VI-MED: Virtual Medical Environment for Nurse Training

Background

Health care professionals in general, and nurses in particular, receive their training through an academic, knowledge-based component, and a practical, skill-based component. Practical training is essential to ensuring that the nursing students are able to apply the knowledge acquired, think on their feet, make decisions in a high stress and high pressure environment, and are able to recover from suboptimal decisions and from errors. While effective and possibly irreplaceable, practical training suffers from the several shortcomings:

»Often practical training is characterized by its steep learning curve where a trial and error approach carries a prohibitive cost

»There is little control over the set of cases that a nursing student is exposed to and low frequency, high risk cases are rare

»The feedback that the students receive is not uniform and is under the sole responsibility of the nurse in charge

In recent years the nursing field has become increasingly interested in alternatives to practical training for its students. We propose to use computer simulation technology and virtual environment to complement the real field experience.

Objective In this project, we propose to complement practical training with a virtual environment where nursing students can train. The system will allow nursing students to be exposed to cases in a controlled way. In this project, we develop a Medical Virtual environment, VI-MED, that trains a medical student in a setting that is as realistic as possible without the risk of harming real patients. This task has two major goals including:

»Giving the nursing faculty more control over what the nursing students learn, what cases they are exposed to, and the quality of the feedback they receive.

»Conveying to the student a realistic sense of the lack of determinacy of health care decisions. Most interventions require the care giver to make educated guesses and monitor the impact of these decisions adjusting their diagnostic and subsequent decisions accordingly.

Virtual Environment Platform

We have used the 3D GameStudio as the platform from which to develop this virtual environment. This software provides for a model editor, a script editor, and level editor to be linked and compiled together. The model editor allows users to create and edit custom entities for the virtual environment. The script editor provides the code to support character movement and graphical users interfaces. The primary editor is the world editor, where the entire environment is produced and the characters and scripts are imported into.

Project and Poster by: Heather Airoldi1 and Jonathan Barr2

1[Gordon College, Wenham, MA], 2[University of Michigan, Ann Arbor, MI]

Advisors: Dr Fatma Mili3, Dr. Laura Pittiglio3, and Dr. Meghan Harris3

3[Oakland University, Rochester, Michigan]

System Architecture

The overall architecture of the system is shown in figure 4 The scripting language ties together each medical component for a

wholesome game and user experience.

Conclusions

VI-MED allows for a smoother transition from an academic setting to the workplace

Our approach focuses on reality based issues such as decision making under uncertainty, critical thinking, and error recovery.

Using virtual reality, student feedback and patient cases can be standardized, allowing for objective grading of the student’s decisions.

The graphical user interface allows for a relatively simple way to interact with the virtual patient and hospital setting

With emphasis on game based learning under uncertainty and un-cued decision making many shortcomings of practical training can be supplemented with this virtual environment

Future work includes:

Animation of the patient

Use of the log to generate feedback and assessment to the student

Game Algorithm

The game session proceeds as follows

1. The student nurse signs in.

2. The system generates a set of patients the student will be responsible for. The set of patients will be generated using a predefined set of criteria

3. The nursing student is briefed about these patients and the shift begins.

4. The shift is continuous, simulating a real nursing shift of 12 hours (a game clock is visible).

The state of each patient continues to evolve with time in accordance with the patient’s diagnosis and characteristics and some element of randomness as specified by the system.

Scheduled events such as meals and sleep are reflected in the patient’s parameters and updated in real time for the user.

At any time, the student nurse may choose interventions that have no impact on the patient’s state. These actions include examining the patient, consulting the patient records, or ordering laboratory tests.

At any time, the student nurse may decide to intervene through actions that do impact the patient’s state such as administering medicine or applying a medical procedure.

5. When the shift ends, a report is generated with a detailed log and summary of the shift.

UnCoRe 2007Undergraduate Computer Research

Oakland University

REU Program

Medical Handbook Medical

Handbook

Pharmacyand

Manual

File Cabinet

Medical Log

Description of Symptoms

Medicines and Interventions

Patient Files List of all events

Script

A6 Game Engine

Model Editor

World Editor

Script Editor

A6 Engine

Finished Game

3D GameStudio3D GameStudio

Map Compiler

Fig.1 Architecture of GameStudio

Fig.5 Introductory Screen to VI-MED

Method

IN GENERAL:

The VI-MED system uses the C-Script code to produce our virtual, yet realistic setting. Several criteria have been outlined for each function and action that takes place within the game.

GENERATION OF THE PATIENT:The symptoms of patients must follow a predefined and realistic distributionPatient cases must include both high and low frequency casesAge, weight, height, name, and the patient’s gender are also randomly generated with a predefined distribution

INTERVENTIONS:The patient’s parameters evolve in a realistic way

• They evolve with time according to the patient’s symptoms

• They react to nurse interventions and scheduled eventsNurses are allowed to make un-cued decisions

• The GUI is accessible at all moments in game time

• The GUI interface is a button hierarchy for ease of use and immediate interactions with patients

• Nurses are not told when they should intervene

USE OF UNCERTAINTY:The game mimics the uncertainty inherent to health care

• Even if correct decisions are made, the patient’s condition may worsen

• The outcome of decisions follows a realistic distributionUncertainty will create a more realistic experience for the userDecisions and outcomes for each patient are logged by the systemThe log can be used to determine if the patient’s deterioration was due to a nursing error or atypical but possible patient's reaction to treatment

Fig.3 Hierarchical Button Scheme

Fig.2 Game Panel – Randomly Generated Patient Statistics and GUI

Fig.4 System Architecture

Patient Parameters

Based on what symptoms are randomly generated, the patient’s statistics vary with time.

Procedures carried out during game-time are reflected in changes in parameters.

These changes are both statistically and medically accurate. The examples below demonstrate the changes in parameters and the

possible decisions nurses may make to vary these parameters.

1. Blood Glucose Level begins at 300 mg/dl

2. Nurse intervenes, administers some dosage of insulin

3. If no intervention, the patient goes into a coma when the blood glucose level climbs to 700 mg/dl

4. Blood glucose level falls to 200 mg/dl in 3 hours

5. Nurse Intervenes, Nurse turns off the Dextrose IV, blood glucose immediately falls to 120 mg/dl

Blo

od

Glu

cose

Lev

el1

23

4

Time (12 hr)

5

Example Case 1: Diabetic Patient

Oxy

gen

Sat

ura

tio

n L

evel

12

3

4

Time (12 hr)

5

1. Oxygen saturation level begins at 88% 2. Nurse intervenes, administers

Albuterol (breathing treatment) 3. If no intervention, the patient goes into

a coma when the oxygen saturation deteriorates to 85% in 3 hours

4. Oxygen saturation climbs to 90% in 2 hours

5. Nurse Intervenes, Nurse applies an oxygen tube, and the Oxygen immediately rises to 96%

Example Case 2: Asthmatic Patient

Fig.6 Blank Patient Briefing Screen

Fig.7 Screen Shots of VI-MED