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Applying a Web and Simulation-Based System for Adaptive Competence Assessment of Spinal Anaesthesia


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The authors present an approach for implementing a system for the assessment of medical competences using a haptic simulation device. Based on Competence based Knowledge Space Theory (CbKST), information on the learners’ competences is gathered from different sources (test questions, data from the simulator, and supervising experts’ assessments). The envisaged architecture consists of three core modules, an LMS (Moodle) containing user model and content objects and realising the interface between system and user, a simulator interface as an own service connecting the LMS to the (external) simulator system, and a CbKST service offering the assessment logic and visualisations of the assessment result for learner and teacher.
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Applying a Web and Simulation-Based System for
Adaptive Competence Assessment of Spinal Anaesthesia
Cord Hockemeyer1, Alexander Nussbaumer1, Erik Lövquist2, Annette Aboulafia2,
Dorothy Breen3, George Shorten3, and Dietrich Albert1
1 Department of Psychology, University of Graz, Austria
2Interaction Design Centre, University of Limerick, Ireland
3Health Services Executive South, Cork University Hospital, Ireland
Abstract. The authors present an approach for implementing a system for the
assessment of medical competences using a haptic simulation device. Based on
Competence based Knowledge Space Theory (CbKST), information on the
learners’ competences is gathered from different sources (test questions, data
from the simulator, and supervising experts’ assessments).
The envisaged architecture consists of three core modules, an LMS
(Moodle) containing user model and content objects and realising the interface
between system and user, a simulator interface as an own service connecting the
LMS to the (external) simulator system, and a CbKST service offering the
assessment logic and visualisations of the assessment result for learner and
Keywords: Adaptive Competence Assessment, Medical Training, Haptics,
Simulation, Moodle, Competence-based Knowledge Space Theory, Spinal
1 Introduction
Medical training has been undergoing major changes worldwide, recently. Reasons
for this include new employment legislation as well as changing patient expectations,
increasing awareness for quality assurance needs, and liability jurisdiction. As a
result, it is becoming less acceptable that doctors in-training practice their procedural
skills on patients. One solution to this is the application of advanced computer
technology (e.g., Virtual Reality or haptic devices) for simulating medical procedures
during the early practical training.
This paper describes the MedCAP [] approach to integrate a
haptic device and a psychological model of knowledge and competences with a state
Hockemeyer, C., Nussbaumer, A., Lövquist, E., Aboulafia, A., Breen, D., Shorten, G., &
Albert, D. (2009). Applying a Web and Simulation-Based System for Adaptive
Competence Assessment of Spinal Anaesthesia. In M. Spaniol, Q. Li, R. Klamma & R.
Lau (Eds.), Advances in Web Based learning - ICWL 2009. Lecture Notes in Computer
Science (Vol. 5686, pp. 182-191). Berlin: Springer.
of the art learning management system. Within this aim, we focus on the technical
realisation of previously published conceptual ideas [1, 2].
After briefly introducing spinal anaesthesia and the Competence-based Knowledge
Space Theory (CbKST) in the remainder of this introduction, we will give some
general information on the web and simulation based system for spinal anaesthesia. In
Section 3, we describe the adaption of CbKST’s competence assessment procedure to
the medical domain, and in Section 4 the architecture of the resulting system.
1.1 Procedure of Spinal Anaesthesia
Spinal anaesthesia involves injecting a small amount of local anaesthetic through a
needle inserted between the spinal vertebrae, below the end of the spinal cord into the
surrounding spinal fluid (Figure 1). The local anaesthetic quickly blocks the patient’s
sensations below the point of injection providing excellent operating conditions for
surgery on the lower part of the abdomen and legs.
Fig. 1. Demonstration of a spinal anaesthetic injection
Almost always, the procedural skill of spinal anaesthesia is learned by watching a
more experienced practitioner and subsequently performing the procedure on a patient
under close supervision. Clearly this process has disadvantages. The patient can be
put at risk by having a potentially hazardous procedure performed by a trainee. The
training opportunities are limited by the type and number of patients who are suitable
for the procedure of spinal anaesthesia during the time of the training.
1.2 Competence based Knowledge Space Theory
Doignon and Falmagne [3, 4] developed the theory of knowledge spaces originally as
a behaviouristic approach to adaptive assessment of knowledge. The core idea is to
describe a domain of knowledge by a set of test items, and to structure this set of test
items by prerequisite relationships. They identify a learner’s knowledge state as the
subset of test items this learner is able to solve. The set of possible knowledge states –
the knowledge space is strongly constrained by the prerequisite relationships. The
knowledge space also delineates reasonable learning paths, i.e. ways to sequence the
items to learn such that the learner has all the prerequisites for the current item.
The prerequisite relationships can be visualised as a Hasse diagram. Figure 2 (left
side) shows a hypothetical Hasse diagram for a set of five items (a to e) where, e.g., a
is a prerequisite of b, and b and c are both prerequisites of e. As a consequence, a also
is a prerequisite of e. The right side of Fig. 2 shows the corresponding knowledge
space (again as a Hasse diagram) and one possible learning path through this space.
Albert and his research groups have focused on investigating the underlying
cognitive structures (see, e.g., [5]) resulting in the development of Competence-based
Knowledge Space Theory (CbKST) [6]. The basic idea here is to assume the
existence of unobservable competences underlying the observed problem solving
behaviour. These competences are again structured by prerequisite relationships.
Fig. 2. Hasse diagrams of a hypothetical prerequisite relation and the corresponding knowledge
space. The dashed arrows denote one possible learning pat within that space.
The adaptive assessment of knowledge is a core element of knowledge space
theory [8, 9]. Ideally, the assessment procedure should start with a test item of
medium difficulty and then, depending on the learner’s answer, continuing with either
easier or more challenging test items. Knowledge space theory allows us to ground
this not only on some rather abstract measure of difficulty but on the concrete
prerequisites between the individual test items (or competences, respectively).
Looking at the hypothetical knowledge space in Fig. 2, a teacher might start an
assessment by asking item b. If the learner gives a correct solution, there is no need to
test item a. In case of a wrong answer, however, there would be no need to test items
d and e. On average, the teacher would have to ask 3.3 items in order to know for all
five items whether the learner can solve them or not. For larger item sets, the savings
are usually larger.
Practically, the assessment works, of course, non-deterministic. The assessment
procedure maintains a likelihood distribution over the knowledge (or competence)
space. After each evidence, the likelihood distribution is updated using a generalised
form of Bayes’ theorem, i.e. the likelihood of states fitting to the last evidence is
increased and the likelihood of states not fitting to the last evidence is decreased. The
deterministic variant described in the previous paragraph is effectively a special case
of the likelihood update where the probabilities for careless errors and lucky guesses
are 0 [8]. Simulation studies have shown that the loss of efficiency (in the sense of the
number of items to be asked) by moving from the deterministic to the probabilistic
procedure is very small [9].
2 A Web and Simulation-based System for Spinal Anaesthesia
The assessment procedure consists of two separate systems for gathering information
from the assessed anaesthetist. These two systems are interlinked to create a natural
flow of the assessment procedure.
2.1 The Web-based system
The assessment procedure utilises a problem-based learning approach, where
scenarios of patients are presented in an electronic format in the open-source learning
management system Moodle ( The patient scenarios is written by
experienced anaesthetists. Each scenario consists of information and questions, which
the assessed anaesthetist has to go through as a part of the assessment procedure. The
scenarios consist of an extensive amount of film clips and pictures, enhancing the
information given in each case. All of the media was taken in the clinical environment
by participating anaesthetists.
2.2 The Haptic Simulator
The simulator uses haptic technology, which enables the user to interact with and feel
objects in virtual environments [10]. The spinal haptic devise simulates the needle
insertion aspects of performing spinal anaesthesia and generates realistic sensations
and visual representations of actual patients [11]. It utilises a Phantom Desktop
[] and is implemented in the haptic environments H3D API
[] and Volume Haptics ToolKit (VHTK) [12].
The haptic device allows tracking the user’s movements in real time, providing the
functionality of incorporating metrics for automatic assessment of performance on the
virtual patient. Textures and 3D models representative of the patients in the cases are
incorporated in the simulator, see Fig 3.
The simulator assessment is directly linked to the question interrogation, i.e. at a
certain stage of a scenario the anaesthetist has to perform the procedure on anatomy
corresponding to the patient of that specific case.
Fig 3. To the left is a picture of the haptic device in use in the virtual environment and
to the right, a screen capture of a patient’s back.
3 Medical Competence Assessment
3.1 Adaptive Competence Assessment
Assessment procedures on “classical” knowledge spaces (i.e. in the original
behaviouristic approach by Doignon and Falmagne) have been well investigated (see,
e.g., [7, 8]). The most common approach models a likelihood distribution over the
complete knowledge space. Test problems are selected for which the likelihood
estimate of being mastered is close to 0.5, i.e. for which the system has yet little
knowledge about their mastery. Depending on the learner’s answer, the likelihood
estimate is updated applying a generalised version of Bayes’ theorem. Simulations
have shown that this procedure is very close to have a complete assessment result
with minimal effort, i.e. number of test problems posed to the learner [9].
Compared to assessment in classical knowledge space theory, the assessment of
competences in CbKST is a rather new area of research and development. A first,
straightforward approach was taken by Heller et al. [6] who suggested to do a
classical assessment on the level of test items and, afterwards, to map the resulting
knowledge state to its corresponding competence state. The more recent approach of
microadaptivity [13] includes changing the order of these steps, i.e. to interpret the
observed responses to the individual test item with respect to the underlying
competences and to perform the assessment procedure on the competence space.
More concretely, the part of microadaptivity used here is an assignment of tested
competences to each test item. Solving or failing such an item is then interpreted as
positive or negative, respectively, evidence on mastering the assigned competences.
3.2 Different Modalities of Information Gathering
In the context of medical assessment to be performed as a mixture of examination
questions, simulator work, and supervised work with patients, this combination of
different modalities provide a special challenge. A computer based system for
medical competence assessment has to be able to deal with all these different sources
of information on the candidate’s competences.
1. The classical source is test items to be posed to the candidate. As described in
Section 3.1 above, the candidate’s answers are interpreted as evidence on having or
not having the competences assigned to the respective test item.
2. A first new source refers to classical ways of teaching by supervised practising.
Instead of posing questions to the candidates, an expert supervises their work on
the simulator or on a patient. Afterwards, the expert answers a questionnaire with
respect to the candidate’s competences.
3. A second new source is given by the simulator itself. In a first step, certain metrics
will be transferred from the simulator to the learning management system after
finishing the simulation. These metrics will then be interpreted with respect to the
learner’s competences. A more advanced usage of the simulator will be the aim of
future research projects.
This leads, of course, to changes in the assessment procedure. Especially, the
selection of test problems has to be changed. The selection of test problems which
promise to uncover maximal information on the candiadate’s copetences is replaced
by a whole set of quasi-problems given at once. While such a block of information
may contain some redundancy, they will nevertheless completely be used.
Furthermore, since testing in medicine frequently follows the storyline of case
scenarios, even in the case of test items to be posed to the candidate, there can be no
arbitrary choice. Many of these test items contain information about the case that is
needed in the later course of the scenario. Therefore, instead of selecting the test item
that maximises the gain of assessment information the system can only decide
whether the next item is likely to give new assessment information or whether it could
be replaced by some message simply telling the medical data contained in the item.
4 An Integrating System Architecture
The overall system consists of three main components which are the Web application,
the Simulator (together with the simulator interface), and the CbKST service. (Two
groups of users (actors) are working on the system, the supervisors/experts and the
candidates. Furthermore, domain model and user model needed for the competence
assessment logic are stored and managed in the CbKST Web service. However,
domain and user model contain only referential information, the actual problems
(assessment items) and user information are stored in the Web application. This
design of separating Web application from assessment logic follows the approach
described in [14] and [15]. An illustration of this architecture is shown in Fig. 4.
The Web application guides the candidate through the several scenarios and
respective problems, which are stored and managed by this Web application. It also
contacts the CbKST Web Service for each problem if it should be posed or not and it
reports back about the correctness of the user’s answers (first assessment source).
Moreover it initiates the work on the simulator by contacting the simulator interface
and by telling the user to switch to the simulator. Also the expert supervising the
candidate uses the Web application to fill out the questionnaire which is also
transmitted to the CbKST Web Service in order to be used for the assessment
calculation (second assessment source). The result of the competence assessment
procedure is presented to the candidate in a simple form by showing a list of available
and non-available skills. For a more detailed graphical visualisation of the assessment
result, the Web application makes available the respective applet as part of the
CbKST Web Service by providing the link which opens this visualisation component.
The simulator allows the user’s actions to be constantly tracked when performing
the procedure on the virtual anatomy (third source of assessment information through
the simulator interface described below). The metrics are used as the measurements of
how the user is performing. Each metric can be seen as an assessment item which
tests a set of skills.
The simulator interface is the software component which connects the physical
simulator to the Web application and the CbKST service. It initiates and controls the
practice on the simulator and it reports the results of this practice to the CbKST
The CbKST service is responsible for the logic of the competence assessment. It
exposes an interface as Web Service which can be contacted by the Web application
and the simulator interface for two purposes, (i) to report correctness of assessment
items and practice on the simulator and (ii) to get the total result of the assessment in
terms of available skills. This service has implemented the algorithms for competence
assessment as described in Section 3, whereby the calculations are based on CbKST
assessment procedures as described in Section 1.2. However, in contrast to the
traditional algorithms, not the optimal problem is chosen to minimise the number to
question, but the sequence of problems is controlled by the Web application. However
updating the probabilistic values of possible knowledge states is done in the
traditional way. Deriving the competence state is conducted by investigating the
assigned skills of questions and metrics which a learner could solve. A domain model
is used which contains information about problems and metrics, skills, skill
assignment to problems, and prerequisites between skills. Furthermore, the CbKST
service has available a user model containing information which problems a learner
has already solved and which skills are available. Domain and user model information
are stored in a database on the machine of the CbKST service.
In addition to the Web Service the CbKST service also has available a visualisation
component which provides the learner with a graphical illustration of the assessment
results. Following the approach described in [16], the learner gets a skill map
(prerequisite relations between skills) in a visual form where the result is depicted. In
this way the learner can see his or her competence state in relation to the knowledge
domain. This method is supposed to initiate reflection and motivation of the learner.
An illustration of this architecture is shown in Fig. 4.
Fig 4: In this figure, the overall system architecture is illustrated containing the main
components of the system and their interconnections as well as the users (actors)
operating on the system.
The Web application is based on the popular Moodle learning management system
(LMS) which is implemented in PHP and which runs inside of an Apache Web Server
together with a MySQL database. The assessment procedure has been implemented as
an extension of Moodle. Connection to the CbKST service is performed by using the
nusoap PHP library (see The simulator
interface is implemented in Python, which is controlled by the simulation to send
appropriate information to the CbKST service. The CbKST service is realised in an
Apache Tomcat servlet container in order to provide visualisation component and
Web service. The visualisation component is developed in Java and is made available
as Applet. The Web service is exposed in an Apache Axis2 environment which is
installed in the Apache Tomcat engine. The database for domain and user model data
is located within the CbKST service. Web application and CbKST service are located
on servers accessible over the Internet. The simulator requires a dedicated workstation
connected to the Internet for accessing the web application. However, if a haptic
workstation is not available, a simplified version of the assessment procedure using
only the web application can be run on any machine with Internet access.
5 Conclusions
We have described a novel approach to competence assessment for medical trainees.
A multi-disciplinary co-operation of physicians, psychologists, and computer
scientists has been leading to an assessment system which offers several important
accomplishments. The inclusion of a haptic simulator device allows, one the one
hand, to assess the trainees’ procedural and haptic abilities without endangering
patients health. On the other side, it is also a solution for restrictions by new working
time regulations as well as restrictions imposed by the rare occurrence of special,
complicated cases. Furthermore, results of the research and development described
herein can serve as a basis towards an objective and standardized competence
assessment for young doctors.
Still, there remains much work to do. One important issue is to go beyond pure
testing and to extend the system in order to allow support also for teaching. A second
issue is to extend the contents of the system in order to comprise the whole field of
spinal anaesthesia.
Besides that, there is also the issue of computational efficiency. The medical
domain of spinal anaesthesia seems to be less structured than other fields (e.g.,
mathematics or physics) resulting in high computational demands [17]. There are
already theoretical developments on decreasing the computational demands during
competence assessment, however [18], some further research is needed in this area.
The work reported in this paper was financially supported by the European
Commission through grant no. LLP/LdV/TOI/2007/IRL-513 within the Lifelong
Learning Programme, Leonardo da Vinci sub programme.
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... The advent of powerful computational devices, 2D/3D displays, human-computer interface technologies, and associated algorithms to process the vast amount of information in real-time has given impetus to further, specialised as well generalised environments (Reiners et al., under review). There are virtual training environments to train students in particular disciplines; e.g., surgery, mechanical engineering, and other domains (Filigenzi et al., 2000;Kizil, 2003;Gunn, 2006;Hockemeyer et al., 2009). The virtual training environment is used in as much detail and authentically as possible. ...
... Different industries are using VTE for their employees. In surgery training, systems are proposed such as collaborative virtual sculpting with haptic feedback (Gunn, 2006), Spinal Anaesthesia (Hockemeyer et al., 2009), the dynamic hip screw surgery training in Vitro (Ahmed et al., 2012), force feedback haptic device for oral implantology (Chen et al., 2012) and many others. In the mining industry, virtual training system applications in virtual reality for mine safety training are extensive (Filigenzi et al., 2000), and some of the VR applications developed by the SMI-VR research group (Kizil, 2003) include drill rig training simulation, open pit simulation, underground hazard identification and barring down training simulation, instron rock testing simulation, accident reconstruction, three-dimensional mining equipment, ventilation survey and real-time monitoring simulations, and virtual mining methods. ...
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Specialised and high priced simulators for surgical training, chemical labs, and flight training can provide real-world simulation in a safe and risk-free environment, but they are not accessible for the broader community due to costs for technology and availability of experts. Thus, training scenarios shifted to virtual worlds providing access for everyone interested in acquiring skills and knowledge at educational or professional institutions. Even in this context, we still expect a detailed formative feedback as would have been provided by a human trainer during the face to face process. Whilst the literature is focusing on goal-oriented assessment, it neglects the performed actions. In this paper, we present the Action-based Learning Assessment Method (ALAM) that analyses the action-sequences of the learners according to reference solutions by experts and automated formative feedback.
... The CbKST service, which is based on the theory described above, provides a software for formative assessment methods that can be integrated into learning activity sequences [39]. It has been applied, for example, to enable competence assessment in a web-based system for medical training [40], and also in the scope of the NEXT-TELL [41] and the ROLE [42] projects. It is part of the ECAAD methodology (Evidence Centred Activity and Assessment Design), specifically the ProNIFA tools ("probabilistic, non-invasive, formative, assessment"). ...
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Service-Oriented Architecture (SOA) is a set of practices for architectural design of software that exploits services as loosely coupled components orchestrated to deliver various functionalities. The SOA paradigm is not well established in the Serious Games (SG) domain, but it is expected to provide benefits, particularly in reducing the conceptual and technological complexity of the development. In this paper, we propose and study the application of a SOA approach to SG development. We have used the SOA approach to develop an adaptive serious game for teaching basic elements of probability to high school and entry-level university students, called The Journey. Details of the architecture implementation are offered, as well as the results of an evaluation of the system using the Architecture Tradeoff Analysis Method (ATAM). Based on our experience, we argue that the SOA approach can make SG development shorter, more flexible and more focused.
... Here, s/he is supervised by an experienced doctor who can intervene whenever necessary and who is asked to answer a questionnaire on the trainee's performance and competencies afterwards. All these information are fed into the assessment procedure (Hockemeyer et al., 2009;Zhang et al., 2008). ...
A saying attributed to Kurt Lewin (1951) states ‘There is nothing so practical as a good theory.’ Accordingly, the theory and models outlined in Chapter 11 of this volume have many practical consequences and can be applied for instance in personalized competence assessment, individualized eTeaching and eLearning, and expert query. Furthermore, for practical reasons recent developments in Competence-based Knowledge Space Theory (CbKST) have to be taken into account.
By generalizing and completing the work initiated by Stefanutti and Albert (2003, Journal of Universal Computer Science, 9, 1455), this article provides the mathematical foundations of a theoretical approach whose primary goal is to construct a bridge between problem solving, as initially conceived by Newell and Simon (1972, Human problem solving. Englewood Cliffs, NJ: Prentice‐Hall.), and knowledge assessment (Doignon and Falmagne, 1985, International Journal of Man‐Machine Studies, 23, 175; Doignon and Falmagne, 1999, Knowledge spaces. Berlin, Germany: Springer‐Verlag.; Falmagne et al., 2013, Knowledge spaces: Applications in education. New York, NY: Springer‐Verlag; Falmagne and Doignon, 2011, Learning spaces: Interdisciplinary applied mathematics. Berlin, Germany: Springer‐Verlag.). It is shown that the collection of all possible knowledge states for a given problem space is a learning space. An algorithm for deriving a learning space from a problem space is illustrated. As an example, the algorithm is used to derive the learning space of a neuropsychological test whose problem space is well known: the Tower of London (TOL; Shallice, 1982, Philosophical Transactions of the Royal Society of London B: Biological Sciences, 298, 199). The derived learning space could then be used for adaptively assessing individual planning skills with the TOL.
Action-based learning plays an important role in today’s education, with assessment being an inevitable aspect that presently requires extensive financial and human expert resources. A major research area is dedicated to the development and implementation of systems to perform an automated or at least support formative assessment of human actions in action-based learning. That is, recognising and comparing the performed actions of the learner with the previously recorded actions undertaken by experts. Human actions are classified according to the developed taxonomy of human actions to facilitate a formative feedback for the learner. The action-based learning assessment method analyses the action sequences of the learners according to reference solutions (generated by experts) and automatically provides formative feedback to improve learner performance.
From its beginning knowledge space theory was developed from a purely behavioristic point of view. It focused on the solution behavior exhibited on the instances of a set of items constituting a knowledge domain. This kind of stimulus-response consideration lead to very successful applications. Knowledge space theory has most effectively been applied especially in educational contexts where there is a curriculum prescribing the content to be covered, allowing for a fairly obvious and more or less complete definition of the relevant knowledge domain. There are, however, good reasons not to limit knowledge space theory to the kind of operationalism that identifies the state of knowledge with the subset of items an individual is capable of solving. The framework offered by knowledge space theory is able to integrate psychological theory by bringing into the picture the underlying cognitive abilities (skills, competencies, . . . ) responsible for the observable behavior. This kind of development may be seen somewhat analogous to traditional mental testing (Falmagne and Doignon, 2011). In this context, psychometric models referring to latent variables are preferred to purely operationalistic approaches, like classical test theory (cf. Borsboom, 2006).
Background In recent years there has been a move towards a competency-based model for assessing the performance of practical procedures in clinical medicine rather than the traditional assumption that competency is achieved with increasing experience. For such an assessment to be valid, the necessary competencies comprising that skill must be identified. Our aim was to map the individual competencies necessary to perform a given procedural skill using spinal anaesthesia as the example, and to explore the relationship of individual competencies with each other.Methods In the first part of the study an extensive hierarchical task analysis (HTA) was undertaken to determine the competencies necessary for the performance of spinal anaesthesia. Secondly, the concept of competency-based knowledge space theory (CbKST) was applied to the map. CbKST is based on the principle that acquisition of a specific skill is usually preceded by a number of dependent or prerequisite skills.Our aim was to map the individual competencies necessary to perform a given procedural skillResultsThe analysis yielded a comprehensive HTA of the skills necessary to perform spinal anaesthesia, comprising 509 individual competencies. Applying the concept of CbKST yielded 194 key competences with at least one dependent or prerequisite skill.DiscussionWe have defined a comprehensive HTA or competency map for use in the assessment of the performance of spinal anaesthesia. This CbKST approach will provide clinicians who undertake medical procedures to better understand their own performance, and to improve over time.
Knowledge Space Theory was founded by Doignon and Falmagne (1985). This paper initiated an extensive body of work 6 , which is still in progress. In this chapter, we present recent examples regarding developments in the theory and its relationship to other approaches, methods and applications. As in other chapters of this volume (e. g., Ch. 10) it becomes obvious that there is a high potential for further developments of Knowledge Space Theory. Furthermore, for theoretical as well as practical reasons the relationship to other theoretical approaches such as Formal Concept Analysis, Latent Class Analysis, and Item Response Theory has to be taken into account.
The current focus on patient safety and evidence-based medical education has led to an increased interest in utilising virtual reality (VR) for medical training. The development of VR-based systems require experts from different disciplines to collaborate with shared and agreed objectives throughout a system's development process. Both the development of technology as well as the incorporation and evaluation of relevant training have to be given the appropriate attention. The aim of this article is to illustrate how constructive relationships can be established between stakeholders to develop useful and usable VR-based medical training systems. This article reports a case study of two research projects that developed and evaluated a VR-based training system for spinal anaesthesia. The case study illustrates how close relationships can be established by champion clinicians leading research in this area and by closely engaging clinicians and educators in iterative prototype design throughout a system's development process. Clinicians and educators have to strive to get more involved (ideally as champions of innovation) and actively guide the development of VR-based training and assessment systems. System developers have to strive to ensure that clinicians and educators are participating constructively in the developments of such systems.
There is a need for a procedure-specific means of assessment of clinical performance in anaesthesia. The aim of this study was to devise a tool for assessing the performance of spinal anaesthesia, which has both content and construct validity. The clinical assessment tool was generated using a focus group discussion of practicing anaesthetists. The tool comprised three components: a checklist of 11 pre-defined errors, two time intervals and a six-item global rating scale (GRS). Thirty-one anaesthetists at three different levels of experience underwent testing using the clinical assessment tool: novice (n=10), intermediate (n=10) and expert (n=11). The error checklist and GRS scores but not the time intervals were significantly different between the three groups (P<0.005). The error checklist and GRS form the basis for a procedure-specific assessment tool for spinal anaesthesia.
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Haptic displays are emerging as effective interaction aids for improving the realism of virtual worlds. Being able to touch, feel, and manipulate objects in virtual environments has a large number of exciting applications. The underlying technology, both in terms of electromechanical hardware and computer software, is becoming mature and has opened up novel and interesting research areas. In this paper, we clarify the terminology of human and machine haptics and provide a brief overview of the progress recently achieved in these fields, based on our investigations as well as other studies. We describe the major advances in a new discipline, Computer Haptics (analogous to computer graphics), that is concerned with the techniques and processes associated with generating and displaying haptic stimuli to the human user. We also summarize the issues and some of our results in integrating haptics into multimodal and distributed virtual environments, and speculate on the challenges for the future.
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Haptic displays are emerging as effective interaction aids for improving the realism of virtual worlds. Being able to touch, feel, and manipulate objects in virtual environments has a large number of exciting applications. The underlying technology, both in terms of electromechanical hardware and computer software, is becoming mature and has opened up novel and interesting research areas. In this paper, we clarify the terminology of human and machine haptics and provide a brief overview of the progress recently achieved in these fields, based on our investigations as well as other studies. We describe the major advances in a new discipline, Computer Haptics (analogous to computer graphics), that is concerned with the techniques and processes associated with generating and displaying haptic stimuli to the human user. We also summarize the issues and some of our results in integrating haptics into multimodal and distributed virtual environments, and speculate on the challenges for the future.
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This paper describes the development of a technology architecture that not only supports the technical performance assessment of a medical simulator but also facilitates a validated competence based assessment system in one selected anaesthetic procedure i.e. spinal anaesthesia. Based on extensive mapping of the competencies required for the performance of this procedure, a system architecture is proposed utilising a specifically designed anaesthetic simulator, a learning management system and back-end assessment logic. The overall system is designed to assess the agreed spinal anaesthetic competencies i.e. patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and system-based practice, as defined by the Accreditation Council for Graduate Medical Education.
Conference Paper
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Adaptation to the learner's knowledge level and competence-based course creation have been a major goal of e-learning research projects. However, besides the research projects there is a powerful and emerging development of many open source learning management systems with little or no adaptation functionality. In order to bring together widespread and popular learning management systems and scientific-oriented approaches of competence-based personalisation, this paper presents a solution how a personalised e-learning approach can be applied to arbitrary Web-based learning management systems. A Web service approach is presented which enables and controls adaptation of learning management systems. The scientific foundation is realised by implementing the Competence-based Knowledge Space Theory which is a framework for representing and connecting domain ontologies and knowledge and competence levels of learners.
Conference Paper
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Adaptation is a well known concept in the field of e-learning and is increasingly applied in modern learning systems. In order to gain more flexibility and to enhance existing e-learning platforms, we have developed a generic solution approach which enables to add adaptation functionality to existing Web-based e-learning systems. In this paper we present a distributed architecture on the basis of Web services, which is based on experiences gained in the AdeLE and iClass research projects. This flexible solution allows for adapting towards various devices, such as PCs and handhelds. The first running prototype implements the formal Competence-based Knowledge Space Theory for effective assessment of pre-knowledge and knowledge acquisition as well as for determining the sequence of learning content.
An easy and common way of assessing a student’s knowledge consists of a written examination. A list of questions is presented, the student’s answers are collected, and finally the examiner returns an appreciation, which usually boils down to a single number or percentage. Table 1.1 presents an excerpt of such a test in elementary arithmetics and will be used for exemplary purpose. We first argue that the information provided by the testing procedure is poorly reflected by a single number. Knowing that a student provided correct answers only to questions, say, α, c, and e, entails more than a numerical appreciation (60% correct) of his or her work. It shows mastery in performing multiplications, and deficiency in division operations. Weaknesses and strengthes of the student’s preparation have thus been revealed. Hence advices for further study can be inferred.
Any element S in a family ψ of subsets of a finite set X can be specified by a sequence of statements such as: x ∈ S, y ∉ S, t ∉ S,…, zϵS. This sequence can be coded as a “word” and a complete set of such words forms a “descriptive language” for the family ψ. This class of languages is defined precisely, and some connections between such languages and families of sets are investigated. It is shown in particular that when ψ is closed under intersections and unions, and satisfies the topological condition known as T0, then ψ can be recovered exactly from any of its descriptive languages. These results have an application in the assessment of knowledge. In this framework, the set X is a set of questions, and any set S ∈ ψ represents a possible knowledge state, containing all the questions that some individual is capable of solving. A subclass of the descriptive languages are then the “assessment languages.” Any such language defines a nonredundant algorithm for determining the knowledge state of any individual.
Conference Paper
Two tools for skill assessment are presented in this paper. First the Adaptive Assessment Tool provides an efficient way for testing the learner's knowledge by posing questions. Second the Self-Evaluation Tool provides a method to assess the learner's knowledge by defining skills based on a controlled vocabulary. In both cases the result is a set of skills which is visualised by the Learner Knowledge Presenter Tool by rendering acquired skills on a skill map. These tools are supposed not only to test the learner's knowledge but also to stimulate self-reflection on what a learner has learned. The presented approach advances traditional testing, since it stimulates self-reflection during the assessment process.