ArticlePublisher preview available

Immersive virtual reality-based training improves response in a simulated operating room fire scenario

August 2018
Surgical Endoscopy 32(5))

DOI:10.1007/s00464-018-6063-x

Authors:

Ganesh Sankaranarayanan

Baylor Health Care System

Denis Dorozhkin

Show all 10 authorsHide

Background: SAGES FUSE curriculum provides didactic knowledge on OR fire prevention. The objective of this study is to evaluate the impact of an immersive virtual reality (VR)-based OR fire training simulation system in combination with FUSE didactics. Methods: The study compared a control with a simulation group. After a pre-test questionnaire that assessed the baseline knowledge, both groups were given didactic material that consists of a 10-min presentation and reading materials about precautions and stopping an OR fire from the FUSE manual. The simulation group practiced on the OR fire simulation for one session that consisted of five trials within a week from the pre-test. One week later, both groups were reassessed using a questionnaire. A week after the post-test both groups also participated in a simulated OR fire scenario while their performance was videotaped for assessment. Results: A total of 20 subjects (ten per group) participated in this IRB approved study. Median test scores for the control group increased from 5.5 to 9.00 (p = 0.011) and for the simulation group it increased from 5.0 to 8.5 (p = 0.005). Both groups started at the same baseline (pre-test, p = 0.529) and reached similar level in cognitive knowledge (post-test, p = 0.853). However, when tested in the mock OR fire scenario, 70% of the simulation group subjects were able to perform the correct sequence of steps in extinguishing the simulated fire whereas only 20% subjects in the control group were able to do so (p = 0.003). The simulation group was better than control group in correctly identifying the oxidizer (p = 0.03) and ignition source (p = 0.014). Conclusions: Interactive VR-based hands-on training was found to be a relatively inexpensive and effective mode for teaching OR fire prevention and management scenarios.

Familiarizing phase with the virtual operating room in VEST-OR fire module. Users are asked to select the fire extinguisher (circled in red), the fiber optic light (circled in yellow), and the surgical drape (the blue cover on top of the patient). (Color figure online)

…

Number of individual oxidizer sources correctly identified by the subjects

…

Number of oxidizer sources correctly identified by the subjects

…

Number of Ignition sources correctly identified by the subjects

…

Number of subjects correctly followed the order of operation under simulated OR fire

…

Figures - available from: Surgical Endoscopy

This content is subject to copyright. Terms and conditions apply.

A preview of this full-text is provided by Springer Nature.

Learn more

Content available from Surgical Endoscopy

This content is subject to copyright. Terms and conditions apply.

Vol.:(0123456789)

1 3

Surgical Endoscopy (2018) 32:3439–3449

https://doi.org/10.1007/s00464-018-6063-x

Immersive virtual reality-based training improves response

inasimulated operating room ﬁre scenario

GaneshSankaranarayanan1 · LizzyWooley1· DeborahHogg2· DenisDorozhkin3· JaisaOlasky4·

SanketChauhan1· JamesW.Fleshman1· SuvranuDe3· DanielScott2· DanielB.Jones5

Received: 15 November 2017 / Accepted: 11 January 2018 / Published online: 25 January 2018

Abstract

Background SAGES FUSE curriculum provides didactic knowledge on OR ﬁre prevention. The objective of this study is

to evaluate the impact of an immersive virtual reality (VR)-based OR ﬁre training simulation system in combination with

FUSE didactics.

Methods The study compared a control with a simulation group. After a pre-test questionnaire that assessed the baseline

knowledge, both groups were given didactic material that consists of a 10-min presentation and reading materials about

precautions and stopping an OR ﬁre from the FUSE manual. The simulation group practiced on the OR ﬁre simulation for

one session that consisted of ﬁve trials within a week from the pre-test. One week later, both groups were reassessed using

a questionnaire. A week after the post-test both groups also participated in a simulated OR ﬁre scenario while their perfor-

mance was videotaped for assessment.

Results A total of 20 subjects (ten per group) participated in this IRB approved study. Median test scores for the control

group increased from 5.5 to 9.00 (p = 0.011) and for the simulation group it increased from 5.0 to 8.5 (p = 0.005). Both groups

started at the same baseline (pre-test, p = 0.529) and reached similar level in cognitive knowledge (post-test, p = 0.853).

However, when tested in the mock OR ﬁre scenario, 70% of the simulation group subjects were able to perform the correct

sequence of steps in extinguishing the simulated ﬁre whereas only 20% subjects in the control group were able to do so

(p = 0.003). The simulation group was better than control group in correctly identifying the oxidizer (p = 0.03) and ignition

source (p = 0.014).

Conclusions Interactive VR-based hands-on training was found to be a relatively inexpensive and eﬀective mode for teaching

OR ﬁre prevention and management scenarios.

Keywords Immersive VR· VR training· Simulation training· OR ﬁre management

Operating room ﬁre have existed from the time when wide-

spread use of combustible anesthetic gases was common.

In an investigation of 230 cases by the American Society

of Anesthetists published in 1941, 36 deaths had been

attributed to operating room (OR) ﬁre at that time [1]. Even

though the incidence of OR ﬁre events has decreased over

time, there are still about 550–650 cases reported each

year, of which 20–30 cases have caused serious injury to

the patients including death. The number of cases is simi-

lar to that of wrong site surgery and generally preventable.

In an analysis of the American Society of Anesthesiolo-

gists closed claims database from 1985 to 2009, there were

103 reported cases of OR ﬁre [2]. Several national organi-

zations have recognized the importance of this sentinel

event and have issued responses. The American Society

and Other Interventional Te

chniques

Presented as a poster at the SAGES 2017 annual meeting.

Electronic supplementary material The online version of this

article (https ://doi.org/10.1007/s0046 4-018-6063-x) contains

supplementary material, which is available to authorized users.

* Ganesh Sankaranarayanan

ganesh.sankaranarayanan@bswhealth.org

1 Baylor University Medical Center, 3500 Gaston Ave. 1st

Floor Roberts Hospital, Dallas, TX75246, USA

2 UT Southwestern Medical Center, Dallas, TX, USA

3 Rensselaer Polytechnic Institute, Troy, NY, USA

4 Mt Auburn Hospital, Cambridge, MA, USA

5 Beth Israel Deaconess Medical Center, Boston, MA, USA

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

A Scoping Review on Hazard Recognition and Prevention Using Augmented and Virtual Reality

Article

Full-text available

Nov 2024

Hazard recognition and prevention techniques utilize augmented reality (AR) and virtual reality (VR) technology for immersive training and identification of potential hazards. Currently, no scoping reviews exist specifically on hazard recognition and prevention using AR and VR, which is crucial for forming evidence-based guidelines. This scoping review aimed to identify the use of AR and VR in hazard recognition and prevention, identify research gaps, and provide future recommendations. This Joanna Brings Institute (JBI) approach was used to investigate hazard recognition and prevention with AR and VR interventions. A total of six reliable databases were included: Google Scholar, IEEE Xplore, ACM Digital Library, PubMed, Scopus, and APA PsycNet, focusing on records and publications from the last five years. The review identified 5438 publications, with 22 meeting final inclusion criteria. The major findings include the use of AR and VR for teaching new skills, ensuring health and safety, enhancing realism, developing cognitive skills, improving performance, increasing engagement, and stimulating a sense of presence. Limitations identified include limited or non-diverse sample size, absence of real-world scenarios or contextual learning, inadequate game mechanics, insufficient validation of test results, lack of dynamic game behaviour, insufficient expert inclusion, technology issues, long-term impact assessment, and cost comparisons with traditional approaches. Technological issues have emerged as an additional impediment, limiting the efficacy of AR/VR applications in hazard recognition and prevention. In light of these findings, future research should focus on integrating contextual learning, expert inclusion, sample recruitment, expert validation, long-term impact assessment, and resolving technological challenges to enhance AR/VR applications’ efficacy and real-world viability.

Integration of Industry 4.0 Technologies in Fire and Safety Management

Article

Full-text available

Sep 2024

The incorporation of Industry 4.0 has integrated various innovations into fire safety management, thus changing the mode of identifying, assessing, and controlling fire risks. This review aims at how emerging technologies like IoT, AI, cloud technology, and BIM are making changes to fire safety in structural structures. With IoT-enabled sensors, data, and analytics coupled with predictive algorithms for real-time scenarios, fire safety systems have become dynamic systems where early detection, quick response, and risk management can be achieved. In addition, cloud web-based solutions improve the storage of information while providing the predictive aspect for certainty of safety measures. This paper also largely focuses on such activities through the likes of ISO/IEC 30141 and IEEE 802.15.4, thus making a critical role in maintaining effective connectivity between IoT devices, which is necessary for the effective performance of fire safety systems. Furthermore, the implementation issues, including the high costs, the difficulty in scaling up the projects, and the cybersecurity concerns, are considered and compared to the possible solutions, which include upgrading in stages and the possibility of subsidies from the government. The review also points out areas for further study, such as the creation of small cell networks with lower latency, the use of AI to carry out the maintenance of IoTs, and the enhancement of protection mechanisms of systems that are based on the IoTs. In general, this paper highlights the vast possibilities offered by Industry 4.0 technologies to support organizational fire safety management or decrease fire fatalities and improve built environment fire safety.

From the simulation lab to the operating room: simulation performance predicts intraoperative performance in robotic gastrojejunostomy

Article

Full-text available

Jul 2024
SURG ENDOSC

Background Simulation and video-based assessment (VBA) offer residents the opportunity to develop operative skills while ensuring patient safety. This study aims to determine whether simulation training can predict residents’ operative performance, focusing on the gastrojejunal (GJ) anastomosis during robotic pancreatoduodenectomy. Methods Twenty-seven general surgery residents completed simulated robotic GJ drills and subsequently performed GJs in the operating room (OR). Both simulated and intraoperative performances were video recorded and retrospectively assessed by two blinded graders using the Objective Structural Assessment of Technical Skills (OSATS) scale, time to completion, and occurrence of errors. Intraoperative GJ OSATS scores were compared in cases with and without Clinically Relevant Delayed Gastric Emptying (CRDGE). Statistical analysis was performed using Spearman’s rho, Chi-square, and Kruskal–Wallis tests. Results For simulated GJs, the median OSATS score was 29 (IQR 27–33), time to completion was 30 min (IQR 27–35), and 11 cases had at least one error. Intraoperative GJs had a median OSATS of 30 (IQR 27–31), time to completion of 41 min (IQR 36–51), and errors occurred in nine cases. The OSATS score on the simulated GJs demonstrated a significant positive correlation to the OSATS score on the operative GJs (r = 0.74; p < 0.001) and less time to completion (r = − 0.68; p < 0.001). A shorter simulated GJ completion time significantly correlated with a higher intraoperative OSATS score (r = − 0.52; p < 0.01). Residents with at least one error in the simulated GJs had lower OSATS scores and higher times intraoperatively. Those cases with CRDGE had significantly lower intraoperative OSATS scores than those without CRDGE. Conclusion Performance on a simulated robotic GJ environment is a robust predictor of OR GJ performance, demonstrating predictive validity. VBA of residents’ operative GJ performance is associated with the presentation of CRDGE. Simulation-based training may be crucial to optimizing surgical outcomes before operating on patients.

From FUSE to a hands-on electrosurgery course using a cadaveric model

Article

Full-text available

Jul 2024
SURG ENDOSC

Introduction Surgical procedures in contemporary practice frequently employ energy-based devices, yet comprehensive education surrounding their safety and effectiveness remains deficient. We propose an innovative course for residents that aims to provide basic electrosurgery knowledge and promote the safe use of these devices. Methods We developed a simulated training course for first-year general surgery and orthopedic residents. First, a survey was conducted regarding their knowledge perception about energy devices. The course consisted of two online theoretical sessions, followed by three in-person practical sessions. First-year residents performed three video-recorded attempts using a cadaveric model and were assessed through a digital platform using the Objective Structured Assessment of Technical Skill (OSATS), a Specific Rating Scale (SRS), and a surgical energy-based devices scale (SEBS). Third-year residents were recruited as a control group. Results The study included 20 first-year residents and 5 third-year residents. First-year residents perceived a knowledge gap regarding energy devices. Regarding practical performance, both OSATS and checklist scores were statistically different between novices at their first attempt and the control group. When we analyzed the novice's performance, we found a significant increase in OSATS (13 vs 21), SRS (13 vs 17.5), and SEBS (5 vs 7) pre- and post-training scores. The amount of feedback referred to skin burns with the electro-scalpel reduced from 18 feedbacks in the first attempt to 2 in the third attempt (p-value = 0.0002). When comparing the final session of novices with the control group, no differences were found in the SRS (p = 0.22) or SEBS (p = 0.97), but differences remained in OSATS (p = 0.017). Conclusion This study supports the implementation of structured education in electrosurgery among surgical trainees. By teaching first-year residents about electrosurgery, they can acquire a skill set equivalent to that of third-year residents. The integration of such courses can mitigate complications associated with energy device misuse, ultimately enhancing patient safety.

Virtual Reality and Embodied Learning: Unraveling the Relationship via Dynamic Learner Behavior

Conference Paper

Full-text available

Dec 2023

Embodied Cognition theory asserts that the physical body, its environment, and the interplay between them hold a pivotal role in the process of embodied learning. In comparison to traditional and computer-based learning methods, Virtual Reality (VR) enhances embodied learning, primarily owing to its capacity to offer a sense of situatedness and engage learners through physical interactions. Furthermore, the incorporation of haptic sensations in VR-based learning introduces tactile sensory memory, complementing the existing auditory and visual sensory dimensions. Despite the evident advantages of VR in facilitating embodied learning, the current body of literature has yet to delve into the dynamic behaviors exhibited by learners within Virtual Reality Learning Environments (VRLEs) during embodied interactions, and their inherent relationship with the embodiment phenomenon. In this paper, we take a significant step by integrating the Interaction Behavioral Data (IBD) collection mechanism, a development from our previous work, into a VRLE. This integration is achieved by adopting a structured framework for embodied learning activities within a VR context. Through an empirical study involving 14 participants, we meticulously logged their interaction traces using the IBD logger. Subsequently, we effectively extracted the diverse embodied learning activities carried out by these participants within the VRLE, from the interaction trace data collected in the IBD logger. Our endeavor aims to establish meaningful connections between these embodied interaction activities and the overarching concept of embodiment. These correlations, once identified, will serve as invaluable insights for VR content developers, offering clear guidelines for the design and creation of VRLEs that optimally facilitate enhanced learning experiences. Ultimately, this knowledge transfer will not only empower instructors and learners to harness VR as a potent educational tool within their regular teaching and learning practices but also foster the seamless integration of VR into mainstream education.

Surgical Simulation: Virtual Reality to Artificial Intelligence

Article

Sep 2024
CURR PROB SURG

Effectiveness of Virtual Reality in Healthcare Education: Systematic Review and Meta-Analysis

Article

Full-text available

Sep 2024

As technology advances, virtual reality (VR) is increasingly being integrated into healthcare education to enhance learning outcomes. This systematic literature review and meta-analysis examined the effectiveness of virtual reality-based healthcare education. Randomized controlled trials (RCTs) published over the past 10 years were retrieved from 10 databases using VR, healthcare, and education as the primary keywords. Following the inclusion and exclusion criteria, 45 studies were included in the final analysis. A meta-analysis was performed to analyze the effects of VR in terms of knowledge, skill, and attitude. The results revealed that the use of VR significantly improved the knowledge (SMD: 0.28, 95% CI: 0.18–0.39, p < 0.001) and skill scores (SMD: 0.23, 95% CI: 0.11–0.34, p < 0.001), shortened the skill performance time (SMD: −0.59, 95% CI: −0.82 to −0.35, p < 0.001), and improved the satisfaction (SMD: 0.65, 95% CI: 0.48–0.81, p < 0.001) and confidence levels (SMD: 0.60, 95% CI: 0.41–0.80, p < 0.001). The in-depth analysis highlighted the significant potential of VR and provided practical implications in educational settings. In conclusion, effectively integrating VR with traditional educational methods is necessary to enhance both the quality of learning and the overall competence of healthcare professionals.

A Simulation-Based Optimization Evaluation of Operating Room in Healthcare under Limitation Capacity: A Multi-objective Approaches

Article

Full-text available

Sep 2024

Ali Ala

Operating room scheduling comprises determining the specific start timings for surgeries and allocating the necessary resources to each scheduled surgery. It takes into account multiple limitations to ensure a comprehensive surgical process, including the availability of resources, specialties, and restrictions. Several surgeons have different specialties, and each has a waiting list of patients whose surgeries must be scheduled on the days the surgeons are in one of the operating rooms. In addressing this matter, two objectives are taken into account: minimizing expenses associated with overtime and unutilized operating rooms, while maximizing the number of days patients wait for surgery. The resolution of this problem involves two approaches: mathematical modeling and optimization through simulation-based methods. The findings indicate that when addressing the operating room scheduling issue, the simulation-based optimization solution matches the quality of the solution provided by the mathematical model for smaller problems and offers a timely and satisfactory solution for larger-scale problems.

The utility of virtual reality and manikin crisis scenario simulations for anaesthesia trainee education: a randomised crossover pilot study

Article

Aug 2024

Simulation education for anaesthesia trainees is essential to build clinical skills and virtual reality can provide a reproducible, high‐fidelity intra‐operative training environment. Compared to in‐situ manikin‐based simulation, this modality has yet to be thoroughly evaluated. Twenty‐six second post‐graduate year anaesthesiology residents were randomly divided into two groups and participated in both virtual reality and manikin crisis scenarios at sessions six months apart. The exposure order was group A virtual reality followed by manikin and group B manikin followed by virtual reality. Clinical assessments were performed using a standardised checklist. Knowledge assessments were conducted. National Aeronautics and Space Administration Task Load Index and System Usability Scale scores were collected immediately after participation. Clinical scores between groups A and B were not significantly different. Group A had improved post‐simulation knowledge scores after both sessions. Task load index scores were lower in mental demand for virtual reality. System usability scores showed less ease of use and more need for support in virtual reality.

Navigating the Educational Frontier and Unveiling the Role of Virtual Reality in Faculty Development: An Emerging Consideration in Global Accreditation

Chapter

Apr 2024

The emphasis on leveraging virtualization to enhance learning has garnered attention in high education accreditation. However, a lack of comprehensive understanding regarding the effective utilization of virtual reality (VR) for advancing faculty development in both professional growth and accreditation requirements in order to maintain teaching quality poses a challenge for policymakers to enact. Implementing additional measures is crucial to guarantee the accessibility of equipment and well-trained staff. This study seeks to investigate the perspective to the extent to which VR applications prove beneficial in faculty development, particularly within the contexts of professional skills and during accreditation process at university level. This study suggests that researchers stay updated to recognize gaps in the integration of VR into education, with a particular focus on improving the teaching competencies at university level. It is essential to develop effective adaptability strategies to optimize the advantages technological advancement toward faculty professional growth.

OR fire virtual training simulator: design and face validity

Article

Full-text available

Sep 2017
SURG ENDOSC

Background: The Virtual Electrosurgical Skill Trainer is a tool for training surgeons the safe operation of electrosurgery tools in both open and minimally invasive surgery. This training includes a dedicated team-training module that focuses on operating room (OR) fire prevention and response. The module was developed to allow trainees, practicing surgeons, anesthesiologist, and nurses to interact with a virtual OR environment, which includes anesthesia apparatus, electrosurgical equipment, a virtual patient, and a fire extinguisher. Wearing a head-mounted display, participants must correctly identify the "fire triangle" elements and then successfully contain an OR fire. Within these virtual reality scenarios, trainees learn to react appropriately to the simulated emergency. A study targeted at establishing the face validity of the virtual OR fire simulator was undertaken at the 2015 Society of American Gastrointestinal and Endoscopic Surgeons conference. Methods: Forty-nine subjects with varying experience participated in this Institutional Review Board-approved study. The subjects were asked to complete the OR fire training/prevention sequence in the VEST simulator. Subjects were then asked to answer a subjective preference questionnaire consisting of sixteen questions, focused on the usefulness and fidelity of the simulator. Results: On a 5-point scale, 12 of 13 questions were rated at a mean of 3 or greater (92%). Five questions were rated above 4 (38%), particularly those focusing on the simulator effectiveness and its usefulness in OR fire safety training. A total of 33 of the 49 participants (67%) chose the virtual OR fire trainer over the traditional training methods such as a textbook or an animal model. Conclusions: Training for OR fire emergencies in fully immersive VR environments, such as the VEST trainer, may be the ideal training modality. The face validity of the OR fire training module of the VEST simulator was successfully established on many aspects of the simulation.

Nursing students’ experiential learning processes using an online 3D simulation game

Article

Full-text available

Jan 2017
Educ Inform Tech

The growing use of game-based simulation in healthcare education reflects the opportunities afforded to learners by serious games, which simulate real-world situations and enable students to emulate the roles of healthcare professionals in a safe and engaging learning environment. As part of a design- based research project to design, test, and evaluate an online 3D simulation game for use in game-based simulation in healthcare education, the present study applied Kolb’s experiential learning theory to investigate nursing students’ expe- riential learning processes during a 3D simulation game. The data, collected from eight nursing students, comprised audio and video recordings from gaming ses- sions and focus group interviews. The results indicate that in 3D simulation game, patient-related experiences were supported by audiovisual authenticity, the authen- ticity of scenarios, and interactivity. Feedback triggered students to reflect on their own learning processes. Students conceptualised knowledge by applying nursing theory, and they internalised procedures that can be used in real life. They also had an opportunity to experiment by exploring and making decisions in the gaming environment. One of the main issues arising from these findings is that 3D simulation games used in game-based simulation should share familiar character- istics of leisure games to ensure an engaging learning experience.

Practice advisory for the prevention and management of operating room fires: An updated report by the American Society of Anesthesiologists Task Force on Operating Room Fires

Article

Full-text available

Jan 2013
ANESTHESIOLOGY

Learning theories application in nursing education

Article

Full-text available

Feb 2015

Learning theories are the main guide for educational systems planning in the classroom and clinical training included in nursing. The teachers by knowing the general principles of these theories can use their knowledge more effectively according to various learning situations. In this study, Eric, Medline, and Cochrane databases were used for articles in English and for the Persian literature, Magiran, Iran doc, Iran medex, and Sid databases were used with the help of keywords including social cognitive learning, learning theory, behavioral theory, cognitive theory, constructive theory, and nursing education. The search period was considered from 1990 to 2012. Some related books were also studied about each method, its original vision, the founders, practical application of the training theory, especially training of nursing and its strengths and weaknesses. Behaviorists believe that learning is a change in an observable behavior and it happens when the communication occurs between the two events, a stimulus and a response. Among the applications of this approach is the influence on the learner's emotional reactions. Among the theories of this approach, Thorndike and Skinner works are subject to review and critique. Cognitive psychologists unlike the behaviorists believe that learning is an internal process objective and they focus on thinking, understanding, organizing, and consciousness. Fundamentalists believe that learners should be equipped with the skills of inquiry and problem solving in order to learn by the discovery and process of information. Among this group, we will pay attention to analyze Wertheimer, Brunner, Ausubel theories, Ganyeh information processing model, in addition to its applications in nursing education. Humanists in learning pay attention to the feelings and experiences. Carl Rogers support the retention of learning-centered approach and he is believed to a semantic continuum. At the other end of the continuum, experiential learning is located with the meaning and meaningful. It applies the minds and feelings of the person. From this group, the main focus will be on the works of Rogers and Novels. Finally, it could be concluded that the usage of any of these theoriesin its place would be desired and useful.

Back to Basics: Preventing Surgical Fires

Article

Sep 2016

Lisa Spruce

When fires occur in the OR, they are devastating and potentially fatal to both patients and health care workers. Fires can be prevented by understanding the fire triangle and methods of reducing fire risk, conducting fire risk assessments, and knowing how to respond if a fire occurs. This Back to Basics article addresses the basics of fire prevention and the steps that can be taken to prevent fires from occurring.

Virtual Reality Training Improves Operating Room Performance

Article

Oct 2002

Technology-enhanced simulation for health professions education

Article

Jan 2011
J Am Med Assoc

New clinical guide to surgical fire prevention. Patients can catch fire--here's how to keep them safer.

Article

Oct 2009
Health Dev

ECRI Institute

Surgical fires, though rare, can have devastating consequences for patients, staff, and the healthcare facility as a whole. it's important to know how such fires can be prevented--and how to handle them if they occur. This article includes new clinical practice recommendations for oxygen delivery that are designed to reduce the likelihood of fires.

Surgical fire injuries continue to occur-prevention may require more cautious use of oxygen

Article