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Simulation for Team Training and Assessment: Case Studies of Online Training with Virtual Worlds

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Individuals in clinical training programs concerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and frequently repetitive. The widely substituted alternative for real patients—high-fidelity, manikin-based simulators (human patient simulator)—are expensive and require trainees to be in the same place at the same time, whereas online computer-based simulations, or virtual worlds, allow simultaneous participation from different locations. Here we present three virtual world studies for team training and assessment in acute-care medicine: (1) training emergency department (ED) teams to manage individual trauma cases; (2) prehospital and in-hospital disaster preparedness training; (3) training ED and hospital staff to manage mass casualties after chemical, biological, radiological, nuclear, or explosive incidents. The research team created realistic virtual victims of trauma (6 cases), nerve toxin exposure (10 cases), and blast trauma (10 cases); the latter two groups were supported by rules-based, pathophysiologic models of asphyxia and hypovolemia. Evaluation of these virtual world simulation exercises shows that trainees find them to be adequately realistic to “suspend disbelief,” and they quickly learn to use Internet voice communication and user interface to navigate their online character/avatar to work effectively in a critical care team. Our findings demonstrate that these virtual ED environments fulfill their promise of providing repeated practice opportunities in dispersed locations with uncommon, life-threatening trauma cases in a safe, reproducible, flexible setting.

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We thank our colleagues at the Center for Advanced Medical Simulation at the Karolinska University Hospital, including C-J. Wallin, Li Fellander-Tsai, Johan Creutzfeld, Christopher Medin, and Leif Hedman (Umea University) for their contribution of the 10 cases to the Virtual ED I project. We thank our collaborators at Forterra Systems, Inc., including Matt Kaufman, Laura Kusumoto, and Arnold Hendrick for the development of the Virtual ED II. Special thanks to Robert Cheng and Shyh-Yuan Kung for the technical development of patient models for Virtual ED I and II and to Kingsley Willis for creating the avatars and environments for Virtual ED I. The Virtual ED projects were supported by grants from Adobe Systems, Inc., the Wallenberg Global Learning Network, and the Telemedicine and Advanced Technology Research Center (TATRC), Army Medical Research and Material Command.

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Correspondence to William LeRoy Heinrichs.

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Heinrichs, W.L., Youngblood, P., Harter, P.M. et al. Simulation for Team Training and Assessment: Case Studies of Online Training with Virtual Worlds. World J Surg 32, 161–170 (2008).

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