| 1. |
- Creutzfeldt, Johan
(författare)
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Avatar : saving lives in virtual worlds
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In medicine, education and recurrent training is fundamental for efficient and safe care. In emergency situations one has to rely on robust protocols that reduce the risk for errors. However, today there is plenty of evidence that the professional level of knowledge, manual, cognitive and teamwork skills as well as suitable attitudes needs to be raised. By using new and promising educational technology it has been proposed that one can address several problems in today’s education and training. So far, in medicine there haven’t been many results on whether gaming technology supports learning although findings from several authors are encouraging. One area of particular interest is that of cardiopulmonary resuscitation (CPR), since all health care professionals are assumed to possess competence in this field. To disseminate the knowledge and skills, with the goal of reaching better outcome after out-of-hospital sudden cardiac arrests, CPR is also trained at schools. With the rapid development in information and communications technology (ICT) and the increase in computer access and skills in a digital native generation, the stage is set for “serious games”. By using cardiopulmonary resuscitation as a model, the aim of this thesis project has been to understand if a virtual world is suitable for training medical and high school students to assist in emergency medical situations. A virtual world with capabilities to train teamwork CPR was developed. Short scenario based training sessions using a virtual school environment was carried out in teams. In study I and II user experiences and reactions were assessed from a social cognitive and games research perspective. The findings in terms of strengthened self-efficacy beliefs and positive ratings on dimensions of “flow” experience indicated that this tool could engage the subjects and carried properties important for learning and execution. Results from Swedish and US high schools were comparable. Study III was a transfer study in which virtual world pre-trained groups were assessed and compared to control subjects in a full-scale high fidelity patient simulator, 6 and 18 months after virtual world CPR team training. Main findings in this study indicated that subjects trained 6 months before simulator assessment delivered higher quality CPR in terms of chest compressions, and followed the CPR protocol better than the other groups. In study IV the aim was to get a more complete picture of how the virtual world CPR team training was perceived by the participants and compare the findings with theories on learning and serious games. Using a qualitative approach, four categories evolved as end result. The findings support many of the proposed benefits of serious games, such as high levels of enjoyment and engagement. Further, learning in teams is beneficial for several reasons. However, there are areas that call for some caution. It can be questioned if a sense of mastery created in a virtual world easily transfers to the real world. Also, not all students are enchanted by computers and computer games – when establishing training in virtual worlds one has to consider the level of computer interest among the users. To evoke the proposed positive effects of virtual world training, one has to meet the demands this game derived method poses in terms of high levels of challenge, proximal goal-setting, affective involvement and rich feed-back. Although being exploratory to its nature, the results from this project demonstrate possibilities within virtual worlds for training in teams. Being accessible, relatively inexpensive to run and rich in variations, virtual worlds based training can be motivated in a variety of settings within medicine.
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| 2. |
- Creutzfeldt, Johan, et al.
(författare)
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Cardiopulmonary resuscitation training in High School using Avatars in Virtual Worlds : An International Feasibility Study
- 2013
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 15:1, s. doi-10.2196/jmir.1715
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Tidskriftsartikel (refereegranskat)abstract
- Background: Approximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today's youth (ie, the digital native generation). Objective: Our main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training. Methods: In this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables. Results: The participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, P<.001). In the Swedish follow-up, it subsequently increased from 5.7/7 (SD 0.56) to 6.3/7 (SD 0.38, P=.006). In the Swedish group, the mean concentration value increased from 52.4/100 (SD 9.8) to 62.7/100 (SD 8.9, P=.05); in the US group, the concentration value increased from 70.8/100 (SD 7.9) to 82.5/100 (SD 4.7, P<.001). We found a significant positive correlation (P<.001) between self-efficacy and concentration scores. Overall, the participants were moderately or highly immersed and the software was easy to use. Conclusions: By using online MMVWs, team training in CPR is feasible and reliable for this international group of high school students (Sweden and United States). A high level of appreciation was reported among these adolescents and their self-efficacy increased significantly. The described training is a novel and interesting way to learn CPR teamwork, and in the future could be combined with psychomotor skills training.
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| 3. |
- Creutzfeldt, Johan, et al.
(författare)
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Effects of pre-training using serious game technology on CPR performance : an exploratory quasi-experimental transfer study
- 2012
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 20, s. 79-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students' retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training. Methods: Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance. Results: The 6 months group displayed greater CPR-related knowledge than the control group, 93 (+/- 11)% compared to 65 (+/- 28)% (p < 0.05), the 18 months group scored in between (73 (+/- 23)%). At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (+/- 0.5), 1.5 (+/- 1.0) and 4.5 (+/- 1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (+/- 44)% in the control group (p < 0.05) and 44 (+/- 49)% in 18 months group where incorrectly paced; differences that disappeared during training. Conclusions: This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.
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| 4. |
- Creutzfeldt, Johan, et al.
(författare)
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Exploring Virtual Worlds for Scenario-Based Repeated Team Training of Cardiopulmonary Resuscitation in Medical Students
- 2010
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 12:3, s. e38-
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundContemporary learning technologies, such as massively multiplayer virtual worlds (MMVW), create new means for teaching and training. However, knowledge about the effectiveness of such training is incomplete, and there are no data regarding how students experience it. Cardiopulmonary resuscitation (CPR) is a field within medicine in high demand for new and effective training modalities.ObjectiveIn addition to finding a feasible way to implement CPR training, our aim was to investigate how a serious game setting in a virtual world using avatars would influence medical students’ subjective experiences as well as their retention of knowledge.MethodsAn MMVW was refined and used in a study to train 12 medical students in CPR in 3-person teams in a repeated fashion 6 months apart. An exit questionnaire solicited reflections over their experiences. As the subjects trained in 4 CPR scenarios, measurements of self-efficacy, concentration, and mental strain were made in addition to measuring knowledge. Engagement modes and coping strategies were also studied. Parametric and nonparametric statistical analyses were carried out according to distribution of the data.ResultsThe majority of the subjects reported that they had enjoyed the training, had found it to be suitable, and had learned something new, although several asked for more difficult and complex scenarios as well as a richer virtual environment. The mean values for knowledge dropped during the 6 months from 8.0/10 to 6.25/10 (P = .002). Self-efficacy increased from before to after each of the two training sessions, from 5.9/7 to 6.5/7 (P = .01) after the first and from 6.0/7 to 6.7/7 (P = .03) after the second. The mean perceived concentration value increased from 54.2/100 to 66.6/100 (P = .006), and in general the mental strain was found to be low to moderate (mean = 2.6/10).ConclusionsUsing scenario-based virtual world team training with avatars to train medical students in multi-person CPR was feasible and showed promising results. Although we found no evidence of stimulated recall of CPR procedures in our test-retest study, the subjects were enthusiastic and reported increased concentration during the training. We also found that subjects’ self-efficacy had increased after the training. Despite the need for further studies, these findings imply several possible uses of MMVW technology for future emergency medical training.
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| 5. |
- Creutzfeldt, Johan, et al.
(författare)
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Using virtual world training to increase situation awareness during cardiopulmonary resuscitation
- 2014
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Ingår i: Medicine meets virtual reality 21. - : IOS Press. - 9781614993742 - 9781614993759 ; 196, s. 83-5
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Konferensbidrag (refereegranskat)abstract
- Situation awareness (SA) is a critical non-technical skill which affects outcome during emergency medical endeavors. Using a modified self-report instrument a significant increase of SA was found during multiplayer virtual world CPR team training among 12 medical students. Further a correlation between SA and attention was noted. Being a vital factor during the process of video-game play, we argue that this skill is suitably practiced using this training method.
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