VIRTUAL PATIENTS GROUP Health Sciences Center Symposium March 12 th, 2010

Interpersonal Scenario Training Training people to interact with people is difficult Lectures Role-play Observe We propose to add simulation

Goals of Talk Motivate Simulating Interpersonal Scenarios Virtual Human Experiences Typing->Natural Interaction->After Action Review Mixed Reality Public Exhibits Open Issues Metrics Learning Training Transfer Role of Technology

Current approaches have difficulty providing: Sufficient opportunities for practice Exposure to infrequent – yet critical – scenarios Tailoring for each student Standardization Patient variability Team-based learning Cultural competency Feedback Addressed with virtual patient experiences

Experiences with Virtual Patients Students practice communication + diagnostic skills Used in conjunction with standardized patients For different level of learners, different benefits Initially, practice and feedback Later, exposure Eventually, continuing medical education

Watch Video Virtual Patients Webpage

Virtual Patients Group Created technology that provides role-playing experiences with interacting with virtual people Students interact with virtual patients to: Cover lecture cases in more detail Be exposed to abnormal findings Reduce anxiety to intimate exams

Continuum of Experiences Second Life Immersive Interaction Video Conference Chat Web Browser Instant Message

IPS System Inputs Natural speech Tracking head, hands, chair, tools Video Outputs Speech and animation Life-size VH Commercial-off-the-shelf 2 PCs 2-4 video cameras Data projector, large-screen TV, or HMD Wireless microphone < $6,000(USD)

Virtual Patients Consortium University of FloridaMedical College of Georgia University of GeorgiaUniversity of Central Florida University of Florida PIs Benjamin Lok, Ph.D. Juan Cendan, M.D. Rick Ferdig, Ph.D. (KSU) Mike Robinson, Ph.D. Senior Personnel Yong Ho Hwang, Ph.D. Students Joon Hao Chuah Willie Maddox Mallory McManamon Diego Rivera-Gutierrez Andrew Robb Brent Rossen Shivashankar Halan Medical College of Georgia PIs D. Scott Lind, M.D. Senior Personnel Adriana Foster, M.D. Angela Gucwa, M.D. Candelario Laserna, M.D. Brenda Rosson, R.N. Peggy Wagner, Ph.D. Jennifer Carrick Students Steven Blackwood Ashita Gehlot Chandni Kalaria Hevil Shah Alyssa Wier University of Georgia PIs Kyle Johnsen, Ph.D. Students Qian Ma Tyler Niles Animesh Thakre University of Central Florida PIs Laura Cuty-Ruiz, Ph.D. Senior Personnel Moshe Feldman, Ph.D. Staff Mike Eakins Dan Sagendorf

Sponsors Current support Prior Support National Science FoundationNational Institutes of HealthAssociation of Surgical Education University of FloridaMedical College of GeorgiaKeele University

Consortium Overview Started in Spring 2004 Four universities 33-person team including Computer Science Medicine Education Psychology 53 active members

Consortium Overview Experiences Immersive: 600+ Online: (with over long conversations) Public exhibits and demos: scenarios Publications: 9 journal, 16 conference, 18 abstracts Awards: IEEE VR 2008 Best Paper Research and Clinical Abstract Awards (Georgia ACS) $2.8 million in funding (NSF, NIH, and ASE)

Scripts (24) at VPF General General Anesthesia Pre-op OSA (UF) Conscious sedation (UF) Cancer Abnormal mammogram (UF) BRCA Pedigree (UCF) Clinical breast exam (UF/MCG) Melanoma (MCG) Pain Abdominal Pain (UF) Chest pain (UF) Gallstones (UCF) Lower back pain (UF) Lower back pain (PCOM) Psychiatry Failure to thrive (UF) Depression (MCG) Bi-polar (MCG) General Breaking bad news (MCG) Cranial Nerve (UF) Dyspepsia – Pharmacy (UF) Gastro-Band (UF) GI Hemorrhage (UF) Meningitis (PCOM) Patient-Centered Counseling (USF) Post Operative Hemorrhage (UF) Sexually Transmitted Diseases (UF) Contraceptive Counseling (UF)

Getting involved Short term (demo) – a few weeksdemo Create a scenario using Virtual People Factory Use an existing case Saves course time Test with students Publish and demo Long term Develop a deployable teaching unit Integrate into curricula at UF Federal funding (e.g. NIH, NSF)

Developing Virtual Character Cognition Virtual People Factory – Web-based interface – End-user creation of content – Pharmacy patient Pharmacy patient In two years – Over 4700 interactions – 24 end-user created scenarios End-user created scripts can reach 85% accuracy UCF integrated into curriculum

NERVE: The Neurological Examination Rehearsal Virtual Environment Virtual multi-tool interface to VH Single input device (Wii Remote) controls multiple virtual tools used in eye exam Gestural and tool input, in addition to speech Medical students can Learn how to use neurological tests to diagnose a patient with a vision disorder Receive additional exposure to patients with abnormal findings (e.g. double vision, lazy eye)

Physical Examinations of Virtual Human Patients Mixed reality humans Passive-haptic interface to life-sized virtual human Applications Clinical breast exam Prostate exam (upcoming) Medical students can Practice merging physical examination and communication skill sets Get real-time feedback of exam performance Coverage Pressure Conversation topics

Museum of Science and Industry  Science museum in Tampa, FL  5 th largest in US (75,000 sq ft.)  1 million guests  Integrate a VH interaction  The Amazing You exhibit  Lifelong wellness information  March 2010  Inspire, inform  Explore race, VH bias  Youtube Video Youtube Video

After-Action Review by Students IPSViz – Web-based interface – Students received with link (automated) – Sample student (10158/00000) Sample student – Self-directed review of content, video, and feedback Each student can review their performance and compare with experts

After-Action Review by Educators IPSViz n – Web-based interface – Educators can review completed student interactions – Data from study Data from study – Filter based on user background Level of expertise Gender Educator-defined metrics Experts can – Identify trends (mean of class) – Identify outliers

Bias  Interact with either a Caucasian or African-American VH  Experts rated empathy  Empathy was correlated to psychology measures of skin-tone bias  VHs can elicit racial biases  People reported that the African- American VH had less education and money  Identical: animations, words spoken  Differences: skin-tone, voice  Other biases to study  Race/Ethnicity  Gender  Age  Weight  Social ‘hot topics’

Pain Perception PI: Mike Robinson Video vignettes of VPs expressing low or high levels (FACS) of pain VPs varied in gender, age, and ethnicities Doctors, nurses, and dentists evaluate perceived levels of pain Identifies variables and weighting of variables that affect healthcare provider’s pain perception

What we think we might know… Does not matter if people believe the virtual human is real or virtual Apply communication skills training until technology proves them wrong Valid interaction Potential benefits above real humans If people see benefits, they overlook technology faults People want to play along

Consortium Expertise University of Florida Technology development Scenario development Abnormal findings Medical College of Georgia Intimate Exams University of Georgia Patient-centered experiences University of Central Florida Assessment Curricular integration

Collaborators Looking to add collaborators Contact me One-on-one discussions Demos Speak to your research group

Virtual Experiences Research Group Thank you!

Experiences 24 Patient-Doc scenarios Intimate Exams Abnormal Findings (Neurological Exam) Conscious Sedation (VP+IPS) Audiology Testing After-Action Reviews You, M.D. Bias studies: Pain perception

Video Conference with a VP All VPF scripts can be experienced video- conference style Interact with 3D VPs using a webcam and typing Enables study of distributed medicine

Audiology collaboration with Mark Billinghurst (NZ) Students administer audiology exams to VP Exams include: History VP visual examination Hearing screen Testing speech understanding Highlights Procedure and communications skills VP presenting abnormal conditions