Developing Objective Metrics for Training Transfer Through the Use

of Virtual Environments

Developing Objective Metrics for Training Transfer Through the Use

of Virtual Environments

Mark D. Wiederhold, M.D., Ph.D, FACPPresident, The Virtual Reality Medical Center

Brenda K. Wiederhold, Ph.D., MBAmwiederhold@vrphobia.comhttp://www.vrphobia.com

The VRMC TeamThe VRMC Team

William H. Rickles, M.D.William H. Rickles, M.D.Malinda Breda, Ph.D.Malinda Breda, Ph.D.Nevin Lantz, Ph.D. Nevin Lantz, Ph.D. Shani Robins, Ph.D.Shani Robins, Ph.D.James L. Spira, Ph.D., MPHJames L. Spira, Ph.D., MPHKathy Vandenburgh, Ph.D.Kathy Vandenburgh, Ph.D.Dennis Patrick Wood, Ph.D.,Dennis Patrick Wood, Ph.D.,ABPP, CAPT MSC USNR (ret)ABPP, CAPT MSC USNR (ret)Kristy Center, M.A. Kristy Center, M.A. Wendy Harder, M.A.Wendy Harder, M.A.Ruth Kogen, M.A.Ruth Kogen, M.A.Lingjun Kong, M.S.Lingjun Kong, M.S.Jennifer Murphy, M.A.Jennifer Murphy, M.A.

Michelle MathieuMichelle MathieuEverly MarianoEverly MarianoRonald MelencioRonald MelencioDonald OttDonald OttLilas RosLilas RosMeiLi TippakornMeiLi TippakornTriet TonTriet TonJocelyn Tong Jocelyn Tong Thuy VuThuy VuMai VuongMai VuongCrystal WintersCrystal WintersStephanie WoltersStephanie WoltersEugene WuEugene Wu

Mark D. Wiederhold, M.D., Ph.D., FACPMark D. Wiederhold, M.D., Ph.D., FACPBrenda K. Wiederhold, Ph.D., MBA, BCIABrenda K. Wiederhold, Ph.D., MBA, BCIA

Michael Yun, M.S.Michael Yun, M.S.Michael AlbaniMichael AlbaniSarah AtilanoSarah AtilanoTina ChenTina ChenJennifer ChuJennifer ChuMaybelle ChuMaybelle ChuSteven CookSteven CookKristin Frame Kristin Frame Micah Helm Micah Helm Gina Hou Gina Hou Brian JaycoxBrian JaycoxThienDi (Kari) LamThienDi (Kari) LamJohn LawJohn Law

Overview of Training ProgramsOverview of Training ProgramsTeenage Driver Training Teenage Driver Training –– study funded by Centers for Disease Controlstudy funded by Centers for Disease Control

P.I. P.I. -- Dr. Brenda WiederholdDr. Brenda WiederholdStudy completed Study completed –– 3 year follow3 year follow--up in progressup in progress

Stress Inoculation Training Stress Inoculation Training –– USAARL, Fort Rucker USAARL, Fort Rucker –– funded by TATRCfunded by TATRCP.I. P.I. –– Major Melba StetzMajor Melba StetzDr. Stetz will discussDr. Stetz will discuss

Stress Inoculation Training Stress Inoculation Training –– Combat Medics Combat Medics –– funded by TATRCfunded by TATRCP.I. P.I. –– Dr. Mark WiederholdDr. Mark WiederholdScenario creation in progressScenario creation in progress

PTSD Prevention PTSD Prevention –– SIT SIT –– VRMC & Balboa Naval HospitalVRMC & Balboa Naval HospitalONRONRP.I. P.I. –– Dr. Brenda WiederholdDr. Brenda Wiederhold

Injury Creation Simulator Injury Creation Simulator –– funded by TATRCfunded by TATRCP.I. P.I. –– Dr. Mark WiederholdDr. Mark WiederholdPhase I: completedPhase I: completed

Overview of Training ProgramsOverview of Training Programs

Student State Student State ––33--year study funded by DARPA, DSOyear study funded by DARPA, DSOEffectiveness of laptop simulator for training military personneEffectiveness of laptop simulator for training military personnellP.I. P.I. –– Dr. Mark WiederholdDr. Mark WiederholdPhase I & II: completedPhase I & II: completed970 participants from US Navy, Marine Corps & Coast Guard 970 participants from US Navy, Marine Corps & Coast Guard

Objectives of DARPA StudyObjectives of DARPA Study

Examine effectiveness of low fidelity, Examine effectiveness of low fidelity, inexpensiveVRinexpensiveVR training simulators for use in training simulators for use in teaching personnel tactical and trauma care skillsteaching personnel tactical and trauma care skillsTeach personnel stress management techniques Teach personnel stress management techniques and have them practice those techniques while and have them practice those techniques while performing stressful tasksperforming stressful tasksImprove performance during realImprove performance during real--life combat life combat situationssituations

(i.e., transfer of training)(i.e., transfer of training)

Transfer-of-Training ModelTransfer-of-Training Model

1) 1) ExperimentalExperimental –– receives simulator receives simulator training prior to performance testingtraining prior to performance testing

2) 2) ControlControl –– receives all training in fieldreceives all training in field

2 Groups

June 2004 military exercise at Strategic Operations

June 2004 military exercise at Strategic Operations

Training exercisesTraining exercisessquads of 20 Marines entered the Iraqi village squads of 20 Marines entered the Iraqi village encountered a variety of civilian and hostile forces encountered a variety of civilian and hostile forces

ScenariosScenariosSome troops were Some troops were ““killedkilled”” while others were woundedwhile others were woundedEchelon I scenarioEchelon I scenario

very basic trauma care was rendered, as the troops are under very basic trauma care was rendered, as the troops are under firefireprovide injuries such as:provide injuries such as:

head wounds, penetrating chest wounds, burns, and head wounds, penetrating chest wounds, burns, and shrapnel from exploding shrapnel from exploding IEDsIEDs. . Basic life support (including airway management) was Basic life support (including airway management) was stressed, as well as control of hemorrhage.stressed, as well as control of hemorrhage.

Hollywood Special EffectsHollywood Special Effects

Training Transfer to 3 types of skills

Training Transfer to 3 types of skills

1. Specific skills1. Specific skills2. General skills2. General skills3. Unrelated tasks3. Unrelated tasks

Injury Creation Simulator (ICS)Injury Creation Simulator (ICS)

– The Next Generation Injury Creation Science

Kernal Blitz 1995Kernal Blitz 1995

The ICS could play a key role in enhancing the training of Sailors and Marines in Kernel Blitz amphibious assault operations.

Dynamic Injuries Dynamic Injuries

Old Methods Old Methods –– moulage techniquesmoulage techniquesDisadvantages to the moulage techniques is that the injuries areDisadvantages to the moulage techniques is that the injuries arestatic and do not change once they are created static and do not change once they are created

New concept in trauma New concept in trauma –– the dynamic injury the dynamic injury For example:For example:

A wound complete with active bleeding that stopped when a tourniA wound complete with active bleeding that stopped when a tourniquet quet was applied was applied Chest wound with a hidden tube that delivered air to the chest iChest wound with a hidden tube that delivered air to the chest injury site njury site Wound where compression was more difficult, bleeding continued; Wound where compression was more difficult, bleeding continued; we we were able to fill large IV bags with specialwere able to fill large IV bags with special--effects blood and deliver tubing effects blood and deliver tubing to the injury site so as to create brisk bleeding from the woundto the injury site so as to create brisk bleeding from the wound

Injury Creation Simulator (ICS)– The Next Generation Injury Creation Science

The simulator will be designed The simulator will be designed with a lightweight but with a lightweight but

completely protective metal completely protective metal plate between the participantplate between the participant’’s s

skin and the skin and the ““wound.wound.””

Echelon I Triage and AssessmentEchelon I Triage and Assessment

Echelon II Treatment (Battalion Aid Station)Echelon II Treatment (Battalion Aid Station)

Military Applications Military Applications

Enhance operational and medical decision makingEnhance operational and medical decision makingImprove medical trainingImprove medical trainingDeliver medical treatment across all barriersDeliver medical treatment across all barriersProviding realistic trainingProviding realistic trainingAllows medics and corpsmen to practice triage and Allows medics and corpsmen to practice triage and transporttransportEnables corpsmen to actually carry or drag their squad Enables corpsmen to actually carry or drag their squad mates to safety.mates to safety.Provides muchProvides much--needed stress inoculation training as needed stress inoculation training as medics see their team members injuredmedics see their team members injured