Virtual Operating room for collaborative

training of surgical nurses Nils Fredrik Kleven, Ekaterina Prasolova-Førland, Mikhail Fominykh,

Norwegian University of Science and Technology

Arne Hansen, Guri Rasmussen

Sør-Trøndelag University College

Lisa Millgård Sagberg

St. Olav’s University Hospital

Frank Lindseth

Sintef Medical Technology

Motivation

• At the core of educational activities of health professionals

at all levels is the patient

– As the hospitals improve their effectiveness, there is dramatically

less time for the student-patient contact

=> Students need more ‘patient’ time

– A patient is treated by a team of specialists, with complex

collaborative procedures and practices within the team

=> Students need to practice on complex interactions

within a team of professionals

• There is a need for solutions to facilitate practice and

explorative learning experiences to meet these challenges

= > Online virtual university hospital as a venue for

learning, research, and development

Related work: types of medical virtual

worlds

• Reconstruction of real life institutions

• Interactive simulations and visualizations – Anatomy

– Procedures

• Team training (e.g. with roleplay) – Emergency

– Nursing

– Patient communication

• Public health and education – Patient support groups and socializing

• Treatment and reconvalescence

Imperial College London

The cranial nerve skywalk (University of

Kentucky/UWA)

Active Worlds: Time Critical Training

(Cardiac Arrest)

S. Parab (2010)

Nursing simulation: post-partum

hemorrhage (Youtube)

Communication training for palliative care

Lowes, S., Hamilton,

G., Hochstetler, V., &

Paek, S. (2013)

Emergency Training (University of Illinois

at Chicago)

“It’s an urban nightmare scenario:

A plane has released anthrax over Chicago.

Millions are exposed and you have 48 hours

to give people antibiotics.”

vAcademia: medical call center training

Virtual Ability

Treatment of phobias and PTS

www.virtuallybetter.com, USC Institute for Creative Technologies

Virtual Operating room – St. Olavs

Waiting room => sluice => operating

room

Learning objectives

• Learning objective L1: Reassuring a patient in advance of

an important and complex operation

• Learning objective L2: Dealing with relatives

• Learning objective L3: Communicating / dealing with

patients with immigrant background, especially women

• Learning objective L4: Reassuring / dealing with children

in advance of an operation

• Learning objective L5: Dealing with a seriously ill and

potentially dying patient

• Learning objective L6: Performing basic medical tasks

prior to the operation (e.g. moving the operating table and

disinfection)

4 typical learning scenarios

1. A 35-year-old woman is admitted to the gynecological department.

She is on her way to a surgery for an abscess that will be operated in

spinal anesthesia.

2. An immigrant woman is going to a scheduled hip operation. Her

husband comes with her along with the nurse from the ward. She

speaks poor Norwegian, and her husband must therefore be there to

translate. She is concerned with keeping her hijab on and wishes to be

treated by female personnel only.

3. A five-year-old boy arrives to the sluice with his mother and nurse

from the ward. He is going to recto- and gastroscopy.

4. A man in the age of 40 is going to surgery due to a malignant brain

tumor. He has two teenage children that he alone is responsible for

back home.

Study setting and data collection

• Participants

• 9 post-graduate surgical nursing students from Sør-

Trøndelag university college

• Data sources

• Screen capture with sound of role-plays

• Written notes and sound capture of discussions

• Questionnaire (28 questions)

‒ Competences of the participants

‒ Use of the platform during the role play

‒ Suitability of the simulation for providing knowledge and skills

‒ Open questions, proposals for changes and improvements

A surgical nursing student participating

in the roleplay

Virtual Operating room: roleplay

Interaction: nurses, patients, relatives

0% 20% 40% 60% 80% 100%

not at all

to a little extent

neutral

to some extent

to a great extent

Can the simulation improve skills in

communication and interaction with

patients?

0% 20% 40% 60% 80% 100%

not at all

to a little extent

neutral

to some extent

to a great extent

Can the simulation improve skills in

communication and interaction with

the relatives of the patient?

0% 20% 40% 60% 80% 100%

not at all

to a little extent

neutral

to some extent

to a great extent

Can the simulation improve skills in

communication/collaboration with

other health professionals?

0% 20% 40% 60% 80% 100%

not at all

to a little extent

neutral

to some extent

to a great extent

Can the simulation be used as a

supplement to preparing surgical

nursing students?

What other areas in medicine could

benefit from simulation in virtual worlds?

Coordination of teams at operating rooms or

emergency rooms

Procedural training

Anatomy visualization

Diagnostic training

Informing patients and relatives

Providing health information to the general

population

18%

23%

20%

18%

13%

10%

Student feedbacks

• Fun and immersive experience:

• telling the patient’s husband to step away from the instrument table

when he gets too close, as these instruments are sterile and prepared

for surgery

• “The role plays got better eventually. Got more comfortable

after some practice”

• “it does take a while to learn”, but “a day more with role-

playing, and they would be skilled”

• “the scenarios would have been too difficult if you do not

have any real experience, one would not know how to

proceed”

• “use our hands more”

• Missing anesthesia nurses

Discussion & improvements suggestions

• “More items to interact with needs to be included if

surgical nurses are to treat and communicate with a

patient”

• Improving navigation and interactivity

• Improving feedback during roleplaying, using

teachers/experts & virtual humans

• Body language

• More gaming elements

• Designing a ‘perfect’ Virtual Hospital

• Realism vs. efficiency?

Conclusions and future work

• Creating guidelines

• For developing virtual hospital as an arena for educational

activities for medics and non-medics

• For developing roleplaying scenarios

• Additional evaluations:

– Surgical nurses at earlier stages of study

– Anesthesia nurses

– Non-medics

– Using Oculus Rift

• Additional technological developments:

• Kinect and CAVE

• Adding new hospital buildings (labs, examination rooms),

interactive features and virtual patients

Virtual Operating room and Oculus Rift

Virtual Operating room and Oculus Rift (2)

Virtual Operating room in a CAVE (EU

Visionair project)

Thank you!

Nils Fredrik Kleven nilsfrk@stud.ntnu.no

Ekaterina Prasolova-Førland ekaterip@ntnu.no

Mikhail Fominykh mikhail.fominykh@ntnu.no

Arne Hansen arne.hansen@hist.no

Guri Rasmussen guri.rasmussen@hist.no

Lisa Millgård Sagberg lisa.millgard.sagberg@ntnu.no

Frank Lindseth frank.lindseth@sintef.no