Giddyup! Horses teaching future doctors
I wish I remembered how I stumbled upon this clip, but like so many things, it has evaporated into the ether/webulous/what-have-you.
In any event, this fun clip from NBC shows students at Stanford Medical School learning about communication and interpersonal skills from horses. Unfortunately the clip is old (2007) but it is still an interesting concept. Looks like Stanford is still offering the class, and students are still enjoying it as evidenced by this blog.
The clip is posted courtesy of Horsensei, which offers a range of programs for equine-assisted learning (for your job, your medical school, your birthday, etc.)
Home safety taught in virtual world
Check it out! That's me again, in Second Life exploring a site designed to train healthcare professionals in conducting home safety assessments. I recently toured this Geriatrics Virtual World with Drs. Jorge Ruiz and Allen Andrade of the University of Miami Miller School of Medicine. The "homes" pictured here are full of hazards for seniors (e.g., bug infestations; stove burner left on; tripping hazards; etc.). When a trainee tours the home, they are able to address the hazards (i.e., turn off the burner; move obstructions; etc.), and their actions can be recorded and fed back for training or assessment purposes. The home safety assessment is one of several research interests of the GVW group--others include interdisciplinary team training; communication skills; patient self-management; and disaster management. To that end, some of their other SL experiments include "text to speech" where avatars play out a scenario of physical activity counseling for a diabetic patient and provide meditation advice. The video below shows an overview of some of their research around avatar animation--have a look!
These projects appear to be a collaborative effort, so please visit Geriatrics Virtual World for further information. Here you'll find additional videos highlighting their work and a teleport link to the Geriatrics Virtual World in Second Life.
Is increased regulation in the Internet’s future?
I was tempted to answer the question posed in the subject line with a simple, definitive "yes", but I realized I should probably elaborate a bit - after all, "yes" isn't much of a blog post.
The concept of identity has been intimately linked to the Internet since its beginnings - after all, computers have identities, users have identities, and all have to be managed as part of the Web. We choose usernames and passwords and use them to manage our online identities; but a lack of a pervasive standardized identity management system like Microsoft's .net software (a la Identity 2.0) enables users to hide behind a layer of anonymity. MrKewlD00D22 isn't afraid to speak his mind on the discussion board of his favorite science magazine, even if he is painfully shy in person. PunkRockGrrl87 and MackDaddy00 chat online each day, but their real-life counterparts have never met.
However, as the lines between reality and virtual reality become more blurry, it seems identity is more of a sticky situation. Take for example the recent, very unfortunate story of a mother pretending to be a teenage boy on Myspace for the sole purpose of harassing one of her daughter's female classmates, which ultimately ended in the 13-year-old girl's suicide. The mother had been facing up to 20 years in prison for conspiracy charges, but the conspiracy charges were thrown out and she now faces 1 year in jail and $300,000 fines for 3 misdemeanors. This situation brings to light all sorts of regulatory issues around the Internet. For example, if one is to be held personally accountable to the Terms of Service on a site, then somehow their online identity must contain meaning that links to their real life. And how many "teeth" do the Terms of Service have in terms of the law? Do the same rules apply online as they do in real life?
These are important questions, and are becoming even more important as future generations engage with and build upon the giant information monstrodome that is the Internet. Frankly, I think the time for more regulation with regard to identity (and information veracity) is far past its due date.
The doctor will see you now
Poking around in one of our latest areas of interest, Clinical Decision Support Systems, I found my way to FreeMD, subtitled your interactive medical library. Dr. Stephen Schueler, the virtual doctor, interviewed me about my "problem" and provided me with a triage report containing:
- conditions of most concern that may be causing my symptoms
- recommended time frame to see a doctor
- a list of tests that might be done
- where I should go for care (ER vs office)
- links to home care information
- links to information for worsening symptoms
- a summary of the report including history, positive and negative findings
For the particular problem I presented with, Dr. Schueler was completely accurate and gave good advice. However, the symptoms were very straightforward. I tried it with more vague symptoms, so I had to answer a lot more questions and there were more "conditions of concern" to be explored.
The site was easy to use and overall I thought it a cut above other sites where you can go with symptoms in search of a disease. A far cry from replacing the real thing though. Try it out and judge for yourself.
According to the About section on the site, FreeMD is written and maintained by physicians at DSHI Systems, a company in business since 1989 developing symptom-based decision support systems.
Surgical skill–it’s not just in the hands
Last week, we hosted Mark Smith, MD and Kanav Kahol, PhD for an in-house seminar. Mark is the System Director of Simulation and Innovation at Banner Good Samaritan Hospital, and Kanav is an Assistant Professor in the Department of Biomedical Informatics at Arizona State University. We first met them at the Medicine Meets Virtual Reality Conference earlier this year, where they were demonstrating an innovative approach to preparing surgical residents to do procedures by practicing with the Nintendo Wii. They modified a Wiimote controller by connecting a laparoscopic probe and had surgical residents warm up with Marble Mania, a simple maze game, prior to doing a procedure on a surgical simulator. Their study showed that residents who practiced with the Wii and Marble Mania did significantly better than those who did not. But that was only the hook to get our attention. Mark and Kanav's presentation whetted our appetites with the range and direction of their research activities around skills and performance training and assessment.
For example
- Cognitive surgical simulators -- adding a layer of cognitive exercises (neuropsychological tasks) to basic simulators to provide more challenging exercises over and above psychomotor skills training
- Dynamic simulations -- an intelligent tutoring system that uses EEG to gage a surgeon's current proficiency and provides tasks and scenarios relevant to their skill level, enabling them to hone skills and focus on areas of weakness
- Visualizing surgical skill -- using real-time analysis to capture hand movement patterns of surgeons while completing a standardized task; comparing with database of novice to expert hand movements; and providing real-time feedback using a graphical hand display driven by a real-time data stream.
- Measuring movement expertise -- a promising approach to objectively evaluating surgical skills based on hand movement analysis instead of tool movement
- Fatigue effects -- focuses on effect of fatigue on surgical residents' cognitive skills during simulated surgical exercises
Some found discussion around cognitive capacity and introducing noise into the simulated environment to be particularly interesting as it related to some of our own BS topics around professional burnout and novice/expert performance. Others were interested in social networking experiments using smart cards. All were interested in further discussions around potential collaborations.
Virtual patients in Second Life
Earlier this week, I joined other members of the Medbiquitous Virtual Patient Working Group in Second Life for a virtual patient demo led by avatar Lucas N. We were hosted by St. George's University of London who apparently partnered with Daden Limited, a virtual world consultancy firm, to develop a virtual patient player that works in Second Life. Of course, all of the Virtual Patient data conforms to the Medbiquitous Virtual Patient Standard.
Using the HUD (heads-up display) to collect necessary tools and instructions for our virtual patient case, we were led to our victim who appeared to have skidded and fallen from his motorcycle (check out the skid marks). He was conscious and able to answer questions. We all took turns poking at various body parts to obtain physical exam data, which was rendered to us via text with instructions to discuss options with the team before proceeding with further assessment and treatment decisions. Since he reported his pain to be 10 on a scale of 1-10, we gave him some ibuprofen--I don't remember why we gave him Paracetamol, I don't even know what it is. Lucas pulled a variety of props from his paramedic bag and secured our patient's leg and slid the backboard under him. I'm not really sure how the props got there, and I don't know how we would have transported our guy to the nearest hospital. I'm thinking instead of flying in, next time we should probably bring an ambulance along...
Other's doing cool medical stuff in Second Life: The list below only represents some of the interesting things I've had the pleasure to view, participate in, or just stumble blindly into.
Ann Myers Medical Center -- I've attended meetings in AMMC with Berci and other interns and educators where the someone presents a case and the group discusses diagnosis and treatment. Often presentations include in-world powerpoint slides and other visual aids. I've also interacted with some educational tools in their radiology department, and I've listened to heart sounds. I wouldn't advise lying down in the MRI machine though, r0wsbud antfarm got a little stuck and had to fly out.
Virtual Patients at the Imperial College of London -- After watching the video, I thought this VP encounter felt a little less "real." You need to click on signs on the wall to hear the patients' breath sounds, instead of on the patient's chest. However, it gets the job done. The ability to suspend disbelief is important in any of these simulations, as physicians don't typically click on their patients to gather information, do procedures or administer meds, etc. That's not to say that they won't be able to click on us in the future to activate whatever implanted system our meds are being delivered from or get a read from the various tracking devices we'll have implanted in us.
SLICE (Second Life Institute for Clinical Education) -- I've been watching this location spring up for months and am interested in learning more about this project, waiting to hear back from the project director at the University of Illinois, Chicago Medical Center. Obviously, it was the 'clinical education' that got me interested.
NESIM (Nursing Education Simulation) -- I became interested in learning more about this group after seeing presentation at Games for Health 2008. During the presentation I became convinced I had stumbled on to this nursing simulation space in my SL travels. After the conference, I tried to return and found the space restricted. (related article)
Second Health Polyclinic, London -- We squatted here, borrowing one of the emergency department examining rooms to try out a doctor/patient encounter once. Our virtual patient survived the appendectomy and the follow-up explosion. We also used one of their elevators as a scene to experiment with recreating a training video using avatars instead of live actors.
More about Second Life:
- A day in my Second Life
- International Virtual Association of Surgeons (iVAS)
- Artificial Intelligence in Second Life
- State-of-the art hospital opens in Second Life
- Play2Train in Second Life
Greetings from Games for Health 2008
My head is spinning! There is so much going on here! The fourth annual Games for Health Conference held in Baltimore, MD is all made possible by the deep pockets of our friends at the Robert Wood Johnson Foundation's Pioneer Portfolio and by the efforts of the Serious Games Initiative staff and community.
Some cool stuff I saw today...
- PIP the Personal Input Pod - "a revolution in stress management"
- One-Handed Guitar Hero - adaptation of a popular game controller
- Pulse!! - my action packed adventure in emergency care of a critically wounded soldier
Yesterday I attended the preconference workshop on Virtual Worlds. On the agenda was:
- Taking Action in Virtual Worlds (John Lester, Linden Labs)
- Virtual World Systems: What's availalbe and how do you work with it? (Tim Holt)
- Virtual Worlds for the National Emergency Medical Standards Preparedness Initiative
- Virtual Worlds & Forterra Systems (Bart Bartlett)
- Health Projects in Whyville (James Bower)
- Play2Train Framework: Idaho Bioterrorism Awareness & Preparedness Program (Ramesh Ramioll)
- Virtual Worlds for Education & Training of Health Professionals (John Miller, RN)
More cool stuff tomorrow...
- 3DiTeams (Jeffrey Taekman, Duke University & Virtual Heroes) combines gaming concepts with healthcare team coordination training curriculum. Funded by AHRQ to provide a controlled and instructive environment using Situation, Background, Assessment and Recommendation (SBAR) techniques and teamSTEPPS protocols.
Take home messages...
- I heard the phrase "Virtual Standardized Patient" more than once
- Forterra and Second Life are not the only options--there are several new companies stepping into the virtual patient space--physiologic modeling enhances the newer VP offerings
- Everyone seems to be doing their own thing -- lots of virtual patient simulation silos -- interoperability is going to be a problem -- no one seems to be thinking about content sharing
- Health games are becoming a big focus for major health insurance companies -- the biggest payor was absent
International Virtual Association of Surgeons (iVAS) Conference in Second Life
No travel arrangements, no hotel, no last minute flight hassles, no cost, no jet lag--in no time I'm at an international conference with surgeons and experts in virtual patients, telerobotics, and using eye tracking to separate the novice from expert surgeons. Speakers included Professor LeRoy Heinrichs of Stanford University (SUMMIT); Mario Nicolaou of St. George's Hospital, UK; Mitch Lum and Hawkeye King of the University of Washington BioRobotics Laboratory. The sessions were very interesting, the venue unique. There were a few technical glitches, which did not detract too much from the flow of the conference. It was relatively short, however, I would expect future conferences will be more robust, as folks become more comfortable with this venue.
The conference was hosted by iVAS
"...a group of surgeons and scientists who want to change the way scientific communications are currently conducted, we will organise conferences entirely within the virtual world. This lowers the cost of attending, negates the need to travel and creates novel surgical research networks across the world."
More about Second Life:
- A day in my Second Life
- Artificial Intelligence in Second Life
- State-of-the art hospital opens in Second Life
- Play2Train in Second Life
A day in my Second Life
That's me in the middle with my back to you--not sure who the guy is levitating next to me, but you can do that if you feel like it. Anyway, on Saturday I met Berci and an international mix of medical students in Second Life at the Ann Meyers Medical Center for an intern meeting. Some members of the group seemed to be acquainted with one another, others were there for the first time. I did not have much of a chance to explore the center, but I hope to in the future. We met in a conference room where the session leader "Vera" presented a patient case and engaged the group in a question/answer brainstorming. After a while it felt like you were actually in a live meeting, even though communication was done via keyboard. While discussion was going on some were using web resources to research the signs and symptoms; something that might have seemed rude in a live meeting, but totally behind the scenes in this setting. The patient case discussion lasted for about an hour; some general discussion about the value and what could be done to improve the experience ensued. Some agreed that voice would add a lot to an encounter like this. Everyone seemed to enjoy the case challenge. I still have a lot of questions about AMMC, and I hope to learn more from Berci and the other AMMC collaborators.
More about Second Life:
- Artificial Intelligence in Second Life
- State-of-the art hospital opens in Second Life
- Play2Train in Second Life
Play2Train — Idaho Bioterrorism Awareness and Preparedness Program
Update (5/8/08) from presentation at Games for Health. The cost of this 3-year project was $28,810, which included developer costs, the purchase of 3 islands, working with subject matter experts. Maintenance cost approximatey $15K per year for Play2Train staff.
Play2Train is a virtual training space in Second Life that spans two islands; one boasting a virtual town and the other a virtual hospital. The developers of this space, Idaho's Bioterrorism Awareness and Preparedness Program, believe that this environment will provide opportunities for interactive training and role playing and will be the basis for future emergency preparedness training. Click here to view their video that does a great job highlighting the potential of Second Life for emergency and other medical training, as well as provides some practical discussion about scripting and utilization of detail and the absence of unnecessary detail in this environment. In about 15 minutes, you can really get a sense of the breadth of things that can be done around medical (and other) simulations. Play2Train also utilizes an open content approach, and will entertain applications to join its alliance, which provides for opportunities to use their training environment for your project.