Virtual simulations for health education: how are user skills assessed?

Andrade, José Raul de Brito; Machado, Liliane dos Santos; Lopes, Leonardo Wanderley; Moraes, Ronei Marcos de

doi:10.1590/1981-5271v46.4-20210389.ING

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Revista Brasileira de Educação Médica

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REVIEW ARTICLE • Rev. bras. educ. med. 46 (04) • 2022 • https://doi.org/10.1590/1981-5271v46.4-20210389.ING copy

Virtual simulations for health education: how are user skills assessed?

Simulações virtuais para educação em saúde: como são avaliadas as habilidades do usuário?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

A virtual simulator, or one based on virtual reality, can computationally recreate real contexts.

Objective:

To analyze works on virtual simulations for training clinical procedures, focusing on the assessment of user skills.

Method:

Integrative literature review, carried out between 2010 and 2020. A total of 56 studies were selected 56 studies.

Results:

The selected studies showed that the variables and parameters of virtual simulators are usually obtained by consulting experts or through medical literature. These simulators mainly focus on developing psychomotor skills and assessing the learner’s performance through real-time alerts, progress indicators, and performance reports after the end of each training.

Conclusion:

Considering the expert’s knowledge exclusively to define the requirements of virtual simulators can limit their reliability and accuracy. The participation of experts in these projects does not follow standards regarding the selection and frequency with which they collaborate. Few simulators provide insightful and pertinent feedback on user performance.

Keywords:
Health Education; Simulation Training; Educational Measurement; Computer Simulation

Subject	Approach	References
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Augmented optometry training simulator with multi-point haptics. IEEE International Conference on Systems, Man, and Cybernetics (SMC). Institute of Electrical and Electronics Engineers. 2012 Oct. p. 2991-7. 10. Bogoni TN, Pinho MS. Avaliação de um simulador háptico de realidade virtual para treinamento de endodontia. Simpósio Brasileiro de Informática na Educação. Sociedade Brasileira de Computação. 2014;25(1):259-68. 11. Silva LFM, Valerio J, Viana W, dos Santos AD, Trinta F, Melo Filho AA, et al. Avaliação do uso de realidade aumentada e gamificação para o treinamento de habilidades em laparoscopia. Simpósio Brasileiro de Informática na Educação. Sociedade Brasileira de Computação. 2015 Oct;26(1):627-36. 12. Chheang V, Saalfeld P, Huber T, Huettl F, Kneist W, Preim B, et al. Collaborative virtual reality for laparoscopic liver surgery training. IEEE International Conference on Artificial Intelligence and Virtual Reality. Institute of Electrical and Electronics Engineers (IEEE). 2019 Dec. p. 1-17. 13. Ruge-Vera E, Uribe-Quevedo A, Jaimes N, Perez-Gutierrez B. Convulsive treatment game-based training app. IEEE Games Entertainment Media Conference. Institute of Electrical and Electronics Engineers (IEEE). 2015 Oct. p. 1-4. 14. Vankipuram A, Khanal P, Ashby A, Vankipuram M, Gupta A, DrummGurnee D, et al. Design and development of a virtual reality simulator for advanced cardiac life support training. IEEE J Biomed Health Inform. 2013;18(4):1478-84. 15. Leung KH, Hung K, Ko CP, Lo SF. Design and development of an augmented reality mobile application for medical training. IEEE 6th International Conference on Engineering Technologies and Applied Sciences. Institute of Electrical and Electronics Engineers. 2019 Dec. p. 1-4. 16. Gupta A, Cecil J, Pirela-Cruz M, Ilidan N. Design of an immersive simulator for orthopedic surgical training. IEEE International Conference on Systems, Man, and Cybernetics. Institute of Electrical and Electronics Engineers (IEEE). 2018 Oct. p. 3813-8. 17. Sankaran NK, Nisar HJ, Zhang J, Formella K, Amos J, Barker LT, et al. Efficacy study on interactive mixed reality (IMR) software with sepsis prevention medical education. IEEE Conference on Virtual Reality and 3D User Interfaces. Institute of Electrical and Electronics Engineers (IEEE). 2019 Mar. p. 664-70. 18. Maier J, Perret J, Huber M, Simon M, Schmitt-Rüth S, Wittenberg T, et al. Force-feedback assisted and virtual fixtures based K-wire drilling simulation. Comput Biol Med. 2019 Nov;114:103473. 19. Soares EAMG. Fusion of online assessment methods for gynecological examination training [dissertation]. João Pessoa: Federal University of Paraíba; 2019 [acesso em 2 jul 2021]. Disponível em: Disponível em: https://repositorio.ufpb.br/jspui/handle/123456789/19381 . https://repositorio.ufpb.br/jspui/handle... 20. Mitchell N, Cutting C, Sifakis E. GRIDiron: an interactive authoring and cognitive training foundation for reconstructive plastic surgery procedures. ACM Transactions on Graphics. 2015; 34(4):1-12. 21. Dumas C, Coles T, de Visser H, Cao CG, Grimpen F. Haptic feedback tuning in colonoscopy simulation. IEEE International Conference on Systems, Man, and Cybernetics. Institute of Electrical and Electronics Engineers (IEEE). 2016 Oct. p. 004400-004404. 22. Toledo LF, Oliveira J, Haack RV. Haptic surgery simulation for cataract. 19th Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2017 Nov. p. 57-64. 23. Azar A, Farahat Z, Benslimane O, Megdiche K, Ngote N, Samir J. Implementation of a virtual reality operating room for simulation purposes in medical training. International Conference on Electrical and Information Technologies. Institute of Electrical and Electronics Engineers (IEEE). 2020 Mar. p. 1-6. 24. Jayakumar A, Mathew B, Uma N, Nedungadi P. Interactive gesture based cataract surgery simulation. Fifth International Conference on Advances in Computing and Communications. Institute of Electrical and Electronics Engineers (IEEE). 2015 Sep. p. 350-3. 25. Wijdenes P, Borkenhagen D, Babione J, Ma I, Hallihan G. Leveraging augmented reality training tool for medical education: a case study in central venous catheterization. In Extended Abstracts of the 2018 CHI Conference on Human Factors in Computing Systems. Association for Computing Machinery (ACM). 2018 Apr. p. 1-7. 26. Sabri H, Cowan B, Kapralos B, Moussa F, Cristanchoi S, Dubrowski, A. Off-pump coronary artery bypass surgery procedure training meets serious games. IEEE International Symposium on Haptic Audio Visual Environments and Games. Institute of Electrical and Electronics Engineers (IEEE). 2010 Oct. p. 1-5. 27. Petrinec K, Savitsky E, Terzopoulos D. Patient-specific interactive simulation of compression ultrasonography. IEEE 27th international symposium on computer-based medical systems. Institute of Electrical and Electronics Engineers (IEEE). 2014 May. p. 113-8. 28. Corrêa ES, Oliveira TEA, Trenhago PR, Oliveira JC. Performance Analysis of the xSight 3120 HMD in a Pleural Puncture Medical Simulation. XV Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2013 May. p. 107-16. 29. Mendes HCM, Costa CIAB, Silva NA, Leite FP, Esteves A, Lopes DS. PIÑATA: pinpoint insertion of intravenous needles via augmented reality training assistance. Computerized Medical Imaging and Graphics. 2020;82:101731. 30. Wang D, Zhao S, Li T, Zhang Y, Wang X. Preliminary evaluation of a virtual reality dental simulation system on drilling operation. Bio-Medical Materials and Engineering. 2015 Aug;26(s1):S747-S756. 31. Yu P, Pan J, Qin H, Hao A, Wang H. Real‐time suturing simulation for virtual reality medical training. Comput Animat Virtual Worlds. 2020;31(4-5):e1940. 32. Pan J, Zhang L, Yu P, Shen Y, Wang H, Hao H, et al. Real-time VR simulation of laparoscopic cholecystectomy based on parallel position-based dynamics in GPU. Conference on Virtual Reality and 3D User Interfaces (VR). Institute of Electrical and Electronics Engineers (IEEE). 2020 Mar. p. 548-56. 33. Muriel-Fernández J, Alonso CP, López-Valverde N, López-Millán JM, Méndez JAJ, Sánchez-Ledesma MJ. Results of the use of a simulator for training in anesthesia and regional analgesia guided by ultrasound. J Med Syst. 2019;43(4):1-6. 34. Paiva PV, Machado LS, Valença AMG, Batista TV, Moraes RM. SimCEC: a collaborative VR-based simulator for surgical teamwork education. Computers in Entertainment . 2018;16(2):1-26. 35. Zadow UV, Buron S, Harms T, Behringer F, Sostmann K, Dachselt R. SimMed: combining simulation and interactive tabletops for medical education. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. Association for Computing Machinery (ACM). 2013 Apr. p. 1469-78. 36. Ribeiro TV, Oliveira JC. SimObturation: Virtual Reality Application for Simulation of Dental Obturation Procedure Training with Phantom Omni Device Integration. 21st Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2019 Oct. p. 165-9. 37. Moura IFMS, Machado LDS, Valença AMG. Incisions in virtual reality simulators: assessing user performance. Res Biomed Eng. 2019;35(2):103-10. 38. Kleven NF, Prasolova-Førland E, Fominykh M, Hansen A, Rasmussen G, Sagberg LM, et al. Training nurses and educating the public using a virtual operating room with Oculus Rift. International Conference on Virtual Systems & Multimedia. Institute of Electrical and Electronics Engineers (IEEE). 2014 Dec. p. 206-13. 39. Macedo ER. Um simulador baseado em realidade virtual para o treinamento de estudantes na administração de medicamentos injetáveis [dissertação]. João Pessoa: Universidade Federal da Paraíba; 2015 [acesso em 2 jul 2021]. Disponível em: Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/9251 . https://repositorio.ufpb.br/jspui/handle... 40. Korzeniowski P, White RJ, Bello F. VCSim3: a VR simulator for cardiovascular interventions. Int J Comput Assist Radiol Surg. 2018;13(1):135-49. 41. Tori R, Wang GZ, Sallaberry LH, Tori AA, Oliveira EC, Machado MA. Vida odonto: ambiente de realidade virtual para treinamento odontológico. Revista Brasileira de Informática na Educação. 2018;26(2):80-101. 42. Souza-Junior VD, Mendes IAC, Tori R, Marques LP, Mashuda FKK, Hirano LAF, et al. VIDA-Enfermagem v1. 0: realidade virtual imersiva na coleta de sangue a vácuo em adulto. Rev Lat Am Enfermagem. 2020;28:e3263. 43. Izard SG, Méndez JAJ, Estella JMG, Ledesma MJS, García-Peñalvo FJ, Ruisoto P. Virtual simulation for scoliosis surgery. Proceedings of the 5th International Conference on Technological Ecosystems for Enhancing Multiculturality. Association for Computing Machinery (ACM). 2017 Oct. p. 1-8.-⁴⁴44. Ribeiro MA, Corrêa CG, Nunes FL. Visual and haptic trajectories applied to dental anesthesia training: conceptualization, implementation and preliminary evaluation. 20th Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2018 Oct. p. 210-9..
Definition of variables	Consulting the medical literature	³3. Sutherland C, Hashtrudi-Zaad K, Sellens R, Abolmaesumi P, Mousavi P. An augmented reality haptic training simulator for spinal needle procedures. IEEE Trans Biomed Eng. 2012 Dec 21;60(11):3009-18., ¹⁷17. Sankaran NK, Nisar HJ, Zhang J, Formella K, Amos J, Barker LT, et al. Efficacy study on interactive mixed reality (IMR) software with sepsis prevention medical education. IEEE Conference on Virtual Reality and 3D User Interfaces. Institute of Electrical and Electronics Engineers (IEEE). 2019 Mar. p. 664-70., ¹⁹19. Soares EAMG. Fusion of online assessment methods for gynecological examination training [dissertation]. João Pessoa: Federal University of Paraíba; 2019 [acesso em 2 jul 2021]. Disponível em: Disponível em: https://repositorio.ufpb.br/jspui/handle/123456789/19381 . https://repositorio.ufpb.br/jspui/handle... , ³⁷37. Moura IFMS, Machado LDS, Valença AMG. Incisions in virtual reality simulators: assessing user performance. Res Biomed Eng. 2019;35(2):103-10., ³⁹39. Macedo ER. Um simulador baseado em realidade virtual para o treinamento de estudantes na administração de medicamentos injetáveis [dissertação]. João Pessoa: Universidade Federal da Paraíba; 2015 [acesso em 2 jul 2021]. Disponível em: Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/9251 . https://repositorio.ufpb.br/jspui/handle... , ⁴⁵45. Tokuyasu T, Nakayama T, Toshimitsu K, Okamura K, Yoshiura K. Development of virtual palpation system for dental education. IEEE 29th International Conference on Advanced Information Networking and Applications Workshops. Institute of Electrical and Electronics Engineers (IEEE). 2015 Mar. p. 44-8., ⁴⁶46. See ZS, Billinghurst M, Rengganaten V, Soo S. Medical learning murmurs simulation with mobile audible augmented reality. SIGGRAPH ASIA 2016 mobile graphics and interactive applications. Association for Computing Machinery (ACM). 2016 Nov. p. 1-4..
Skills	Technical skills	³3. Sutherland C, Hashtrudi-Zaad K, Sellens R, Abolmaesumi P, Mousavi P. An augmented reality haptic training simulator for spinal needle procedures. IEEE Trans Biomed Eng. 2012 Dec 21;60(11):3009-18., ⁵5. Mani G, Li W. 3D web based surgical training through comparative analysis. Proceedings of the 18th International Conference on 3D Web Technology. Association for Computing Machinery. 2013. p. 83-6. 6. Shewaga R, Uribe-Quevedo A, Kapralos B, Lee K, Alam F. A serious game for anesthesia-based crisis resource management training. Computers in Entertainment. 2018;16(2):1-16. 7. Gomes DC, Machado LS. A Simulator for Regional Anesthesia Training. 19th Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2017. p. 289-92. 8. Gupta M, Bertrand JW, Babu SV, Polgreen P, Segre AM. An evolving multi-agent scenario generation framework for simulations in preventive medicine education. Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium. Association for Computing Machinery. 2012 Jan. p. 237-46. 9. Wei L, Najdovski Z, Abdelrahman W, Nahavandi S, Weisinger H. Augmented optometry training simulator with multi-point haptics. IEEE International Conference on Systems, Man, and Cybernetics (SMC). Institute of Electrical and Electronics Engineers. 2012 Oct. p. 2991-7. 10. Bogoni TN, Pinho MS. Avaliação de um simulador háptico de realidade virtual para treinamento de endodontia. Simpósio Brasileiro de Informática na Educação. Sociedade Brasileira de Computação. 2014;25(1):259-68. 11. Silva LFM, Valerio J, Viana W, dos Santos AD, Trinta F, Melo Filho AA, et al. Avaliação do uso de realidade aumentada e gamificação para o treinamento de habilidades em laparoscopia. Simpósio Brasileiro de Informática na Educação. Sociedade Brasileira de Computação. 2015 Oct;26(1):627-36. 12. Chheang V, Saalfeld P, Huber T, Huettl F, Kneist W, Preim B, et al. Collaborative virtual reality for laparoscopic liver surgery training. IEEE International Conference on Artificial Intelligence and Virtual Reality. Institute of Electrical and Electronics Engineers (IEEE). 2019 Dec. p. 1-17. 13. Ruge-Vera E, Uribe-Quevedo A, Jaimes N, Perez-Gutierrez B. Convulsive treatment game-based training app. IEEE Games Entertainment Media Conference. Institute of Electrical and Electronics Engineers (IEEE). 2015 Oct. p. 1-4.-¹⁴14. Vankipuram A, Khanal P, Ashby A, Vankipuram M, Gupta A, DrummGurnee D, et al. Design and development of a virtual reality simulator for advanced cardiac life support training. IEEE J Biomed Health Inform. 2013;18(4):1478-84., ¹⁶16. Gupta A, Cecil J, Pirela-Cruz M, Ilidan N. Design of an immersive simulator for orthopedic surgical training. IEEE International Conference on Systems, Man, and Cybernetics. Institute of Electrical and Electronics Engineers (IEEE). 2018 Oct. p. 3813-8. 17. Sankaran NK, Nisar HJ, Zhang J, Formella K, Amos J, Barker LT, et al. Efficacy study on interactive mixed reality (IMR) software with sepsis prevention medical education. IEEE Conference on Virtual Reality and 3D User Interfaces. Institute of Electrical and Electronics Engineers (IEEE). 2019 Mar. p. 664-70. 18. Maier J, Perret J, Huber M, Simon M, Schmitt-Rüth S, Wittenberg T, et al. Force-feedback assisted and virtual fixtures based K-wire drilling simulation. Comput Biol Med. 2019 Nov;114:103473. 19. Soares EAMG. Fusion of online assessment methods for gynecological examination training [dissertation]. João Pessoa: Federal University of Paraíba; 2019 [acesso em 2 jul 2021]. Disponível em: Disponível em: https://repositorio.ufpb.br/jspui/handle/123456789/19381 . https://repositorio.ufpb.br/jspui/handle... 20. Mitchell N, Cutting C, Sifakis E. GRIDiron: an interactive authoring and cognitive training foundation for reconstructive plastic surgery procedures. ACM Transactions on Graphics. 2015; 34(4):1-12. 21. Dumas C, Coles T, de Visser H, Cao CG, Grimpen F. Haptic feedback tuning in colonoscopy simulation. IEEE International Conference on Systems, Man, and Cybernetics. Institute of Electrical and Electronics Engineers (IEEE). 2016 Oct. p. 004400-004404.-²²22. Toledo LF, Oliveira J, Haack RV. Haptic surgery simulation for cataract. 19th Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2017 Nov. p. 57-64., ²⁴24. Jayakumar A, Mathew B, Uma N, Nedungadi P. Interactive gesture based cataract surgery simulation. Fifth International Conference on Advances in Computing and Communications. Institute of Electrical and Electronics Engineers (IEEE). 2015 Sep. p. 350-3. 25. Wijdenes P, Borkenhagen D, Babione J, Ma I, Hallihan G. Leveraging augmented reality training tool for medical education: a case study in central venous catheterization. In Extended Abstracts of the 2018 CHI Conference on Human Factors in Computing Systems. Association for Computing Machinery (ACM). 2018 Apr. p. 1-7. 26. Sabri H, Cowan B, Kapralos B, Moussa F, Cristanchoi S, Dubrowski, A. Off-pump coronary artery bypass surgery procedure training meets serious games. IEEE International Symposium on Haptic Audio Visual Environments and Games. Institute of Electrical and Electronics Engineers (IEEE). 2010 Oct. p. 1-5. 27. Petrinec K, Savitsky E, Terzopoulos D. Patient-specific interactive simulation of compression ultrasonography. IEEE 27th international symposium on computer-based medical systems. Institute of Electrical and Electronics Engineers (IEEE). 2014 May. p. 113-8. 28. Corrêa ES, Oliveira TEA, Trenhago PR, Oliveira JC. Performance Analysis of the xSight 3120 HMD in a Pleural Puncture Medical Simulation. XV Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2013 May. p. 107-16. 29. Mendes HCM, Costa CIAB, Silva NA, Leite FP, Esteves A, Lopes DS. PIÑATA: pinpoint insertion of intravenous needles via augmented reality training assistance. Computerized Medical Imaging and Graphics. 2020;82:101731. 30. Wang D, Zhao S, Li T, Zhang Y, Wang X. Preliminary evaluation of a virtual reality dental simulation system on drilling operation. Bio-Medical Materials and Engineering. 2015 Aug;26(s1):S747-S756. 31. Yu P, Pan J, Qin H, Hao A, Wang H. Real‐time suturing simulation for virtual reality medical training. Comput Animat Virtual Worlds. 2020;31(4-5):e1940. 32. Pan J, Zhang L, Yu P, Shen Y, Wang H, Hao H, et al. Real-time VR simulation of laparoscopic cholecystectomy based on parallel position-based dynamics in GPU. Conference on Virtual Reality and 3D User Interfaces (VR). Institute of Electrical and Electronics Engineers (IEEE). 2020 Mar. p. 548-56. 33. Muriel-Fernández J, Alonso CP, López-Valverde N, López-Millán JM, Méndez JAJ, Sánchez-Ledesma MJ. Results of the use of a simulator for training in anesthesia and regional analgesia guided by ultrasound. J Med Syst. 2019;43(4):1-6. 34. Paiva PV, Machado LS, Valença AMG, Batista TV, Moraes RM. SimCEC: a collaborative VR-based simulator for surgical teamwork education. Computers in Entertainment . 2018;16(2):1-26. 35. Zadow UV, Buron S, Harms T, Behringer F, Sostmann K, Dachselt R. SimMed: combining simulation and interactive tabletops for medical education. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. Association for Computing Machinery (ACM). 2013 Apr. p. 1469-78. 36. Ribeiro TV, Oliveira JC. SimObturation: Virtual Reality Application for Simulation of Dental Obturation Procedure Training with Phantom Omni Device Integration. 21st Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2019 Oct. p. 165-9. 37. Moura IFMS, Machado LDS, Valença AMG. Incisions in virtual reality simulators: assessing user performance. Res Biomed Eng. 2019;35(2):103-10. 38. Kleven NF, Prasolova-Førland E, Fominykh M, Hansen A, Rasmussen G, Sagberg LM, et al. Training nurses and educating the public using a virtual operating room with Oculus Rift. International Conference on Virtual Systems & Multimedia. Institute of Electrical and Electronics Engineers (IEEE). 2014 Dec. p. 206-13. 39. Macedo ER. Um simulador baseado em realidade virtual para o treinamento de estudantes na administração de medicamentos injetáveis [dissertação]. João Pessoa: Universidade Federal da Paraíba; 2015 [acesso em 2 jul 2021]. Disponível em: Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/9251 . https://repositorio.ufpb.br/jspui/handle... 40. Korzeniowski P, White RJ, Bello F. VCSim3: a VR simulator for cardiovascular interventions. Int J Comput Assist Radiol Surg. 2018;13(1):135-49. 41. Tori R, Wang GZ, Sallaberry LH, Tori AA, Oliveira EC, Machado MA. Vida odonto: ambiente de realidade virtual para treinamento odontológico. Revista Brasileira de Informática na Educação. 2018;26(2):80-101. 42. Souza-Junior VD, Mendes IAC, Tori R, Marques LP, Mashuda FKK, Hirano LAF, et al. VIDA-Enfermagem v1. 0: realidade virtual imersiva na coleta de sangue a vácuo em adulto. Rev Lat Am Enfermagem. 2020;28:e3263. 43. Izard SG, Méndez JAJ, Estella JMG, Ledesma MJS, García-Peñalvo FJ, Ruisoto P. Virtual simulation for scoliosis surgery. Proceedings of the 5th International Conference on Technological Ecosystems for Enhancing Multiculturality. Association for Computing Machinery (ACM). 2017 Oct. p. 1-8. 44. Ribeiro MA, Corrêa CG, Nunes FL. Visual and haptic trajectories applied to dental anesthesia training: conceptualization, implementation and preliminary evaluation. 20th Symposium on Virtual and Augmented Reality. Institute of Electrical and Electronics Engineers (IEEE). 2018 Oct. p. 210-9. 45. 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