MILITARY RELEVANCE

Military clinicians often arrive to deployment locations only having a few days to assume full medical treatment capabilities. British medical teams assuming control of in-theater ROLE III facilities have been known to train in an identical medical environment prior to their arrival.  U.S. medical teams attempt this practice as well, but simulated training environments frequently fail to accurately and realistically recreate the range and multitude of deployable settings/scenarios in which clinicians actually find themselves. Immersive virtual reality (IVR) can fill this gap by providing a high-fidelity, realistic experience which enhances task performance by creating a sense of presence and fully engaging spatial memory. (1,2)

Medical and traumatic emergencies can be intimidating and stressful.  This is especially true for early-career medical personnel practicing outside their primary specialty in austere, poorly resourced settings. Combat potentiates stressors through a myriad of emotional, cognitive, and physical demands. (3-6) Training providers to respond effectively to medical emergencies before being confronted with a real scenario is limited by unnatural or high cost training modalities which fail to realistically replicate the stress and gravity of real-world trauma management. Opportunities to perform critical procedures and cardinal cases, such as managing a complex trauma, are often limited in garrison settings. Adding combat elements and stressors to training is even more challenging. Research shows that presenting individuals with realistic and stressful scenarios, in a safe, controlled environment, can optimize performance and potentially decrease the risk of psychological trauma when the event is experienced again.(6)

Deployment experience is extremely heterogeneous and degradation of skills and loss of proficiency can occur for healthcare workers who may spend months with sparse, intermittent patient contact. Currently military medical leaders are developing individual critical task lists that will require providers to annually complete a designated number of procedures in order to fulfill Army readiness requirements. Achieving the projected quantities of these procedures will be challenging for many providers due existing practice setting limitations. Simulation training’s evolution over the past decade has allowed it to become a proven and effective education modality for medical personnel of all levels to learn and sustain interpersonal and technical competencies. (7-11) Sim training, despite its significant progress, still has limitations which include the need for space, prohibitive equipment costs, and requisite skilled personnel to operate the devices and run the scenarios. Virtual reality offers a unique portable solution to provide independent, asynchronous medical training in resource-limited garrison and deployed settings, using only a laptop and headset. 

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  3. Campbell, S. J., Ritzer, D. R., Valentine, J. N., & Gifford, R. (1998). Operation Joint Guard, Bosnia: An assessment of operational stress and adaptive coping mechanisms of soldiers. Washington, DC, Walter Reed Institute of Research.
  4. Kavanagh, J. (2005). Stress and Performance A Review of the Literature and its Applicability to the Military. RAND CORP SANTA MONICA CA.
  5. Stetz, M. C., Thomas, M. L., Russo, M. B., Stetz, T. A., Wildzunas, R. M., McDonald, J. J., ... & Romano, J. A. (2007). Stress, mental health, and cognition: a brief review of relationships and countermeasures. Aviation, space, and environmental medicine, 78(5), B252-B260.
  6. Pallavicini, Federica, et al. "Virtual reality applications for stress management training in the military." Aerospace medicine and human performance 87.12 (2016): 1021-1030.
  7. McGaghie, William C., et al. "A critical review of simulation‐based mastery learning with translational outcomes." Medical Education 48.4 (2014): 375-385.
  8. Vattanavanit, Veerapong, Jarernporn Kawla-ied, and Rungsun Bhurayanontachai. “High-Fidelity Medical Simulation Training Improves Medical Students’ Knowledge and Confidence Levels in Septic Shock Resuscitation.” Open Access Emergency Medicine : OAEM 9 (2017): 1–7. PMC. Web. 6 Nov. 2017.
  9. Lamb, Richard L., Leonard Annetta, and Jonah Firestone. "A meta-analysis with examination of moderators of student cognition, affect, and learning outcomes while using serious educational games, serious games, and simulations." Computers in Human Behavior (2017).
  10. Scalese, Ross J., Vivian T. Obeso, and S. Barry Issenberg. "Simulation technology for skills training and competency assessment in medical education." Journal of general internal medicine 23.1 (2008): 46-49.
  11. Grantcharov, Teodor P., et al. "Randomized clinical trial of virtual reality simulation for laparoscopic skills training." British Journal of Surgery 91.2 (2004): 146-150.