Presentation
Iterative use of Expert and Novice feedback on simulator design: A multi-stakeholder approach in central venous catheterization
DescriptionMedical simulation is an essential component of training physicians that has facilitated the paradigm shift of medical training from “see one, do one, teach one” to “see one, simulate many, do one, teach one”. While simulators for many medical procedures are commercially available, there exists a need for the continuous innovation of medical simulation to improve usability and transferability to the clinical environment. One procedure that could benefit from improved simulation training is central venous catheterization (CVC). CVC can be broken down into stages, needle insertion vessel access, and post vessel access catheter insertion. The standard for CVC training is manikin simulators that are useful for practicing needle insertion. However, manikin simulators lack specific, personalized performance feedback and durability, and only provide training on the needle insertion portion of the procedure, neglecting the remainder of the steps and medical tools. Based on the limitations of currently available training methods, there is a need for the development of a whole procedure trainer that can provide practice in all the steps of CVC with automated feedback. During the design process, prototypes are often used to gain feedback from stakeholders, defined as individuals who will be impacted by or exposed to the item being design. The primary stakeholders for medical simulation training are the system users, in this case, new residents (novices) and the physicians in charge of their training (experts). To address the need for a whole procedure trainer for CVC, we followed an iterative design cycle approach. For design cycle one, ten experts participated in a demonstration and interview of a virtual prototype. This prototype was a simulated interface that was demonstrated to participants through pre-made videos. The feedback from these ten expert interviews was used to inform design cycle two and create a low fidelity physical prototype which was used in a demonstration and interview with three additional experts. The low fidelity physical prototype included an interface and a false vein channel to simulate the vein that the catheter is inserted into during CVC. These interviews informed design cycle three, which included a medium-fidelity physical prototype and a demonstration and interview with four additional experts. This prototype included an updated interface, a false vein channel, a full CVC medical tray with all equipment used for the procedure, and sensors to indicate successful catheter insertion and provide feedback to the trainee. After design cycle three, NVivo was used to qualitatively analyze the overall feedback given across all design cycles. In the final version of the simulator to be used for new resident training, the interface was updated to include patient vitals. Computer vision was utilized in the physical system to track the tools as they were moved in and out of the CVC medical tray to practice mechanical steps and sensors were used to monitor the insertion of tools into the vein. Twenty-nine novices, the main users, trained on the simulator and answered a Likert-scale survey and open-ended questions about the utility of the simulator and where it could be improved. Overall, both experts and novices indicated the utility of a whole procedural simulator and its potential to positively impact resident training. Interestingly, the expert feedback focused more on the aspects of CVC to include in the training to ensure that it was teaching the most important skills, and the novice feedback focused on how the system could be best structured to help them learn. Both expert and the novice feedback are necessary to design the most usable training system.
Event Type
Oral Presentations
TimeTuesday, March 268:52am - 9:15am CDT
LocationSalon A-4
Simulation and Education