Search

Pediatric emergencies are high-stakes yet low-volume clinical encounters for emergency medical services (EMS) clinicians, necessitating innovative approaches to training. We sought to explore the acceptability, usability, and ergonomics of a novel augmented reality (AR) software for EMS crisis management training. This was a prospective, mixed-methods study employing qualitative and quantitative analyses. We enrolled emergency medical technicians (EMTs) and paramedics at a municipal fire service in Northern California. We ran the Chariot Augmented Reality Medical simulation software (Stanford Chariot Program, Stanford University, Stanford, CA) on the ML1 headset (Magic Leap, Inc., Plantation, FL), which enabled participants to view an AR image of a patient overlaid with real-world training objects. Participants completed a simulation of a pediatric hypoglycemia-induced seizure and cardiac arrest. Participants subsequently engaged in structured focus group interviews assessing acceptability, which we coded and thematically analyzed. We evaluated the usability of the AR system and ergonomics of the ML1 headset using previously validated scales, and we analyzed findings with descriptive statistics. Twenty-two EMS clinicians participated. We categorized focus group interview statements into seven domains after an iterative thematic analysis: general appraisal, realism, learning efficacy, mixed reality feasibility, technology acceptance, software optimization, and alternate use cases. Participants valued the realism and the mixed reality functionality of the training simulation. They reported that AR could be effective for practicing pediatric clinical algorithms and task prioritization, building verbal communication skills, and promoting stress indoctrination. However, participants also noted challenges with integrating AR images with real-world objects, the learning curve required to adapt to the technology, and areas for software improvement. Participants favorably evaluated the ease of use of the technology and comfortability of wearing the hardware; however, most participants reported that they would need technical support. Participants positively evaluated the acceptability, usability, and ergonomics of an AR simulator for pediatric emergency management training, and participants identified current technological limitations and areas for improvement. AR simulation may serve as an effective training adjunct for prehospital clinicians. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) technology has seen increasing use in physical rehabilitation and in the management of acute and chronic pain. Functional movement disorders (FMDs) are a source of disability with no known association to neurologic pathology, and patients are generally offered multidisciplinary treatment approaches to improve functional movement. However, patients who are not compliant with rehabilitation may have persistent FMD and long-term disability. Given VR's use in physical rehabilitation, it may serve as a useful adjunct for the management of FMD. Utilizing an application called MovementTM to create a playlist of targeted applications for the restoration of motor function and balance, this case study presents the application of VR as a tool to engage patients in physical therapy for the management of FMD. The VR games were selected to encourage movement while customization of levels within the games facilitated achievement of physical therapy goals. Physical rehabilitation aided by VR, when used in collaboration with a multidisciplinary care team, may be used to facilitate recovery from FMD. [ABSTRACT FROM AUTHOR]

Perioperative anxiety and distress are common in pediatric patients undergoing general anesthesia and increase the risk for immediate and long‐term postoperative complications. This concise review outlines key research and clinically‐relevant scales that measure pediatric perioperative affect. Strengths and weaknesses of each scale are highlighted. A literature review identified 11 articles with the following inclusion criteria: patients less than or equal to 18 years, perioperative anxiety or distress, and original studies with reliability or validity data. Although robust research‐based assessment tools to measure anxiety have been developed, such as the Modified Yale Preoperative Anxiety Scale, they are too complex and time‐consuming to complete by clinicians also providing anesthesia. Clinically‐based anxiety measurement scales tend to be easier to use, however they require further testing before widespread standard utilization. The HRAD ± scale (Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperation) may be a promising observational anxiety scale that is efficient and includes an assessment of compliance. Further studies are needed to refine a clinically‐relevant anxiety assessment tool and appraise interventions that reduce perioperative distress. [ABSTRACT FROM AUTHOR]

The description of our fellowship DEI course sequence may serve as a template for other fellowships seeking to establish a formal course sequence within their own fellowship curriculum. Curriculum, diversity, education, equity, fellowship, inclusion Keywords: curriculum; diversity; education; equity; fellowship; inclusion EN curriculum diversity education equity fellowship inclusion 487 488 2 02/16/22 20220301 NES 220301 DATA AVAILABILITY STATEMENT Data sharing is not applicable to this article as no new data were created or analyzed in this study. [Extracted from the article]

Background: Hospitalized pediatric patients and their caregivers often experience anxiety and fear, resulting in withdrawal and aggression. Despite virtual reality (VR) being a safe and effective anxiolytic, it is unknown what software design aspects contribute to its effectiveness. This prospective observational study evaluated which VR application elements increased awe, which is correlated with improved behavior and satisfaction. Methods: Patients aged 6 to 25 years and their caregivers at an academic pediatric hospital interacted with a custom VR application that compared design aspects, including environment, graphics fidelity, and presence of a motivational character. Outcomes investigated self-reported awe, vastness, accommodation, and engagement. Data were analyzed using repeated measure ANOVA tests and correlation analyses. Results: A total of 202 participants were enrolled, and 179 (88 pediatric patients, 91 adult caregivers) were included in the final analysis. A fictional environment was more effective at increasing awe in pediatric patients ( P = 0.030) compared with a realistic environment. However, increased graphics fidelity was more effective at increasing awe in caregiver adults ( P = 0.023) compared with low resolution graphics. Presence of a motivational character did not influence awe in either patients or caregivers ( P = 0.432, P = 0.904, respectively). All measures of awe were positively correlated with application engagement ( P < 0.005). Conclusion: In conclusion, when software developers design VR software for pediatric patients and their caregivers, fictional settings and increased graphic fidelity should be considered for pediatric patients and adults, respectively. Future studies will explore other VR elements in gameplay settings.

Competing Interests: Conflicts of interest: None

Background: Simulations are a critical component of anesthesia education, and ways to broaden their delivery and accessibility should be studied. The primary aim was to characterize anesthesiology resident, fellow, and faculty experience with augmented reality (AR) simulations. The secondary aim was to explore the feasibility of quantifying performance using integrated eye-tracking technology., Methods: This was a prospective, mixed-methods study using qualitative thematic analysis of user feedback and quantitative analysis of gaze patterns. The study was conducted at a large academic medical center in Northern California. Participants included 7 anesthesiology residents, 6 cardiac anesthesiology fellows, and 5 cardiac anesthesiology attendings. Each subject participated in an AR simulation involving resuscitation of a patient with pericardial tamponade. Postsimulation interviews elicited user feedback, and eye-tracking data were analyzed for gaze duration and latency., Results: Thematic analysis revealed 5 domains of user experience: global assessment, spectrum of immersion, comparative assessment, operational potential, and human-technology interface. Participants reported a positive learning experience and cited AR technology's portability, flexibility, and cost-efficiency as qualities that may expand access to simulation training. Exploratory analyses of gaze patterns suggested that trainees had increased gaze duration of vital signs and gaze latency of malignant arrythmias compared with attendings. Limitations of the study include lack of a control group and underpowered statistical analyses of gaze data., Conclusions: This study suggests positive user perception of AR as a novel modality for medical simulation training. AR technology may increase exposure to simulation education and offer eye-tracking analyses of learner performance., Competing Interests: Conflicts of interest: None, (© 2023 Society for Education in Anesthesia.)

Background and Aim: Due to limited clinical exposure, non-acute care pediatric providers often rely on simulated experiences to maintain resuscitation skills. Few training options designed for the non-acute care setting exist, are often difficult to access, and lack incorporation of non-technical skills. The first five minutes (FFM) is a previously published curriculum designed to train non-acute care providers. The goal of this study was to determine the curriculum's effectiveness during a pilot intervention., Methods: A single cohort of multi-professional, non-acute care pediatric providers participated. The primary outcome skill was "establishing leadership," and secondary outcomes included other technical and non-technical skills. Learning of outcome skills was assessed using changes in retrospective pre-post self-assessment Likert scale scores. Differences were compared using paired t-tests and ANOVA., Results: Thirty-seven participants submitted self-assessments. There was improvement in establishing leadership (pre-mean 1.14, post-mean 2.30, P < 0.01), and all other objectives studied. Compared to each other, subgroups of nurses, physicians, and respiratory therapists demonstrated significant differences in learning of technical skills, but similar improvements with non-technical skills., Conclusion: These findings suggest that the FFM curriculum is an effective tool for training non-acute care pediatric providers interprofessional resuscitation skills. Future research should assess provider behavioral changes, retention of training requirements, and patient outcomes., Relevance for Patients: Traditional resuscitation education programs focus largely, or entirely, on performance of technical skills and algorithmic actions. However, non-technical skills, such as leadership, are crucial to the overall success of resuscitation efforts. The FFM program was developed to incorporate leadership principles into the resuscitation education of non-acute care pediatric inpatient providers, and this curricular evaluation suggests that improvements in participant leadership skills occurred due to the program., Competing Interests: The evaluation received no funding and the authors have nothing to declare., (Copyright: © 2022 Author(s).)

Background: Augmented reality (AR) and eye tracking are promising adjuncts for medical simulation, but they have remained distinct tools. The recently developed Chariot Augmented Reality Medical (CHARM) Simulator combines AR medical simulation with eye tracking. We present a novel approach to applying eye tracking within an AR simulation to assess anesthesiologists during an AR pediatric life support simulation. The primary aim was to explore clinician performance in the simulation. Secondary outcomes explored eye tracking as a measure of shockable rhythm recognition and participant satisfaction., Methods: Anesthesiology residents, pediatric anesthesiology fellows, and attending pediatric anesthesiologists were recruited. Using CHARM, they participated in a pediatric crisis simulation. Performance was scored using the Anesthesia-centric Pediatric Advanced Life Support (A-PALS) scoring instrument, and eye tracking data were analyzed. The Simulation Design Scale measured participant satisfaction., Results: Nine each of residents, fellows, and attendings participated for a total of 27. We were able to successfully progress participants through the AR simulation as demonstrated by typical A-PALS performance scores. We observed no differences in performance across training levels. Eye tracking data successfully allowed comparisons of time to rhythm recognition across training levels, revealing no differences. Finally, simulation satisfaction was high across all participants., Conclusions: While the agreement between A-PALS score and gaze patterns is promising, further research is needed to fully demonstrate the use of AR eye tracking for medical training and assessment. Physicians of multiple training levels were satisfied with the technology.

Introduction: A key simulation component is its capability to elicit physiological changes, improving recall. The primary aim was to determine whether parasympathetic responses to head-mounted display simulations (HMDs) were noninferior to in-person simulations. The secondary aims explored sympathetic and affective responses and learning effectiveness., Methods: The authors conducted a noninferiority trial. Hospital providers who did not use chronotropic medications, have motion sickness, or have seizures were included. The authors randomized participants to in-person or HMD simulation. Biometric sensors collected respiratory sinus arrhythmia and skin conductance levels to measure parasympathetic and sympathetic states at baseline, during, and after the simulation. Affect was measured using a schedule. The authors measured 3-month recall of learning points and used split-plot analysis of variance and Mann-Whitney U tests to analyze., Results: One hundred fifteen participants qualified, and the authors analyzed 56 in each group. Both groups experienced a significant change in mean respiratory sinus arrhythmia from baseline to during and from during to afterward. The difference of change between the groups from baseline to during was 0.134 (95% confidence interval = 0.142 to 0.410, P = 0.339). The difference of change from during the simulation to after was -0.060 (95% confidence interval = -0.337 to 0.217, P = 0.670). Noninferiority was not established for either period. Sympathetic arousal did not occur in either group. Noninferiority was not established for the changes in affect that were demonstrated. The mean scores of teaching effectiveness and achievement scores were not different., Conclusions: Although a parasympathetic and affective response to the video simulation on an HMD did occur, it was not discernibly noninferior to in-person in this study., Competing Interests: T.J.C. is on the board of directors for Chariot Kids, a California nonprofit organization that seeks to train providers how to use technologies in healthcare and distribute technologies to sick children. He receives no realized or potential financial benefit. The other authors declare no conflict of interest., (Copyright © 2021 Society for Simulation in Healthcare.)