虚拟现实与医疗教学外文翻译中英文Word文档格式.docx

1、Medical Student Perspectives on the Use of Immersive Virtual Reality for Clinical Assessment TrainingMatthew Zackoff, Francis Real， Bradley Cruse，David Davis，Melissa KleinWhats New?Medical students reported an immersive virtual reality （VR） curriculum on respiratory distress as clinically accurate a

2、nd likely to impact future patient assessment. VR training was rated as equally or more effective than high-fidelity mannequins and standardized patients but less effective than bedside teaching.Keywords：Clinical assessment，respiratory distress，virtual realityBackgroundThe practice of medicine has t

3、raditionally relied on an apprenticeship model for clinical training an approach in which bedside teaching was the primary source for knowledge transfer. However, the frequency of bedside teaching is declining due to duty hour restrictions, increased patient turnover, and competing demands for physi

4、cians time.Alternatives to bedside teaching have emerged including simulation-based medical education though current approaches are limited in applicability to and functionality for pediatric training. For instance, standardized patients are not available for many pediatric conditions especially for

5、 diseases that predominantly affect infants. Moreover, patient simulators often cannot display critical physical exam findings for discriminating between sick and healthy patients （eg mental status, work of breathing, perfusion changes）.An emerging educational modality, immersive virtual reality （VR

6、）, could potentially fill this gap. Immersive VR utilizes a three-dimensional, computer generated environment in which users interact with graphical characters （avatars）. While screen-based simulation training has been demonstrated to enhance learning outcomes, immersive VR has the potential to have

7、 a broader impact through increased learner engagement, and improved spatial representation and learning contextualization. To date, this technology has demonstrated effectiveness in communication skills training; however, it has not been investigated for clinical assessment training. To evaluate th

8、e role of immersive VR in medical student clinical assessment training, we created a VR curriculum focused on respiratory distress in infants. Our pilot study explored medical student attitudes toward VR and perceptions of VR compared to other common medical educational methods.Educational Approach

9、and InnovationSetting andStudyPopulationAn IRB approved prospective pilot study was conducted at Cincinnati Childrens Hospital Medical Center, a large academic childrens hospital, during the 2017 to 2018 academic year. A randomized sample of third-year medical students, based upon predetermined clin

10、ical team assignment during their pediatric rotation, was invited to participate in a VR curriculum.CurriculumDesignThe curricular goal, to improve third year medical students ability to appropriately categorize a pediatric patients respiratory status, aligns with an Association of American Medical

11、Colleges Core Entrustable Professional Activity for entering residency, the ability to recognize a patient that requires an urgent or emergent escalation of care. To address this goal, an immersive VR curriculum using the clinical scenario of an admitted infant with bronchiolitis was developed colla

12、boratively between clinicians, educators, and simulation developers. A virtual Cincinnati Childrens Hospital Medical Center inpatient hospital room was created using the Unity development platform and was experienced through an Oculus Rift headset. The environment included a vital signs monitor, vir

13、tual stethoscope, and avatars for the patient and preceptor. The patient avatar could demonstrate key exam findings （ie mental status, work of breathing, and breath sounds） that correlated with three clinical scenarios: 1） no distress, 2） respiratory distress, and 3） impending respiratory failure. T

14、he displayed vital signs and auscultatory findings matched the clinical status of the patient. Learners received feedback on their performance immediately following each simulated case. The preceptor avatar, controlled by a physician facilitator （M.Z., F.R.）, guided the student through the VR simula

15、tion. Learners were expected to recognize and interpret the vital signs, physical exam, and auscultatory findings and come to an overall assessment of the patients respiratory status. Detailed algorithms correlating learner input to avatar responses allowed for standardization of the avatar precepto

16、r prompts. For example, if a student did not comment on the patients lung sounds, the facilitator is guided to select the avatar prompt, “What do you think of his lung sounds?” Facilitator-provided feedback for each scenario was standardized to ensure consistent learner experiences.Scenarios were piloted on four critical care attending physicians, two hospitalists, two general pediatricians, four critical ca