Virtual reality in medical training
CMAJ 1997;157:1352
The recent article "Time to 'rethink models of medical education,' ACMC meeting told," by Nancy Robb (CMAJ 1997;157[3]:304-5), contained an important sidebar on virtual reality. It reported on a workshop given by Dr. David Kaufman, in which he described some of the new developments in this field that are being applied to medical education.
Virtual reality is an interesting form of simulation and may be best suited to the acquisition of both knowledge and skills. The simulators usually fall between low-fidelity models, as found on a computer screen, and medium- to high-fidelity simulators, which can re-create a cockpit or an operating room. Low-fidelity simulators are best suited to acquiring knowledge, whereas the more sophisticated models allow the acquisition of knowledge, skills and attitudes.1
The sidebar reported the hope of workshop participants that virtual reality might allow physicians (including those in training) to "reach mastery" of a skill and then to maintain that mastery. Kaufman added that "airline pilots have the same biologic responses when they practise on aircraft simulators as when they fly. Indeed, pilots have to be certified in flight simulation before they can fly commercially."
However, one important use of high-fidelity aviation (and operating room2) simulators is not just mastery of "stick and rudder" skills, but also the learning and practice of traits vitally important in team interaction: communication, decision-making and conflict resolution. Unfortunately, virtual reality as described in the sidebar is a single-participant trainer, allowing only one individual to experience 3-dimensional re-creations of, for example, a virtual patient. Team members cannot experience the training simultaneously (although, in the case of aviation, one individual can interact with the flight management computer, which becomes an "electronic crew-member"3). For this reason, the need for high-fidelity simulation -- which allows entire teams to participate4 -- will continue to be both important and necessary.
Jan M. Davies, MSc, MD
Professor of Anaesthesia
University of Calgary
Foothills Medical Centre
Calgary, Alta.
Robert L. Helmreich, PhD
Professor of Psychology
Aerospace Crew Research Project
University of Texas at Austin
Austin, Tex.
References
- Helmreich RL, Davies JM. Anaesthetic simulation and lessons to be learned from aviation. Can J Anaesth 1997;44(9):907-12.
- Burt DER. Virtual reality in anaesthesia. Br J Anaesth 1995;75:472-80.
- Helmreich RL. Flight crew behaviour. Soc Behav 1987;2:63-72.
- Helmreich RL, Davies JM. Human factors in the operating room: interpersonal determinants of safety, efficiency and morale. In: Aitkenhead AR, editor. Quality assurance and risk management. Baillieres Clin Anaesthesiol 1996;10:277-95.
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