MEDICAL TRAINING VIA VIRTUAL SIMULATION

Progress in Medical Training Via Virtual Simulation

Lauren N. Sheehan
College of DuPage

Author Note
This paper was prepared as fulfillment of a requirement for English 1102 Spring 2014.

MEDICAL TRAINING VIA VIRTUAL SIMULATION

This paper discusses the use of virtual simulation as a training tool for medical students and how
the students are able to use this environment to their benefit. Although these simulations can be
extremely expensive, students are able to practice at the time of their convenience and receive
automatic feedback on their progress. Also, the trainees are able to utilize these simulations in a
risk-free environment, which allows them to fully understand the technique of surgery and
prepare them for when they conduct a procedure on a real patient. Overall, as technology
continues to advance, virtual simulation in the medical industry is very possible and is growing
in popularity with time. With the adoption and correct use of this tool, there are numerous
possibilities towards greater training for doctors and ultimately, greater patient care.

MEDICAL TRAINING VIA VIRTUAL SIMULATION

Virtual Simulation
Virtual Simulation, also known as virtual gaming, is making great advances in numerous
fields, particularly the medical field. Although rigorous and time consuming, many doctorate
programs do not offer the most beneficial learning tactics available a fault that can not only
effect the student in training but further on the patient they will later be in contact with. Virtual
training for medical students allows for practice of real medical procedures and occurrences
without the pressures and possible fatalities of a real life situation. In general, medical
simulations aim to imitate real patients, anatomic regions, or clinical tasks as well as mirror real
life circumstances in which medical services are rendered (Scalese, Obeso & Issenberg, 2008)
while also providing a stress free environment for the student to work in. Take for example,
Georgetown Universitys simulator, GUS, that can realistically replicate physiological
conditions and symptoms and pharmacological responses. GUS, who can be age 18 or 70,
features heart and lung sounds, papillary reactions, and can be used to teach ventilation,
intubation, and follow-up assessment.
Considering such powerful advances in technology, simulation can prove its extremely
beneficial qualities in the training of medical students, but may also serve to show that this
training tool does have its drawbacks and must be incorporated correctly in a well-thought out
curriculum in order to be successful (Seymour, Gallagher, Roamn, OBrien, Bansal, Andersen &
Satava, 2002, p. 458).
Benefits of Virtual Simulation
Virtual simulation began to take form when the rapid expansion of minimally invasive
surgery (MIS) came into effect, proving that the traditional model of see one, do one, teach
one is not an optimal approach for training certain surgical skills (Gallagher et al., n.d. 2005, p.

MEDICAL TRAINING VIA VIRTUAL SIMULATION

364). Since, virtual medical simulators have grown and shown their strength in many areas,
proving to be a students best friend at times. Performance can be measured with immediate
feedback given without the need to have an experienced teacher present during each step of
instruction. Simulators can be made available to the student at any convenient time, as well as
minimize the expensive and problematic use of animals for educational purposes (Ahlberg,
Arvidsson, Heikkinen, Iselius, Leijonmarck, & Rutqvist, 2002). In addition, simulators do not
become tired or embarrassed or behave unpredictably as might real, especially ill patients
(Scalese, Obeso & Issenberg, 2008, p 187), which can be extremely helpful to a student looking
for the basis of training without disturbances. One of the greatest benefits virtual simulators may
offer is the allowance of the trainee to automate in a risk-free environment and the trainer to
monitor the users progress (Gallagher, Ritter, Champion, Higgins, Fried, Moses, Smith, &
Satava, 2005, p. 364).
FIGURE 1

MEDICAL TRAINING VIA VIRTUAL SIMULATION

Figure 1. Using Simulators. Students can use simulators to practice skills and prepare
for surgery in a virtual, risk free setting.
Laerdal Virtual I.V. Simulator [Photograph]. (n.d.). Retrieved from
http://www.immersion.com/markets/medical/products/#tab=viv

Simulators attempt to give the student the most realistic virtual experience possible,
incorporating virtual humans to help guide the user on their simulated course. Virtual humans
have become a large and important part of many virtual reality applications due to their
believable and more natural interactions with the users, while also serving as an instructor
(Rizzo, 2008).
Although seemingly flawless, many have had their reservations about this powerful tool,
which has caused a delay in its adoption in the medical field. According to Gallagher (2005), the
two most likely reasons this delay of virtual simulators is due to the "initial lack of robust
scientific evidence to support the use of VR for skills training" as well as the "lack of knowledge
of how to effectively apply simulation to a surgical skills training program, both of which issues
will be covered later. But aside from these concerns lies a somewhat greater obstacle, its
expense.
Many of the most sophisticated VR simulators can be extremely expensive, for example
the VIST system, a full physics model of the vascular system that simulates in real time, can cost
around $300,000 per unit. Not all training programs are able to afford this level of simulation,
forcing teachers to either do without this tool, or purchase a lower model which requires looking
beyond face validity of simulators and asking more important questions, such as, does it work
(ie, train the appropriate skills, how well does it work, and how good is the evidence?)
(Gallagher, 2005). Although value and some training tactics may be lost, even lower model

MEDICAL TRAINING VIA VIRTUAL SIMULATION

simulators can offer great practice and training for students if incorporated into the students
curriculum correctly, a point that will be discussed further on.

Practice Put to the Test

To test the transfer of skills from virtual reality to operating room a study was conducted
under the Department of Surgery at Yale University School of Medicine. Sixteen surgical
residents were randomized into VR (virtual reality) training or control non-VR training prior to
performing a laparoscopic cholecystectomy with an attending surgeon blinded to training status.
Next, two investigators, also blinded to training status, reviewed videotapes of the gallbladder
dissection independently and results were pro-VR. Gall bladder dissection was 29% faster for
VR trained residents. Non-VR trained residents were nine times more likely to transiently fail to
make progress, and five times more likely to injure the gallbladder or burn nontarget tissue.
Mean errors were six times less likely to occur in the VR-trained group (Seymour, Gallagher,
Roamn, OBrien, Bansal, Andersen & Satava, 2002, p. 458).
Years later in 2010, a study was conducted to find a sufficient way to implement CPR
training and investigate how a serious game setting in a virtual world would influence medical
students subjective experiences as well as retention of knowledge. A MMVW (massively
multiplater virtual world) was refined and used in this study to train twelve medical students in
CPR in 3-person teams in a repeated fashion six months apart. The majority of the subjects
reported that they had enjoyed the training, had found it to be suitable, and had learned
something new, although several asked for more difficult and complex scenarios as well as a
richer virtual environment (Cruetzfeldt, Hedman, Medin, Heinrichs, Li-Fellander-Tsai, 2010).
Over the six-month experience, the mean values for knowledge dropped, self-efficiency

MEDICAL TRAINING VIA VIRTUAL SIMULATION

increased, and mean perceived concentration increased. According to this study, using scenario
based virtual world team training to train medical students in multi-person CPR was feasible and
showed promising results as well as reported increased concentration and enthusiasm during
training.
FIGURE 2

Figure 2. Inside the Virtual World. Students can use simulators to work in teams within
the virtual world to practice procedures and prepare for medical occurrences,
such as CPR.

[Virtual Reality Medical Simulation]. (n.d.). Retrieved from

http://www.medgadget.com/2010/06/virtual_reality_medical_simulator_being_adopted_
by_duke_medical_school.html

Curriculum
Prior to training in a virtual setting, the individuals being prepared to perform the specific
procedure need to know what to do, what not to do, how to do what they need to do, and how to

MEDICAL TRAINING VIA VIRTUAL SIMULATION

identify when they have made a mistake. That being said, one cannot just jump into virtual
reality medical training nor have it be their sole teacher and training tactic. According to
Gallagher (2005), virtual reality is most likely to be successful if it is systematically integrated
into a well-thought-out education and training program that objectively assesses technical skills
proximate to the learning experience. As mentioned before, a delay in the adoption of virtual
reality is partly due to lack of knowledge in how to effectively apply simulation to a surgical
skills training program. As used today, simulators primarily provide training rather than
education. Training, referred to as the acquisition of skills, is a large part of the curriculum but
does not account for the education part, which refers to the communication or acquisition of
knowledge (Gallagher, Ritter, Champion, Higgins, Fried, Moses, Smith, & Satava, 2005, p. 364).
A program must offer a balance between the two in order to produce success within the student.
Another crucial component to success includes the concepts of skills generalization and
skills transfer, elements that must be incorporated into any virtual reality curriculum. Although
similar, skills generalization refers to the training situation where the trainee learns fundamental
skills that are crucial to completion of the actual operative task or procedure while skills transfer
refers to a training modality that directly mimics the task to be performed in vivo or in the testing
condition (Gallagher, 2005). Gallagher proposed template for developing a curriculum,
including the means of study from beginning, middle, to end. The steps included: (1) didactic
teaching of relevant knowledge (ie. Anatomy, physiology etc.), (2) instruction on the steps of the
procedure, (3) defining common errors, (4) testing on previous didactic information to determine
if student understands cognitive skills prior to performing technical skills, (5) technical skills
training on simulator, (6) provide immediate feedback when error occurs, (7) provide summative
feedback at completion of trial.

MEDICAL TRAINING VIA VIRTUAL SIMULATION

In order for the best outcomes for students, Gallagher writes that a given programs
virtual reality simulator and its trainers and must know and track how the student is progressing
and/or where they are on the learning curve as well as assess their progress in psychomotor and
cognitive learning consistently (2005).

Conclusion
In conclusion, the research has shown evidence to believe that virtual simulation for the
use of medical training is not only possible, but also has had positive effects on students and
users. With the help of virtual training, medical students should be able to practice their skills
through this game-based interaction, a tool that will help them further their knowledge without
dealing with (or possibly harming) a live human in the process. Although a tool like this may be
high in cost, the benefit of saving lives in a more efficient and well-rehearsed manner may
certainly outweigh such downfalls. It is in the best interest of the medical world to continue
research in this area of technology in hopes of better patient care as well as working towards
safer and more consistent doctors. As a current nursing student, I look forward to such advances
and will continue to invest a great deal of interest in this topic.

MEDICAL TRAINING VIA VIRTUAL SIMULATION

10

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