported that the exercise was a valuable learning experience.Conclusions:A virtual, live exercise using the disastermed.ca patient database was an inexpensive method to evaluate the emergency department disaster plan. This included discovery of new approaches to managing patients, delineating the rate-limiting steps, and evaluating triage accuracy. Use of the patient timestamps has potential as a standardized international benchmark of hospital disaster plan efficacy. Participant satisfaction was high.

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Talbot, Thomas B., Kenji Sagae, Bruce John, and Albert A. Rizzo. "Sorting Out the Virtual Patient." International Journal of Gaming and Computer-Mediated Simulations 4, no. 3 (July 2012): 1–19. http://dx.doi.org/10.4018/jgcms.2012070101.

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Since Dr. Howard Barrows (1964) introduced the human standardized patient in 1963, there have been attempts to game a computer-based simulacrum of a patient encounter; the first being a heart attack simulation using the online PLATO system (Bitzer, 1966). With the now ubiquitous use of computers in medicine, interest and effort have expended in the area of Virtual Patients (VPs). One problem in trying to understand VPs is that there are several quite distinct educational approaches that are all called a ‘virtual patient.’ This article is not a general review of virtual patients as current reviews of excellent quality exist (Poulton & Balasubramaniam, 2011; Cook & Triola, 2009). Also, research that demonstrates the efficacy of virtual patients is ample (Triola, et al., 2006). This article assesses the different kinds of things the authors call “virtual patients”, which are often mutually exclusive approaches, then analyzes their interaction structure or ‘game-play’, and considers the best use scenarios for that design strategy. This article also explores dialogue-based conversational agents as virtual patients and the technology approaches to creating them. Finally, the authors offer a theoretical approach that synthesizes several educational approaches over the course of a medical encounter and recommend the optimal technology for the type of encounter desired.

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Huang, Grace, Robby Reynolds, and Chris Candler. "Virtual Patient Simulation at U.S. and Canadian Medical Schools." Academic Medicine 82, no. 5 (May 2007): 446–51. http://dx.doi.org/10.1097/acm.0b013e31803e8a0a.

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Lubarda, Jovana, Robert Braun, and Maria T. Abreu. "Improving Management of Ulcerative Colitis Through Virtual Patient Simulation." American Journal of Gastroenterology 111 (October 2016): S313. http://dx.doi.org/10.14309/00000434-201610001-00689.

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Krause, Andreas. "The virtual patient: Developing drugs using modeling and simulation." CHANCE 23, no. 1 (March 2010): 48–52. http://dx.doi.org/10.1007/s00144-010-0010-5.

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Beshir, Semira Abdi, Affana Parveen Mohamed, Aadith Soorya, Sheron Sir Loon Goh, Eman Moussa El-Labadd, Nadia Hussain, and Amira S. A. Said. "Virtual patient simulation in pharmacy education: A systematic review." Pharmacy Education 22, no. 1 (December 17, 2022): 954–70. http://dx.doi.org/10.46542/pe.2022.221.954970.

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Background: This review summarises the impact of virtual patient simulation (VPS) on pharmacy students’ knowledge, skills, and perceptions. Methods: The PubMed, Cochrane Library, and Web of Science databases were searched using relevant keywords. Full-text articles in English, published between 2010 and August 2021, were retrieved if they evaluate the impact of web-based interactive VPS in pharmacy education. Results: This review included 19 studies, 9 of which were comparative. VPS was used to develop or assess different pharmacy-related skills. In general, post-VPS exposure test scores were better than the pre-VPS test scores in 12 studies. VPS significantly improved higher-level learning, counselling, and decision-making skills more than paper-based cases. The favourable impact of VPS on learners’ confidence, student engagement, and satisfaction was noted. Conclusion: VPS enhances knowledge and clinical decision-making skills. It can also address the needs of pharmacy students with active learning preferences.

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Burdea, G. C. "Virtual Rehabilitation – Benefits and Challenges." Methods of Information in Medicine 42, no. 05 (2003): 519–23. http://dx.doi.org/10.1055/s-0038-1634378.

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Summary Objectives: To discuss the advantages and disadvantages of rehabilitation applications of virtual reality. Methods: VR can be used as an enhancement to conventional therapy for patients with conditions ranging from musculo-skeletal problems, to stroke-induced paralysis, to cognitive deficits. This approach is called “VR-augmented rehabilitation.” Alternately, VR can replace conventional interventions altogether, in which case the rehabilitation is “VR-based.” If the intervention is done at a distance, then it is called “telerehabilitation.” Simulation exercises for post-stroke patients have been developed using a “teacher object” approach or a video game approach. Simulations for musculo-skeletal patients use virtual replicas of rehabilitation devices (such as rubber ball, power putty, peg board). Phobia-inducing virtual environments are prescribed for patients with cognitive deficits. Results: VR-augmented rehabilitation has been shown effective for stroke patients in the chronic phase of the disease. VR-based rehabilitation has been improving patients with fear of flying, Vietnam syndrome, fear of heights, and chronic stroke patients. Telerehabilitation interventions using VR have improved musculo-skeletal and post-stroke patients, however less data is available at this time. Conclusions: Virtual reality presents significant advantages when applied to rehabilitation of patients with varied conditions. These advantages include patient motivation, adaptability and variability based on patient baseline, transparent data storage, online remote data access, economy of scale, reduced medical costs. Challenges in VR use for rehabilitation relate to lack of computer skills on the part of therapists, lack of support infrastructure, expensive equipment (initially), inadequate communication infrastructure (for telerehabilitation in rural areas), and patient safety concerns.

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Daher, Salam, Jason Hochreiter, Ryan Schubert, Laura Gonzalez, Juan Cendan, Mindi Anderson, Desiree A. Diaz, and Gregory F. Welch. "The Physical-Virtual Patient Simulator." Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 15, no. 2 (April 2020): 115–21. http://dx.doi.org/10.1097/sih.0000000000000409.

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Champagne-Langabeer, Tiffany, Samuel E. Neher, Marylou Cardenas-Turanzas, and Jennifer L. Swails. "Unintended Consequences of a Transition to Synchronous, Virtual Simulations for Interprofessional Learners." Healthcare 10, no. 11 (October 31, 2022): 2184. http://dx.doi.org/10.3390/healthcare10112184.

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The coronavirus pandemic shifted in-person environments to virtual environments. Little is known about the effectiveness of fully synchronous, virtual interprofessional education (IPE). This study aims to compare two IPE cases that occurred in-person pre-pandemic and virtual during-pandemic. Two cases are analyzed: a medical error care and a charity care case. Participants were students from various health science disciplines. Assessments were captured through The Interprofessional Collaborative Competency Attainment Survey (ICCAS). Effect sizes were calculated for the pre-and post-surveys and analyzed using Cohen’s d for independent samples. From the in-person collection period, a total of 479 students participated in the medical error simulation and 479 in the charity care simulation. During the virtual collection period, a total of 506 students participated in the medical error simulation and 507 participated in the charity care simulation. In the data for the virtual simulations, the medical error case study maintained a large effect size (0.81) while the charity care simulation had a lesser impact (0.64 effect size). Structural details of the patient cases may be a critical variable. Future research is needed to better understand how health science students can obtain more training to notice the subtle cues from patients assessed through telemedicine modalities.

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Fernández-Reyes, Bernardo A., Ana K. Flores-González, Luis Adrian Alvarez-Lozada, Juventino T. Guerrero-Zertuche, Francisco J. Arrambide-Garza, Xavier G. Quiroz-Perales, Alejandro Quiroga-Garza, Rodrigo E. Elizondo-Omaña, and Santos Guzmán-López. "The importance of simulation training in surgical sciences." International Surgery Journal 9, no. 6 (May 26, 2022): 1289. http://dx.doi.org/10.18203/2349-2902.isj20221430.

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Simulators have been used throughout history to practice complicated procedures before performing them on human beings. The earliest simulation attempts were in cadavers. Donor bodies are still used for teaching and research but involve costly infrastructure, ethical and legal issues, as well as animal models. Training models need to be purposefully designed. These can be physical models, 3-D printed, simulators with virtual reality, augmented reality, or a hybrid simulation. The inert model is an alternative for animal tissue models, based on a trial-and-error method, the learning curve is approximately 65 procedures for a laparoscopist. Simulations models with virtual and augmented reality have shown that can reduce the time of practitioners with experience in laparoscopy, with an approximate reduction of 30 to 58%. Video-based learning method has been adopted in recent years but has shown to be less effective than hand-on learning using a simulator. Simulation can be involved to simulate specific scenarios, recreate simulated trauma patients, help develop a doctor-patient relationship and prepare complex approaches. Patient safety concerns call for the need to train medical personnel in simulated settings to reduce cost and patient morbidity because the ability to acquire surgical skills requires consistent practice. Simulation represents ideal teaching methods to optimize the knowledge and skill of residents before they are entrusted with procedures with real patients.

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Umoren, Rachel A., Julie A. Poore, Linda Sweigart, Natalia Rybas, Evalyn Gossett, Miles Johnson, Martina Allen, Patricia J. Scott, Barbara Truman, and Rohit Das. "TeamSTEPPS Virtual Teams: Interactive Virtual Team Training and Practice for Health Professional Learners." Creative Nursing 23, no. 3 (2017): 184–91. http://dx.doi.org/10.1891/1078-4535.23.3.184.

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Medical errors because of communication failure are common in health care settings. Teamwork training, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), improves team performance and patient outcomes. Academic institutions seek high-quality, low-cost curricula for interprofessional education (IPE) to prepare learners for clinical experiences before and after graduation; however, most IPE curricula involve lectures, simple tabletop exercises, and in-person simulations and are not readily accessible to geographically distributed and asynchronously engaged learners. To address this need, interprofessional faculty from multiple institutions and specialties created a series of eight screen-based interactive virtual simulation cases featuring typical clinical situations, with the goal of preparing learners to provide safe and effective care in clinical teams. Virtual simulations permit flexible, asynchronous learning on the learner’s schedule and allow educators an opportunity to identify gaps in knowledge and/or attitudes that can be addressed during class or forum discussions. In 2016, 1,128 unique users accessed the scenarios. As a result of such virtual activities, learner selection of the appropriate TeamSTEPPS tool increased with progression through the scenarios.

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Mannali, Vimal, Paul Strickland, Craig laBuscagne, and Joy Clift. "Digitalised remote-delivery of AVATr Simulation in Psychiatry: a unique success in COVID-19 pandemic." BJPsych Open 7, S1 (June 2021): S146. http://dx.doi.org/10.1192/bjo.2021.411.

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AimsSurrey and Borders NHS Foundation Trust's AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient Simulation System, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents. Actors are filmed responding to several domains of clinical questions, further categorised into three narrative-modes of being ‘Engaged, Neutral or Disengaged’, to build a bank of scenarios. During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ‘out-of-body' perspective, immersed in a custom-designed interactive virtual environment. The simulation facilitator engages with the learner and determines the appropriate choices of responses for the Virtual Patient and if needed, can prompt with explorative cues to continue the narrative-linked conversation. AVATr model pioneered in United Kingdom the use of an innovative ‘self-observational approach’ in Psychiatry training. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. The use of Facilitated-Debrief and Peer-Debrief in sessions, render another layer to the simulation experience.MethodDuring the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams.ResultThe hybrid model of AVATr has received tremendous feedback, as it now simulates video-consultations that a vast majority of Psychiatry trainees, especially community-based, undertake due to COVID-19 restrictions. The format of AVATr simulation sessions has remained unchanged, and the remote delivery has been particularly successful as it allows trainees to log in from different remote locations to come together for an interactive training session, without any physical restrictions.ConclusionSince 2015, our simulation platform has been utilised for Post-Graduate Medical Education, to enhance essential professional skills and stimulate professional growth. Currently the hybrid model of AVATr is being expanded to Nursing, Psychology and Allied Health Professional (AHP) clinical training streams, along with Undergraduate Medical Education, to address identified gaps in face-to-face training amidst COVID-19 pandemic.

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Cai, Y. Y., C. K. Chui, X. Ye, J. H. Anderson, K. M. Liew, and I. Sakuma. "Simulation-based Virtual Prototyping of Customized Catheterization Devices." Journal of Computing and Information Science in Engineering 4, no. 2 (May 28, 2004): 132–39. http://dx.doi.org/10.1115/1.1705667.

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Human vascular systems have considerable anatomic variations. In diseased situation, significant pathological changes will be developed with the systems. However, vascular catheterization devices commercially available are essentially designed on normal or average anatomy. Their inadequacies in representing major deviations in human vascular anatomy may present problems during diagnostic or therapeutic interventions. A virtual reality (VR) based simulation method is described in this paper for prototyping of customized patient-specific catheterization devices. Techniques are developed to model patient-specific vascular network, to design catheterization devices, and to simulate physical-based interactions between blood vessels and the devices. Emphasis is made on the integration of normal and variant vascular models, the integration of modeling, visualization and interaction, and the integration of real-time simulation and virtual prototyping.

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Macnamara, Alexandra Frances, Katie Bird, Alan Rigby, Thozhukat Sathyapalan, and David Hepburn. "High-fidelity simulation and virtual reality: an evaluation of medical students’ experiences." BMJ Simulation and Technology Enhanced Learning 7, no. 6 (June 16, 2021): 528–35. http://dx.doi.org/10.1136/bmjstel-2020-000625.

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BackgroundSimulation technology is widely used in medical education, providing an environment in which students can develop and practise a multitude of skills that are relevant to clinical practice, without the risk of harm to patients.MethodsWe conducted a mixed methods cross-over study with quantitative and qualitative outcomes. This analysed students’ perceptions of two simulation technologies: a high-fidelity patient simulator and virtual reality. Twenty final year medical students completed a questionnaire after having experienced both simulation modalities.ResultsStudents scored the patient simulator higher in domains such as developing team working and ‘ABCDE assessment skills’, whereas the virtual reality simulation was more immersive and fun. Participants found the patient simulator more useful in preparing them for clinical practice.ConclusionMedical students in this study expressed that a high-fidelity patient simulator, in a simulated clinical environment, was of greater value to their preparation for clinical practice than virtual reality simulation of a similar environment. However, the virtual reality simulation offered a near comparable experience, and was found to be was enjoyable, immersive and easily portable.

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O’Brien, Kimberly H. McManama, Shai Fuxman, Laura Humm, Nicole Tirone, Warren Jay Pires, Andrea Cole, and Julie Goldstein Grumet. "Suicide risk assessment training using an online virtual patient simulation." mHealth 5 (August 2019): 31. http://dx.doi.org/10.21037/mhealth.2019.08.03.

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GUISE, V., M. CHAMBERS, and M. VÄLIMÄKI. "What can virtual patient simulation offer mental health nursing education?" Journal of Psychiatric and Mental Health Nursing 19, no. 5 (November 1, 2011): 410–18. http://dx.doi.org/10.1111/j.1365-2850.2011.01797.x.

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Boschetti, F., F. M. Montevecchi, and R. Fumero. "Virtual Extracorporeal Circulation Process." International Journal of Artificial Organs 20, no. 6 (June 1997): 341–51. http://dx.doi.org/10.1177/039139889702000608.

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Virtual instruments for an extracorporeal circulation (ECC) process were developed to simulate the reactions of a patient to different artificial perfusion conditions. The computer simulation of the patient takes into account the hydraulic, volume, thermal and biochemical phenomena and their interaction with the devices involved in ECC (cannulae dimensions, oxygenator and filter types, pulsatile or continuous pump and thermal exchangers). On the basis of the patient's initialisation data (height, weight, Ht) and perfusion variables (pump flow rate, water temperature, gas flow rate and composition) imposed by the operator, the virtual ECC monitors simulated arterial and venous pressure tracings in real time, along with arterial and venous flow rate tracings, urine production tracing and temperature levels. Oxyhemoglobin arterial and venous blood saturation together with other related variables (pO2, pCO2, pH, HCO3) are also monitored. A drug model which allows the simulation of the effect of vasodilator and diuretic drugs is also implemented. Alarms are provided in order to check which variables (pressure, saturation, pH, urine flow) are out of the expected ranges during the ECC simulation. Consequently the possibility of modifying the control parameters of the virtual devices of the ECC in run-time mode offers an interaction mode between the operator and the virtual environment.

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McJury, M., B. Foran, J. Conway, S. Dixon, K. Wilcock, G. Brown, and M. H. Robinson. "Optimising the use of virtual and conventional simulation: a clinical and economic analysis." Journal of Radiotherapy in Practice 6, no. 2 (June 2007): 83–91. http://dx.doi.org/10.1017/s1460396907006061.

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AbstractBackground and purpose: Currently, optimal use of virtual simulation for all treatment sites is not entirely clear. This study presents data to identify specific patient groups for whom conventional simulation may be completely eliminated and replaced by virtual simulation.Sampling and method: Two hundred and sixty patients were recruited from four treatment sites (head and neck, breast, pelvis, and thorax). Patients were randomly assigned to be treated using the usual treatment process involving conventional simulation, or a treatment process differing only in the replacement of conventional plan verification with virtual verification. Data were collected on set-up accuracy at verification, and the number of unsatisfactory verifications requiring a return to the conventional simulator. A micro-economic costing analysis was also undertaken, whereby data for each treatment process episode were also collected: number and grade of staff present, and the time for each treatment episode.Results: The study shows no statistically significant difference in the number of returns to the conventional simulator for each site and study arm. Image registration data show similar quality of verification for each study arm. The micro-costing data show no statistical difference between the virtual and conventional simulation processes.Conclusions: At our institution, virtual simulation including virtual verification for the sites investigated presents no disadvantage compared to conventional simulation.

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Patel, Devika, Jessica Hawkins, Lara Zena Chehab, Patrick Martin-Tuite, Joshua Feler, Amy Tan, Benjamin S. Alpers, et al. "Developing Virtual Reality Trauma Training Experiences Using 360-Degree Video: Tutorial." Journal of Medical Internet Research 22, no. 12 (December 16, 2020): e22420. http://dx.doi.org/10.2196/22420.

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Historically, medical trainees were educated in the hospital on real patients. Over the last decade, there has been a shift to practicing skills through simulations with mannequins or patient actors. Virtual reality (VR), and in particular, the use of 360-degree video and audio (cineVR), is the next-generation advancement in medical simulation that has novel applications to augment clinical skill practice, empathy building, and team training. In this paper, we describe methods to design and develop a cineVR medical education curriculum for trauma care training using real patient care scenarios at an urban, safety-net hospital and Level 1 trauma center. The purpose of this publication is to detail the process of finding a cineVR production partner; choosing the camera perspectives; maintaining patient, provider, and staff privacy; ensuring data security; executing the cineVR production process; and building the curriculum.

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Khalifa, G. E. A. "(A104) Simulation in Disaster and Emergency Medicine." Prehospital and Disaster Medicine 26, S1 (May 2011): s28—s29. http://dx.doi.org/10.1017/s1049023x11001063.

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SimulationAn activity or situation that produces conditions which are not real, but have the appearance of being real, used especially for testing something. Longman Dictionary of Contemporary English. Simulation has evolved over the centuries but has not been applied to medicine until the 20th century with the introduction of virtual reality and computers. Prior to the 20th century simulation took the forms of physical models and cadavers. With the introduction of flight simulation there was an effort to move similar approaches into medicine. This was pushed by the demands of minimally invasive surgery and the introduction of robotics in surgery. In the 21st century in addition to cognitive task analysis tools we are beginning to see the migration of advanced intelligence tools to simulation. We are just at the beginning of how we will use adversarial reasoning in the medical environment and in high risk time constrained situations like Emergency Medicine. The practitioner of emergency medicine is at high risk for errors because of multiple factors including high decision density, high levels of diagnostic uncertainty, high patient acuity, and frequent distractions. Some authors have suggested that instructing physicians in “cognitive forcing strategies” or “metacognition” will help reduce the amount of cognitive error in medical practice. It has been said ‘‘[There is an] ethical obligation to make all efforts to expose health professionals to clinical challenges that can be reasonably well simulated prior to allowing them to encounter and be responsible for similar real-life challenges.’' TYPES OF SIMULATION • Verbal • Tactile • Visual • Situational • Environmental TYPES OF SIMULATION TRAINING • Standardized patients (role play) • Basic models (partial task trainers) • Simple level • Higher level • Mannequins • Low fidelity • High fidelity • Virtual patients • Screen-based; computer-based • COMBINATIONS • Augmented sp encounters with technology • Crises management HUMAN PATIENT SIMULATION • Realistic • Suitable for all levels • Safe • Wide variety of training programs • Expensive ADVANTAGES OF SIMULATION • Patients are never at risk • Serious but infrequent events, in predictable times and places • Errors can be allowed to occur, and play-out • Rehearsal, repetition, mastery • Crisis management simulation, planning • Reduces institutional liability • Increases operational confidence • Produces rapid results • Allows team training • Increases institutional prestige The use of high fidelity simulations to train multidisciplinary teams in critical environments is well established.

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McIntosh, Keith S., James C. Gregor, and Nitin V. Khanna. "Computer-Based Virtual Reality Colonoscopy Simulation Improves Patient-Based Colonoscopy Performance." Canadian Journal of Gastroenterology and Hepatology 28, no. 4 (2014): 203–6. http://dx.doi.org/10.1155/2014/804367.

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BACKGROUND: Colonoscopy simulators that enable one to perform computer-based virtual colonoscopy now exist. However, data regarding the effectiveness of this virtual training are limited.OBJECTIVE: To determine whether virtual reality simulator training translates into improved patient-based colonoscopy performance.METHODS: The present study was a prospective controlled trial involving 18 residents between postgraduate years 2 and 4 with no previous colonoscopy experience. These residents were assigned to receive 16 h of virtual reality simulator training or no training. Both groups were evaluated on their first five patient-based colonoscopies. The primary outcome was the number of proctor ‘assists’ required per colonoscopy. Secondary outcomes included insertion time, depth of insertion, cecal intubation rate, proctor- and nurse-rated competence, and patient-rated pain.RESULTS: The simulator group required significantly fewer proctor assists than the control group (1.94 versus 3.43; P≤0.001), inserted the colonoscope further unassisted (43 cm versus 24 cm; P=0.003) and there was a trend to intubate the cecum more often (26% versus 10%; P=0.06). The simulator group received higher ratings of competence from both the proctors (2.28 versus 1.88 of 5; P=0.02) and the endoscopy nurses (2.56 versus 2.05 of 5; P=0.001). There were no significant differences in proctor-, nurse- or patient-rated pain, or attention to discomfort.CONCLUSIONS: Computer-based colonoscopy simulation in the initial stages of training improved novice trainees’ patient-based colonoscopy performance.

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Gonzalez, Laura, Salam Daher, and Greg Welch. "Neurological Assessment Using a Physical-Virtual Patient (PVP)." Simulation & Gaming 51, no. 6 (August 12, 2020): 802–18. http://dx.doi.org/10.1177/1046878120947462.

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Background. Simulation has revolutionized teaching and learning. However, traditional manikins are limited in their ability to exhibit emotions, movements, and interactive eye gaze. As a result, students struggle with immersion and may be unable to authentically relate to the patient. Intervention. We developed a new type of patient simulator called the Physical-Virtual Patients (PVP) which combines the physicality of manikins with the richness of dynamic visuals. The PVP uses spatial Augmented Reality to rear project dynamic imagery (e.g., facial expressions, ptosis, pupil reactions) on a semi-transparent physical shell. The shell occupies space and matches the dimensions of a human head. Methods. We compared two groups of third semester nursing students (N=59) from a baccalaureate program using a between-participant design, one group interacting with a traditional high-fidelity manikin versus a more realistic PVP head. The learners had to perform a neurological assessment. We measured authenticity, urgency, and learning. Results. Learners had a more realistic encounter with the PVP patient (p=0.046), they were more engaged with the PVP condition compared to the manikin in terms of authenticity of encounter and cognitive strategies. The PVP provoked a higher sense of urgency (p=0.002). There was increased learning for the PVP group compared to the manikin group on the pre and post-simulation scores (p=0.027). Conclusion. The realism of the visuals in the PVP increases authenticity and engagement which results in a greater sense of urgency and overall learning.

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Houze-Cerfon, Charles-Henri, Christine Vaissié, Laurent Gout, Bruno Bastiani, Sandrine Charpentier, and Dominique Lauque. "Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study." JMIR Serious Games 7, no. 3 (August 8, 2019): e13993. http://dx.doi.org/10.2196/13993.

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Background Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. Objective This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviors on quality of care in the context of ED overcrowding. Methods A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% (12/13) of the participants. Results The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. Conclusions The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding.

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Hovland, Cynthia. "Adaptation of Geriatric Interprofessional Education from In-Person to Virtual Simulation." Innovation in Aging 5, Supplement_1 (December 1, 2021): 1–2. http://dx.doi.org/10.1093/geroni/igab046.003.

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Abstract We modified an in-person simulation-enhanced interprofessional education model as necessitated by COVID-19 restrictions to a fully virtual education experience. Online prework remained unchanged but adjustments were made related to previously in-person activities. Diverging from the in-person training we held live virtual poster sessions with learner-presenter interaction. In preparation for their role in the team meeting simulation, learners were moved into preassigned profession-specific breakout rooms for a live virtual huddle with facilitators. Next, learners were moved to preassigned interprofessional breakout rooms where they began the simulated team meeting. After initial discussion, a standardized patient joined the breakout room to present the patient/caregiver perspective. The event ends with a virtual reflective debrief focused on interprofessional collaborative competencies.

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Kim, Min-A., Jiyeong Lee, and So-Eun Choi. "Effect of Virtual Simulation Practice for Nursing Students: Focusing on Virtual Presence and Virtual Patient Learning System Evaluation (VPLSE)." Journal of Korea Society for Simulation in Nursing 10, no. 1 (June 30, 2022): 89–102. http://dx.doi.org/10.17333/jkssn.2022.10.1.89.

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Nasralla, Moustafa M. "Sustainable Virtual Reality Patient Rehabilitation Systems with IoT Sensors Using Virtual Smart Cities." Sustainability 13, no. 9 (April 23, 2021): 4716. http://dx.doi.org/10.3390/su13094716.

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To develop sustainable rehabilitation systems, these should consider common problems on IoT devices such as low battery, connection issues and hardware damages. These should be able to rapidly detect any kind of problem incorporating the capacity of warning users about failures without interrupting rehabilitation services. A novel methodology is presented to guide the design and development of sustainable rehabilitation systems focusing on communication and networking among IoT devices in rehabilitation systems with virtual smart cities by using time series analysis for identifying malfunctioning IoT devices. This work is illustrated in a realistic rehabilitation simulation scenario in a virtual smart city using machine learning on time series for identifying and anticipating failures for supporting sustainability.

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Heng, Pheng-Ann, Ping-Fu Fung, Kwong-Sak Leung, Han-Qiu Sun, and Tien-Tsin Wong. "Virtual Bronchoscopy." International Journal of Virtual Reality 4, no. 4 (January 1, 2000): 21–43. http://dx.doi.org/10.20870/ijvr.2000.4.4.2654.

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Patients potentially suffer and are exposed to danger during invasive bronchoscopic diagnosis and surgery. In order to reduce this hazardous risk, we have developed an interactive virtual environment for the simulation of bronchoscopy (in short, called "virtual bronchoscopy"). Because of this state-of-the-art application, medical doctors can now obtain pre-operative information and perform pilot examinations in a virtual environment without any invasive or needless surgery. This 3D lung volume data of the patient is first acquired from CT and/or MRI scanning, without any pain being inflicted upon the patient. Then a vessel-tracking process is used to extract the patient's bronchial tree from the data. It is important to note that while manual tracking is tedious and labor-intensive, fully automatic tracking may not be as reliable in such a critical medical application. Thus a semi-automatic tracking technique called the Intelligent Path Tracker, which provides automation and sufficient user control during the tracking process, is most useful. This methodology is applied to a virtual bronchoscopy session, where doctors can use a 3D pen input device to navigate and visualize the bronchial tree of patients in a natural and interactive manner. To support an interactive frame rate, we also propose a new volume rendering acceleration technique, named IsoRegion Leaping. Through this technique visualization is further accelerated using a distributed rendering process based upon a TCP/IP network of low-cost PCs. Combining these approaches enables a 256x256x256 volumetric data representation of a human lung to be navigated and visualized at a frame rate of over 10 Hz in our virtual bronchoscopy system.

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Barber, Samuel R., Kevin Wong, Vivek Kanumuri, Ruwan Kiringoda, Judith Kempfle, Aaron K. Remenschneider, Elliott D. Kozin, and Daniel J. Lee. "Augmented Reality, Surgical Navigation, and 3D Printing for Transcanal Endoscopic Approach to the Petrous Apex." OTO Open 2, no. 4 (October 2018): 2473974X1880449. http://dx.doi.org/10.1177/2473974x18804492.

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Otolaryngologists increasingly use patient-specific 3-dimensional (3D)–printed anatomic physical models for preoperative planning. However, few reports describe concomitant use with virtual models. Herein, we aim to (1) use a 3D-printed patient-specific physical model with lateral skull base navigation for preoperative planning, (2) review anatomy virtually via augmented reality (AR), and (3) compare physical and virtual models to intraoperative findings in a challenging case of a symptomatic petrous apex cyst. Computed tomography (CT) imaging was manually segmented to generate 3D models. AR facilitated virtual surgical planning. Navigation was then coupled to 3D-printed anatomy to simulate surgery using an endoscopic approach. Intraoperative findings were comparable to simulation. Virtual and physical models adequately addressed details of endoscopic surgery, including avoidance of critical structures. Complex lateral skull base cases may be optimized by surgical planning via 3D-printed simulation with navigation. Future studies will address whether simulation can improve patient outcomes.

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Bellizzi, Gennaro G., Kemal Sumser, Iva VilasBoas-Ribeiro, Sergio Curto, Tomas Drizdal, Gerard C. van Rhoon, Martine Franckena, and Margarethus M. Paulides. "Standardization of patient modeling in hyperthermia simulation studies: introducing the Erasmus Virtual Patient Repository." International Journal of Hyperthermia 37, no. 1 (January 1, 2020): 608–16. http://dx.doi.org/10.1080/02656736.2020.1772996.

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Larkin, Amy, and Donald Blatherwick. "SUCCESS OF VIRTUAL PATIENT SIMULATION AT IMPROVING MANAGEMENT OF CHRONIC HYPERKALEMIA." Journal of the American College of Cardiology 77, no. 18 (May 2021): 3338. http://dx.doi.org/10.1016/s0735-1097(21)04692-1.

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Richardson, Charlotte Lucy, Stephen Chapman, and Simon White. "Establishing the acceptability and usability of an animated virtual patient simulation." Exploratory Research in Clinical and Social Pharmacy 4 (December 2021): 100069. http://dx.doi.org/10.1016/j.rcsop.2021.100069.

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Altmiller, Gerry, Francisco Jimenez, Jack Wharton, Cheryl Wilson, and Natalie Wright. "HIV and Contact Tracing: Impact of a Virtual Patient Simulation Activity." Clinical Simulation in Nursing 64 (March 2022): 58–66. http://dx.doi.org/10.1016/j.ecns.2021.12.005.

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Yudaeva, Yu A., V. V. Nevolina, and Z. F. Zakirzyanova. "VIRTUAL PATIENT AS A FORM OF SIMULATION TRAINING IN MEDICAL EDUCATION." Современные проблемы науки и образования (Modern Problems of Science and Education), no. 2 2022 (2022): 38. http://dx.doi.org/10.17513/spno.31596.

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Persad, Amit, Eleni Stroulia, and Sarah Forgie. "A novel approach to virtual patient simulation using natural language processing." Medical Education 50, no. 11 (October 19, 2016): 1162–63. http://dx.doi.org/10.1111/medu.13197.

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Putra Manuaba, Ida Bagus Amertha, Ni Gusti Ayu Putu Lestari Santika Dewi, I. Putu Yuda Prabawa, Agha Bhargah, and Chien-Chih Wu. "Virtual patient simulation method for learning and assessment in cardiology field." Bali Medical Journal 9, no. 3 (October 17, 2020): 553. http://dx.doi.org/10.15562/bmj.v9i3.2010.

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Carrard, Valerie, Céline Bourquin, Sandy Orsini, Marianne Schmid Mast, and Alexandre Berney. "Virtual patient simulation in breaking bad news training for medical students." Patient Education and Counseling 103, no. 7 (July 2020): 1435–38. http://dx.doi.org/10.1016/j.pec.2020.01.019.

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Larkin, Amy, David Anderson, Martin Warters, Gwen Littman, Javed Butler, and Mikhail Kosiborod. "EFFECT OF VIRTUAL PATIENT SIMULATION AT IMPROVING MANAGEMENT OF CHRONIC HYPERKALEMIA." Journal of the American College of Cardiology 75, no. 11 (March 2020): 3533. http://dx.doi.org/10.1016/s0735-1097(20)34160-7.

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Schüller, Patrick, Frank Bruns, Stefan Hesselmann, Kirsten Horn, Joan E. Panke, Andreas Schuck, Ulrich Schäfer, Oliver Micke, and Normann Willich. "Simulator Verification of the Accuracy of Patient Repositioning after Virtual Simulation." Strahlentherapie und Onkologie 178, no. 12 (December 1, 2002): 715–21. http://dx.doi.org/10.1007/s00066-002-1037-1.

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Galappaththige, Suran, Richard A. Gray, Caroline Mendonca Costa, Steven Niederer, and Pras Pathmanathan. "Credibility assessment of patient-specific computational modeling using patient-specific cardiac modeling as an exemplar." PLOS Computational Biology 18, no. 10 (October 10, 2022): e1010541. http://dx.doi.org/10.1371/journal.pcbi.1010541.

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Reliable and robust simulation of individual patients using patient-specific models (PSMs) is one of the next frontiers for modeling and simulation (M&S) in healthcare. PSMs, which form the basis of digital twins, can be employed as clinical tools to, for example, assess disease state, predict response to therapy, or optimize therapy. They may also be used to construct virtual cohorts of patients, for in silico evaluation of medical product safety and/or performance. Methods and frameworks have recently been proposed for evaluating the credibility of M&S in healthcare applications. However, such efforts have generally been motivated by models of medical devices or generic patient models; how best to evaluate the credibility of PSMs has largely been unexplored. The aim of this paper is to understand and demonstrate the credibility assessment process for PSMs using patient-specific cardiac electrophysiological (EP) modeling as an exemplar. We first review approaches used to generate cardiac PSMs and consider how verification, validation, and uncertainty quantification (VVUQ) apply to cardiac PSMs. Next, we execute two simulation studies using a publicly available virtual cohort of 24 patient-specific ventricular models, the first a multi-patient verification study, the second investigating the impact of uncertainty in personalized and non-personalized inputs in a virtual cohort. We then use the findings from our analyses to identify how important characteristics of PSMs can be considered when assessing credibility with the approach of the ASME V&V40 Standard, accounting for PSM concepts such as inter- and intra-user variability, multi-patient and “every-patient” error estimation, uncertainty quantification in personalized vs non-personalized inputs, clinical validation, and others. The results of this paper will be useful to developers of cardiac and other medical image based PSMs, when assessing PSM credibility.

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Journal articles on the topic 'Virtual patient simulation'

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