Trauma Virtual Reality Simulator

Five million people die of trauma every year, mostly in low- and middle-income countries. Trauma care requires team-based management and specialized procedures. High-fidelity simulation, the standard in rich countries, is too resource-intensive for global use, where the need is greatest. Virtual Reality simulation offers a novel solution - high-fidelity simulation, with iterative and multi-player team-based training, at minimal resource investment.

The Trauma VR simulator (TVRSim) offers a range of training possibilities based on resource constraints, local team capabilities and the chance to replicate nuanced decision-making in the high-stress life-or-death environment of immediate trauma care. Through iterative learning and feedback on time to decision, decisions per minute, and accuracy of perception and action, TVRSim allows novices to master life-saving procedures through stand-alone modules and practice them in simulated scenarios and gives advanced learners the opportunity to practice complex intraoperative scenarios in a virtual operating theater.

TVRSim is a software platform that allows learners to apply Advanced Trauma Life Support (ATLS) principles in simulated trauma scenarios using the Oculus Quest virtual reality headset or any device platform (smartphone, tablet, computer).  TVRSim allows simulation of a wide range of injury patterns in the VR setting with patient vital signs responding dynamically and realistically to interventions, delays in care or incorrect treatments. We plan to add haptic stimulation to create realistic, responsive scenarios and provide immediate feedback to the user.  Learners will have access to an interactive table of their decisions and a leaderboard which will demonstrate their performance compared to themselves and to others and act as incentives to encourage repeated use and improve technical performance. Learners can also learn key life-saving procedures at their own pace in a separate module. Using a behavioral skills training model, this program will hone the learner’s perception-action coordination through robust immediate feedback until they are ready to try them in simulated trauma scenarios. The program can also be easily tailored to allow various combinations of staff and equipment that approximate clinical environments from district hospitals to tertiary referral centers. 

Trauma care needs successful trauma team management and the ability to deploy a wide range of procedural skills. TVRSim aims to teach users team-based care through dynamic scenarios which will raise 1)situational awareness to rapidly recognize a deteriorating clinical situation, 2) allow practice making evidence-based decisions in stressful situations, 3) management of an interdisciplinary team and 4) conduct of specific life-saving procedures. The software will also have standalone procedure modules for learners to practice endotracheal intubation, cricothyroidotomy, chest tube insertion, pelvic stabilization and Focused Abdominal Sonography for Trauma, before deploying those skills in the dynamic simulated scenarios.  Chest tube placement will be the first procedure developed in TVRSim as it is the simplest and most fundamental invasive procedure in trauma which can quickly prevent needless deaths. These critical skills are often taught briefly during initial medical education. However, district hospital physicians often lack them because there is no mechanism to learn or practice these skills at a later date. Lastly, the scenarios will also be multiplayer so that the team leader can practice overall management and a second user can practice deploying key procedures.

TVRSim has the potential to serve all levels of medical trainees from students to physicians-in-training to faculty surgeons in LMICs such as Mongolia, where smartphones are increasingly ubiquitous and internet access has become more robust. Through TVRSim, medical students can learn critical clinical priorities in trauma care, physicians-in-training can gain proficiency in leading trauma teams, and senior physicians and faculty surgeons can refine clinical reasoning in complex or unusual scenarios. Globally, because of minimal capital investment needs, educational institutions can use TVRSim to cheaply and rapidly deliver standardized training to every clinician and prepare them for a variety of clinical environments instead of trying to conduct expensive in-person team-based training workshops. The proof of concept of using VR for surgical training is established - the psychomotor learning curve is accelerated in a dynamic and repetitive environment and VR offers objective and precise assessment. The main international committee accrediting trauma training has already expressed interest in such training capabilities to educate American physicians. Through this project we will aim to add hardware to the skills lab at the Mongolian National University of Medical Sciences to incorporate this training platform readily into surgical education.

Co-Lead: Sarnai Erdene, MD; Surgeon and ATLS director at Mongolia National University of Medical Science

Co-Lead: Jade Nunez, MD; Trauma Surgeon at University of Utah, Site Director for Mongolia at UU Center for Global Surgery

Clinician: Sudha Jayaraman, MD MPH; Trauma Surgeon at University of Utah and Director of UU Center for Global Surgery

Clinician: Raminder Nirula, MD MPH; Trauma Surgeon and Chief of General Surgery at University of Utah

Clinician: Alexander Colonna, MD MSCI; Trauma Surgeon and MS4 Surgery Clerkship director at University of Utah

Clinician: Michael Hollands, MBBS; Surgeon at Westmead Hospital, Sydney Australia. Led development of ATLS around Pacific Rim.

Educator: Aaron Fischer, PhD Educational Psychologist, specializing in behavioral learning and assessment at University of Utah

Educator: Sarah Creem-Regehr, PhD; Educational Psychologist specializing in skill acquisition and assessment at University of Utah

Educator: Jeanine Stefanucci, PhD; Educational Psychologist specializing in skill acquisition and assessment at University of Utah

Technical Expert: Benjamin Engel, VR Developer, Head of VR Lab at University of Utah Health