Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of training interdisciplinary healthcare personnel in a virtual, 3D, world versus a physical simulation laboratory? Is training in a virtual, 3D, world transferrable to a physical environment?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Simulation may include high-fidelity simulators versus simulations mirroring the immersive environment found in commercial video games that offer a variety of benefits superior to physical mannequins. These include the ability to quickly and accurately produce numerous low volume/high risk medical situations encountered infrequently in clinical situations, the ability for the trainee to practice often and obtain feedback privately, and the potential to virtually encounter different patient, family and staff behaviors/cultures which are complex to model, but likely to substantially affect patient outcome.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

All patient groups during acute events, i.e respiratory and/or cardiac arrest. The focus would be on interdisciplinary teams of healthcare providers

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Video game technology is a powerful medium for training and offers a variety of benefits superior to physical mannequins or actors. These include the ability to quickly and accurately produce numerous low incidence/high risk medical situations not encountered in clinical situations, the ability to practice often and obtain feedback privately, and the potential to virtually encounter different patient, family and staff behaviors/cultures which are complex to model, but likely to substantially affect patient outcome. Additionally,

• Shorten training time
• Provide training to large numbers, more than live demos or physical simulations can handle at one time
• Provide “worst-case” scenarios in a risk-free environment
• Improve training for high-risk, low volume cases, and address training by random encounter
• Permit the learner to learn in a self-directed way with as many repetitions as desired to enhance practice and practice decision making
• Standardize the care situations considered critical to safe, quality care in which each new employee must demonstrate competence
• Standardize the evaluation process for both entry into practice and periodic updating
• Improve interdisciplinary team communications
• Enhance cultural competence (that related to patient heritage as well as that associated with work environment)
• Enhance patient safety
• Incorporate evidence based care

Describe any health-related risks, side effects, or harms that you are concerned about.

None identified

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Pulmonary disease/asthma

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

None

Importance

Describe why this topic is important.

Communication failures are the leading cause of inadvertent patient harm. In July of 2004, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) published a sentinel event report, The primary root cause in over 70% was communication failure. Organizational culture was cited as a barrier to effective communication and teamwork, i.e. hierarchy, intimidation, failure to function as a team, and failure to follow the chain-of communication.”

JCAHO went on to make recommendations to improve the areas identified in the root cause analysis. These recommendations include team training, mock emergency drills, and debriefings aimed at evaluating team performance in order to identify areas in need of improvement.

Unfortunately, the emphasis today in healthcare is on the individual practitioner’s knowledge and skills, instead of team performance. Quality and safety has previously been structured around one individual practitioner, rather than the team as a whole. Teamwork, which includes effective communication, has often been assumed and training and assessment in many of these areas has not been done.6 Additionally, human factors related to team performance are usually not documented or evaluated. Simulation may be one tool that can be utilized to increase competence for all members of the medical team. However, physical simulation laboratories are limited by brick and mortar. A virtual simulation laboratory offers benefits such as:

• Ease of training. No brick-and-mortar facilities are needed for virtual training.

With the proper design, trainees can use the system at any time, from anywhere in the world. Many more trainees can be reached than with physical simulations, and virtual trainers can be more cost effective in the long run.

• Virtual environments can create training situations difficult or impossible to create with physical simulation or real-world patients.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

The University of Texas at Dallas (UT Dallas) and the University of Texas at Arlington School of Nursing(UTASON) have collaborated to create a new type of medical virtual training for neonatal/infant care based on serious games, driven by behavioral/cultural models, which has raised the level of medical training realism. Our 3-D Interactive Model integrates visualization, sound design, and behavioral/cultural modeling with recursive assessment tools to create a medical living world that is sensory and culturally realistic.

Key elements are the virtual infant patient (VIPTM), the virtual patient family (VPFTM) and the virtual medical staff (VMSTM).

In the collaboration between UT Dallas and UT Arlington many of the skill sets necessary to advance this technology are present. UTASON faculty serve as neonatal/infant subject matter experts, while faculty at UT Dallas provide technology design and production. The alliance is seeking a corporate partner to accelerate development of the technology and provide additional key resources.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

no

If yes, please explain:

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

With the proper design, trainees can use the system at any time, from anywhere in the world. Many more trainees can be reached than with physical simulations, and virtual trainers can be more cost effective in the long run.

Describe the timeframe in which an answer to your question is needed.

a. Phase One – Development year one and 2 Step One: Identify Training Module Requirements

• Content
• Data Availability
• Training Audience
• Training Assessment Criteria and Plan
• Analysis and recommendation of appropriate game/simulation engine and other hardware/software requirements (iterative and ongoing).

Step Two: Develop Production Plan for Training Module Requirements

• Visualization
• Audio Design
• Behavioral/cultural models
• Recursive assessment tools Step Three: Production of Stage One Training Module Step Four: Training Trial Step Five: Training Trial Assessment Step Six: Training Module Enhancement and Modification Step Seven: Training Trial Step Eight: Final Enhancements and Modifications Step Nine: Roll Out of Training Module Step Ten: Assessment of Rollout
• Phase Two—Implementation year 3 Step One: Identify full trainee plan Step Two: Identify full training module production plan

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

With the proper design, trainees can use the system at any time, from anywhere in the world. Many more trainees can be reached than with physical simulations, and virtual trainers can be more cost effective in the long run.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

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