Design and Implementation of “AugMedicine: Lung Cases,” an Augmented Reality Application for the Medical Curriculum on the Presentation of Dyspnea

Introduction: Augmented Reality is a technique that enriches the real-life environment with 3D visuals and audio. It offers possibilities to expose medical students to a variety of clinical cases. It provides unique opportunities for active and collaborative learning in an authentic but safe environment. We developed an Augmented Reality application on the clinical presentation of shortness of breath (dyspnea), grounded on a theoretical instructional design model. Methods: A team of various stakeholders (including medical teachers and students) was formed to design the application and corresponding small group learning session, grounded on principles of instruction as described by Merrill. Evaluation was performed by an explorative questionnaire, consisting of open and closed questions (Likert scales), covering user experience, content and physical discomfort. Results: Multiple interactive cases of dyspnea were designed. The application plays back audio samples of abnormal lung sounds corresponding to a specific clinical case of dyspnea and displays a 3D model of the related pulmonary pathologies. It was implemented in the medical curriculum as an obligatory small group learning session scheduled preceding clinical clerkships. Prior knowledge was activated prior to the learning session. New knowledge was acquired with the application by solving an authentic problem based on a real patient case. In total 110 students participated in the study and 104 completed the questionnaire. 85% of the students indicated that the virtually auscultated lung sounds felt natural. 90% reported that the augmented reality experience helped them to better understand the clinical case. The majority of the students (74%) indicated that the experience improved their insight in the portrayed illness. 94.2% reported limited or no physical discomfort. Discussion: An Augmented Reality application on the presentation of dyspnea was successfully designed and implemented in the medical curriculum. Students confirm the value of the application in terms of content and usability. The extension of this Augmented Reality application for education of other healthcare professionals in currently under consideration.

[1]  Derrick L. Cheng,et al.  Augmented reality in medical education: a systematic review , 2019, Canadian medical education journal.

[2]  Sharaf Sheik-Ali,et al.  Next-generation Virtual and Augmented Reality in Surgical Education: A Narrative Review. , 2019, Surgical technology international.

[3]  Noor Christoph,et al.  Augmented reality in medical education? , 2014, Perspectives on Medical Education.

[4]  Andreas Holzinger,et al.  Some Aspects of the Development of Low-Cost Augmented Reality Learning Environments as Examples for Future Interfaces in Technology Enhanced Learning , 2007, HCI.

[5]  Hein Putter,et al.  Stereoscopic three‐dimensional visualisation technology in anatomy learning: A meta‐analysis , 2020, Medical education.

[6]  Nassir Navab,et al.  Enhancement of Anatomical Education Using Augmented Reality: An Empirical Study of Body Painting , 2019, Anatomical sciences education.

[7]  Beerend P. Hierck,et al.  The Effect of Stereoscopic Augmented Reality Visualization on Learning Anatomy and the Modifying Effect of Visual‐Spatial Abilities: A Double‐Center Randomized Controlled Trial , 2019, Anatomical sciences education.

[8]  Hendrik Friederichs,et al.  Combining simulated patients and simulators: pilot study of hybrid simulation in teaching cardiac auscultation. , 2014, Advances in physiology education.

[9]  Fridolin Wild,et al.  Simulator Sickness in Augmented Reality Training Using the Microsoft HoloLens , 2018, CHI.

[10]  Isabel Harb Manssour,et al.  Augmented reality environment for life support training , 2009, SAC '09.

[11]  Christoph M Friedrich,et al.  Augmented Reality in Medicine: Systematic and Bibliographic Review , 2019, JMIR mHealth and uHealth.

[12]  T. Loetscher,et al.  Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis , 2020, Frontiers in Human Neuroscience.

[13]  Egui Zhu,et al.  Augmented reality in healthcare education: an integrative review , 2014, PeerJ.

[14]  Alireza Mazloumi Gavgani,et al.  Profiling subjective symptoms and autonomic changes associated with cybersickness , 2017, Autonomic Neuroscience.

[15]  I. Lundberg,et al.  Experiencing virtual patients in clinical learning: a phenomenological study , 2011, Advances in health sciences education : theory and practice.

[16]  K. Shadan,et al.  Available online: , 2012 .

[17]  C. Moro,et al.  The effectiveness of virtual and augmented reality in health sciences and medical anatomy , 2017, Anatomical sciences education.

[18]  Elisa Raffaella Ferrè,et al.  Cybersickness: a Multisensory Integration Perspective. , 2018, Multisensory research.

[19]  M. David Merrill,et al.  First principles of instruction , 2012 .

[20]  R. Hatala,et al.  Simulation-Based Training for Cardiac Auscultation Skills: Systematic Review and Meta-Analysis , 2013, Journal of General Internal Medicine.

[21]  Fabiola Giudici,et al.  A prospective study on the efficacy of patient simulation in heart and lung auscultation , 2019, BMC Medical Education.

[22]  U. von Jan,et al.  mARble – Augmented Reality in Medical Education , 2012 .

[23]  Michelle K. Smith,et al.  Active learning increases student performance in science, engineering, and mathematics , 2014, Proceedings of the National Academy of Sciences.

[24]  P. Rea,et al.  Augmented and Virtual Reality in Anatomical Education - A Systematic Review. , 2020, Advances in experimental medicine and biology.

[25]  Alexandre Cardoso,et al.  On the use of Augmented Reality techniques in learning and interpretation of cardiologic data , 2010, 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology.

[26]  Dieter Schmalstieg,et al.  Mathematics and geometry education with collaborative augmented reality , 2003, Comput. Graph..

[27]  Peter Dieckmann,et al.  Augmented reality and mixed reality for healthcare education beyond surgery: an integrative review , 2020, International journal of medical education.

[28]  Björn J. E. Johansson,et al.  Acceptance of augmented reality instructions in a real work setting , 2008, CHI Extended Abstracts.

[29]  Andraž Cej,et al.  Agile software development with Scrum , 2010 .

[30]  D. Scott Lind,et al.  Real-Time Evaluation and Visualization of Learner Performance in a Mixed-Reality Environment for Clinical Breast Examination , 2012, IEEE Transactions on Visualization and Computer Graphics.

[31]  Halimah Badioze Zaman,et al.  Evaluation of User Acceptance of Mixed Reality Technology. , 2011 .

[32]  Keiko Abe,et al.  The use of simulated patients in medical education: AMEE Guide No 42 , 2009, Medical teacher.

[33]  A. Huberman,et al.  Qualitative Data Analysis: A Methods Sourcebook , 1994 .

[34]  Paul Anderson,et al.  Design and Implementation of Augmented Reality Environment for Complex Anatomy Training: Inguinal Canal Case Study , 2009, HCI.

[35]  P. Sestini,et al.  Multimedia presentation of lung sounds as a learning aid for medical students , 2002 .

[36]  Séamas Weech,et al.  Presence and Cybersickness in Virtual Reality Are Negatively Related: A Review , 2019, Front. Psychol..

[37]  Eric Rosenbaum,et al.  On Location Learning: Authentic Applied Science with Networked Augmented Realities , 2007 .

[38]  Jeffrey J Ward,et al.  Technology for Enhancing Chest Auscultation in Clinical Simulation , 2011, Respiratory Care.

[39]  Ben Blachnitzky,et al.  Augmented reality , 2012, 2012 IEEE Hot Chips 24 Symposium (HCS).