Wier Grady S, Tree Rebekah, Nusr Rasha
From the Axiom Resource Management, Inc. (G.S.W), Program Manager, Air Force Medical Service Analytics, Air Force Medical Operations Agency, San Antonio, TX DCS Corporation (R.T.), Army Research Laboratory, Aberdeen, MD; and Ministry of Public Health Doha, Qatar. All authors previously worked on a government contract with Air Force Medical Modeling and Simulation Training (AFMMAST).
Simul Healthc. 2017 Feb;12(1):28-40. doi: 10.1097/SIH.0000000000000207.
The success of war fighters and medical personnel handling traumatic injuries largely depends on the quality of training they receive before deployment. The purpose of this study was to gauge the utility of a Wide Area Virtual Environment (WAVE) as a training adjunct by comparing and evaluating student performance, measuring sense of realism, and assessing the impact on student satisfaction with their training exposure in an immersive versus a field environment.
This comparative prospective cohort study examined the utility of a three-screen WAVE where subjects were immersed in the training environment with medical simulators. Standard field training commenced for the control group subjects. Medical skills, time to completion, and Team Strategies and Tools to Enhance Performance and Patient Safety objective metrics were assessed for each team (n = 94). In addition, self-efficacy questionnaires were collected for each subject (N = 470).
Medical teams received poorer overall team scores (F1,186 = 0.756, P = 0.001), took longer to complete the scenario (F1,186 = 25.15, P = 0.001), and scored lower on The National Registry of Emergency Medical Technicians trauma assessment checklist (F1,186 = 1.13, P = 0.000) in the WAVE versus the field environment. Critical thinking and realism factors within the self-efficacy questionnaires scored higher in the WAVE versus the field [(F1,466 = 8.04, P = 0.005), (F1,465 = 18.57, P = 0.000), and (F1,466 = 53.24, P = 0.000), respectively].
Environmental and emotional stressors may negatively affect critical thinking and clinical skill performance of medical teams. However, by introducing more advanced simulation trainings with added stressors, students may be able to adapt and overcome barriers to performance found in high-stress environments.
战斗人员和医疗人员处理创伤性损伤的成功很大程度上取决于他们在部署前接受的训练质量。本研究的目的是通过比较和评估学生表现、测量真实感以及评估沉浸式环境与实地环境对学生训练满意度的影响，来衡量广域虚拟环境（WAVE）作为一种训练辅助手段的效用。
这项比较性前瞻性队列研究考察了三屏WAVE的效用，在该环境中受试者通过医疗模拟器沉浸于训练环境。对照组受试者开始进行标准实地训练。对每个团队（n = 94）的医疗技能、完成时间以及提高绩效和患者安全的团队策略与工具客观指标进行评估。此外，为每个受试者（N = 470）收集自我效能量表。
与实地环境相比，医疗团队在WAVE环境中的总体团队得分更低（F1,186 = 0.756，P = 0.001），完成场景所需时间更长（F1,186 = 25.15，P = 0.001），并且在国家紧急医疗技术员注册创伤评估清单上的得分更低（F1,186 = 1.13，P = 0.000）。自我效能量表中的批判性思维和真实感因素在WAVE环境中的得分高于实地环境[分别为（F1,466 = 8.04，P = 0.005）、（F1,465 = 18.57，P = 0.000）和（F1,466 = 53.24，P = 0.000）]。
环境和情绪压力源可能会对医疗团队的批判性思维和临床技能表现产生负面影响。然而，通过引入带有更多压力源的更先进模拟训练，学生或许能够适应并克服在高压力环境中出现的表现障碍。
