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Enhanced Online Learning with Simulations and Virtual Worlds

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Enhanced Online Learning with Simulations and Virtual Worlds
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  Enhanced Online Learningwith Simulations and Virtual Worlds Ioana A. Stănescu 1 , Antoniu Ştefan 1 , Felix G. Hamza-Lup 2 ,Veronica Ştefan 3   (1)   Advanced Technology Systems - ATS, 222 Calea Domnească, Târgovişte,ROMANIA(2)   Armstrong Atlantic State University, Savannah, GA, USA(3)   Valahia University of Târgovişte, ROMANIAE-mail: ioana.stanescu@ats.com.ro Abstract The era of information technology has generated a cultural shift that is transforming education and training. The new generation of learners, very different in terms of skills and attitudes, demand radical changes. The paper presents the development settings of a prototype of a web-based knowledge-driven decision support system designed for implementation in clinical settings. The system developers have envisioned a framework where teachers and students can connect, under security restrictions, to a practice-based environment where physicians activate and thus access clinical cases and simulate real-lifedecisions. The authors investigate the impact of emergent technologies to supplement teaching and learning methods and explore the use of virtual reality training solutions in practice-based learning and skill rehearsal in medical and clinical situations to create lifelike simulations. They consider the impact of haptic technologies in education and howeducators might use haptic technology to augment the sense of presence that a student  perceive while working in virtual worlds or on a digital assignment. Multimodal environments where visual, auditory and haptic stimuli are present convey information moreefficiently since the user manipulates and experiences the environment through multiple sensory channels. This approach builds upon the link towards next generations of learnersthat enhance their knowledge in connection to real-life situations while they operate inmandatory safety conditions. Keywords : knowledge management, CDSS, simulation, haptic technology   Introduction The information technology has made a significant impact in the areas of teaching and training andhas generated a cultural shift in focus, in transforming learning from passive listening todiscovery-based experiential and example-based learning; intelligence organized in easilyaccessible databases; and community of practice emerging from sharing tasks involving both tacitand explicit knowledge over a substantial period of time.Educators who facilitate learning for students in the health professions are faced with evenmore increased challenges to promote deep and applied learning required for providing patientcare in today’s complex health care settings [Kheddar, 2008; Plaisier]. Challenges come fromvaried sources including professional organisations, institutions of higher education, students and patients, all of whom call for relevant and meaningful learning experiences to prepare graduatesfor safe clinical practice.  University of Bucharest and University of Medicine and Pharmacy Târgu-Mureş 340 Health professions educators have been challenged to prepare a health care workforce that isable to synthesize, communicate with patients, use decision support tools, and provide safe patientcare. The challenge of guiding student learning is made more difficult by increasing bodies of knowledge, textbooks full of rapidly out-dated information, and access to Internet-based sourceseasily retrieved, but less easily critiqued [Ball et al., 2004]. While content will continue to be thefoundation of educational programs, educators now also must create opportunities for students todevelop skills in acquiring, synthesizing, and using information to make enhanced clinicaldecisions for their patients [Berner and La Lande, 2006]. New Dimensions of Learning Practice-based approaches potentiate understanding and knowledge retention in learning andtraining settings. The authors analyse the premises for the implementation of a developmental andmotivating online learning environment, which values and empowers learners at all levels, andfocus on the underlying issues of teaching and learning in the health professions under the need toengage students in active and applied learning.The paper presents the development settings of MEDIS, a prototype of a web-basedknowledge-driven decision support system designed for implementation in clinical settings. Thesystem developers have envisioned a framework where teachers and students can connect, under security restrictions, to a practice-based environment where physicians activate and thus accessclinical cases and simulate real-life decisions.The authors approach emergent technologies to supplement teaching and learning methods andexplore the use of virtual reality training solutions in practice-based learning and skill rehearsal inmedical and clinical situations. They consider the impact of haptic technologies in education andhow educators might use haptic technology to augment the sense of presence that a student perceive while working in virtual worlds or on a digital assignment.Haptics is the science of merging tactile sensation with computer applications, therebyenabling users to receive feedback they can feel (in addition to auditory and visual cues).Multimodal environments where visual, auditory and haptic stimuli are present conveyinformation more efficiently since the user manipulates and experiences the environment throughmultiple sensory channels [Hamza-Lup and Stănescu, 2009]. Simulation in medical education Recent trends related both to higher education and healthcare delivery systems have created anenvironment of change for medical education. Driven by the need to address patient safetyconcerns and improve quality of care, increased technology with which to deliver health care,higher patient acuity and , in some cases, less funding for clinical sites, teachers and physiciansmust determine alternative and creative ways to teach future medical personnel. Educators andadministrators face a number of challenges, such as introduction of more complicated technologywith which to deliver health care, limitations on orientation times, a need to address concernsrelated to patient safety and quality of care, and a need for improved interdisciplinary team performance – all of which require new and creative solutions.One solution to the growing concerns linked to these trends is the advent of health caresimulation in education programs and in hospitals. These simulations, which serve as adjuncts todidactic learning, represent the closest possible technology to real patients and allow for arepetitive “hands-on” learning in a safe environment where mistakes can be safely made. Thestudents who participate in simulations gain experience and confidence on their ability to malecritical clinical decisions in acute care situations, where time and skill often have criticalconsequences   The 5 th International Conference on Virtual Learning ICVL 2010   341 The practice of medicine has always relied on visualizations. These visualizations either have been direct or have required extensive mental reconstruction, as in the microscopic examination of serial histologic sections. The revolutionary capabilities of new three-dimensional (3D) and four-dimensional (4D) imagining modalities underscore the vital importance of spatial visualization tothis science[Knottnerus et al., 2008].The use of virtual reality (VR) technology opens new realms in the teaching and practice of medicine by allowing the visualizations to be manipulated with intuitive immediacy similar to thatof real objects; by allowing the objects to be dynamic, either in response to viewer actions or toillustrate normal or abnormal motion; and by engaging other sense, such as touch and hearing toenrich the visualization [Kortum, 2008]. Medical application can include basic anatomyinstruction, surgical simulation for instruction, visualization for diagnosis, and surgical simulationfor treatment planning and rehearsal [Brewster, S. and Murray-Smith, 2009].Although the greatest potential for revolutionary innovation in the teaching and practice of medicine lies in dynamic, fully immersive, multi-sensory fusion of real and virtual informationdata streams, this technology is still under development and not yet generally applicable to themedical researcher. Knowledge-based Decision Making Under the premises above, the authors considered the development of an enhanced environmentfor clinical practice and have built their research on the functionalities of a Clinical DecisionSupport Systems (CDSS), designed to impact clinical decision making about individual patients atthe point in time when these decisions are made [Stănescu and Ştefan, 2010]. With the increasedfocus on the prevention of medical errors [Berner et al, 2006], CDSS have the potential to changethe way medicine has been taught and practiced [Greenes et al; 2006; Pol et al, 2009]. CDSS have been shown to improve both patient outcomes, as well as the cost of care [Filip, 2008], and thedevelopers of such systems have constantly aimed to extend their capabilities through the use of emerging technologies. The Development Framework of MEDIS MEDIS is a prototype of a clinical decision support system developed to explore the potential of computer assisted decision making in clinical environments. The system addresses the challengeof providing real-time support and feedback [Berthold and Hand, 2007] to clinical decision-makers and its main objectives are to support knowledge acquisition and reuse, and to foster optimal problem-solving, decision-making and action in the clinical environment. The system can be accessed from desktop and mobile environments to obtain real-time information and knowledgeconcerning patients, diseases and treatments. It comprises treatment options, customised for each patient based on his medical record. For example, if a doctor prescribes a treatment that includesincompatibilities with the patient records, the systems automatically signals the problem. Thisapproach is extremely useful as it reduces the number of medical errors and improves themedication.MEDIS addresses a wide range of users, from medical personnel to patients, teachers andstudents. This approach focuses on enlarging the dimension of knowledge collection and reuse, bycomprising multiple, heterogeneous sources and by providing suitable knowledge-reuse tools that potential decision-makers can access and assimilate in their daily practice. The system wasdeveloped with the purpose of initiating a framework for future connections and collaborations between the practice-based clinical environments and the medical education institutions, in order to sustain the educational process by helping students better their future performance. The students  University of Bucharest and University of Medicine and Pharmacy Târgu-Mureş 342 can access a real clinical environment, based on strict security protocols and they can practiceclinical decision making in a safe environment and analyse the real decisions taken by physicians. Figure 1. Authentication in the system MEDIS collects knowledge generated in heterogeneous environments. The database backend is based on Hibernate, thus the system can incorporate both relational and object-oriented data bases,increasing accessibility and lowering costs for knowledge acquisition [Linwood et al, 2006; Inmonet al, 2007]. As gathering knowledge does not reach its maximum efficiency unless it is pairedwith powerful search options, MEDIS combines the two components with the purpose of enrichingusers’ experience when interacting with the system. Mobile Access through 2D Barcode Applications The system can be accessed on handheld devices, such as PDAs, XDAs and smart phones. This in-creases accessibility and provides support for decision making in ambulatory environments[Whitten et al., 2005; Lumsden, 2008]. Thus, the system provides real-time assistance anytime,anywhere and constitutes an innovative approach to CDSS [Stănescu et al., 2009]. Figure 2. The mobile interface of MEDISFigure 3. 2D barcodes for quick andsecure authentication   The 5 th International Conference on Virtual Learning ICVL 2010   343 In order to facilitate quick access for emergency situations, the system allows access to the patient’s medical records by scanning a two dimensional barcode printed on the patient’s healthcard. Because the patient’s medical records contain sensitive information, the link contained in the2D bar code can only be accessed by users who have already been authenticated in the system. Asthe number of Internet connections and especially of wireless connections increases rapidly, such adevelopment takes benefits of the latest access technologies. The Role of Simulation in Medical Education Simulations have changed the way medicine was taught by improving students’ and physicians’ performance. For example, surgical simulators and artificial environments have been developed tosimulate the procedures and model the environment involved in surgery. Through the developmentof optical technologies, rapid development and use of minimally invasive surgery has becomewidespread and places new demands on student education and surgical training. Traditionallystudents learn new techniques in surgery by observing procedures performed by experiencedsurgeons, and they have to go through an extensive and lengthy training procedure [Knottnerus etal., 2008]. However, surgical simulators provide an environment for the future physician to practice many times before operating on a patient. In addition, virtual reality technologies allowthe student in training to learn the details of surgery by providing both visual and tactile feedback to the surgeon working on a computer-generated model of the organs of the human body.Based on the development settings of MEDIS, the authors have considered the integration of haptic technologies within the system with the purpose of extending the potential benefits thesystem can bring to its users and to enhance the learning experience of students. Research on haptic simulation Practitioners and researchers have carried out studies to analyse the effect of haptic feedback oncollaborative task performance (Kortum, 2008; Brewster and Murray-Smith, 2009; Hamza-Lup,Lambeth, & LaPlant, 2009; Hamza-Lup and Stănescu, 2009).One of the concepts that the authors have analysed as a potential beneficiary of the haptic paradigm concerned friction. The students learning about friction can be confused both by itsmathematical description and by its nature as a force. The studies conducted showed that thetraditional approach presented a few limitations concerning the consistency and the customizationof the experiment, and also the user control over a continuous (large) range of physical parameters.Motivated by these limitations theresearchers have designed and implemented anenvironment that simulates the force of frictionand the associated paradigms. Students use thehaptic device to manipulate a cube on aninclined plane and receive force feedback fromthe device (Fig. 5).Students may apply varying amounts of forceand directly receive varying resultant forces fromthe cube. They can also change the values thataffect frictional force, such as the mass of thecube, the coefficients of static and kineticfriction, and the slope of the plane along whichthe cube moves. The visuo-haptic simulation provides additional benefits, such as: Figure 4. Test results (group A – no haptic;group B – with haptic) (Hamza-Lup and Adams, 2008)
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