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Medigage http://medigage.co.uk Medigage- Like Like VR Clinical skills Simulation training Tue, 22 Aug 2017 06:05:05 +0000 en-US hourly 1 https://wordpress.org/?v=4.7.5 http://medigage.co.uk/wp-content/uploads/2016/10/cropped-Medigage-icon-square-trans-1-32x32.png Medigage http://medigage.co.uk 32 32 The VR Doctor: The Design Fundamentals For Effective VR Learning http://medigage.co.uk/vr-doctor-design-fundamentals-effective-vr-learning http://medigage.co.uk/vr-doctor-design-fundamentals-effective-vr-learning#respond Sat, 05 Aug 2017 11:53:32 +0000 http://medigage.co.uk/?p=476 The fundamentals and design necessary to make effective VR learning and education applications In the 2nd instalment of feature series Dr. Raphael Olaiya, a doctor and medical education academic, who works with the NHS on virtual reality (VR) immersive training programmes for doctors and nurses. Discusses the fundamentals and design necessary to make effective VR learning and education applications. You can contact […]

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The fundamentals and design necessary to make effective VR learning and education applications

In the 2nd instalment of feature series Dr. Raphael Olaiya, a doctor and medical education academic, who works with the NHS on virtual reality (VR) immersive training programmes for doctors and nurses. Discusses the fundamentals and design necessary to make effective VR learning and education applications. You can contact Dr. Raphael Olaiya at raphael.olaiya@nhs.net.

THE VR DOCTOR

 

Winning and being elected by a unanimous decision, the education and learning sector is the chosen one. The pilot study for Virtual Reality technology application to industries outside gaming, its the cause for acceleration and mass global investment wider than just for gaming. Before we all get too excited and spoil the potential revolutionary fruits of education and learning in VR. Education and learning is an industry older than technology itself, not to mention that of VR which is in its 30s ,and despite this the recommended gold standard approach, paradigm and fundamentals of education and learning are still significantly up for debate so the question is what is the best way to apply VR to education?

 The Question is: What is the best way to apply VR to education?

Utterly amazing that the art of optimising education & learning which is the basis of all knowledge transfer since the beginning of humankind is still yet to be concretely define. The answer to this lies in the fact that it is most certainly a blend of science and ART: flexible and dynamic just like the human experience itself which is as individualistic as the way we are physically formed. As a medical doctor, a published medical education academic author and a creative I have seen how rigorous stimulation of the creative muscle can complement seemingly uncreative fields. It doesn’t take a quote from Einstein on creativity to believe this!

“It is most certainly a blend of science and ART: flexible and dynamic just like the human experience itself which is as individualistic as the way we are physically formed

Medigage-Ltd--Lifelike-VR

Image courtesy of Medigage Ltd- Lifelike VR clinical simulation training

To optimise application of VR to learning and education we need to be methodical, scientific with a creative spark (I look forward to explaining this later).

The wide education and learning industry (not just medical) is perceived by the tech community as a secure and powerful global adoption force for VR tech, taking the baton and going centre stage to push the growth of virtual reality further into the living rooms and classrooms.

Since 2015 tech juggernauts Google, Microsoft and dozens of well-funded VR start-ups funnel millions into educational and learning VR business development, every step of the ladder from primary school education all the way to post-graduate learning and vocational simulation training.

We all agree on some clear obvious factors that make VR a superior learning medium than most traditional methods, broadly speaking. 

  • Increased Engagement
  • Increased recall and retention
  • Less distractions

However speaking broadly about VR for learning and being non-meticulous is the trap, it will lead to sub-optimal VR learning and education applications that depend on the wow innovation factor of VR instead of measuring the learning products by how effectively they further optimise the transfer of knowledge and skill!

 

Speaking broadly about VR for learning and being non meticulous is the TRAP

The opportunity with VR for learning is too great to be dampened by unneeded sub-optimization driven by hastiness to market products.  Why settle for sub-optimal especially when the developmental processes to create optimal education resources has already been defined.

Design thinking: A popular concept in silicon-valley/start-up communities, architects, UX designers and physical product designer.

TheVRDoctor (3)

A human usercentered development process to VR application development, that draws upon evidence supported systematic reasoning and creativity to explore horizontal design possibilities through utilising the technological advancements of which the innovation is based to then create further benefits to the user than current solutions. 

To further explain this and give it pragmatic context:

  • What degree of interactivity is useful
  • What degree of simulation of physical presence is useful
  • UX and User journey
  • 3As Accessibility, affordability, acceptability
  • How to personalise to suit individual user’s learning styles and preferences
  • Intended use of knowledge or skill after learning has taken place
  • When considering the VR learning solution as options what does the user compare it to
  • The content (complexity, type, length )
  • Human user-centered approach: identify the priorities for the user and focus on optimal delivery through VR:
  • Evidence supported reasoning: Address the user priorities by using what evidence and experience suggests not just logic alone. Freely available academia research online often sheds objective light on seemingly difficult design questions. And if academic research comes close to help your decide on design features then your own primary research is best.
  • Creatively explore obvious and hidden learning dynamics exposed by the new technology
  • Don’t be paralysed by the degree of open creative options when designing learning programs through VR instead, see this as the advantage to tread new ground for better or for worse. It may be useless or it could lead to the discovery of a disruptive revolutionary learning dynamic.
  • Throughout focus on the end goal of furthering user benefits and preferences
  • Don’t get caught up in design for design sake, ensure all cannons points towards to target.
  • Optimising the learning process itself : The Constructivist approach;

 

The most important user priority is of course the content delivery so this needs to be addressed early on in the design process. Whether or not the VR user/learner journey design compliment the learning theory underpinning the content delivery will dictate whether the user ultimately likes it, so its very important.  The current dominant theory for how things should be taught to optimise learning is the constructivism theory of learning coined by Robert Gagne an academic educational psychology pioneer in the 70s. The constructivist theory explains how people may acquire knowledge and skill it says;

Each of us as individuals experience every sensory stimulant differently and then construct our own understanding and knowledge of the world through reflecting on those experiences and external and internal feedback loops. When we encounter something new, we have to reconcile it with our previous ideas and experience, maybe changing what we believe, or maybe discarding the new information as irrelevant. In any case, we are active creators of our own knowledge. Our individual constructed worlds can be vastly different but the constraints of linguistics and our thirst for objectivity gives us the impression that we seem to share an equal internal learning world which is largely false. 

So how do we exploit this for the betterment of Learning and education resources?

By building a platform that creates a dynamic that’s lends itself to giving knowledge construction ownership to the learner themselves. Empowerment and entrustment are key, learning is organic and only poor learning resources try to force rigid blueprint for knowledge and skills onto learners learning pathways. Nonetheless, too much learning freedom can be paralysing and give ambiguity of where to start constructing our learning a fine balance is needed.

“Lends itself to giving knowledge construction ownership to the learner themselves.

Nonetheless too much learning freedom can be paralysing and give ambiguity

The more rigid the learning blueprint the stronger the analytical and problem solving mental faculty needed in to deconstruct the fixed information chunks and convert to be received by the one’s unique learning pathways.

Take for example: Remember using multiple books, videos and asking different people to research the exact same topic this is because you were looking for the one that fits your learning pathway most snugly.

Factors that increase a learning systems ability to give knowledge construction ownership to the learner include:

  • Exploration
  • Immersion
  • Immediate feedback
  • Ability to rewind, repeat and skip at will
  • Customizability of content delivery that suits learner’s learning style
  • Hands-on practice and experimentation
  • Embarrassment and risk-free practice
  • Gamification
  • Visible tracking of progress and achievement
  • Increasing difficulty on progress
  • Convincing the user why the content is important for them to learn
  • On demand option for social collaboration in reaching learning or creation objectives

Finally, virtual and augmented reality gives us the perfect platform to facilitate an amalgamation of these factors.

Each one of these factors requires technical expertise and experience to implement correctly and also the optimal combination selection is important not all factors are appropriate for each learning program.

Ordering the content delivery is in essence an important part of the UX or UJ (user experience or user journey) and is a priority in VR educational design. The expertise comes into play when balancing freedom of exploration of learning and ordered step by step learning. Robert Gagne published the Gagne 9 steps of instruction a step-by-step guideline for learning programs to present comprehensive and successful learning experiences. Each step is designed to be placed in the prime position to help learners understand and retain information effectively.

Gagne’s nine levels of learning provide a checklist:

Gagne9Steps

Although Gagne’s model is different from other popular training models, you can still combine it with other models. A good example is 4mat method that helps you to structure your approach so that people with different learning styles will learn just as effectively as everyone else.

The ARCS model works well with Gagne’s model, it focusing on motivation and ensuring that learners understand the benefits of the content.

The last puzzle piece: Creativity

A seemingly objective brick on brick topic: the dogma of learning and education can innately shun using creativity to explore new opportunities for better learning experiences. We must indeed remember creativity is a fundamental of learning and education and especially for VR where the experience boundaries are even yet to be defined. There are no VR education and learning experts only those daring enough to blend systematic scientific approach with boundless creativity.

 

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The VR Doctor: How To Effectively Apply Virtual Reality To The Largest Global Industry, Healthcare? http://medigage.co.uk/vr-doctor-effectively-apply-virtual-reality-largest-global-industry-healthcare http://medigage.co.uk/vr-doctor-effectively-apply-virtual-reality-largest-global-industry-healthcare#respond Sun, 07 May 2017 11:52:06 +0000 http://medigage.co.uk/?p=474 When will the mass medical sector take VR seriously? Dr. Raphael Olaiya MBCHB asks in a new series In a new feature series Dr. Raphael Olaiya MBCHB, who works with the NHS on virtual reality (VR) immersive training programmes for doctors and nurses. Discusses how VR’s impact will be and should be felt throughout the healthcare […]

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When will the mass medical sector take VR seriously? Dr. Raphael Olaiya MBCHB asks in a new series

In a new feature series Dr. Raphael Olaiya MBCHB, who works with the NHS on virtual reality (VR) immersive training programmes for doctors and nurses. Discusses how VR’s impact will be and should be felt throughout the healthcare industry. You can contact Dr. Raphael Olaiya at raphael.olaiya@nhs.net.

Are we there yet? No, not yet.

2016, heralded as the brink of the horizons of virtual technologies reaching the mass consumer sectors including the medical sector. If your, like most people, intrigued by the fast developing tech industry there’s no doubt you’ve been bombarded with viral technology news updates via social media, TV news, or Hollywood reaffirming that the VR industry has been born and is here to stay, become your best friend and then grow and take over.

THE VR DOCTOR

Waiting patiently for the VR wave to come and revolutionise the medical world.  

No VR conference, hype blog or article goes without talking about VR influencing the medical industry in a serious way. As a industry that undoubtedly affects every human on the planet its no wonder the general public are excited about the innovations even the specialists leading the medical world, doctors, professors and surgeons are they themselves watching and waiting for something to happen with great concentration. But therein lies the massive problem.

The great saying goes “Everybody’s job is nobodies job”

And this applies very well to the delayed mass launch of VR in the medical sector. The largest global sector itself in current times and for at least the next 50 years is healthcare. Naturally the most active drivers bringing VR to healthcare are non healthcare professionals as one might expect they are generally entrepreneurs and innovation focused corporate enterprises looking to win big in the colossal opportune market.

For the optimal application of virtual technologies to the medical world the medical sectors insiders need to lead the march forth into the unknown and yes it is unknown.

Applying virtual technologies to the medical/surgical sub-sectors is not a simple face lift or a drag and drop into the VR folder on the desktop.  

Just like in medical research and clinical trials where progress is made by using the well establish scientific evidence based approach, statistical significance and then forming hypothesises and conclusions. This thought process is needed for VR application to the medical world because there are thousands of directions possible each dangerously easy to get excited about and literally invest billions into.

The current situational paradigm for VR being introduced to medicine is via developmental partnerships where VR entrepreneurs and innovation focused corporate enterprises lead the partnership made with medical professionals and healthcare subject matter expertise to work together to develop useful VR applications.

The design of this developmental pathway is deeply flawed in that the subject matter expert is not leading the development journey. VR expert developers know that the factors and elements that determine high quality VR are very complex and dynamic.

Factors that determine high quality VR are very complex and dynamic

To discover the optimal design and application for VR to health care is to equip the subject matter expert with the knowledge and mastery of what has been learned by the VR industry over the last 3 decades since VR became a possibility. Still a young art, trade and industry for VR there are undoubtedly many more mistakes that will be made to learn from but the task on our hands now is to limit these mistakes by optimising the quality of the thought leadership of those in position to direct the road map of VR integrating into healthcare.

What does published academic research show about VR for the medical sector:

Surprisingly little and where there are efforts to establish some sort of evaluative consensus about VR being used for healthcare there are many weaknesses in the fundamentals of the studies. For examples a reoccurring problem is that the definition of VR seems to be a blurred line and the control on the factors that determine the quality of the VR are not controlled. I.e. structured reviews comparing studies that compare VR healthcare applications to their tradition counter parts, in this sort of study it is imperative to ensure accurate representation of VR are used but you will find  desktop PC based medical CGI simulators being compared to real life medical dummy simulations being compare to haptic feedback clinical skills/surgical simulators being compared to headset based simulators. This is as ludicrous as trying to compare electric cars to fossil fuel cars by studying the difference between electric cars made in the 1980s and modern TESLA electric cars and modern fossil fuels cars from Mercedes.

Dr. Raphael Olaiya

Comparing electric cars made in 1980s to TESLA cars and the latest Mercedes Benz

These technical inaccuracies stem from a disconnection between:

  1. the cutting edge VR innovation expertise relating to the latest technology itself and how best to apply the technology.

And

  1. The medical sector innovators and academic looking to bridge the gap between VR and the healthcare world.

How do we fix this disconnection: 

The innovators in the medical sector looking to apply VR need to appreciate the complexities of VR and take the time, energy and resources to get to grips with what factors and details need to be considered when designing VR applications in health care. The best way to do this is for meaningful and strong relationships to be made with the real VR development experts  not just those looking for a fast opportunity to apply VR to health care and attract venture capital in this VR bubble we find currently growing.

By putting a priority focus on the scalability and acceptability of any VR application for healthcare. By letting VR technical specialists lead the way as is being done, marvellous healthcare VR application are developed but;

  1. i) lack of design provision for the psychology of the healthcare sector target market I.e. the patients, doctors, nurses and anyone who will interact with the VR applications. Standard patients psychology is still not fully understood despite the decades of research by the medical industry, the VR industry cannot just waltz in and believe they know what the industry want and how it should look, feel and perform.
  2. ii) lack of design provision for scalability will limit the scaling of these innovations to find examples of this it doesn’t take long on google.

iii) The price point logistical and practical elements needed to allow the VR applications to be used by the target customer/client.

  • VR Development teams need to ask what are the priorities for healthcare systems, what budgets and objectives do they have. It’s well understood in healthcare that technological innovations in healthcare have a incredibly slow rate of reaching far and wide and even slower to those communities that need the innovations the most. As our rate of development of technological advances as a human race, speeds up by geometric proportions, in healthcare we must keep a key focus on designing our innovations so they can be scaled to benefit not only the top 1% economically prosperous communities. This train of though benefits the commercial perspective and the moral perspective.

An additional limiting factor of scalability is that the key ingredients that will cause exponential viral growth, product “stickiness” and maximum word of mouth factor will only be known by the industry subject matter expert, those that have been through the system both from the inside and from the outside plus understand the social element. The provision for these factors need to present from the beginning.

Sub-sectors of healthcare with VR application scope: 

  • Patient-Doctor adherence to medication and lifestyle advice
  • Medical and Surgical theory education
  • Remote surgical procedures
  • Virtual Doctor patient consultations- Telemedicine
  • Visualisation of bespoke per patient anatomical profiles to assist procedures
  • Clinical setting work flow and communications
  • Patient disease education
  • Team Task Virtual exercises
  • Clinical situational judgement education, assessments and simulations
  • Medical and surgical Clinical Skills simulation training

Virtual technologies for the healthcare industry should achieve following: 

  • Increase patient safety
  • Save more lives
  • Increase the preparedness and competency of health care professionals
  • Save health systems financial resources
  • Cost benefit analysis should show significant beneficial outcomes
  • Empower patients in decision making
  • Increase the access to medical informational resources
  • Increase efficiencies in health systems
  • Increase the efficiency of reaching medical educational learning outcomes

 

Where do we begin: thought leadership and design thinking is a good enough start!

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The VR Doctor: Gamification, Education & The Possible VR Future Of Healthcare http://medigage.co.uk/vr-doctor-gamification-education-possible-vr-future-healthcare http://medigage.co.uk/vr-doctor-gamification-education-possible-vr-future-healthcare#respond Wed, 01 Feb 2017 11:38:01 +0000 http://medigage.co.uk/?p=471 NHS doctor and VRFocus contributor Dr. Raphael Olaiya discusses VR’s role in healthcare as part of a video essay on the subject. Regular VRFocus readers will be aware of our interest not just in the use of virtual reality (VR) as a means to entertain but also as a tool to educate and help the human condition. […]

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NHS doctor and VRFocus contributor Dr. Raphael Olaiya discusses VR’s role in healthcare as part of a video essay on the subject.

Regular VRFocus readers will be aware of our interest not just in the use of virtual reality (VR) as a means to entertain but also as a tool to educate and help the human condition. To that end we have as part of our features section “Your Virtual Health” which covers an array of topics relating to healthcare and the medical technology (medtech) industry as a whole. We’ve had discussions on how VR is being used to benefit mental health, how and why it affects the brain in series VR & The Mind and I even discussed my own thoughts on an unspoken issue of VR technology, namely how it is just not suitable for those suffering from more general sickness.

Our most regular series dealing with VR’s healthcare possibilities however is The VR Doctor, written by NHS doctor and Director of Medigage Ltd, Dr. Olaiya with the UK’s National Health Service (NHS) on VR immersive training programmes for doctors and nurses.

Back in April Dr. Olaiya and Economics PHD fellow Nandor F Kiraly discussed the possibilities of how VR may influence healthcare and we’re able to bring you that discussion today, as well as a portion of Kiraly’s Creative Economies video essay which the interview takes place.

You can read Dr. Olaiya opinions and see the video clip below.

How do you think Virtual Reality will influence clinical skills simulation training for healthcare?

VR runs along a continuum, and further along that continuum involves haptics, motion sensing and even involving smells – all of these are senses that brings us to a deeper level of immersion and realism and currently lots of these technologies that are available to connect into the virtual reality experience – it’s just not connecting to the right markets, the tipping point hasnt been reached so to speak!

Right now we are talking about healthcare, so, coming back to the main question that you asked; number one I think VR in heathcare will be very useful. The main disadvantage of mannequin based simulation is that it’s not really as customizable as it needs to be, it’s variables which are very important to make the trainee adaptive, are often very fixed so, if we want to structure VR clinical skills simulation training to be as effective as possible then customisation of each very healthcare scenario he trainee is put in must be atleast slightly different otherwise it will seem artificial like a dejavu and another big factor is touch.

A program we have at the minute is basic life support, and as soon as people put on the headset and are in a hospital having to perform basic life support, the first thing they do is put their hands in front of them, to see if their hands are actually involved in the program; and in the first version we developed at Medigage there is no hand motion sensing, however it was still an effective learning tool when used alone or when supplementing physical manikin based training. Particularly through: 1) Increasing the accuracy and detail of how much the trainee retained of how to do the procedure itself. 2) Simulating the environmental emotional pressure or stress of having to carry out a medical procedure alone when new to the skill.

Haptics have different levels of realism, which make the VR experience more realistic. In standard non-VR manikin simulation based training you can touch a mannequin but it doesn’t feel at all real; a tool that most medical students in the western world have used for training, is the Advanced life support high fidelity manikin there are several companies that manufacture this and it costs between £40,000 – £100,000, which increases the realism and customisation of the simulation.

Mativision VRinOR - Medical TrainingAs haptics in VR become more sophisticated, adaptive and realistic, we do strongly believe it will bridge the gap needed to converting even the staunchest of VR sceptics and in healthcare there is a lot of them.

Social aspects – Working in a team an aspect of healthcare, which is crucially important and cannot be overlooked. A common misconception of course is that VR is a isolating, lonely and a solitary experience. VR infact allows us to be more connected than ever before imagine collaborative surgery where the operating room has a multidisciplinary team who are all working together simultaneously in a vr space from different countries or even continents.

These are all important factors that make the VR experience more effective as a learning tool.

Currently where is the technology right now?

It’s there, it just needs to be directed, and the right expertise is needed to develop it. It comes down to managing it and allowing it to be used – to make it so that is as effective as possible.

Would you agree with the following statement: “With the dropping prices of electronics and technologies, the training of practitioners via the use of VR will be better than current methods – such as doing the same training on carcases – from a cost effective standpoint?”

In the future I firmly100% beleive this. Its realizing how soon that is and when we should be investing more capital and finance in to it to speed up the process, because before we invest more finance into it, we have to be on the right track; currently there are a lots of different talented people and development companies going off in different directions, but there is no standard set guidelines (of the best way to do it). Before we start pushing things to replace what is already there -cadavers as you said – we need to come up with a gold standard. Medical education itself is a speciality itself, which is hundreds of years old, some of the great scientists had their take on it, and we are still developing it right now, so adding VR into the mix cannot be looked upon lightly.

First, we need to find the best way, and secondly push it in the right direction. Every step of the way we will need to conduct research to confirm that what we are on the right track, and only then can we start financing the transition towards a more VR based education system.

Washington Leadership Academy
To answer your question – in terms of actual objective finances – a cutting edge advanced life support high fidelity mannequin room is around £100,000 for the full set, which normally is equipped with a two-way mirror, so that the clinical skills tutor can observe what the team are doing, and then you also need to calculate for the clinical skills tutor; their training, the effectiveness of their teaching methods, and their salary. With this simple example, we can already see that the costs are mounting up… But how do we replace that with virtual reality? First of all, virtual reality comes down to customizability, and implementing a level of artificial intelligence that would allow the virtual reality system to know factors such as what level of training the participant is at, and adapting the course to their needs. Then there is the actual hardware itself; anything that can be done with mannequins now can be adapted for virtual reality.

Financially, using virtual reality will allow the most elaborate simulations to be affordable by substituting the most expensive manikin based simulation hardware and other important elements for virtual assets instead. The most expensive part of VR development for VR sim training in healthcare will the touch feedback/haptics; of course manual dexterity and muscle memory development is a crutial part of simulation training and integration of this is the current factor that steeply increases the cost of VR sim training. Different medical skills require different amounts of emphasis on manual dexterity and muscle memory development for the trainee. The most expensive part of VR sim training is the touch feedback/haptics and how accurate it needs to be and this is the current decider of whether VR sim training will be more cost effective than high fidelity manikin training.

There is an interesting point you made Raphael, as with training of pilots, no amount of simulation is comparable to doing the real thing, as simulation do not factor in the human elements. In regards to medical studies, VR training would have to go hand in hand with hands on training, as well as work based training, though would you say that VR could prepare students for the real thing?

Yes, the individualism of the human experience and the nature of human beings is that nothing can really replace dealing with a human being, but of course we are comparing virtual reality to the golden standards( manikin based sim training) of clinical training without actually dealing with a patient – because when you are dealing with a patient you risk doing harm to said patient; for example when you are practicing taking blood from a patient – the first time you do it, the success rate is going to be much lower compared to the tenth time you do it, but in those ten times you may have failed numerous time, and you may have harmed the patients. Of course that is just a simple example, but take chest-drains; you can seriously injure a couple of people if you complete that wrong. You can practice on the mannequins, but what if we can increase the efficiency on that, as there is still that cross-over period. We have a motto in Medigage; “We are bridging the gap between clinical skills, classroom based training and real life Grade A clinical performance on human beings”. It’s about making that gap seamless as possible, so when a person moves on from all these technologically advanced training techniques onto a real human being, they should be as prepared as possible and the chance of failure is minimized. The human factor is a constant element which we can’t replace, but it’s all about bridging the gap through training.

Would you say the field of Medical VR can be considered a Creative Economy at its current state, as there is no golden standard? Everyone is trying to tackle the issue of creating something that will ultimately benefit the students, or very specific to specialisms like surgery or anaesthesia, and do you believe there will be a turning point once said golden standard is achieved where the creative process will be more boxed in and standardised?

One of the exciting things is that there is huge potential for the creative community and creatives themselves to be involved in designing the different methods of teaching through virtual reality for medical education and other domains as well. There is going to be a big input from the creative economy and we really need to capitalise on that, and to see all the different options, and eventually there will be some design techniques, user journey profiles, and ways of developing programs that are more effective for most people which will set the precedent, but at the same time since VR is so dynamic it will allow for other design fundamentals and techniques to always have a place, as opposed to structuring medical education lectures which has a lot less scope to be different.

In a lecture, you have the lecturer themselves and a important variable is how dynamically can they connect with the audience of learners and then there is the lecture content itself, and the use of multimedia and applied interactivity. Let’s go back 200 years where the lecture was blackboard, very one-dimensional, and the structure was very rigid. As a learner you really had to have the learning style to benefit and the people whose personal style of learning was such were in a great position to learn, but the people who it didn’t, most likely fell off the academic ladder. Coming back to the question you asked, there will be a huge opportunity for the creative industry to get involved, and in my opinion that should be pushed and encouraged, and the medical education sector should allow that to happen, invest financial resources and really be open minded. And whilst some of the most effective ways will be more successful, become popular, and take off, there still will be opportunities for other innovative ways to be the optimal learning style for some students who learn differently. It’s going to be like nothing before because virtual reality is so dynamic.

I have an HTC Vive set up in my living room, and it was quite hilarious watching an actual surgeon (my father) play Surgeon Simulator, this made me think can’t we have an approved first aider training program that is like that game, but which would teach lifesaving skills for the public? From what I understand, first aid training costs precious resources like time and money, couldn’t that be conveyed through a video game at the fraction of the cost?

What your talking about is turning medical simulation training into a game, essentially gamification; it’s a wonderful technique that has been capitalized upon the business and management sectors to take advantage of our inclination as humans to want to track progress through whatever we are doing, to have rewards, and have feedback, and know how far we are to finish what we are on. These are just some factors of gamification and applying that to VR for medical education – for example first aid as you mentioned – is a fantastic opportunity, and that’s been one of the main aspects we wanted to involve in our programs at Medigage. Let’s talk about specifics and a example; the emergency first aid at work is a three-day course, each day takes six hours, so 18 hours with an assessment at the end. There is extra studying at home involved so let’s count 25 hours in all to be really competent in being first aider at work. That does not involve advanced life support. So that course itself can be very expensive, over a thousand pounds, it involves a qualified trainer, and the people who do the course have to stop what they are doing in their own professional lives, there is a lot of cost involved, and the people who are doing the course and their employers often do it reluctantly like a choir as it’s not really an enjoyable thing – often seen as just ticking a box. So if there was a way to make it more engaging, to gamify it, make it enjoyable, I think virtual reality has a massive opportunity there. And gamification is really the word we are looking for here; ways of gamification are very creative and there are ways to do it that haven’t even been exposed yet, as such gamification can never be forgotten when it comes to using virtual reality for medical education. And with Medigage our first product at medigage.co.uk is basic life support, its gamified.

What would you say are the risks in training medical professionals in virtual reality – if any?

100% there are risks with everything, and first risk is that what we have already talked about, which is going down the wrong track and spending lots of resources and finance in developing something that is not as effective as it could be. With virtual reality a lot of people who invest and develop see the financial incentive to commercialize VR, and of course that is a great massive opportunity, but at the same time you have to be cautious, methodical, systematic, and you can’t jump with both feet into the first idea that comes to mind, because it could jeopardise the wider perspective on VR for medical education.

Second risk is how technology is still developing, and relatively, compared to what we have now and what we had 20 years ago it looks advanced, but if you understand VR and how advanced it can be, you’ll see how we have relatively primitive technology in terms of where we could go; primitive as in its not adapted to our biology as humans. For example, there are our eyes, or how we process information; whether it will be healthy for our brains, we are not sure what health risks there are in the long term effects from multiple hours of looking at a screen which is literally centimetres away from your eye. Currently the research available on the negative health effects of VR – concentrating on the eyes – are quite positive in the sense that your eyes become used to how far the screen is from your eyes, and only people with pre-existing eye conditions would they be adversely affected; there is no real evidence to suggest that currently, but it needs to be further researched.

Social aspect is another risk that needs to be mentioned; how is VR medical education going to change the social aspect of medicine and healthcare? Healthcare itself relies a lot on teamwork, and it helps when people like each other, and are active team members. With VR we need to work as a team to ensure the social element, and putting emphasis on us working with each other for better patient care from the very beginning. There is no real technological limit stopping VR from becoming a social experience; there is a scope for multiple VR users to be in the same environment and for it to be as social as sitting in the same room together. But the risk is, that this is not focused on, so it needs to be given priority from the start, to make it a social experience as opposed to an isolating experience – like the image of a gamer in their parent’s basement whose life is all about that video game – and we don’t want that.

Let’s hypothetically say that VR medical training replaces the 5 years of university studies, and all your training comes from VR, is there a risk of desensitization?

There is a risk, a bonus, and an opportunity. All doctors have a risk to be desensitized to the original reason and motivation as to why they chose their profession. Every day they risk being subjected to very sad emotive situations, such as breaking sad news like cancer. And after a while we see that people who have to deal with that a lot sometimes develop an emotional struggle to really express their emotions and empathy that is needed to give for patient care whether it is to their family or the patient themselves. This has been an issue since the start of medicine and patient care. In virtual reality if someone completes training – for 5 years through a VR course – then what risk does that have in terms of desensitizing them? It takes decades to desensitize a doctor to the level where they are no longer sympathetic or empathic – so I don’t think that is a risk that comes to basic medical training. The opportunity of using VR is that because it’s still different from real life and anyone can see that difference and understand that it is for training purposes – it’s not the real thing, but they are bridging that gap. They can take the advantages of the training and limiting the disadvantages by recognizing that it is not real, their empathy can be preserved. We don’t know, this is just my experience talking as a health care professional, a doctor and as a virtual reality developer. You mentioned virtual reality courses replacing the primary medical degree, the 5-year degree, and I don’t think VR could ever replace the degree, from the way I am looking at it, there needs to be a balance between technology assisted learning and real life experience; all those elements which you can’t simulate in a virtual environment. But the fidelity and realism in virtual reality is a spectrum, and there are dynamic properties of this technology that we haven’t realised yet, due to it seeming impossible at this point in time. And such element could be a degree of realism which would allow for a complete replacement of the 5-year degree via virtual reality.

In one of your publications you stated that one of the biggest hurdles when it comes to virtual reality and medicine is lack of a robust artificial intelligence. Could you explain a bit more?

Artificial intelligence is a spectrum; it is a broad wide spectrum with a longitudinal quality. What I mean by that is AI can be as simple as a calculator if we look at its basic fundamentals. And at its sophisticated level it’s something which understands a situation – which is abstract – and can come up with an answer; like a human, or even completely unlike a human. It will have to come up with an answer though, which it can then use to learn more information, and it can learn by itself from its environment, and allow itself to adapt. Thus, allowing unlimited potential. This is still in a fairly primitive stage of development, especially its adaptiveness; the current most powerful artificial intelligent machine – from my understanding – is IBM Watson, very powerful and incredible machine being used for really fantastic feats in particularly the healthcare field, and the business field, and in big data. With healthcare particularly, a specific project in the US is to do with oncology ( study and treatment of cancer) looking at big data patterns with gene coding, and understanding what sort of genes give rise to cancer, and trying to detect that, deal with it, and treat it most effectively. Despite how amazing the AI is here, it is very specialised and not adaptive at all: It’s a AI has a super narrow and specific range.

My opinion is that artificial intelligence being used in VR simulation training will allow every clinical training environment to be different and adapt and respond and react to the trainee in a natural way best for learning effectiveness. It will allow for the trainee to vethinking on their feet and not have the disadvantages which we currently face with mannequins; if we are taking a blood sample from a mannequin you know exactly where the vein is, because you have done it a hundred times, and you can see the puncture sites that you and your colleagues have done. It’s not customizable; VR with artificial intelligence could present a different patient, with a different voice, a different sized arm, different coloured arm allowing randomisation. And that’s just customisation of visuals, pushing that further one could have branching levels of customisation, where by selecting a set of options the artificial intelligence will then customize and adapt to your learning situation making it as challenging – in order to make it as effective towards your development. That is a lot more complex.

For that level of complexity, you would need an enormous collection of data on patients. Wouldn’t that incur a level of risk regarding patient confidentiality, and making the AI a possible target for hacking?

In order to cover all variables, a lot of memory is needed, and this should be fine because the rate of digital memory(available) expansion is skyrocketing. I don’t think there is an issue with memory. What underpins this all is big data, masses and masses of petabytes is needed to assist artificial intelligence and virtual reality to keep on developing. At the core of it, what is needed is communication between what’s actually happening in the real life, such as a real life clinical statistics on what actually happens with patients and the AI engine of the simulation, this would allow the AI to learn live as more and more data is collected.

Regarding the security aspect of patient confidentiality being breached, it is a fundamental concept within the medical education domain to use patient data – very confidential information about patients– and use it for teaching purposes. As long as everyone understands that this data needs to be kept within the domain of medical education, and that only particular people who are learning to become better clinicians have access to them and patient identification information is completely anonymised, the security risk is a minimal risk.

The VR Doctor will return again soon to VRFocus with another discussion. Interested in Healthcare? Why not check out some of the other articles in the series.

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The VR Doctor: Where Virtual Reality Meets Artificial Intelligence For Healthcare http://medigage.co.uk/vr-doctor-virtual-reality-meets-artificial-intelligence-healthcare http://medigage.co.uk/vr-doctor-virtual-reality-meets-artificial-intelligence-healthcare#respond Sun, 08 Jan 2017 11:52:50 +0000 http://medigage.co.uk/?p=475 Dr. Raphael Olaiya returns, this time to discuss VR and the application of A.I. in the medtech space. In the next instalment of his series, Dr. Raphael Olaiya, a NHS doctor and medical education academic, who works with the NHS on virtual reality (VR) immersive training programmes for doctors and nurses. Discusses the meeting point of VR and A.I. for healthcare.  […]

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Dr. Raphael Olaiya returns, this time to discuss VR and the application of A.I. in the medtech space.

In the next instalment of his series, Dr. Raphael Olaiya, a NHS doctor and medical education academic, who works with the NHS on virtual reality (VR) immersive training programmes for doctors and nurses. Discusses the meeting point of VR and A.I. for healthcare. 

We can see it, feel it, touch it, taste and even smell it, virtual reality (VR) is very tangible and its sophistication and fidelity are increasing at a rate where anyone who self-identifies as a technology fan must chase updates biweekly to prevent being left behind. An accepted consensus is that by 2030 VR/Augmented Reality (AR) with be the fundamental platform for mobile communication and be firmly embedded as a mainstay within the industries of energy, entertainment, education, training and healthcare.

Raphael Olaiya

Conversely A.I., artificial intelligence from the perspective of the average self-identified technology fan can only be perceived in depictions from what Hollywood directors spoon feed us. An optimistic but plausible feat all the same, however actualizing it seems much more of a lucid dream than reality for the masses. When Siri, Catana and Amazon Echo are publically self-hailing themselves as having artificially intelligent capability it throws the masses of technology hobbyists into confusion because the only thing they see here is glorified voice recognition search tools.

A.I.: Glorified Voice Recognition Search Tools

A.I. to the masses means firstly on demand adaptive learning and android-esque tendencies physically, emotionally or intellectually stemming from Hollywood’s portrayal of characters including J.A.R.V.I.S from Iron Man, Skynet, Bicentennial ManEx MachinaStar Wars amongst others. This example highlights a problem with the classification of the definition of A.I. which has lead to a degree of trivialization of commercial A.I. and reducing its appeal because the recurrent depictions are just simply not realistic technology right now.

Trivialization of Commercial A.I. and Reducing its Appeal

Robot Earth

Delving deeper in A.I. technicalities, A.I. is certainly alive and kicking. IBM Watson at the forefront with Google Deepmind, Microsoft Oxford and currently changing the way businesses trade, the way doctors diagnose and how engineers construct. Deep learning algorithms that are able to re-synthesize formulae for future tasks based on the results of previous formulae. However, the reach of IBM Watson and its cousins seems somewhat disconnect to the masses. Why? This boils down to the sedimentary reasons of;

  1. The current level of cutting edge A.I. in 2017 focuses on area specific ( i.e. IBM Watson X Sloan Kettering partnership focusing on more effective and efficient cancer diagnosis and treatment ) big data processing and delivers directed specific answers after arduous instructions and direction from the subject matter experts i.e. world-renowned oncologists. So the focus of technological advancement is not on A.I. for consumer tech rather for area specific specialist.
  1. There is not a strong enough tie yet between the organisations/companies with mass consumer reach and the tech communities working hard on breakthrough expert level programming needed to adapt up to date artificial intelligence tech to a use that will serve the masses directly. This disconnection will soon bridge.
  1. Tangible applications to channel current available A.I. tech into “perceived real A.I.” applications have not taken off in the open market yet. Eager A.I. fans wait for the anticipated killer/golden app. The app that will utilise A.I. technology in a way that bridges away from the island of gimmick and enters a realm of the value add whether it be saving time, money, or enhancing entertainment.

VR/AR represents a golden ticket opportunity to present to the mass consumer market a application of artificial intelligence that is very easy to relate to and get excited about for anybody. This highlights the importance of the user experience and perception of A.I., for example, an A.I. application field that billions of dollars are currently being invested to currently is an A.I. medical diagnosis tool for patients with no/delayed access to a doctor. It doesn’t take a controlled experiment for us to agree that the user experience would be more successful with a realistic CGI android style VR/AR artificially intelligent voice

A Golden Ticket Opportunity

Recognising an A.I. nurse/doctor as such more than a messenger style chat box despite having the exact same level of A.I. sophistication is such.

Health Robot

Whether or not we define or perceive A.I. as algorithmic formulae clever enough to generate more formulae and build upon past experience, in order to learn deeply coupled with a powerful searching function doesn’t take away the fact that how we interact with it is the most important feature of all! After all, A.I. is for the betterment of our lives, to increase joy and pleasure, ease suffering and further the realisation of our ability as humans to supersede ourselves.

VR and A.I. intertwining in a multidisciplinary approach to serve us more holistically is the goal. Healthcare a universal priority is a worthwhile focus point for this blending.

Application for A.I. and VR/AR for healthcare: (Non-exhaustive)

  1. Hospital or healthcare facility management and work flow visualisation, planning and implementing.
  1. On demand patient healthcare triage system to prioritise medical or surgical emergencies.
  1. On demand patient home diagnosis. (limited without clinical judgement and examination)
  1. Artificially intelligent VR/AR assistants for Medical doctors to reduce errors.
  1. Medical education and simulation training adaptive to the own users learning style to optimise learning and retaining knowledge.
  1. Demonstrating the neural pathway of the artificially intelligent system in use: There will be a point where the AI being used for healthcare reaches a point that we as humans cannot comprehend the process. VR/AR represents a method by which these processes can be explained to us more effectively than code.

So just as this article started to see it, feel it, touch it, taste and even smell to do this is to make A.I. a human experience.

You can contact Dr. Raphael Olaiya on this topic or his work at Medigage Ltd via raphael.olaiya@nhs.net.

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