Teaching mass casualty triage skills using immersive three-dimensional virtual reality.

OBJECTIVES Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy. METHODS Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training. RESULTS Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p < 0.001). Time to complete each scenario decreased significantly from A (8:10 minutes) to B (5:14 minutes; p < 0.001) and from B to C (3:58 minutes; p < 0.001). Self-efficacy improved significantly in the areas of prioritizing treatment, prioritizing resources, identifying high-risk patients, and beliefs about learning to be an effective first responder. CONCLUSIONS Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, fully immersed VR triage experience.

[1]  A. Bandura.  Perceived Self-Efficacy in Cognitive Development and Functioning , 1993, Educational Psychologist.

[2]  Andrei Sherstyuk,et al.  Design and Development of a Pose-Based Command Language for Triage Training in Virtual Reality , 2007, 2007 IEEE Symposium on 3D User Interfaces.

[3]  L. Lottenberg,et al.  Use of a Human Patient Simulator for the Advanced Trauma Life Support Course , 2002, The American surgeon.

[4]  Paul N. Kizakevich,et al.  Virtual Simulation-Enhanced Triage Training for Iraqi Medical Personnel , 2007, MMVR.

[5]  Timothy E. Goldsmith,et al.  The Effect of Degree of Immersion upon Learning Performance in Virtual Reality Simulations for Medical Education , 2008, MMVR.

[6]  P N Kizakevich,et al.  Virtual medical trainer. Patient assessment and trauma care simulator. , 1998, Studies in health technology and informatics.

[7]  J R Clarke,et al.  Simulated casualties and medics for emergency training. , 1997, Studies in health technology and informatics.

[8]  B. Mavis,et al.  Self-Efficacy and OSCE Performance Among Second Year Medical Students , 2001, Advances in health sciences education : theory and practice.

[9]  Scott Lozanoff,et al.  Virtual patient simulator for distributed collaborative medical education. , 2003, Anatomical record. Part B, New anatomist.

[10]  M Fato,et al.  JUST in time health emergency interventions: an innovative approach to training the citizen for emergency situations using virtual reality techniques and advanced IT tools (the VR Tool). , 2004, Studies in health technology and informatics.

[11]  J. Price,et al.  Validation and Use of an Instrument to Measure the Learning Environment as Perceived by Medical Students , 2000, Teaching and learning in medicine.

[12]  Lydia Tapia,et al.  Design and Implementation of a Virtual Reality System and Its Application to Training Medical First Responders , 2000, Presence: Teleoperators & Virtual Environments.

[13]  M. Devita,et al.  Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator , 2005, Quality and Safety in Health Care.