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Simulations offer the benefits of a safer and more accessible learning environment, where learners can practice until the point of proficiency. While research into the effectiveness of simulations as learning tools has found tangible benefits, fewer studies have examined retention and differences between high and low fidelity simulations. This research sought to supplement the literature in this domain by investigating whether participants who learned to construct an electrical circuit using a 2D or 3D breadboard simulation could achieve comparable learning, transfer, and retention outcomes to those who learned using a physical breadboard. The influence of learner characteristics - cognitive ability and goal orientation - were also evaluated. This study had two parts: a cross-sectional portion that examined learning and transfer outcomes and a longitudinal portion that examined retention outcomes after a 2 and 4-week period. The cross-sectional analysis included 70 participants and the longitudinal analysis included 40 participants. The results found that the physical fidelity of the learning environment significantly impacted several transfer outcomes (construction and construction time) but not retention outcomes. Cognitive ability was a significant predictor of learning (gain score, circuit design score) and retention (posttest scores, construction time) outcomes. Learning goal orientation significantly predicted circuit construction over time and measurement occasion significantly predicted posttest scores and interacted with fidelity to predict circuit design score. The study demonstrated that simulated environments can lead to comparable, or better, proficiency than physical environments. These findings have implications for the design and implementation of simulated environments, specifically for courses delivered in an online setting., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

With costs of head-mounted displays (HMDs) and tracking technology decreasing rapidly, various virtual reality applications are being widely adopted for education and training. Hardware advancements have enabled replication of real-world interactions in virtual environments to a large extent, paving the way for commercial grade applications that provide a safe and risk-free training environment at a fraction of the cost. But this also mandates the need to develop more intrinsic interaction techniques and to empirically evaluate them in a more comprehensive manner. Although there exists a body of previous research that examines the benefits of selected levels of interaction fidelity on performance, few studies have investigated the constituent components of fidelity in a Interaction Fidelity Continuum (IFC) with several system instances and their respective effects on performance and learning in the context of a real-world skills training application. Our work describes a large between-subjects investigation conducted over several years that utilizes bimanual interaction metaphors at six discrete levels of interaction fidelity to teach basic precision metrology concepts in a near-field spatial interaction task in VR. A combined analysis performed on the data compares and contrasts the six different conditions and their overall effects on performance and learning outcomes, eliciting patterns in the results between the discrete application points on the IFC. With respect to some performance variables, results indicate that simpler restrictive interaction metaphors and highest fidelity metaphors perform better than medium fidelity interaction metaphors. In light of these results, a set of general guidelines are created for developers of spatial interaction metaphors in immersive virtual environments for precise fine-motor skills training simulations.

Purpose - The purpose of this paper is to investigate violations against work standards associated with using a new health information technology (HIT) system. Relevant recommendations for implementing HIT in rural hospitals are provided and discussed to achieve meaningful use. Design/methodology/approach - An observational study is conducted to map medication administration process while using a HIT system in a rural hospital. Follow-up focus groups are held to determine and verify potential adverse factors related to using the HIT system while passing drugs to patients. Findings - A detailed task analysis demonstrated several violations, such as only relying on the barcode scanning system to match up with patient and drugs could potentially result in the medical staff forgetting to provide drug information verbally before administering drugs. There was also a lack of regulated and clear work procedure in using the new HIT system. In addition, the computer system controls and displays could not be adjusted so as to satisfy the users' expectations. Nurses prepared medications and documentation in an environment that was prone to interruptions. Originality/value - Recommendations for implementing a HIT system in rural healthcare facilities can be categorized into five areas: people, tasks, tools, environment, and organization. Detailed remedial measures are provided for achieving continuous process improvements at resource-limited healthcare facilities in rural areas.

This article reviews the peer-reviewed literature addressing the healthcare information available on YouTube. Inclusion and exclusion criteria were determined, and the online databases PubMed and Web of Knowledge were searched using the search phrases: (1) YouTube* AND Health* and (2) YouTube* AND Healthcare*. In all, 18 articles were reviewed, with the results suggesting that (1) YouTube is increasingly being used as a platform for disseminating health information; (2) content and frame analysis were the primary techniques employed by researchers to analyze the characteristics of this information; (3) YouTube contains misleading information, primarily anecdotal, that contradicts the reference standards and the probability of a lay user finding such content is relatively high; (4) the retrieval of relevant videos is dependent on the search term used; and (5) videos from government organizations and professional associations contained trustworthy and high-quality information. YouTube is used as a medium for promoting unscientific therapies and drugs that are yet to be approved by the appropriate agencies and has the potential to change the beliefs of patients concerning controversial topics such as vaccinations. This review recognizes the need to design interventions to enable consumers to critically assimilate the information posted on YouTube with more authoritative information sources to make effective healthcare decisions., (© The Author(s) 2014.)

This study demonstrates a series of systematic methods for mapping medication administration processes and for elaborating violations of work standards at two rural hospitals. Thirty-four observational periods were conducted to capture the details of clinical activities, and hierarchical task analysis (HTA) was used to demonstrate the current medication administration process. Facility nurse managers in five units across the two facilities participated in focus group discussions to validate the observational data and to generate a reliable context-appropriate medication administration process. The potential errors or misconduct when passing the drugs were identified, such as unsafe storage and transportation of drugs from room to room. Those hazards would cause drug contamination, loss, or access by unauthorized individuals. Hospitals without 24-hour pharmacy coverage and other interruptions would hinder the medication administration process. Preparing drugs for more than one patient at a time would increase the risk of passing the drugs to the wrong patient. This study shows the use of observation and focus groups to describe and identify violations in the medication administration process. A clear road map for continuous clinical process improvement obtained from the current study could be used to help future health information technology implementation., (Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Purpose: Ethical and legal requirements for healthcare providers in the United States, stipulate that patients sign a consent form prior to undergoing medical treatment or participating in a research study. Currently, the majority of the hospitals obtain these consents using paper-based forms, which makes patient preference data cumbersome to store, search and retrieve. To address these issues, Health Sciences of South Carolina (HSSC), a collaborative of academic medical institutions and research universities in South Carolina, is developing an electronic consenting system, the Research Permissions Management System (RPMS). This article reports the findings of a study conducted to investigate the efficacy of the two proposed interfaces for this system - an iPad-based and touchscreen-based by comparing them to the paper-based and Topaz-based systems currently in use., Methods: This study involved 50 participants: 10 hospital admission staff and 40 patients. The four systems were compared with respect to the time taken to complete the consenting process, the number of errors made by the patients, the workload experienced by the hospital staff and the subjective ratings of both patients and staff on post-test questionnaires., Results: The results from the empirical study indicated no significant differences in the time taken to complete the tasks. More importantly, the participants found the new systems more usable than the conventional methods with the registration staff experiencing the least workload in the iPad and touchscreen-based conditions and the patients experiencing more privacy and control during the consenting process with the proposed electronic systems. In addition, they indicated better comprehension and awareness of what they were signing using the new interfaces., Discussion: The results indicate the two methods proposed for capturing patient consents are at least as effective as the conventional methods, and superior in several important respects. While more research is needed, these findings suggest the viability of cautious adoption of electronic consenting systems, especially because these new systems appear to address the challenge of identifying the participants required for the complex research being conducted as the result of advances in the biomedical sciences., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: One mechanism to increase participation in research is to solicit potential research participants' general willingness to be recruited into clinical trials. Such research permissions and consents typically are collected on paper upon patient registration. We describe a novel method of capturing this information electronically., Purpose: The objective is to enable the collection of research permissions and informed consent data electronically to permit tracking of potential research participants' interest in current and future research involvement and to provide a foundation for facilitating the research workflow., Methods: The project involved systematic analysis focused on key areas, including existing business practices, registration processes, and permission collection workflows, and ascertaining best practices for presenting consent information to users via tablet technology and capturing permissions data. Analysis was followed by an iterative software development cycle with feedback from subject matter experts and users., Results: An initial version of the software was piloted at one institution in South Carolina for a period of 1 year, during which consents and permission were collected during 2524 registrations of patients. The captured research permission data were transmitted to a clinical data warehouse. The software was later released as an open-source package that can be adopted for use by other institutions., Limitations: There are significant ethical, legal, and informatics challenges that must be addressed at an institution to deploy such a system. We have not yet assessed the long-term impact of the system on recruitment of patients to clinical trials., Conclusions: We propose that by improving the ability to track willing potential research participants, we can improve recruitment into clinical trials and, in the process, improve patient education by introducing multimedia to informed consent documents.

Informed consents are a critical and essential component of the clinical research process. Currently, most consents and research privacy authorizations are being captured on paper. In this paper we describe a novel method of capturing this information electronically. The objective is to allow easier tracking of research participants' intent for current and future research involvement, enhance consent comprehension and facilitate the research workflow. After multidisciplinary analysis in key hospital registration areas and research participant enrollment, an open source software product was designed to capture this data through a user-friendly touch screen interface. The data may then be fed into a clinical data warehouse for use in cohort discovery or consent tracking. Despite ethical, legal and informatics challenges in clinical and research environments, we propose that this technology opens new avenues for significantly enhancing the consent process and positively impacting recruitment.

Objective: A model of semisystematic search was sought that could account for both memory retrieval and other performance-shaping factors., Background: Visual search is an important aspect of many examination and monitoring tasks. As a result, visual search performance has been the topic of many empirical investigations. These investigations have reported that individual search performance depends on participant factors such as search behavior, which has motivated the development of models of visual search that incorporate this behavior. Search behavior ranges from random to strictly systematic; variation in behavior is commonly assumed to be caused by differences in memory retrieval and search strategy., Methods: This model ultimately took the form of a discrete-time nonstationary Markov process., Results: It yields both performance and process measures that include accuracy, time to perception, task time, and coverage while avoiding the statistical difficulties inherent to simulations. In particular, it was seen that as the search behavior becomes more systematic, expected coverage and accuracy increase while expected task time decreases., Conclusion: In addition to explaining these outcomes and their interrelationships from a theoretical standpoint, the model can predict these outcomes in practice to a certain extent as it can create an envelope defined by best- and worst-case search performance., Application: The model also has the capability of supporting assessment. That is, it can be used to assess the effectiveness of an individual's search performance, and to provide possible explanations for this performance, through the use of one or more of the output measures.

The aircraft maintenance industry is a complex system consisting of several interrelated human and machine components. Recognizing this, the Federal Aviation Administration (FAA) has pursued human factors related research. In the maintenance arena the research has focused on the aircraft inspection process and the aircraft inspector. Training has been identified as the primary intervention strategy to improve the quality and reliability of aircraft inspection. If training is to be successful, it is critical that we provide aircraft inspectors with appropriate training tools and environment. In response to this need, the paper outlines the development of a virtual reality (VR) system for aircraft inspection training. VR has generated much excitement but little formal proof that it is useful. However, since VR interfaces are difficult and expensive to build, the computer graphics community needs to be able to predict which applications will benefit from VR. To address this important issue, this research measured the degree of immersion and presence felt by subjects in a virtual environment simulator. Specifically, it conducted two controlled studies using the VR system developed for visual inspection task of an aft-cargo bay at the VR Lab of Clemson University. Beyond assembling the visual inspection virtual environment, a significant goal of this project was to explore subjective presence as it affects task performance. The results of this study indicated that the system scored high on the issues related to the degree of presence felt by the subjects. As a next logical step, this study, then, compared VR to an existing PC-based aircraft inspection simulator. The results showed that the VR system was better and preferred over the PC-based training tool.

The influence of viewing distance and individual differences in the oculomotor resting states (dark vergence and dark focus) on both inspection performance and visual fatigue was investigated by asking 24 college students to perform a visual inspection task for 40 min twice, once with a 20 cm viewing distance and once with a 60 cm viewing distance. During the task participants visually searched enlarged images of contact lenses for six different types of defects. Lens images were presented at a constant visual angle (17.5 degrees) on a CRT. Inspection performance varied significantly across the two viewing distances: participants spent on average more than twice as much time inspecting individual lenses in the near condition (mean = 18.32 s lens(-1)) than in the far condition (mean = 7.25 s lens(-1)). Participants also reported greater visual fatigue in the near condition than in the far condition. At both viewing distances, participants who experienced relatively large inward shifts in dark vergence also tended to be slow inspectors. Neither inspection performance nor measures of fatigue were related to dark focus. These results support existing evidence against the use of near viewing distances and suggest that an oculomotor mechanism links inspection performance and visual fatigue to viewing distance.

Feedback of information has consistently shown positive results in human inspection, provided it is given in a timely and appropriate manner. Feedback serves as the basis of most training schemes; traditionally this has been performance feedback. Other forms of feedback which provide strategy information rather than performance information may have a role in improving inspection. This study compared performance feedback and cognitive feedback in a realistic simulation of an aircraft structural inspection task. Performance (time, errors) feedback showed the greatest improvements in performance measures. Cognitive feedback enhanced efficiency measures of search strategy. When cognitive feedback consisted of visual representations of the path and the coverage of the search sequence, subjects also were able to use this task information to improve their search performance.

Individual differences in the oculomotor resting states (dark vergence and dark focus) have previously been linked to subjective and visual consequences of near visual work. The present experiment investigated whether these resting states are related also to performance on a near visual inspection task. Dark vergence and dark focus were measured in 38 students before and after they spent 40 min searching for a target letter among distractor letters on a video display terminal at a distance of 20 cm. Subjects with relatively near dark vergence positions performed the inspection task significantly more quickly than subjects with relatively far dark vergence positions. Also, subjects who showed a relatively large inward shift in dark vergence tended to perform quickly. Inspection performance was not related to individual differences in dark focus. These results extend existing oculomotor theory and suggest that the performance of visual inspectors is maximized when the mismatch between the task distance and their dark vergence posture is minimized.