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A PILOT STUDY TO INTEGRATE AN IMMERSIVE VIRTUAL PATIENT WITH A BREAST COMPLAINT AND BREAST EXAM SIMULATOR INTO A MEDICAL STUDENT SURGERY CLERKSHIP.

sigourney-buckley
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  1. A PILOT STUDY TO INTEGRATE AN IMMERSIVE VIRTUAL PATIENT WITH A BREAST COMPLAINT AND BREAST EXAM SIMULATOR INTO A MEDICAL STUDENT SURGERY CLERKSHIP Adeline M. Deladisma MD MPH1; Mamta Gupta MS1; Aaron Kotranza BS2; James G. Bittner MD1; Toufic Imam MD1; Dayna Swinson BSN1; Robert Nesbit MD1; Benjamin Lok PhD2; Carla Pugh MD PhD3; D. Scott Lind MD1 1Department of Surgery, Virtual Education and Surgical Simulation Laboratory, Medical College of Georgia, Augusta, GA2Department of Computer and Information Science Engineering, University of Florida, Gainesville, FL3Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL

  2. Background • Screening mammograms and clinical breast exam (CBE) are important tools in the early detection of breast cancer • Current guidelines recommend CBE as part of annual health exam for women 40 years of age and older1 • Thus, taking a history and performing a breast examination on a woman with a breast complaint are essential clinical skills 1Saslow, et al. CA: A Cancer Journal for Clinicians 2004; 54:327.

  3. Background • The AAMC has identified clinical breast exam (CBE) as an important skill that should be taught as part of undergraduate medical curricula1 • Many students feel they need additional training in CBE • “Fear of missing a lesion” and intimate nature of CBE account for much of the anxiety when performing CBE2 • MS 3 surgery clerkship presents prime opportunity 1AAMC. The AAMC project on the clinical education of medical students. 2005. 2Pugh, et al. Am J Surg 2007; 193:166-70.

  4. Background • Simulation has become an important adjunct to traditional teaching methods in medical education Sachdeva, et al. Am J Surg 1997; 173:320-5. Campbell, et al. Acad Med 1994; 69:993-5. Deladisma, et al. Am J Surg 2007; 193:756-60.

  5. Background • The purpose of this study was to determine if a curriculum to teach these skills using a virtual scenario and a simulated breast mannequin can prepare third-year medical students rotating on surgery for history-taking (HT) and performing a breast exam (BE) on a real patient (RP) with a breast complaint.

  6. Methods • Curriculum • Faculty lecture • Small group session • Patient interaction in surgical oncology clinic

  7. Methods • In addition to participating in the standard curriculum, third year medical students at the Medical College of Georgia (N=21) were randomized into one of two groups: • Group 1: Interaction with a virtual patient (VP) with a breast complaint (N=11) • Group 2: No VP interaction (N=10)

  8. Methods • Students then interviewed and examined a real patient with a breast complaint in the surgical oncology clinic • Group 2 crossover post-RP interaction • Participants completed baseline and exit surveys to assess confidence and anxiety regarding HT and BE and the educational value of the curriculum (Likert-type scale) • Data were analyzed using paired and Student’s t-tests

  9. Results Comparison of Experiences by Group 1Number (percent) 2Mean (range) Table 1: Comparison of Baseline and Completion Measures (N=21)

  10. Results • Most students felt the components of the breast curriculum were valuable: • Lecture- 89% • Small group- 89% • Surgical oncology clinic experience- 100%

  11. Results Comparison of Baseline and Completion Measures (N=21) 1Five-point Likert-type scale (1=least confident; 5=most confident) 2Five-point Likert-type scale (1=least anxious; 5=most anxious) *p<0.05, paired t-test Table 1: Comparison of Baseline and Completion Measures (N=21)

  12. Results Comparison of Completion Measures by Group 1Five-point Likert-type scale (1=least confident; 5=most confident) 2Five-point Likert-type scale (1=least anxious; 5=most anxious) *p<0.05, Student’s t-test Table 1: Comparison of Baseline and Completion Measures (N=21)

  13. Study Limitations • Small n • Data represent 1/3 of MS 3 class • Single interaction • Impact of repetitive practice? • Assessment of performance lacking • Practice vs. assessment

  14. Conclusions • In the context of a curriculum to teach breast history-taking and examination, VPs increase learner confidence in history-taking • There is tremendous potential to enhance current methods of teaching these skills through the use of virtual scenarios and mannequin-based simulators • Current research includes the development of mixed reality humans (MRH) which integrate virtual humans with a mannequin-based physical interface

  15. Evolution Mixed Reality Humans combine a Virtual Human Tangible Interface

  16. Virtual Character Team Medical College of Georgia Surgery D. Scott Lind Adeline Deladisma, James Bittner, Mamta Gupta, Toufic Imam Family Medicine Peggy Wagner University of Florida College of Engineering (CISE) Ben Lok Andrew Raij, Kyle Johnsen, Brent Rossen, Aaron Kotranza Northwestern University Surgery Carla Pugh

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