Learning in Critical Care using Avatar and CEP ... - CRRT Online

Learning in Critical Care usingAvatar and CEP softwareCRRT 2011, San Diego Hilton BayfrontIan BaldwinR.N. PhDMelbourne Australia

Worse again….the University

Edgar D, Cone of LearningPassiveActive

The virtual world

Acronyms - terms• MMVW – Massively Multiplayer Virtual World• Web 2.0 - WWW apps such as face book, blogs,wiki’s Pod Casting, YouTube, Twitter.• SL – Second Life social interactive venues used bymultiple animated characters, lectures.conference, groups.• MMOG – Massively Multiplayer Online Games• Avatar – unique fictitious self or human figurewhere the user may sit stand, talk, swim, walk.• Wii – Nintendo software to replicate movement.

Virtual world• The immersive environment the Avatar movesand interacts within…….an MMOG• Is usually 3D, enables socialization, building,conduct of business, education etc• Has an educational and research potential• Safe, simulated, fun, interactive, collaborative

Design yourself as an Avatar

The Ann Myers Medical Center(AMMC) founded by Dr AnnBuchanan.Virtual conference

International Virtual Assoc. of Surgeons1 st meeting in 2 nd Life 2008

The virtual hospital3D simulation of the Royal Sussex CountyHospital in BrightonSecond Health London Hospital

Virtual autopsy

The Virtual ICU

Virtual Nephrology

Huge- everyone is developing this• Engineers• Medicine / health care• IBM• Universities

University of Southern Queensland, Australia andUniversity of San Francisco, School of Nursing U.S.A.• Avatar and 3 D design tutorials• You tube this at “ ALIVE Classmate”

Benefits for learning• Immersion & Role playing• Simulation• Critical thinking and ‘discovery’ learning• Programmable learning outcomes• Collaborative, interaction, dynamic• Transferable learning to the real world• 24/7 access, distance education

Key requirements• Design and construct, ‘world set up ‘• Educator interest and creativity to use the tool• Funds - cost

ICU nursing ‘handover’

ICU nursing handover templateName, age and day no. in ICURules for presenter.Prepare, use logical flow, focus, don‟trepeat, show & tell.Original diagnosis for admission to ICU, relevant, past historyCurrent problem(s) – summary statement(s), relevant data/obs.Current management plan for eachReview of drugs and IV’s orderedReview of patient - physicalOutstanding care needsFamily – social issuesReview of equipment, bay – IV’sRules for audience.Listen, engage, avoid interruption, takenotes, ask Q‟s later, give feedback.Questions – answers, teaching etcV 1.0 2007

Health Process Simulation InVirtual WorldsRoss Brown and Rune RasmussenFaculty of Science and TechnologyQUT, Queensland, AustraliaIan Baldwin, Dept. of Intensive Care, Austin Health, Victoria,Australia

Initial Meeting Process• Meeting room for handoverbriefing meeting

• Bed physical simulationICU bed Simulation• Perform physical and equipmentchecks• Access care plan from desk

Patient Care Planning• Present care plan is presented tostudents• Students can modify as part ofhandover session• Integrated with teaching system

Student Note Taking• Note taking can be integratedwith teaching systems -Sharepoint• Instructor can then reviewreports and grade/comment

Dr Ross Brown, QUT, Australia• Email:– r.brown@qut.edu.au– r.rasmussen@qut.edu.au• Blog:– www.bpmve.org• Youtube:– www.youtube.com/BPMVE• Twitter:– www.twitter.com/BPMVE

Evidence ?

Triage: ‘game’ Vs ‘Table top’ (cards)Jarvis S and de Freitas S, 2009

The real World

The real WorldHow do we ensure „competency‟ ?

“Now, which onedid they say not toturn off ?”……Post op cardiac surgery..But need competent nurses…..

hrs3000200010000The staffing gap….Austin ICUNursing 175 staff, 118 EFT2084…..57 Full time….156 ICU „qualified‟ or in trainingICU: Monthly Total Patient Admissions2502007-1000-ve 260200150-20002344-3000Staffing ICU – nursing over year 2007100500Jul-05Aug-05Sep-05Oct-05Nov-05Dec-05Jan-06Feb-06Mar-06Apr-06May-06Jun-06AdmissionsAug-06Sep-06Oct-06Nov-06Dec-06Jan-07Feb-07Mar-07Apr-07May-07Jul-06Moving Average AdmissionMonthly total admissions 2005 – 07‟Jun-07

World wide shortage of nurses• Cross global recruitment for nurses with ICU skills• Attractive offers in employment conditions• Salary incentives• Immediate immigration and long term visaor permanent residency

Check - lists….protocolsShift checklist and plannerNursing standards - summary

Domain of educational objectivesCognitivePsychomotorAffective

Traditional curriculum : Time and experience(s)Set experiences anticipating effective learningLimited control over specificsHurdles – assessments / appraisalsNo guaranteesDesigned to fit the calendar year, work needsAchievement determined by summative process - examsStartFinish6 months 6 monthsExamExam

Problems with current education models for clinical learningBased on fixed timeVariable clinical environments to provide developmentPotential for individuals to influence learningDifficulty standardizing clinical learning, ,New learning styles of the digital worldNeed to respond to the „Y‟ and „Z‟ generations

The Y & Z generations(1982 – 2000) & (1990 – 2010)Why ? gen.NET gen.Now gen.24/7 gen.„Me‟ gen.Generation mobile

Need to track competency development•Modulate learning experience(s)•Allows for minimum skills sets•Standardize within groups•Give better feedback•Improve certification standards anddocumentation for this

Potential for personal computer totrack clinical learning ?How to do it ?Which software, program ?Need for speed, real time, simple entryIndividual work space, mobile…wireless …

Concept of competency loggingNetwork ServerPC – Clinical TeacherPC – Shift managerPC – Post grad.PDA wireless connection• Mobile• Personal, individualReportsAuditsTranscripts

Microsoft SharepointMicrosoft SharePoint browser-based collaboration anddocument-management platform.It can be used to host web sites that access sharedworkspaces and documents, as well as specializedapplications like wikis and blogs from a browser.

Austin HealthICU Procedure LogPHONE: +61 3 9326 0000Address: nSynergyLevel 7, 365 Little Collins StreetMelbourne Vic 3000

Individual log on and password

CEP home page – sitehttp://midpoint.nsynergy.com/demo/cep/default.aspxTeachers view of shift entries

Site contentAnnouncements, tutorials, blogs, wiki etc

For shift entry use :http://midpoint.nsynergy.com/demo/cep/mobilepages/mobileexperience.aspxThis view contains all fieldsNew

Concept of competency loggingNetwork ServerPC – Clinical TeacherPC – Shift managerPC – Post grad.PDA wireless connection• Mobile• Personal, individualReportsAuditsTranscripts

ICU Procedure LogUsing an InternetConnection (GPRSor Wirelessconnection) and aweb browser,navigate to theICU Procedure LogForm.This address canbe saved in thefavourites.

ICU Procedure LogData may beentered using thePDA’s Stylus orKeyboard.Dropdown boxes,radio buttons andselection lists areavailable forsimplified dataentry.

ICU Procedure LogData may beentered using thePDA’s Stylus orKeyboard.Dropdown boxesare available forsimplified dataentry.

ICU Procedure LogData may beentered using thePDA’s Stylus orKeyboard.Dropdown boxesare available forsimplified dataentry.

ICU Procedure LogData may beentered using thePDA’s Stylus orKeyboard.Selection Lists areavailable forsimplified dataentry.Submit optionsenable the data tobe transferredimmediately tothe SharePointServer foranalysis.

ICU Procedure LogDetails are available as a SharePoint List.Each form needs to be approved by thesupervisor.Data may be filtered and sorted.

ICU Procedure LogData may be exported to MS Excel for analysis andreporting.

CEP data review Aug. 09’35302520151050No entriesDayEveningPod APod BCAGSSepsisRespSpinalConfidence scoreSammi HuangNoentries Day Evening Pod A Pod B CAGS Sepsis Resp SpinalSammi Huang 32 15 17 17 15 9 3 5 2 4.8Confidencescore

ConclusionsThe „digital world‟ has high potential foreducation and training in health careHow the current and future generationslearn will be different but within thisEfficiency gains are evident; cost, quality etcOutcomes need to be investigated