Advanced Cardiac Life Support Simulator Prototype
Advanced Cardiac Life Support Simulator Prototype
If you’ve ever heard a tv doctor call a “code blue,” you know that it means a patient has usually gone into cardiac arrest and needs immediate medical attention to survive. Media often shows doctors rushing in and performing CPR, but the actual process of saving a patient is even more complex. Advanced Cardiac Life Support, or ACLS, is an important part of any future doctor’s training. ACLS training teaches doctors how to assess a patient’s situation, quickly diagnose the issue, and lead other medical professionals through the necessary steps to stabilize their patient. However, due to infrequent exposure to this training, future doctors feel comfortable with the facts, but not with leading a code. To address this need, our team designed a prototype ACLS simulator using 360-video.
Opportunity
When a code is called in the hospital, available staff rushes to the scene to help. Whichever physician arrives first is automatically designated as the person leading the code. When seconds matter for the patient, there’s no time to wait for someone more experienced to arrive; even the most junior doctors need to be ready at a moment’s notice to run a code. However, studies show that up to 49.3% of residents feel inadequately trained to lead a code. Code leadership is one of the largest contributors to a successful code, but this skill is not always a part of ACLS training. Furthermore, because of the complexity of setup, scheduling, and content, ACLS training is only repeated every two years for recertification.
Inspired by a 2003 study of internal medicine residents at Thomas Jefferson University, we focused our efforts on simulation training. Their study revealed that while only 17% of graduating interns reported feeling “comfortable” leading a code prior to their simulation intervention, this number tripled after completing a simulated code and receiving expert feedback. Our team sought to expand upon this experience by using virtual reality (VR) technology. VR allows for low consequence training that residents can attend anytime and anywhere, allowing them to practice clinical reasoning and code management skills as often as desired.
We designed our VR prototype as a 360-video simulation of a “code blue”, including other virtual “medical professionals” for the user to direct. The prototype also featured voice input to manage this virtual code team to encourage the user to practice communicating with their team. The prototype was designed to meet the American Heart Association (AHA) guidelines and included prompts for the user at various critical moments during the simulated code.
Challenges
Just as each patient is unique, so are the dynamics of each code. Some are fairly straightforward, following standard patterns, while others are incredibly complex with slim chances for success. To create a simulator encompassing so much variety was a large undertaking, so we worked with code experts at Jefferson, the JeffSTAT team, to make a simulation that started simple, with the option to scale up.
In addition to the science of the simulator, some of the technical aspects also posed challenges. Speech to text technology has vastly improved in recent years, but it is still complicated to train voice technology to understand medical terminology. To help simplify this, we included multiple-choice options for the user to read through. This allowed us to streamline the process of training the speech to text function while also continuing to encourage users to read instructions aloud, reinforcing the actual skills used while leading a code.
Finally, for this prototype, the decision was made to use 360-video. This dramatically cut down on the development time, but it meant there were some trade-offs. For example, to simplify filming needs, incorrect multiple-choice responses informed the user of their error and then proceeded with the correct one. This is obviously not how it works in the real world, but the alternative would have required filming the results of each incorrect choice, effectively doubling production time. We decided to address this in further iterations of the simulator.
Vision and Value
In early 2018, The DICE Group’s Clinical Fellow, Pavitra Krishnamani, recognized the need for additional ACLS training for medical students and residents after participating in a code. Our team envisioned this prototype as a simulator that would supplement existing training because of the flexibility added by using VR. Medical students and residents would be able to practice ACLS skills at their own pace whenever desired. We hoped that it would allow them to experience running a code in a safe environment long before they ever had to do so for a real patient.
Additionally, we began planning for future iterations that would increase case complexity and allow for learning to be tracked and managed over time. The vision was to create a code scenario with branching pathways that required the user to exercise the clinical reasoning and communication skills necessary to achieve a successful outcome. This would allow students to make mistakes and see how those mistakes would play out, including witnessing their virtual patient dying depending on their choices — a very real consequence that could occur during an actual code. These choices would then be logged in a learner management system, allowing them to track their progress, assess their personal aptitude for various scenarios, and even allow for benchmark comparisons with their peers.
As with any good idea, there is always a chance that someone else has had it too. We discontinued work on this prototype ACLS simulator in March 2019, after seeing a similar product released by Health Scholars emerge on the market. Our team continues to explore ways to increase communication and provide supplemental training for medical students and residents at Thomas Jefferson University.
About the XR Lab
The XR Lab at The DICE Group is a multidisciplinary team passionate about transforming healthcare and education through immersive technology. They believe that XR should be easily accessible to everyone and that it can potentially change the healthcare experience.
Interested in this intersection of VR, ACLS, and medical training? Want to pursue a similar project? Contact us anytime, ARVR@jefferson.edu. Subject: ACLS.
