Step 1 Define a Desired Skill Set and Learning Objectives

Successful simulation projects require extensive input from the subject matter expert. When choosing physician collaborators, simulation developers need to look for physicians who are expert teachers/communicators first and technical experts second.

The first and arguably most important contribution the physician can make is defining the application or the procedure being simulated. Such a choice should be driven by training need first and apparent capability to simulate the skill set second, as

TABLE 1 ■ Advantages/Disadvantages of Virtual Reality Simulators in 2004

Advantages

Disadvantages

Objective metrics

Expensive to develop

Learner centered

Expensive to purchase

Immediate user feedback

Lack of funding sources

Patient-specific data

Fidelity

Testing of new instruments

Validation lacking

Safe

Technology needs to recapitulate biology

Ability to break down complex tasks

Need to define the metrics

into modules

Assessment capability

Need to define the standards

Does not require mentored supervision

Requires intense multi-disciplinary collaborations

to build

Can build in curriculum

Lack of curriculum

Can discern cognitive versus

technical errors

Can track motion

Animal welfare

With current technology, patient-specific models can be imported into the simulation environment, allowing for the practice of specific cases prior to performing them in real life.

The use of virtual reality simulators to test new instruments is also a potential advantage for industry to develop cutting edge technology and train their sales staff.

Because the training need is the crux of the whole project, the physician needs to continuously supervise development to assure that the training needs are the focus and are properly being addressed. If training needs are not addressed, then the quality of graphics and model interaction become irrelevant.

The cognitive component of the procedure, or how and when these skill sets are put together, is the true backbone of the procedure. It has been approximated that 85% of what is learned for a given surgical procedure lies in the cognitive domain. The virtual reality simulator has the unique ability to dissect these domains allowing for critical and instructive analysis of causality of errors and techniques at a level much higher than inanimate simulators and even mentored instruction.

Curriculum development and implementation is probably best done by a team of subject matter experts (urologists) in consultation with an expert in medical education.

it is only with extensive discussion/bridging of the knowledge gap between computer scientists and physicians that the distinction between what can and a cannot be accomplished is defined.

Because the training need is the crux of the whole project, the physician needs to continuously supervise development to assure that the training needs are the focus and are properly being addressed. If training needs are not addressed, then the quality of graphics and model interaction become irrelevant.

There are essentially four learning domains that need to be considered:

The affective domain (ability to manage a team, focus, attention, etc.)

■ The cognitive domain (judgment, knowledge)

■ The visual-spatial domain (ability to navigate in virtual space)

■ The psychomotor domain (motor skills)

Some attempts have been made to measure the affective domain, but its abstract nature makes it more difficult to assess and quantify. Studies examining the effect of stress and lack of sleep in the operating room and subjective evaluation of interpersonal skills are examples of such studies (16-23).

Every urologic procedure is made up of several "skill sets," which can be thought of as building blocks. Performance of these isolated skill sets lies primarily in the visual-spatial and psychomotor domains. Thus, simulators created to simulate these basic tasks are only measuring and assessing these learning components.

The cognitive component of the procedure, or how and when these skill sets are put together, is the true backbone of the procedure. It has been approximated that 85% of what is learned for a given surgical procedure lies in the cognitive domain. The virtual reality simulator has the unique ability to dissect these domains allowing for critical and instructive analysis of causality of errors and techniques at a level much higher than inanimate simulators and even mentored instruction.

With this in mind, subject matter experts need to critically examine a given uro-logical procedure for its cognitive, visual-spatial, and psychomotor components and look for the best opportunities by which simulation may help lessen the learning curve. The learning objectives can then be defined.

0 0

Post a comment