Gary Hardee | University of Texas at Dallas (original) (raw)

Papers by Gary Hardee

Research paper thumbnail of Can a Virtual Patient Trainer Teach Student Nurses How to Save Lives—Teaching Nursing Students About Pediatric Respiratory Diseases

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2012

Virtual environments offer a variety of benefits and may be a powerful medium with which to provi... more Virtual environments offer a variety of benefits and may be a powerful medium with which to provide nursing education. The objective of this study was to compare the achievement of learning outcomes of undergraduate nursing students when a virtual patient trainer or a traditional lecture was used to teach pediatric respiratory content. This was a randomized, controlled, posttest design. A virtual pediatric hospital unit was populated with four virtual pediatric patients having different respiratory diseases that were designed to meet the same learning objectives as a traditional lecture. The study began in Spring 2010 with 93 Senior I, baccalaureate nursing students. Students were randomized to receive either a traditional lecture or an experience with a virtual patient trainer. Students' knowledge acquisition was evaluated using multiple-choice questions, and knowledge application was measured as timeliness of care in two simulated clinical scenarios using high-fidelity mannequins and standardized patients. Ninety-three students participated in the study, of which 46 were in the experimental group that received content using the virtual patient trainer. After the intervention, students in the experimental group had significantly higher knowledge acquisition (P = 0.004) and better knowledge application (P = 0.001) for each of the two scenarios than students in the control group. The purpose of this project was to compare a virtual patient trainer to a traditional lecture for the achievement of learning outcomes for pediatric respiratory content. Although the virtual patient trainer experience produced statistically better outcomes, the differences may not be clinically significant. The results suggest that a virtual patient trainer may be an effective substitute for the achievement of learning outcomes that are typically met using a traditional lecture format. Further research is needed to understand how best to integrate a virtual patient trainer into undergraduate nursing education.

Research paper thumbnail of Game-Based Virtual Patients - Educational Opportunities and Design Challenges

other forms of synthetic patients and present key trends and seminal papers in the literature. We... more other forms of synthetic patients and present key trends and seminal papers in the literature. We propose ten development criteria for clinical simulation. We also present a proposed framework for creating game-based virtual patients and medical simulations. Finally, we critique our work based on these development criteria and discuss design challenges in creating virtual patients as well as potential areas for future research. With the aging of the baby-boomer population, the increasing need for more healthcare professionals has been well documented. One of the major factors contributing to the shortage of healthcare providers is the shortage of faculty. Medical simulations and synthetic patients can help extend the reach of current faculty to train new healthcare providers and help current practitioners improve their measurable performance quicker. The use of synthetic patients with game-based simulations creates greater outreach opportunities through improved distance education. ...

Research paper thumbnail of FINESSE: Foundations for Immersive Non-Fiction Narrative as Embodied/Situated Simulation Experiences -- A Conceptual Framework for Immersive Journalism Design

Research paper thumbnail of Developing Virtual Patients with VR/AR for a natural user interface in medical teaching

2017 IEEE 5th International Conference on Serious Games and Applications for Health (SeGAH)

Professionalism and communication skills are important aspects of medical training, and virtual p... more Professionalism and communication skills are important aspects of medical training, and virtual patient applications can offer cost effective, easily accessible platforms for communication practice which complement flexible, studentdriven medical school curriculum design. Further, numerous virtual and augmented reality platforms have been introduced recently. This paper explores potential advantages and disadvantages Virtual and Augmented Reality (VR/AR) technologies offer to the development of a virtual patient application specifically for communication practice-the Emotive Virtual Patients-with a natural user interface. VR/AR technologies may offer highly interactive, immersive virtual patient experiences that tie to our research goals, improve presence and create a more fertile environment to practice empathy, however they may also present platform-specific challenges. A potential virtual patient design framework is discussed, and the unique benefits and limitations of VR/AR devices are analyzed. We put our research in the context of other virtual patient research, and hypothesize what benefits in terms of presence and natural user interfaces VR/AR may provide.

Research paper thumbnail of Exploring medical cyberlearning for work at the human/technology frontier with the mixed-reality emotive virtual human system platform

2018 IEEE 6th International Conference on Serious Games and Applications for Health (SeGAH)

This paper describes the Mixed-Reality Emotive Virtual Human System Platforma machine for cyberle... more This paper describes the Mixed-Reality Emotive Virtual Human System Platforma machine for cyberlearning at the human/technology frontier. Our initial use case is for medical school students practicing patient interviewing in preparation for Objective Structured Clinical Exams (OSCEs). The work is deliberately focused on a futures environment where students can seamlessly enter a virtual learning experience and return to the face-to-face. For the context of our work, we define mixed reality as the ability to traverse real and synthetic learning experiences utilizing a variety of technologies such as augmented reality and virtual reality in a dynamic, emergent environment. Much of the work is based on the Emotive Virtual-Reality Patient research sponsored by the Southwestern Medical Foundation and exploration of the US Ignite ultra-high speed network, sponsored by the National Science Foundation. We use the US Ignite network to facilitate the development of virtual humans and the overall platform. We also explore evolving learning theory that supports the development of this knowledge system which blends real and synthetic roles of professors, mentors, and standardized patients in an emergent artificial intelligence and machine learning driven environment. Future applications of the model are also discussed.

Research paper thumbnail of Ten Possible States in the Age of 3D3C Art: The Contil Case

Journal For Virtual Worlds Research

Four factors take different meaning in the digital age: (a) 3D - moving from the real world into ... more Four factors take different meaning in the digital age: (a) 3D - moving from the real world into the screens, phones, and lately into our eyes with Google Glass, (b) Community - with Facebook/Twitter like digitally-enhanced communities, (c) Creation - with modern 3D printing, YouTube, Wikipedia and (d) Commerce - with virtual goods and virtual money from Linden Dollar to Bitcoin (aka 3D3C for short). We contend that 3D3C enable and push for a paradigm shift in how art could be shared, created, presented and sold, both through real and virtual means.In this paper, we describe ten states, or methods, of connecting real world art to the virtual wearing the 3D3C glasses.

Research paper thumbnail of Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice

The Spine Journal

BACKGROUND CONTEXT Back pain is the leading cause of disability, in the United States. Most acute... more BACKGROUND CONTEXT Back pain is the leading cause of disability, in the United States. Most acute low back pain (LBP) remits within a few weeks, but up to 10% of individuals develop a chronic condition characterized by long-term pain, disability, and resource cost. Maladaptive beliefs about pain and physical activity (ie, pain-related fear) contribute to poor outcomes following back injury. High fear individuals are more likely to avoid back-stressing physical activities, which they feel may exacerbate injury/damage, thus reinforcing a cycle of pain, functional disability, and potentially further injury. Graded exposure is a leading cognitive behavioral intervention to challenge fearful pain beliefs and gradually promote physical activity. PURPOSE As part of the North American Spine Society Young Investigator Grant, the current research team developed a virtual reality (VR) gaming interface as a flexible interactive platform to deliver graded-exposure intervention for high fear individuals with CLBP. A recently completed pilot study examined the safety and feasibility of this prototype, designed to challenge fearful pain beliefs and gradually promote physical activity. STUDY DESIGN/SETTING Repeated-measures lab-based intervention protocol. PATIENT SAMPLE Participants were 34 men (n=17) and women (n=17) with CLBP who reported high pain/movement-related fear, as measured by the Tampa Scale of Kinesiophobia. OUTCOME MEASURES Participants completed measures of pain intensity, perceived disability, and pain-related fear prior to and following intervention. Participants also completed a measure of treatment acceptability at the conclusion of the intervention period. METHODS The gaming interface allows participants to control a customizable robot avatar via motion-tracking features of the Microsoft Kinect system. Player movement is mirrored by the movement of the robot avatar. A brief psychoeducation session preceded the VR game-play, which occurred over 3 days. Participants were asked to guide the robot through progressively more difficult, back-challenging tasks (eg, watering plants, setting up shelter) to help prepare a new planet for habitation. The tasks were graded in difficulty and derived from traditional graded exposure treatment. RESULTS Repeated-measures analyses revealed a marginal decline in pain intensity scores and a significant decline in scores on the measure of pain/movement-related fear. No significant change was observed in participant ratings of disability related to low back pain. Mean scores on the treatment evaluation inventory indicated that participants reported above moderate levels of perceived treatment acceptability and overall positive interest in the intervention. CONCLUSIONS Findings support the safety and feasibility of a VR gaming intervention model designed to deliver cognitive behavioral treatment for maladaptive pain beliefs while promoting physical activity among individuals with CLBP. The intervention tested thus far will be extended and adapted across settings. Future validation efforts will focus on reduction of pain-related disability and assessment of the longevity of observed effects. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Research paper thumbnail of FIJI: A Framework for the Immersion-Journalism Intersection

Frontiers in ICT

As journalists experiment with developing immersive journalism-first-person, interactive experien... more As journalists experiment with developing immersive journalism-first-person, interactive experiences of news events-guidelines are needed to help bridge a disconnect between the requirements of journalism and the capabilities of emerging technologies. Many journalists need to better understand the fundamental concepts of immersion and the capabilities and limitations of common immersive technologies. Similarly, developers of immersive journalism works need to know the fundamentals that define journalistic professionalism and excellence and the key requirements of various types of journalistic stories. To address these gaps, we have developed a Framework for the Immersion-Journalism Intersection (FIJI). In FIJI, we have identified four domains of knowledge that intersect to define the key requirements of immersive journalism: the fundamentals of immersion, common immersive technologies, the fundamentals of journalism, and the major types of journalistic stories. Based on these key requirements, we have formally defined four types of immersive journalism that are appropriate for public dissemination. In this article, we discuss the history of immersive journalism, present the four domains and key intersection of FIJI, and provide a number of guidelines for journalists new to creating immersive experiences.

Research paper thumbnail of Attitudes toward a virtual reality physical activity intervention among veterans with chronic low back pain

The Journal of Pain

Chronic postsurgical pain occurs in around 20% of children after undergoing major surgeries. Chil... more Chronic postsurgical pain occurs in around 20% of children after undergoing major surgeries. Child and parent psychosocial risk factors (e.g. anxiety, pain catastrophizing) predict persistence of pain and poor health-related quality of life. Psychosocial interventions aimed at improving longterm pain and recovery need to be developed. The aims of this study were to 1) understand the child's and family's experiences of pain over the course of their surgical experience (before surgery, perioperative period, postsurgery period) and 2) gather stakeholder input from children who underwent surgery, their parents, and perioperative providers regarding potential barriers and facilitators of intervention delivery in the perioperative period. Semi-structured interviews were conducted individually with 15 children age 10-18 years (M=15.4, 60% female) who underwent recent major surgery, their parents, and 17 perioperative healthcare providers. Interviews were coded, according to semantic thematic analysis. The perioperative period was difficult emotionally for children and presented unique stressors for parents. They experienced high levels of worry regarding surgery success and anticipated pain, and struggled to cope during the early perioperative period. Families reported feeling unprepared for the intensity and duration of pain and the length of recovery experienced. Children encountered unexpected challenges with physical recovery and return to school and activities. Both children and parents perceived a need for learning coping skills to help manage pain and anxiety. Providers emphasized that families need more detailed information about what to expect over the entire course of surgery and recovery. Providers expressed feeling ill-equipped to adequately help children and families. Time and distance were recognized as potential barriers of delivering a psychosocial intervention, with internet delivery identified as a potential facilitator. Research to develop and evaluate interventions to address pain and anxiety in children undergoing major surgery is critically needed. Supported by American Pain Society Future Leaders in Pain Research Grant. This APS grant awards young investigators who are selected based on demonstrating the greatest merit and potential for success.

Research paper thumbnail of Beyond fun and games: Toward an adaptive and emergent learning platform for pre-med students with the UT TIME Portal

2016 IEEE International Conference on Serious Games and Applications for Health (SeGAH), 2016

The University of Texas Transformation in Medical Education Portal (UT TIME Portal) is a game-bas... more The University of Texas Transformation in Medical Education Portal (UT TIME Portal) is a game-based learning platform for select pre-med students. The UT TIME Portal offers unique opportunities for assessment of player performance through rich quantitative and qualitative user data, asynchronous access to content and individualized feedback, and motivational mechanics like game-earned badges and professorawarded discussion board stars. Our initial findings suggest that the UT TIME Portal helps students improve knowledge regarding basic patient interviewing skills and influences attitudes about professionalism in social media use. This paper explores the results of our first experiments with the UT TIME Portal-suggesting parameters for an adaptive and emergent learning platform for healthcare professional education based on the rich data set available from the multi-faceted design.

Research paper thumbnail of Immersive Journalism in VR: Four Theoretical Domains for Researching a Narrative Design Framework

Lecture Notes in Computer Science, 2016

A major focus of research in Virtual Reality (VR) media examines the technological affordances fo... more A major focus of research in Virtual Reality (VR) media examines the technological affordances for creating immersion, which in turn can generate presence-the feeling of being therein a virtual environment. This research has given rise to an emerging form of fact-based storytelling called immersive journalism, a term used to describe digitally produced stories designed to provide a first-person, interactive experience with news events. This paper examines the concept of immersive journalism and discusses both its potential and its limitations as a narrative and journalistic genre. Immersive journalism will require a new narrative design framework, and four theoretical domains are discussed as underscoring this framework. The four are VR presence, narrative, cognition and journalistic ethics.

Research paper thumbnail of A Serious-Game Framework to Improve Physician/Nurse Communication

Lecture Notes in Computer Science, 2015

This paper focuses on a serious-game framework for a dialogue-driven game called GLIMPSE (A Game ... more This paper focuses on a serious-game framework for a dialogue-driven game called GLIMPSE (A Game to Learn Important Communications Methods for Patient Safety Enhancement). The eight essential components of the framework include: recommended communication behavior; accurate translation; narrative-driven, role-playing episodes that allow practice in different challenging situations; perspective sharing mechanisms; a design paradigm that accommodates time challenges of participants; motivational gameplay rewards; feedback/assessment mechanisms; and curriculum. The paper explores how the framework was developed as well as implementation challenges, lessons learned and opportunities for future research.

Research paper thumbnail of Using A Game-based Simulation to Complement Face-to-Face Medical Education: Preliminary Findings

Objective: The objective of this study is to establish an assessment framework for game-based sim... more Objective: The objective of this study is to establish an assessment framework for game-based simulations to complement face-to-face classroom education for premed students enrolled in the UT System's Transformation in Medical Education (TIME) initiative. Another objective is to discover effective approaches for designing cognitive and behavioral simulations in gaming. Our research questions were: 1) can a game-based simulation help improve knowledge and attitudinal measures regarding basic interviewing skills, the medical interview, and professionalism in social media use; and 2) is a game-based simulation an effective education module for enhancing classroom lectures. The purpose of the study was to inform future design and development considerations of educational simulations based on the participants' self-assessment of knowledge and attitudinal measures and responses to the simulation design. Background/Preparation: Studies show that game-based virtual patient (VP) case...

Research paper thumbnail of Board 554 - Technology Innovations Abstract An Asynchronous Social, Web-Enabled Serious Game for Improving Physician-Nurse Communication (Submission #417)

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013

ABSTRACT Introduction/Background: Ineffective interprofessional communication is a leading contri... more ABSTRACT Introduction/Background: Ineffective interprofessional communication is a leading contributor to preventable patient harm. Despite recognized need to understand professional, cultural, and personal differences that impact interprofessional communication, traditional Methods for teaching communication skills and changing behaviors encounter logistical and engagement difficulties. "Serious" games utilize video game technology and constructs such as quests, rewards and 3-D environments in a compelling, but subject matter appropriate, way. Games allow healthcare providers to experience the impact of ineffective interprofessional communication, while experimenting with and learning more effective skills and behaviors through practice and feedback - offering new approaches for improvement. Based on these ideas, we developed a social, web-based serious game called GLIMPSE (A Game to Learn Important Communication Methods for Patient Safety Enhancement). GLIMPSE is guided by curriculum grounded in communication, cultural competency and perspective sharing theories. Through instant game feedback, physician and nurse players experience the impact of communication on patient safety and satisfaction, while practicing structured and team-based communication. GLIMPSE immerses players in perspective sharing, situational awareness, power-gradient traps and similar concepts. The game is playable on computers and iPad's to maximize delivery flexibility. Importantly, the game can be played asynchronously to overcome logistical difficulties. GLIMPSE is sponsored by the Agency for Healthcare Research Quality (AHRQ). Methods: GLIMPSE follows key curriculum education objectives on structured communication techniques, team-based communication/perspective sharing skills, and effects of communication on patient safety. The design takes inspiration from the success of social media games. GLIMPSE is developed in the Unity game engine to support web-browsers and computer, mobile and tablet platforms. Design features that support curriculum objectives include viral episodic content with prescriptive themes and virtual role playing to experience perspective sharing. The game design features asynchronous gameplay with colleagues, 13 short episodes which allow nurses and physicians to fit play into busy schedules, and the ability to virally message and share content among players. While each player is assigned to a team, game play is not dependent on team member coordination. However, scores are reported for individuals and the full team, creating an "implied" team setting. Team competition and in-game rewards for learning and practicing prescriptive themes facilitate engagement and player accomplishment. Gameplay occurs in a 3-D Virtual MedSurg Unit. Essential to gameplay are dialog interactions between players which are scored using interaction or "i" points. Players gain "i" points by following suggested communication strategies. They also lose "i" points by showing anger or excessive ego - behaviors often experienced as barriers for effective team communication. The game also allows players to gain points by making an effort to get a "glimpse" or insight into the source of a colleague's behavior. Players also win badges depending on their gameplay and virtual "thank you's" from teammates such as - notes, gifts such as chocolates, or even a cup of coffee. The web dashboard features points scored and team rankings - spurring competition and engagement. Data is collected throughout gameplay on player performance statistics such as elapsed time per episode and frequency that episodes are accessed. Player demographics are also collected. The final episode of the game is a survey that collects information on knowledge gained and reported attitude change. Results: Conclusion: GLIMPSE features an innovative methodology to explore whether asynchronous social games can engage nurses and physicians to complete communication education with a flexible schedule, in a chunked episodic format. Should this technique and design be successful in a planned evaluation study, a new paradigm for combined physician/nurse and interprofessional education will be created. This technique potentially opens new educational windows in environments where healthcare professionals have limited time and need new motivations to gain insights into the importance of communication for patient safety. Disclosures: LWW.

Research paper thumbnail of Simulation in Healthcare

journals.lww.com

The editors of this journal are pleased to offer electronic publication of accepted papers prior ... more The editors of this journal are pleased to offer electronic publication of accepted papers prior to print publication. These papers can be cited using the date of access and the unique DOI number. Any final changes in manuscripts will be made at the time of print publication and will be reflected in the final electronic version of the issue.

Research paper thumbnail of Developing a Platform-flexible Game-based Simulation for Cultural Training

The Interservice/Industry Training, Simulation & Education Conference (I/ITSEC), 2010

This paper analyzes the design and development opportunities and challenges of creating a virtual... more This paper analyzes the design and development opportunities and challenges of creating a virtual cultural training simulation whose core features can be deployed across diverse media platforms such as personal computers, mobile devices, game platforms, the web, and Cave Automatic Virtual Environments (CAVE). This paper describes progress on a platform-flexible design approach for The First Person Cultural Trainer (FPCT), a high-fidelity simulation in which the user must build rapport with culturally rendered Afghan and Iraqi ...

Research paper thumbnail of Creating Micro-expressions and Nuanced Nonverbal Communication in Synthetic Cultural Characters and Environments

The Interservice/Industry Training, Simulation & Education Conference (I/ITSEC), 2011

Understanding how to observe and analyze nonverbal communication of virtual humans in synthetic e... more Understanding how to observe and analyze nonverbal communication of virtual humans in synthetic environments can assist warfighters with determining source credibility, deception detection, behavior observation, process training and other training objectives. The First Person Cultural Trainer (FPCT) is a high-fidelity, game-based simulation that trains cross-cultural decision making and is also a platform for the creation of synthetic characters which display culturally accurate facial and micro-expressions. These facial and micro- ...

Research paper thumbnail of Creating Micro-expressions and Nuanced Nonverbal Communication in Synthetic Cultural Characters and Environments ABOUT THE AUTHORS

Understanding how to observe and analyze nonverbal communication of virtual humans in synthetic e... more Understanding how to observe and analyze nonverbal communication of virtual humans in synthetic environments can assist warfighters with determining source credibility, deception detection, behavior observation, process training and other training objectives. The First Person Cultural Trainer (FPCT) is a high-fidelity, game-based simulation that trains cross-cultural decision making and is also a platform for the creation of synthetic characters which display culturally accurate facial and micro-expressions. These facial and micro-expressions serve as a channel for factors such as invariants and affordances within the synthetic environment that also communicate critical nonverbal information. This paper will discuss technical challenges and solutions in creating facial and micro-expressions and environmental invariants and affordances such as those needed in our high-fidelity training projects. The paper will also provide an overview of the state-of-the-art for creating nuanced nonv...

Research paper thumbnail of Arts in virtual worlds

Research paper thumbnail of Combining Constructive Models with a 3D Game for Enhanced Immersion

The Interservice/Industry Training, Simulation & Education Conference (I/ITSEC), 2012

Incorporating constructive models into a 3D game is an effective, realistic and nonlinear way to ... more Incorporating constructive models into a 3D game is an effective, realistic and nonlinear way to prepare warfighters for operational environment complexities. In its third development spiral, The Hybrid Irregular Warfare Network-defeat Toolkit federation, or HINT, sponsored by TRADOC G2 Intelligence Support Activity, combines an immersive 3D game-based simulation-The First Person Cultural Trainer (FPCT)-with the One Semi-Automated Force (OneSAF) and the Joint Non-kinetic Effects (JNEM) models in a hybrid model framework ...

Research paper thumbnail of Can a Virtual Patient Trainer Teach Student Nurses How to Save Lives—Teaching Nursing Students About Pediatric Respiratory Diseases

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2012

Virtual environments offer a variety of benefits and may be a powerful medium with which to provi... more Virtual environments offer a variety of benefits and may be a powerful medium with which to provide nursing education. The objective of this study was to compare the achievement of learning outcomes of undergraduate nursing students when a virtual patient trainer or a traditional lecture was used to teach pediatric respiratory content. This was a randomized, controlled, posttest design. A virtual pediatric hospital unit was populated with four virtual pediatric patients having different respiratory diseases that were designed to meet the same learning objectives as a traditional lecture. The study began in Spring 2010 with 93 Senior I, baccalaureate nursing students. Students were randomized to receive either a traditional lecture or an experience with a virtual patient trainer. Students' knowledge acquisition was evaluated using multiple-choice questions, and knowledge application was measured as timeliness of care in two simulated clinical scenarios using high-fidelity mannequins and standardized patients. Ninety-three students participated in the study, of which 46 were in the experimental group that received content using the virtual patient trainer. After the intervention, students in the experimental group had significantly higher knowledge acquisition (P = 0.004) and better knowledge application (P = 0.001) for each of the two scenarios than students in the control group. The purpose of this project was to compare a virtual patient trainer to a traditional lecture for the achievement of learning outcomes for pediatric respiratory content. Although the virtual patient trainer experience produced statistically better outcomes, the differences may not be clinically significant. The results suggest that a virtual patient trainer may be an effective substitute for the achievement of learning outcomes that are typically met using a traditional lecture format. Further research is needed to understand how best to integrate a virtual patient trainer into undergraduate nursing education.

Research paper thumbnail of Game-Based Virtual Patients - Educational Opportunities and Design Challenges

other forms of synthetic patients and present key trends and seminal papers in the literature. We... more other forms of synthetic patients and present key trends and seminal papers in the literature. We propose ten development criteria for clinical simulation. We also present a proposed framework for creating game-based virtual patients and medical simulations. Finally, we critique our work based on these development criteria and discuss design challenges in creating virtual patients as well as potential areas for future research. With the aging of the baby-boomer population, the increasing need for more healthcare professionals has been well documented. One of the major factors contributing to the shortage of healthcare providers is the shortage of faculty. Medical simulations and synthetic patients can help extend the reach of current faculty to train new healthcare providers and help current practitioners improve their measurable performance quicker. The use of synthetic patients with game-based simulations creates greater outreach opportunities through improved distance education. ...

Research paper thumbnail of FINESSE: Foundations for Immersive Non-Fiction Narrative as Embodied/Situated Simulation Experiences -- A Conceptual Framework for Immersive Journalism Design

Research paper thumbnail of Developing Virtual Patients with VR/AR for a natural user interface in medical teaching

2017 IEEE 5th International Conference on Serious Games and Applications for Health (SeGAH)

Professionalism and communication skills are important aspects of medical training, and virtual p... more Professionalism and communication skills are important aspects of medical training, and virtual patient applications can offer cost effective, easily accessible platforms for communication practice which complement flexible, studentdriven medical school curriculum design. Further, numerous virtual and augmented reality platforms have been introduced recently. This paper explores potential advantages and disadvantages Virtual and Augmented Reality (VR/AR) technologies offer to the development of a virtual patient application specifically for communication practice-the Emotive Virtual Patients-with a natural user interface. VR/AR technologies may offer highly interactive, immersive virtual patient experiences that tie to our research goals, improve presence and create a more fertile environment to practice empathy, however they may also present platform-specific challenges. A potential virtual patient design framework is discussed, and the unique benefits and limitations of VR/AR devices are analyzed. We put our research in the context of other virtual patient research, and hypothesize what benefits in terms of presence and natural user interfaces VR/AR may provide.

Research paper thumbnail of Exploring medical cyberlearning for work at the human/technology frontier with the mixed-reality emotive virtual human system platform

2018 IEEE 6th International Conference on Serious Games and Applications for Health (SeGAH)

This paper describes the Mixed-Reality Emotive Virtual Human System Platforma machine for cyberle... more This paper describes the Mixed-Reality Emotive Virtual Human System Platforma machine for cyberlearning at the human/technology frontier. Our initial use case is for medical school students practicing patient interviewing in preparation for Objective Structured Clinical Exams (OSCEs). The work is deliberately focused on a futures environment where students can seamlessly enter a virtual learning experience and return to the face-to-face. For the context of our work, we define mixed reality as the ability to traverse real and synthetic learning experiences utilizing a variety of technologies such as augmented reality and virtual reality in a dynamic, emergent environment. Much of the work is based on the Emotive Virtual-Reality Patient research sponsored by the Southwestern Medical Foundation and exploration of the US Ignite ultra-high speed network, sponsored by the National Science Foundation. We use the US Ignite network to facilitate the development of virtual humans and the overall platform. We also explore evolving learning theory that supports the development of this knowledge system which blends real and synthetic roles of professors, mentors, and standardized patients in an emergent artificial intelligence and machine learning driven environment. Future applications of the model are also discussed.

Research paper thumbnail of Ten Possible States in the Age of 3D3C Art: The Contil Case

Journal For Virtual Worlds Research

Four factors take different meaning in the digital age: (a) 3D - moving from the real world into ... more Four factors take different meaning in the digital age: (a) 3D - moving from the real world into the screens, phones, and lately into our eyes with Google Glass, (b) Community - with Facebook/Twitter like digitally-enhanced communities, (c) Creation - with modern 3D printing, YouTube, Wikipedia and (d) Commerce - with virtual goods and virtual money from Linden Dollar to Bitcoin (aka 3D3C for short). We contend that 3D3C enable and push for a paradigm shift in how art could be shared, created, presented and sold, both through real and virtual means.In this paper, we describe ten states, or methods, of connecting real world art to the virtual wearing the 3D3C glasses.

Research paper thumbnail of Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice

The Spine Journal

BACKGROUND CONTEXT Back pain is the leading cause of disability, in the United States. Most acute... more BACKGROUND CONTEXT Back pain is the leading cause of disability, in the United States. Most acute low back pain (LBP) remits within a few weeks, but up to 10% of individuals develop a chronic condition characterized by long-term pain, disability, and resource cost. Maladaptive beliefs about pain and physical activity (ie, pain-related fear) contribute to poor outcomes following back injury. High fear individuals are more likely to avoid back-stressing physical activities, which they feel may exacerbate injury/damage, thus reinforcing a cycle of pain, functional disability, and potentially further injury. Graded exposure is a leading cognitive behavioral intervention to challenge fearful pain beliefs and gradually promote physical activity. PURPOSE As part of the North American Spine Society Young Investigator Grant, the current research team developed a virtual reality (VR) gaming interface as a flexible interactive platform to deliver graded-exposure intervention for high fear individuals with CLBP. A recently completed pilot study examined the safety and feasibility of this prototype, designed to challenge fearful pain beliefs and gradually promote physical activity. STUDY DESIGN/SETTING Repeated-measures lab-based intervention protocol. PATIENT SAMPLE Participants were 34 men (n=17) and women (n=17) with CLBP who reported high pain/movement-related fear, as measured by the Tampa Scale of Kinesiophobia. OUTCOME MEASURES Participants completed measures of pain intensity, perceived disability, and pain-related fear prior to and following intervention. Participants also completed a measure of treatment acceptability at the conclusion of the intervention period. METHODS The gaming interface allows participants to control a customizable robot avatar via motion-tracking features of the Microsoft Kinect system. Player movement is mirrored by the movement of the robot avatar. A brief psychoeducation session preceded the VR game-play, which occurred over 3 days. Participants were asked to guide the robot through progressively more difficult, back-challenging tasks (eg, watering plants, setting up shelter) to help prepare a new planet for habitation. The tasks were graded in difficulty and derived from traditional graded exposure treatment. RESULTS Repeated-measures analyses revealed a marginal decline in pain intensity scores and a significant decline in scores on the measure of pain/movement-related fear. No significant change was observed in participant ratings of disability related to low back pain. Mean scores on the treatment evaluation inventory indicated that participants reported above moderate levels of perceived treatment acceptability and overall positive interest in the intervention. CONCLUSIONS Findings support the safety and feasibility of a VR gaming intervention model designed to deliver cognitive behavioral treatment for maladaptive pain beliefs while promoting physical activity among individuals with CLBP. The intervention tested thus far will be extended and adapted across settings. Future validation efforts will focus on reduction of pain-related disability and assessment of the longevity of observed effects. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Research paper thumbnail of FIJI: A Framework for the Immersion-Journalism Intersection

Frontiers in ICT

As journalists experiment with developing immersive journalism-first-person, interactive experien... more As journalists experiment with developing immersive journalism-first-person, interactive experiences of news events-guidelines are needed to help bridge a disconnect between the requirements of journalism and the capabilities of emerging technologies. Many journalists need to better understand the fundamental concepts of immersion and the capabilities and limitations of common immersive technologies. Similarly, developers of immersive journalism works need to know the fundamentals that define journalistic professionalism and excellence and the key requirements of various types of journalistic stories. To address these gaps, we have developed a Framework for the Immersion-Journalism Intersection (FIJI). In FIJI, we have identified four domains of knowledge that intersect to define the key requirements of immersive journalism: the fundamentals of immersion, common immersive technologies, the fundamentals of journalism, and the major types of journalistic stories. Based on these key requirements, we have formally defined four types of immersive journalism that are appropriate for public dissemination. In this article, we discuss the history of immersive journalism, present the four domains and key intersection of FIJI, and provide a number of guidelines for journalists new to creating immersive experiences.

Research paper thumbnail of Attitudes toward a virtual reality physical activity intervention among veterans with chronic low back pain

The Journal of Pain

Chronic postsurgical pain occurs in around 20% of children after undergoing major surgeries. Chil... more Chronic postsurgical pain occurs in around 20% of children after undergoing major surgeries. Child and parent psychosocial risk factors (e.g. anxiety, pain catastrophizing) predict persistence of pain and poor health-related quality of life. Psychosocial interventions aimed at improving longterm pain and recovery need to be developed. The aims of this study were to 1) understand the child's and family's experiences of pain over the course of their surgical experience (before surgery, perioperative period, postsurgery period) and 2) gather stakeholder input from children who underwent surgery, their parents, and perioperative providers regarding potential barriers and facilitators of intervention delivery in the perioperative period. Semi-structured interviews were conducted individually with 15 children age 10-18 years (M=15.4, 60% female) who underwent recent major surgery, their parents, and 17 perioperative healthcare providers. Interviews were coded, according to semantic thematic analysis. The perioperative period was difficult emotionally for children and presented unique stressors for parents. They experienced high levels of worry regarding surgery success and anticipated pain, and struggled to cope during the early perioperative period. Families reported feeling unprepared for the intensity and duration of pain and the length of recovery experienced. Children encountered unexpected challenges with physical recovery and return to school and activities. Both children and parents perceived a need for learning coping skills to help manage pain and anxiety. Providers emphasized that families need more detailed information about what to expect over the entire course of surgery and recovery. Providers expressed feeling ill-equipped to adequately help children and families. Time and distance were recognized as potential barriers of delivering a psychosocial intervention, with internet delivery identified as a potential facilitator. Research to develop and evaluate interventions to address pain and anxiety in children undergoing major surgery is critically needed. Supported by American Pain Society Future Leaders in Pain Research Grant. This APS grant awards young investigators who are selected based on demonstrating the greatest merit and potential for success.

Research paper thumbnail of Beyond fun and games: Toward an adaptive and emergent learning platform for pre-med students with the UT TIME Portal

2016 IEEE International Conference on Serious Games and Applications for Health (SeGAH), 2016

The University of Texas Transformation in Medical Education Portal (UT TIME Portal) is a game-bas... more The University of Texas Transformation in Medical Education Portal (UT TIME Portal) is a game-based learning platform for select pre-med students. The UT TIME Portal offers unique opportunities for assessment of player performance through rich quantitative and qualitative user data, asynchronous access to content and individualized feedback, and motivational mechanics like game-earned badges and professorawarded discussion board stars. Our initial findings suggest that the UT TIME Portal helps students improve knowledge regarding basic patient interviewing skills and influences attitudes about professionalism in social media use. This paper explores the results of our first experiments with the UT TIME Portal-suggesting parameters for an adaptive and emergent learning platform for healthcare professional education based on the rich data set available from the multi-faceted design.

Research paper thumbnail of Immersive Journalism in VR: Four Theoretical Domains for Researching a Narrative Design Framework

Lecture Notes in Computer Science, 2016

A major focus of research in Virtual Reality (VR) media examines the technological affordances fo... more A major focus of research in Virtual Reality (VR) media examines the technological affordances for creating immersion, which in turn can generate presence-the feeling of being therein a virtual environment. This research has given rise to an emerging form of fact-based storytelling called immersive journalism, a term used to describe digitally produced stories designed to provide a first-person, interactive experience with news events. This paper examines the concept of immersive journalism and discusses both its potential and its limitations as a narrative and journalistic genre. Immersive journalism will require a new narrative design framework, and four theoretical domains are discussed as underscoring this framework. The four are VR presence, narrative, cognition and journalistic ethics.

Research paper thumbnail of A Serious-Game Framework to Improve Physician/Nurse Communication

Lecture Notes in Computer Science, 2015

This paper focuses on a serious-game framework for a dialogue-driven game called GLIMPSE (A Game ... more This paper focuses on a serious-game framework for a dialogue-driven game called GLIMPSE (A Game to Learn Important Communications Methods for Patient Safety Enhancement). The eight essential components of the framework include: recommended communication behavior; accurate translation; narrative-driven, role-playing episodes that allow practice in different challenging situations; perspective sharing mechanisms; a design paradigm that accommodates time challenges of participants; motivational gameplay rewards; feedback/assessment mechanisms; and curriculum. The paper explores how the framework was developed as well as implementation challenges, lessons learned and opportunities for future research.

Research paper thumbnail of Using A Game-based Simulation to Complement Face-to-Face Medical Education: Preliminary Findings

Objective: The objective of this study is to establish an assessment framework for game-based sim... more Objective: The objective of this study is to establish an assessment framework for game-based simulations to complement face-to-face classroom education for premed students enrolled in the UT System's Transformation in Medical Education (TIME) initiative. Another objective is to discover effective approaches for designing cognitive and behavioral simulations in gaming. Our research questions were: 1) can a game-based simulation help improve knowledge and attitudinal measures regarding basic interviewing skills, the medical interview, and professionalism in social media use; and 2) is a game-based simulation an effective education module for enhancing classroom lectures. The purpose of the study was to inform future design and development considerations of educational simulations based on the participants' self-assessment of knowledge and attitudinal measures and responses to the simulation design. Background/Preparation: Studies show that game-based virtual patient (VP) case...

Research paper thumbnail of Board 554 - Technology Innovations Abstract An Asynchronous Social, Web-Enabled Serious Game for Improving Physician-Nurse Communication (Submission #417)

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013

ABSTRACT Introduction/Background: Ineffective interprofessional communication is a leading contri... more ABSTRACT Introduction/Background: Ineffective interprofessional communication is a leading contributor to preventable patient harm. Despite recognized need to understand professional, cultural, and personal differences that impact interprofessional communication, traditional Methods for teaching communication skills and changing behaviors encounter logistical and engagement difficulties. "Serious" games utilize video game technology and constructs such as quests, rewards and 3-D environments in a compelling, but subject matter appropriate, way. Games allow healthcare providers to experience the impact of ineffective interprofessional communication, while experimenting with and learning more effective skills and behaviors through practice and feedback - offering new approaches for improvement. Based on these ideas, we developed a social, web-based serious game called GLIMPSE (A Game to Learn Important Communication Methods for Patient Safety Enhancement). GLIMPSE is guided by curriculum grounded in communication, cultural competency and perspective sharing theories. Through instant game feedback, physician and nurse players experience the impact of communication on patient safety and satisfaction, while practicing structured and team-based communication. GLIMPSE immerses players in perspective sharing, situational awareness, power-gradient traps and similar concepts. The game is playable on computers and iPad's to maximize delivery flexibility. Importantly, the game can be played asynchronously to overcome logistical difficulties. GLIMPSE is sponsored by the Agency for Healthcare Research Quality (AHRQ). Methods: GLIMPSE follows key curriculum education objectives on structured communication techniques, team-based communication/perspective sharing skills, and effects of communication on patient safety. The design takes inspiration from the success of social media games. GLIMPSE is developed in the Unity game engine to support web-browsers and computer, mobile and tablet platforms. Design features that support curriculum objectives include viral episodic content with prescriptive themes and virtual role playing to experience perspective sharing. The game design features asynchronous gameplay with colleagues, 13 short episodes which allow nurses and physicians to fit play into busy schedules, and the ability to virally message and share content among players. While each player is assigned to a team, game play is not dependent on team member coordination. However, scores are reported for individuals and the full team, creating an "implied" team setting. Team competition and in-game rewards for learning and practicing prescriptive themes facilitate engagement and player accomplishment. Gameplay occurs in a 3-D Virtual MedSurg Unit. Essential to gameplay are dialog interactions between players which are scored using interaction or "i" points. Players gain "i" points by following suggested communication strategies. They also lose "i" points by showing anger or excessive ego - behaviors often experienced as barriers for effective team communication. The game also allows players to gain points by making an effort to get a "glimpse" or insight into the source of a colleague's behavior. Players also win badges depending on their gameplay and virtual "thank you's" from teammates such as - notes, gifts such as chocolates, or even a cup of coffee. The web dashboard features points scored and team rankings - spurring competition and engagement. Data is collected throughout gameplay on player performance statistics such as elapsed time per episode and frequency that episodes are accessed. Player demographics are also collected. The final episode of the game is a survey that collects information on knowledge gained and reported attitude change. Results: Conclusion: GLIMPSE features an innovative methodology to explore whether asynchronous social games can engage nurses and physicians to complete communication education with a flexible schedule, in a chunked episodic format. Should this technique and design be successful in a planned evaluation study, a new paradigm for combined physician/nurse and interprofessional education will be created. This technique potentially opens new educational windows in environments where healthcare professionals have limited time and need new motivations to gain insights into the importance of communication for patient safety. Disclosures: LWW.

Research paper thumbnail of Simulation in Healthcare

journals.lww.com

The editors of this journal are pleased to offer electronic publication of accepted papers prior ... more The editors of this journal are pleased to offer electronic publication of accepted papers prior to print publication. These papers can be cited using the date of access and the unique DOI number. Any final changes in manuscripts will be made at the time of print publication and will be reflected in the final electronic version of the issue.

Research paper thumbnail of Developing a Platform-flexible Game-based Simulation for Cultural Training

The Interservice/Industry Training, Simulation & Education Conference (I/ITSEC), 2010

This paper analyzes the design and development opportunities and challenges of creating a virtual... more This paper analyzes the design and development opportunities and challenges of creating a virtual cultural training simulation whose core features can be deployed across diverse media platforms such as personal computers, mobile devices, game platforms, the web, and Cave Automatic Virtual Environments (CAVE). This paper describes progress on a platform-flexible design approach for The First Person Cultural Trainer (FPCT), a high-fidelity simulation in which the user must build rapport with culturally rendered Afghan and Iraqi ...

Research paper thumbnail of Creating Micro-expressions and Nuanced Nonverbal Communication in Synthetic Cultural Characters and Environments

The Interservice/Industry Training, Simulation & Education Conference (I/ITSEC), 2011

Understanding how to observe and analyze nonverbal communication of virtual humans in synthetic e... more Understanding how to observe and analyze nonverbal communication of virtual humans in synthetic environments can assist warfighters with determining source credibility, deception detection, behavior observation, process training and other training objectives. The First Person Cultural Trainer (FPCT) is a high-fidelity, game-based simulation that trains cross-cultural decision making and is also a platform for the creation of synthetic characters which display culturally accurate facial and micro-expressions. These facial and micro- ...

Research paper thumbnail of Creating Micro-expressions and Nuanced Nonverbal Communication in Synthetic Cultural Characters and Environments ABOUT THE AUTHORS

Understanding how to observe and analyze nonverbal communication of virtual humans in synthetic e... more Understanding how to observe and analyze nonverbal communication of virtual humans in synthetic environments can assist warfighters with determining source credibility, deception detection, behavior observation, process training and other training objectives. The First Person Cultural Trainer (FPCT) is a high-fidelity, game-based simulation that trains cross-cultural decision making and is also a platform for the creation of synthetic characters which display culturally accurate facial and micro-expressions. These facial and micro-expressions serve as a channel for factors such as invariants and affordances within the synthetic environment that also communicate critical nonverbal information. This paper will discuss technical challenges and solutions in creating facial and micro-expressions and environmental invariants and affordances such as those needed in our high-fidelity training projects. The paper will also provide an overview of the state-of-the-art for creating nuanced nonv...

Research paper thumbnail of Arts in virtual worlds

Research paper thumbnail of Combining Constructive Models with a 3D Game for Enhanced Immersion

The Interservice/Industry Training, Simulation & Education Conference (I/ITSEC), 2012

Incorporating constructive models into a 3D game is an effective, realistic and nonlinear way to ... more Incorporating constructive models into a 3D game is an effective, realistic and nonlinear way to prepare warfighters for operational environment complexities. In its third development spiral, The Hybrid Irregular Warfare Network-defeat Toolkit federation, or HINT, sponsored by TRADOC G2 Intelligence Support Activity, combines an immersive 3D game-based simulation-The First Person Cultural Trainer (FPCT)-with the One Semi-Automated Force (OneSAF) and the Joint Non-kinetic Effects (JNEM) models in a hybrid model framework ...