Computer-Based Training

THE MILITARY HAS LONG RECOGNIZED THE VALUE OF COMPUTER-BASED TRAINING FOR A VARIETY OF SPECIFIC SKILL SETS—INCLUDING MEDICAL.

The use of simulations in training of military medical personnel has become increasingly prevalent in recent years as standard desktop computers have become robust enough to run graphicsintensive software, and reliable broadband connections have enabled remote access to online training resources.

Some resources still require combat casualty care specialists to travel for training. The U.S. Army established the Fort Drum Regional Medical Training Simulation Center at Fort Drum, N.Y., in March 2006 to test medical skills with a computer-based patient simulator. The medical training simulation center houses four classrooms and four patient-simulation testing rooms. Students practice medical skills on manikins hooked up to computers, which monitor the trainees’ ability to perform intubations and tracheotomies, dress wounds, insert catheters and IVs, apply stints, and more.

Trainers at the center also can simulate environmental conditions, such as duplicating the effects of an attack during a battle, using smoke, temperature, lights, sounds and other elements to change the trainees’ surroundings.

RETAINING KNOWLEDGE

The Army depends on Reserve warfighters to fulfill military occupational specialties (MOS) they may often not perform as civilians. That unfortunately applies to military medical personnel as well, as RTI International, based in Research Triangle Park, N.C., discovered.

Take the MOS 91W, the Army’s enlisted health care specialist, for example. 91Ws must provide emergency medical treatment including initial primary care many times in conflict situations. They also must evacuate their fellow soldiers from battlefield areas so they can receive more advanced care from top medical professionals. RTI International used its Sim-Patient simulation platform to develop a solution that helps keep Reserve 91Ws trained in important procedures, Robert Furberg, an RTI research analyst, told Military Medical Technology.

“We have a long history of collaboration with DoD, not the least of which recently has been our development of a mass casualty triage simulation that we developed with the 91W in mind,” Furberg explained.

“We did so for several reasons,” he added. “First, unlike most MOSs’, 91Ws are in low-density assignments throughout the entire force structure. We were amazed to realize the majority of the Reserve component of the 91Ws doesn’t practice any medical care in their civilian employment. This gives us with the opportunity to provide a high-yield educational methodology to get them up to speed practicing the use of a really perishable cognitive skill, which is mass casualty triage.”

RTI International began development of Sim-Patient about 10 years ago with initial funding from the U.S. Army Telemedicine and Advanced Technologies Research Center. In a simulated triage scenario, Sim-Patient presents a trainee with a number of sick and injured warfighters that overwhelms the Army’s capacity to care for them on the spot. So the trainee must establish an order for priority of care among the wounded to treat the most critical cases first.

“Our Sim-Patient application presents a student with highfidelity graphic avatars on either a laptop screen or projected on a wall,” Furberg elaborated. “Each of these characters comes equipped with a full array of injuries. Some are pretty graphic. Some require a bit of digging and assessing to determine the severity of their injuries.”

RTI International is the second largest, independent, non-profit, multi-disciplinary research organization in the United States, Furberg emphasized. It was established by three universities in the Research Triangle in 1958—the University of North Carolina at Chapel Hill, Duke University and NC State University. RTI International continues to refine Sim-Patient, paying close attention to advances in trauma care that occur during wartime. Furberg said the company plans to continue to keep the simulation platform current by incorporating methods such as the judicious and quick use of tourniquets for hemorrhage control and advancements in the management of isolated extremity amputations from improvised explosive devices.

“Looking ahead to developing the next generation, we want to make this evidence-based and 100 percent relevant to the servicemember in the field or preparing to go to the field to make the most of their time spent training so they can have a big effect on saving the lives of others,” Furberg stated.

“I think ultimately, given the critical nature of providing combat casualty care, the time spent getting organized in an acute situation rather than providing care can lead to a detrimental loss of confidence, it can lead to confusion and it can ultimately lead to loss of life. Our mission is to do anything we can do to move our system ahead to combat that,” he added.

HANDS-ON TRAINING

Applications using a cognitive learning model dominate U.S. military medical training, but SensAble Technologies Inc. of Woburn, Mass., has become a leader in introducing haptic applications to health professionals. “SensAble Technologies manufactures software, its OpenHaptics toolkit and FreeForm application, and hardware, its line of Phantom haptic devices, to provide a 3D tactile training environment where trainees can touch, feel and handle anatomically correct and appropriately parameterized bones, tools and the like,” said Curt Rawley, SensAble Technologies chairman and CEO

“Our haptic devices and toolkits enable other developers to generate custom solutions,” Rawley continued. “People are doing everything from molecular modeling to dental simulations. They write the programs that take advantage of the haptics that we provide based on our software development toolkit and forcefeedback devices.” One SensAble client uses the OpenHaptics Tooklit and Phantom device to simulate ear surgery operations. A trainee then could literally feel the structure of the ear while exploring a 3D virtual space.

The company’s FreeForm systems, on the other hand, offer touch-enabled solutions for fast 3-D modeling of organic shapes, created from virtual clay. “An outfit in Europe, the University Hospital Maastricht, uses the system to create prosthetic ears,” Rawley commented. “Starting in FreeForm with a scan of the patient’s healthy ear, the 3D model can be quickly and accurately mirrored, and then used to design the prosthetic ear. A rapid prototype of the prosthetic is made, and then the artificial ear can be cast out of biocompatible material for the patient. That’s an example of someone using our FreeForm modeling system to develop a medical prosthetic.”

The modeling of patient’s bones and the creation of prosthetics also have been useful for doctors treating soldiers returning from Iraq. At the Walter Reed Army Medical Center, specialists design prosthetics and implants for injured warfighters who have suffered skull injuries and the like.

“We design the 3D model of the implant or prosthetic in FreeForm; it is then sent to a rapid prototyping machine; making a model of the part that is then cast with biocompatible material. The surgeon is then able to implant that into the patient,” Rawley said. “We have a set of organic design tools in FreeForm, so you can bend it, shape and sculpt them to make it look as though it is part of the natural shape of the patient’s skull for a perfect fit.”

For training purposes, medical trainees learn procedures well and retain them when they work in a hands-on environment such as that provided by haptically enabled simulations. The simulations also assist with the practice of operations where a surgeon would not be able to see the affected area. In such blind operations, surgeons must rely on their sense of touch. Using haptics, they can learn how the blind areas feel and thus learn how to properly handle them.

“We have client companies that have made epidural simulators,” Rawley recounted. “The sense of touch is critical for learning how to give this injection correctly. The application must guide trainees to place a needle through multiple layers of tissue, which feel differently, until it’s safe to release the injection. A wrong shot could have disastrous consequences.” The Phantom devices provide force feedback that, coupled with the right software, can warn trainees against making inappropriate moves.

SensAble offers Phantom devices that connect to workstations through the parallel port or a firewire connection.

BLENDED AND INTERACTIVE

SensAble Technologies has worked with mySmartSimulations Inc. of Saratoga Springs, N.Y., to produce haptic solutions using mySmartSimulations’ unique proprietary software. mySmartSimulations, founded about seven years ago, began to rapidly expand its presence in medical communities recently with its Worldwide Interactive Learning Designer (WILD) authoring tool, Bill Cornelius, mySmartSimulations president and CEO, told MMT.

“We saw a tremendous void in the training and the learning curve on that side of it,” Cornelius recalled. “Most people still today are trained by watching video and reading documents and manuals. There is not really a lot of interactive or face-to-face training. The training we felt would be important is if you had the ability to watch something on your computer and then actually do something to make it more interactive.”

“It’s not just pressing a button to advance a slide, but your mouse becomes an instrument and you are using that instrument in an interactive way to demonstrate your competency. So we saw that the industry might be looking for a very strong online cognitive model. It turns out that is definitely what the industry is looking for,” he added.

WILD enables mySmartSimulations’ developers to create customized applications, specifically customized for the specific goals of their clients. The tool enables the creation of software faster and cheaper, significantly reducing the costs of custom orders.

So, for example, device manufacturers have turned to mySmart- Simulations for interactive training solutions for their salespeople. These manufacturers also use mySmartSimulations solutions to train their customers—including surgeons, nurses and other health care professionals—in the use of their devices. mySmart- Simulations created the WILD authoring tool to meet such a need, equipping the company with the ability to design customized training for specific devices, procedures, and so on.

Cornelius compares the tool’s impact to creating a PowerPoint presentation. A user in PowerPoint will put his content into a presentation that PowerPoint helps to organize and make professional. And so the WILD tool takes content from its users and creates an equally professional final product. mySmartSimulations began assisting government clients in 2004 with the Department of Criminal Justice in New York state. The company’s applications train police officers about blood alcohol content and the proper use and maintenance of breathalyzers.

mySmartSimulations most recently received a contract from the Veterans Health Administration (VHA) to provide online training for VHA hospital personnel.

“We are finding that people are not happy with the current way of learning that is available, which is really manuals and videos. They also are not happy with some of the current online training, which is basically just manuals and video online,” Cornelius noted.

“So we have created tools that really create interactions that make the content very rich and really blend it. You can watch the video and do some interaction. You can observe how something is done. We all learn differently, so the goal is to offer a nice blended solution to enable people to learn at their own pace, anywhere or anytime,” he added. ♦

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