Enhancing the future of simulation-based education in pediatrics

New technologies should become part and parcel of procedural skills training. This could be the case of Augmented Reality (AR) systems, such as Microsoft HoloLens, Oculus devices or Google Glass. From this standpoint, their use could enable procedural skills teaching as if both mentor and trainee were in the same location, even if they work remotely. As an example, these devices could be used to capture the learner’s first-person view of a simulated emergency/delivery room through mixed reality capture, while the mentor’s hand gestures are captured through motion tracking (such as Leap Motion) and virtually displayed in the trainee’s AR space. These may represent valid solutions to exploit communication through visual channel.

However, vision is not the only sense one can use to provide information. Indeed, an alternative solution may be the use of tactile feedback. Touch is one of the most ancestral senses in Nature, which typically requires lower cognitive efforts as compared to audio/visual feedback. Because of this peculiarity, the use of tactile communication may introduce considerable benefits. Roboticists have proposed many solutions to convey a number of different stimuli, such as vibrations, normal and tangential forces, temperature. Many pilot studies investigated the use of this kind of stimuli in medical settings [10]. As an example, vibration-based feedback seems very effective in conveying directional cues, which may be used to naturally guide the arm of the trainee toward given targets. Force stimuli, e.g. through an engineered fabric band which squeezes the arm of the operator, could be used to codify “alert” signals. The very same technology, redesigned to fit at fingertip level, may be controlled to replicate pulsations, which for example could simulate the perception of arterial beats during palpation. Voice coils motors, finally, seem very effective in reproducing the contact with a surface, its roughness, and potentially its temperature with the addition of thermal displays. It would be fascinating to investigate this line of research, especially considering that haptic technologies may be integrated in existing AR/VR settings, opening highways of potential applications in SBME.

The learner could enhance their teamwork, leadership and clinical decision-making skills throughout the use of suitable serious games (games used with a pedagogical purpose) [11]. Meanwhile, the mentors could take advantage of the available recorded simulation sessions to assess what has been done before and find what can be improved, even with the help of experienced staff (e.g. counselors). This would result in a “meta-analysis” which could definitely lead to future tailor-made interventions in order to endlessly improve non-technical skill teaching.

Moreover, virtual e-learning platforms should be implemented with live webinars, which should be preferred to video-recorded lessons, to facilitate the debate among mentors and learners.

From this standpoint, debriefing sessions should be the core of e-learning education and video-assisted ones should be provided (even using previously video-recorded simulation sessions when a simulation session cannot be performed). This could enable the trainees to learn from (other people’s) mistakes.

A great obstacle to these challenging perspectives could be funding resources. Indeed, the newest technologies often require conspicuous capital investments. Especially for rural hospitals, or low- and middle-income countries this could be unaffordable. For this reason, great effort should be put into devising and producing low-cost devices, to avoid the introduction of social disparities. Furthermore, it is worth mentioning that -at the current stage - the usage of such technologies does not require conspicuous investments. Indeed, their cost typically ranges between hundreds to a maximum of few thousand dollars, thanks to the extensive employment for other commercial purposes, such as electronic games.

On the other hand, governments and University institutions should guarantee their maximum effort in covering medical education costs, as this lays the foundation for a safer world while potentially sparing dreaded expensive medico-legal issues.