Medical Training 2.0

Written by Marty Kauchak

Take, for example, the Navy’s reserve hospital corpsman interactive course, in which participants use the Navy’s E-Learning network to do 74 lessons totaling about 120 hours, but also serve as residents at the Naval Hospital Corps School in Great Lakes, Ill. Leo Grassi, the department head of the Navy’s medicine, manpower, personnel, training and education division, notes that the purpose of the course—intended for reserve hospital corpsmen that have not attended “A” school—is to establish a standardized medical training program that mirrors the resident training course for hospital corpsmen.

Other Navy courses—including the basic medical department officer course; expeditionary medicine; and the chemical, biological, radiological, nuclear and highyield explosive course—all use technology to supplement or enhance in-residence coursework, reflecting DoD’s effort in general to train reserve and guard members through nonresident, technology-supported courses or modules when feasible.

At the U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), technology augments medical learning through the use of robotic manikin that are deployed in small group settings to rehearse casualty treatment; computer learning games, including one called Chem Squares, review classroom learning objectives in an engaging team environment; and simulators such as the command’s SIMapse nerve agent laboratory, which presents nerve agent antidotes in a live interactive model.

The software and scenarios for these technologies were developed in house, noted Major Thomas B. Talbot, M.D., chief of operations for USAMRICD chemical care division.

Beyond these and other courses, technology-based learning is also embedded in courses for all department health care communities. Air Force Colonel Deborah Burgess, M.D., who is chief of the medical modernization division and director of the Air Force Medical Modeling and Simulation Program at Air Education and Training Command, said that her division’s mission is to integrate modeling and simulation training into all education, training and sustainment platforms for physicians, nurses and allied health professionals.

BRIDGING THE GAP

While virtual technology-based courses enable 24/7 access to learning and provide other resourcesaving benefits, there are other more fundamental reasons to use technology, according to Burgess, who also serves as a military consultant to the Air Force surgeon general for nephrology.

“Many of our medical treatment facilities lack exposure to critically ill patients and civilian trauma,” Burgess said. “As a result, we must bridge that gap with high-fidelity human-fidelity simulators and effective, realistic simulation training that meets readiness training objectives.”

Simulation can also provide essential trauma training in the absence of appropriate trauma cases and can re-create specific situations to ensure systematic exposure to all elements of battlefield trauma and critical care.

“Participants learn how to manage specific battlefield injuries through the continuum of care: from point of injury to arrival in a field hospital and finally critical care air transport for definitive care,” Burgess said.

The return on investment in learning technology can be gleaned through at least one metric: The Air Force can now meet 75 percent to 97 percent of all readiness skill verification program requirements with simulation training, Burgess said.

CURRENT DEVELOPMENTS

A wide range of virtual technologies is now being fielded, including games, virtual worlds and other applications, according to industry and government representatives. Haptic technology, for example, which creates a sense of “touch feedback” in simulators, mobile phones and other applications, underpins the simulation portfolio of San Jose, Calif.-based Immersion.

Immersion Vice President and Medical Director Kevin Kunkler said haptics help make contemporary medical training far more realistic by combining the sense of touch with physics-based algorithms to provide appropriate interactions between instruments and tissue in high-resolution, real-time, anatomically correct 3-D models that have detailed clinical content and appropriately measured metrics and evaluation.

“The combination of all this enriched technology provides one of the most immersive medical training systems one can experience,” Kunkler said.

Previous DoD grants to Immersion supported simulation development for central venous catheterization, needle thoracentesis, femur fracture and flexible ureteroscopy. The company’s products in service at medical facilities include Virtual IV, AccuTouch Endoscopy, LaparoscopicVR and AccuTouch Endovascular.

San Mateo, Calif.-based Forterra Systems, meanwhile, is a developer of virtual worlds that could eventually be used for such applications as building operating room team skills and refining patient care processes at medical treatment facilities. With Forterra’s software, distributed massively multiplayer online game technology lets any user with a mid-grade PC and network connection participate in medical simulation training. Participants using such software are represented as avatars, but are able to discuss the tasks at hand in their natural voices.

Forterra Federal Systems general manager Dr. Mike Macedonia said applications could include instructor-led training sessions; self-paced sessions in which 3-D objects such as rooms or kiosks are manipulated to view digital media assets; practice sessions in which individuals or teams rehearse new skills in realistic environments such as crowds or under fire; and after-action reviews in which instructors replay and critique sessions.

The Army’s Talbot said virtual worlds could be particularly useful for mirroring the condition of large team exercises involving multiple casualties and multiple echelons of care.

“We lack capability to integrate with combat forces and use the radio net,” Talbot said. “We have been looking at virtual worlds because they can overcome these limitations and even let us do follow-on training remotely.”

MOVING FORWARD

A number of projects and technology offerings are currently in various stages of development. For example, the U.S. Army RDECOM’s Simulation and Training Technology Center partnered with the University of Southern California Institute for Creative Technologies to develop a prototype Virtual Sick Call program, featuring a virtual, life-sized human.

In addition, Immersion released an update to its laparoscopic cholecystectomy that more closely mimics the real dissection of Calot’s triangle and the removal of the gallbladder. For the company’s EndoVR system, it also recently released an endobronchial ultrasound with guided transbronchial needle aspiration that allows a user to navigate the bronchial tree and visualize lymph nodes and vessels via ultrasound assistance. Lymph node samples are then aspirated with a simulated needle.

“Laparoscopic appendectomy is the next module on the development horizon,” Immersion’s Kunkler said. “It will utilize many of the developments from laparoscopic cholecystectomy, but will have additional instruments to perform this procedure.”

For its part, Forterra will provide three new or updated features to its software in the next six months that will aid medical training, including a scenario editor, which will be released to complement the company’s existing scene editor.

“The combination of these two editors allows mix and match of terrain scenes, objects, and loadable ‘actives’ to create reusable realistic or imagined settings,” Macedonia said. “Scenarios can be configured with role-based positions and pre-set clothing for repeatable training exercises or practice sessions.”

Forterra has also enhanced its 3-D record and replay feature for supporting after-action reviews, to enable easier labeling and bookmarking of replays, and enhancing some of the voice control features. The company also will release an application program interface to support artificial intelligence middleware integration so nonplayer characters can be added into scenarios.

While ever more capable virtual learning applications are being delivered to the service customer, a number of applications remain on people’s wish lists. For example, the Air Force’s Colonel Burgess said that there are no realistic simulator models of intra-thoracic or intra-abdominal tissue or bleeding. Of course, not only are there still technological limitations, but funding limitations exist as well. In an era of potentially tighter DoD budgets, affordability remains on the mind of vendors and their government customers. Immersion’s Kunkler observed that there is a tradeoff, for instance, between higher resolution computing platforms and cost.

“[But] as performance of the underlying platform continues to improve at lower price points, we will be able to deliver higher fidelity graphics and haptics at price points that are optimal for our customers,” he said. ♦

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