September 6, 2018By Lance Baily

Using Extended Virtual Reality in Healthcare Training from Tech Trends

After a 25-year career as a learning scientist and the last 3 years “immersed” in the private sector Todd Maddox, Training Correspondent at Tech Trends and CEO of Cognitive Design & Statistical Consulting, has the opinion that xR technologies have the potential to improve the quality and quantity of training, to reduce training costs and to enhance patient satisfaction through better care from healthcare professionals and a deeper understanding for patients. To support this claim, today on Tech Trends he outlined a framework report for understanding how the brain learns which derives from some of his own research supported by over $10 million in federal grants to support his laboratory, and a huge body of research conducted across the world over the past 100+ years focused on learning.

Tech Trends Extended VR Article Excerpt

Suppose you are a medical student faced with the problem of learning the anatomy and physiology of the human body. The human body is a 3-dimensional structure that functions as a dynamic system. The ultimate goal of training is to facilitate the formation of a 3D dynamic mental representation of the human body in the learner’s brain that perfectly mimics the actual form. The best way to achieve this is to present the learner with a 3D dynamic visualization, yet most traditional teaching methods use textbooks or slideshows filled with 2D static images. Thus, the learner must convert a series of 2D static images into a 3D dynamic mental representation in the brain that accurately reflects the human form.


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Attempting to construct a 3-dimensional dynamic representation of the human body from a series of 2-dimensional static images requires a huge amount of cognitive effort. First, you have to hold a mental representation of a series of 2-dimensional static images in short-term (working) memory. Second, you have to hold these 2-dimensional static mental representations in your working memory and combine them on the fly to construct an accurate 3-dimensional static representation. Finally, you have to infer and impart the dynamic nature of the human form onto this 3-dimensional static representation. Each of these steps requires an enormous amount of cognitive capacity (in the form of working memory), and an enormous amount of cognitive energy (in the form of executive attention). Any time working memory load and executive attentional demands are taxed, you are more likely to make an error and generate an inferior mental representation.

Now consider an xR solution in which you place a Microsoft HoloLens on your head and a 3-dimensional, dynamic representation of the human body appears in front of you. You can walk around the body and can rotate it so that you can see it from all angles. You can select a skeletal view and when you touch a bone its name appears. In this case, you have a highly accurate 3-dimensional dynamic xR visualization tool that is intuitive and facilitates the development of a highly accurate 3-dimensional dynamic representation in the learner’s brain. A tool like this engages the visual representation learning system in the brain that recruits occipital and temporal lobe structures. By removing the need to construct a 3-dimensional dynamic mental representation from a series of 2-dimensional static images, the working memory and executive attention load on the learner has been slashed. Those resources can be used to learn the names of the bones, muscles, arteries, etc., but with a rich visual mental representation upon which to attach them.

The same logic holds for other cognitive skills learning problems. Suppose you are a patient or caregiver who needs to care for and maintain a central line. The most common approach to central line care and maintenance training is to have learners read documents describing in detail all of the required steps. From a psychological and brain science perspective translating this abstract text-based representation into a rich visual representation that you can use to guide your behavior is challenging. Yet putting on a HMD (Head Mounted Display) and being transported into an immersive setting in which you are watching someone care and maintain a central line in a virtual world in real-time instantly reduces the areas in the brain which are engaged. Learning will be enhanced, quicker and more robust.

Because behavioral skills are learned gradually and incrementally via dopamine-mediated, error-correction learning in the basal ganglia of the brain, they require extensive practice, yet traditional real-world approaches are limited due to difficulty and expense.


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xR medical training technologies are being developed which bypass these difficulties, however. Some of the more advanced platforms include realistic artificial cadavers that provide the appropriate haptic feedback, for example. When implemented correctly, technologies like this will speed the training of medical procedures and will give learners enough practice that they will be job-ready before entering a medical facility to see patients.

Emotional learning affects how one processes and links the cognitive and behavioral aspects of a situation. A nurse or doctor with strong situational awareness knows what to say and do when appropriate. They know how to be compassionate or firm – only after years of exposure to multiple situations do medical personnel gain the expertise and situational awareness necessary to respond effectively in all situations. With xR technologies though, the medical practitioner and the patient can receive training in a broad range of routine, but also non-routine situations.

In our opinion, VR has a massive role to play in the future of healthcare simulation training technologies. Thanks to Todd Maddox for these insights to help demonstrate why!

Read Todd’s entire Extended VR in Healthcare Article on
Tech Trends


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