Validating the Utility of Online Learning and Non-Immersive Virtual Reality on Central Venous Catheterization Education
Restricted (Penn State Only)
- Author:
- Gonzalez-Vargas, Jessica
- Graduate Program:
- Industrial Engineering
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 09, 2023
- Committee Members:
- Steven Landry, Program Head/Chair
Paul Griffin, Major Field Member
Jason Moore, Outside Unit & Field Member
Scarlett Miller, Chair & Dissertation Advisor
Hui Yang, Major Field Member
Elizabeth Sinz, Special Member - Keywords:
- medical education
central venous catheterization
online training
virtual reality
surgical education
complications
medical training
non-immersive virtual reality - Abstract:
- Medical training is a vital part of our medical system because it trains professionals in the knowledge and skills needed to deliver efficient and effective patient care. One such procedure that is important in medical training is Central Venous Catheterization (CVC) which is used to provide fluids, blood, or medications directly to the heart. While more than 5 million CVC procedures are conducted annually in the United States alone, there is a high incidence rate with up to a 15% of patients experiences one or more complications. Importantly, these preventable medical errors have been directly attributed to the experience level of the doctor performing the procedure. This is problematic for a number of reasons, but perhaps most importantly is the fact that medical error is the third cause of death in the United States, with approximately 200,000 deaths annually attributed to medical error. In an attempt to reduce medical mistakes and improve training experience, the “See One, Do One, Teach One” teaching philosophy has been widely integrated throughout medical education including the steps of observing, attempting the procedure (on real patients), and teaching others how to perform it. However, recent studies have shown that this training method is associated with 28% to 42% of residents expressing a lack of confidence in their procedural performance. In light of this, attempts have been made to improve medical education through the use of didactic lectures to teach procedural knowledge and simulation-based training for mechanical skill development. However, these too have limitations such as the time required to perform the training, the need of a trained preceptor to provide feedback, the challenges balancing clinical responsibilities with educational trainings, and the transfer of these skills to the clincal environment. Recent advances in simulation-based training including the Penn State design Dynamic Haptic Robotic Trainer (DHRT) overcome some of the limitations of these previous approaches in that it provides more realistic training that transfer to clinical environments. However, it is limited in its training of procedural skills, and developing confidence in the use of the tools needed to perform the procedure. This brings to question how new educational systems such as online-learning and virtual reality can be used to improve the efficiency and effectiveness of CVC, while also allowing for flexibility in when the training occurs. In light of this, the objective of this dissertation was to identify the effects of online and non-immersive virtual reality training on resident learning and skill transfer to the clinical environment. This is achieved through three means: (1) identifying the impact of online versus in-person procedural skills training, (2) examining the utility of non-immersive virtual reality for procedural knowledge, self-efficacy, and satisfaction, and (3) validating the impact of standardized ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) training on clinical outcomes. The results of this dissertation shows that the (1) online procedural training was just as effective as in-person training for surgical resident’s acquisition of knowledge development of the technical skillset, (2) non-immersive VR training is adds educational value for US-IJCVC education and it is better than traditional multiple-choice test in residents self-efficacy, number of attempts, and overall learning experience, and (3) the large-scale deployment of the US-IJCVC training might be improving clinical performance by seeing a reduction of mechanical, infectious, and thrombosis complications at the teaching hospital. These results provides the groundwork for implementing and assessing standardized training throughout medical training to ensure medical residents are prepared to perform medical procedures on patients in a clinical environment.