Assessment of construct validity of a virtual reality laparoscopy simulator.

BACKGROUND: The aim of this study was to assess whether virtual reality (VR) can discriminate between the skills of novices and intermediate-level laparoscopic surgical trainees (construct validity), and whether the simulator assessment correlates with an expert's evaluation of performance. METHODS: Three hundred and seven (307) participants of the 19th-22nd Davos International Gastrointestinal Surgery Workshops performed the clip-and-cut task on the Xitact LS 500 VR simulator (Xitact S.A., Morges, Switzerland). According to their previous experience in laparoscopic surgery, participants were assigned to the basic course (BC) or the intermediate course (IC). Objective performance parameters recorded by the simulator were compared to the standardized assessment by the course instructors during laparoscopic pelvitrainer and conventional surgery exercises. RESULTS: IC participants performed significantly better on the VR simulator than BC participants for the task completion time as well as the economy of movement of the right instrument, not the left instrument. Participants with maximum scores in the pelvitrainer cholecystectomy task performed the VR trial significantly faster, compared to those who scored less. In the conventional surgery task, a significant difference between those who scored the maximum and those who scored less was found not only for task completion time, but also for economy of movement of the right instrument. CONCLUSIONS: VR simulation provides a valid assessment of psychomotor skills and some basic aspects of spatial skills in laparoscopic surgery. Furthermore, VR allows discrimination between trainees with different levels of experience in laparoscopic surgery establishing construct validity for the Xitact LS 500 clip-and-cut task. Virtual reality may become the gold standard to assess and monitor surgical skills in laparoscopic surgery.

Clinical Learning Environment and Supervision. Development and Validation of the CLES Evaluation Scale

The purpose of the study is: (1) to describe how nursing students' experienced their clinical learning environment and the supervision given by staff nurses working in hospital settings; and (2) to develop and test an evaluation scale of Clinical Learning Environment and Supervision (CLES). The study has been carried out in different phases. The pilot study (n=163) explored the association between the characteristics of a ward and its evaluation as a learning environment by students. The second version of research instrument (which was developed by the results of this pilot study) were tested by an expert panel (n=9 nurse teachers) and test-retest group formed by student nurses (n=38). After this evaluative phase, the CLES was formed as the basic research instrument for this study and it was tested with the Finnish main sample (n=416). In this phase, a concurrent validity instrument (Dunn & Burnett 1995) was used to confirm the validation process of CLES. The international comparative study was made by comparing the Finnish main sample with a British sample (n=142). The international comparative study was necessary for two reasons. In the instrument developing process, there is a need to test the new instrument in some other nursing culture. Other reason for comparative international study is the reflecting the impact of open employment markets in the European Union (EU) on the need to evaluate and to integrate EU health care educational systems. The results showed that the individualised supervision system is the most used supervision model and the supervisory relationship with personal mentor is the most meaningful single element of supervision evaluated by nursing students. The ward atmosphere and the management style of ward manager are the most important environmental factors of the clinical ward. The study integrates two theoretical elements - learning environment and supervision - in developing a preliminary theoretical model. The comparative international study showed that, Finnish students were more satisfied and evaluated their clinical placements and supervision with higher scores than students in the United Kingdom (UK). The difference between groups was statistical highly significant (p= 0.000). In the UK, clinical placements were longer but students met their nurse teachers less frequently than students in Finland. Arrangements for supervision were similar. This research process has produced the evaluation scale (CLES), which can be used in research and quality assessments of clinical learning environment and supervision in Finland and in the UK. CLES consists of 27 items and it is sub-divided into five sub-dimensions. Cronbach's alpha coefficient varied from high 0.94 to marginal 0.73. CLES is a compact evaluation scale and user-friendliness makes it suitable for continuing evaluation.

Evaluation of Virtual Reality Snowplow Simulator Training: A Literature Review, September 2006

Each winter, the Iowa Department of Transportation (Iowa DOT) maintenance operators are primarily responsible for plowing snow off federal and state roads. Drivers typically work long shifts under treacherous conditions. In addition to properly navigating the vehicle, drivers are required to operate several plowing mechanisms simultaneously, such as plow controls and salt sprayers. However, operators have few opportunities during the year to practice and refine their skills. An ideal training program would provide operators with the opportunity to practice these skills under realistic yet safe conditions, as well as provide basic training to novice or less-experienced operators. Recent technological advancements have made driving simulators a desirable training and research tool. This literature review discusses much of the recent research establishing simulator fidelity and espousing its applicability. Additionally, this report provides a summary of behavioral and eye tracking research involving driving simulators. Other research topics include comparisons between novice and expert drivers’ behavioral patterns, methods for avoiding cybersickness in virtual environments, and a synopsis of current personality measures with respect to job performance and driving performance. This literature review coincides with a study designed to examine the effectiveness of virtual reality snowplow simulator training for current maintenance operators, using the TranSim VS III truck and snowplow simulator recently purchased by the Iowa DOT.

Evaluation of Virtual Reality Snowplow Simulator Training, January 2007

Each winter, Iowa Department of Transportation (Iowa DOT) maintenance operators are responsible for plowing snow off federal and state roads in Iowa. Drivers typically work long shifts under treacherous conditions. In addition to properly navigating the vehicle, drivers are required to operate several plowing mechanisms simultaneously, such as plow controls and salt spreaders. There is little opportunity for practicing these skills in real-world situations. A virtual reality training program would provide operators with the opportunity to practice these skills under realistic yet safe conditions, as well as provide basic training to novice or less-experienced operators. In order to provide such training to snowplow operators in Iowa, the Iowa DOT purchased a snowplow simulator. The Iowa DOT commissioned a study through Iowa State University designed to (1) assess the use of this simulator as a training tool and (2) examine personality and other characteristics associated with being an experienced snowplow operator. The results of this study suggest that Iowa DOT operators of all ages and levels of experience enjoyed and seemed to benefit from virtual reality snowplow simulator training. Simulator sickness ratings were relatively low, implying that the simulator is appropriate for training a wide range of Iowa DOT operators. Many reported that simulator training was the most useful aspect of training for them.

Access to a simulator is not enough: the benefits of virtual reality training based on peer-group-derived benchmarks--a randomized controlled trial.

BACKGROUND: Virtual reality (VR) simulators are widely used to familiarize surgical novices with laparoscopy, but VR training methods differ in efficacy. In the present trial, self-controlled basic VR training (SC-training) was tested against training based on peer-group-derived benchmarks (PGD-training). METHODS: First, novice laparoscopic residents were randomized into a SC group (n = 34), and a group using PGD-benchmarks (n = 34) for basic laparoscopic training. After completing basic training, both groups performed 60 VR laparoscopic cholecystectomies for performance analysis. Primary endpoints were simulator metrics; secondary endpoints were program adherence, trainee motivation, and training efficacy. RESULTS: Altogether, 66 residents completed basic training, and 3,837 of 3,960 (96.8 %) cholecystectomies were available for analysis. Course adherence was good, with only two dropouts, both in the SC-group. The PGD-group spent more time and repetitions in basic training until the benchmarks were reached and subsequently showed better performance in the readout cholecystectomies: Median time (gallbladder extraction) showed significant differences of 520 s (IQR 354-738 s) in SC-training versus 390 s (IQR 278-536 s) in the PGD-group (p < 0.001) and 215 s (IQR 175-276 s) in experts, respectively. Path length of the right instrument also showed significant differences, again with the PGD-training group being more efficient. CONCLUSIONS: Basic VR laparoscopic training based on PGD benchmarks with external assessment is superior to SC training, resulting in higher trainee motivation and better performance in simulated laparoscopic cholecystectomies. We recommend such a basic course based on PGD benchmarks before advancing to more elaborate VR training.

Supporting interdisciplinary case studies: development and implementation of a joint learning environment for students in forensic science and criminal law

Scientific reporting and communication is a challenging topic for which traditional study programs do not offer structured learning activities on a regular basis. This paper reports on the development and implementation of a web application and associated learning activities that intend to raise the awareness of reporting and communication issues among students in forensic science and law. The project covers interdisciplinary case studies based on a library of written reports about forensic examinations. Special features of the web framework, in particular a report annotation tool, support the design of various individual and group learning activities that focus on the development of knowledge and competence in dealing with reporting and communication challenges in the students' future areas of professional activity.

The future of patient safety: Surgical trainees accept virtual reality as a new training tool.

BACKGROUND: The use of virtual reality (VR) has gained increasing interest to acquire laparoscopic skills outside the operating theatre and thus increasing patients' safety. The aim of this study was to evaluate trainees' acceptance of VR for assessment and training during a skills course and at their institution. METHODS: All 735 surgical trainees of the International Gastrointestinal Surgery Workshop 2006-2008, held in Davos, Switzerland, were given a minimum of 45 minutes for VR training during the course. Participants' opinion on VR was analyzed with a standardized questionnaire. RESULTS: Fivehundred-twenty-seven participants (72%) from 28 countries attended the VR sessions and answered the questionnaires. The possibility of using VR at the course was estimated as excellent or good in 68%, useful in 21%, reasonable in 9% and unsuitable or useless in 2%. If such VR simulators were available at their institution, most course participants would train at least one hour per week (46%), two or more hours (42%) and only 12% wouldn't use VR. Similarly, 63% of the participants would accept to operate on patients only after VR training and 55% to have VR as part of their assessment. CONCLUSION: Residents accept and appreciate VR simulation for surgical assessment and training. The majority of the trainees are motivated to regularly spend time for VR training if accessible.

Emotions in a Web-based Learning Environment

The aim of this thesis was to examine emotions in a web-based learning environment (WBLE). Theoretically, the thesis was grounded on the dimensional model of emotions. Four empirical studies were conducted. Study I focused on students’ anxiety and their self-efficacy in computer-using situations. Studies II and III examined the influence of experienced emotions on students’ collaborative visible and non-collaborative invisible activities and lurking in a WBLE. Study II also focused on the antecedents of the emotions students experience in a web-based learning environment. Study IV concentrated on clarifying the differences between emotions experienced in face-to-face and web-based collaborative learning. The results of these studies are reported in four original research articles published in scientific journals. The present studies demonstrate that emotions are important determinants of student behaviour in a web-based learning, and justify the conclusion that interactions on the web can and do have an emotional content. Based on the results of these empirical studies, it can be concluded that the emotions students experience during the web-based learning result mostly from the social interactions rather than from the technological context. The studies indicate that the technology itself is not the only antecedent of students’ emotional reactions in the collaborative web-based learning situations. However, the technology itself also exerted an influence on students’ behaviour. It was found that students’ computer anxiety was associated with their negative expectations of the consequences of using technology-based learning environments in their studies. Moreover, the results also indicated that student behaviours in a WBLE can be divided into three partially overlapping classes: i) collaborative visible ii) non-collaborative invisible activities, and iii) lurking. What is more, students’ emotions experienced during the web-based learning affected how actively they participated in such activities in the environment. Especially lurkers, i.e. students who seldom participated in discussions but frequently visited the online environment, experienced more negatively valenced emotions during the courses than did the other students. This result indicates that such negatively toned emotional experiences can make the lurking individuals less eager to participate in other WBLE courses in the future. Therefore, future research should also focus more precisely on the reasons that cause individuals to lurk in online learning groups, and the development of learning tasks that do not encourage or permit lurking or inactivity. Finally, the results from the study comparing emotional reactions in web-based and face-to-face collaborative learning indicated that the learning by means of web-based communication resulted in more affective reactivity when compared to learning in a face-to-face situation. The results imply that the students in the web-based learning group experienced more intense emotions than the students in the face-to-face learning group.The interpretations of this result are that the lack of means for expressing emotional reactions and perceiving others’ emotions increased the affectivity in the web-based learning groups. Such increased affective reactivity could, for example, debilitate individual’s learning performance, especially in complex learning tasks. Therefore, it is recommended that in the future more studies should be focused on the possibilities to express emotions in a text-based web environment to ensure better means for communicating emotions, and subsequently, possibly decrease the high level of affectivity. However, we do not yet know whether the use of means for communicating emotional expressions via the web (for example, “smileys” or “emoticons”) would be beneficial or disadvantageous in formal learning situations. Therefore, future studies should also focus on assessing how the use of such symbols as a means for expressing emotions in a text-based web environment would affect students’ and teachers’ behaviour and emotional state in web-based learning environments.

Touching the void: exploring virtual objects through a vibrotactile glove

This paper describes a simple low-cost approach toadding an element of haptic interaction within a virtualenvironment. Using off-the-shelf hardware and software wedescribe a simple setup that can be used to explore physically virtual objects in space. This setup comprises of a prototype glove with a number of vibrating actuators to provide the haptic feedback, a Kinect camera for the tracking of the user's hand and a virtual reality development environment. As proof of concept and to test the efficiency of the system as well as its potential applications, we developed a simple application where we created 4 different shapes within a virtual environment in order to try toexplore them and guess their shape through touch alone.

Extending body space in immersive virtual reality: a very long arm illusion

Recent studies have shown that a fake body part can be incorporated into human body representation through synchronous multisensory stimulation on the fake and corresponding real body part- the most famous example being the Rubber Hand Illusion. However, the extent to which gross asymmetries in the fake body can be assimilated remains unknown. Participants experienced, through a head-tracked stereo head-mounted display a virtual body coincident with their real body. There were 5 conditions in a between-groups experiment, with 10 participants per condition. In all conditions there was visuo-motor congruence between the real and virtual dominant arm. In an Incongruent condition (I), where the virtual arm length was equal to the real length, there was visuo-tactile incongruence. In four Congruent conditions there was visuo-tactile congruence, but the virtual arm lengths were either equal to (C1), double (C2), triple (C3) or quadruple (C4) the real ones. Questionnaire scores and defensive withdrawal movements in response to a threat showed that the overall level of ownership was high in both C1 and I, and there was no significant difference between these conditions. Additionally, participants experienced ownership over the virtual arm up to three times the length of the real one, and less strongly at four times the length. The illusion did decline, however, with the length of the virtual arm. In the C2-C4 conditions although a measure of proprioceptive drift positively correlated with virtual arm length, there was no correlation between the drift and ownership of the virtual arm, suggesting different underlying mechanisms between ownership and drift. Overall, these findings extend and enrich previous results that multisensory and sensorimotor information can reconstruct our perception of the body shape, size and symmetry even when this is not consistent with normal body proportions.

The Use of virtual reality in the study of people's responses to violent incidents

This paper reviews experimental methods for the study of the responses of people to violence in digital media, and in particular considers the issues of internal validity and ecological validity or generalisability of results to events in the real world. Experimental methods typically involve a significant level of abstraction from reality, with participants required to carry out tasks that are far removed from violence in real life, and hence their ecological validity is questionable. On the other hand studies based on fi eld data, while having ecological validity, cannot control multiple confounding variables that may have an impact on observed results, so that their internal validity is questionable. It is argued that immersive virtual reality may provide a unifi cation of these two approaches. Since people tend to respond realistically to situations and events that occur in virtual reality, and since virtual reality simulations can be completely controlled for experimental purposes, studies of responses to violence within virtual reality are likely to have both ecological and internal validity. This depends on a property that we call"plausibility"- including the fi delity of the depicted situation with prior knowledge and expectations. We illustrate this with data from a previously published experiment, a virtual reprise of Stanley Milgram"s 1960s obedience experiment, and also with pilot data from a new study being developed that looks at bystander responses to violent incidents.

Multisensory stimulation can induce an illusion of larger belly size in immersive virtual reality

Body change illusions have been of great interest in recent years for the understanding of how the brain represents the body. Appropriate multisensory stimulation can induce an illusion of ownership over a rubber or virtual arm, simple types of out-of-the-body experiences, and even ownership with respect to an alternate whole body. Here we use immersive virtual reality to investigate whether the illusion of a dramatic increase in belly size can be induced in males through (a) first person perspective position (b) synchronous visual-motor correlation between real and virtual arm movements, and (c) self-induced synchronous visual-tactile stimulation in the stomach area.

First person experience of body transfer in virtual reality

Altering the normal association between touch and its visual correlate can result in the illusory perception of a fake limb as part of our own body. Thus, when touch is seen to be applied to a rubber hand while felt synchronously on the corresponding hidden real hand, an illusion of ownership of the rubber hand usually occurs. The illusion has also been demonstrated using visuomotor correlation between the movements of the hidden real hand and the seen fake hand. This type of paradigm has been used with respect to the whole body generating out-of-the-body and body substitution illusions. However, such studies have only ever manipulated a single factor and although they used a form of virtual reality have not exploited the power of immersive virtual reality (IVR) to produce radical transformations in body ownership.

Body Image in Eating Disorders: The Influence of Exposure to Virtual-Reality Environments.

The aim of this article was to study the effect of virtual-reality exposure to situations that are emotionally significant for patients with eating disorders (ED) on the stability of body-image distortion and body-image dissatisfaction. A total of 85 ED patients and 108 non-ED students were randomly exposed to four experimental virtual environments: a kitchen with low-calorie food, a kitchen with high-calorie food, a restaurant with low-calorie food, and a restaurant with high-calorie food. In the interval between the presentation of each situation, body-image distortion and body-image dissatisfaction were assessed. Several 2 x 2 x 2 repeated measures analyses of variance (high-calorie vs. low-calorie food x presence vs. absence of people x ED group vs. control group) showed that ED participants had significantly higher levels of body-image distortion and body dissatisfaction after eating high-calorie food than after eating low-calorie food, while control participants reported a similar body image in all situations. The results suggest that body-image distortion and body-image dissatisfaction show both trait and state features. On the one hand, ED patients show a general predisposition to overestimate their body size and to feel more dissatisfied with their body image than controls. On the other hand, these body-image disturbances fluctuate when participants are exposed to virtual situations that are emotionally relevant for them.

Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study

Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1) simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions); (2) dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries). Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered