Training Industry Magazine - May/June 2020 - 49

representation of the patient's internal
anatomy can be superimposed on the
image of the patient, allowing the student
to see exactly what is being scanned.
Once ready for editing, the videos were
imported into Adobe Premiere. Both
the top-down view and the ultrasound
output were matched the clinician's
actions and precise timing. Then the
videos were parsed into shorter video
scenarios and saved as MP4 files in an
equirectangular format.
AUTHORING THE LEARNING
ENVIRONMENT

Like most medical devices, ultrasound
machines are expensive; each new
machine can cost over $100,000. While
portable probes that can be attached to
a smartphone are much less expensive,
they are still very costly. A broken
probe can still cost thousands of dollars
to replace.
THE BENEFITS OF VIRTUAL REALITY
Since Vanderbilt had a limited number
of devices and instructors, students
needed a safe environment to simulate
skill development. By replicating the
clinical setting in virtual reality (VR),
students are more likely to hit the ground
running when given hands-on time with
a device and a patient. Furthermore,
the chances of a student encountering
patients with specific and diverse
problems during training sessions are
low, so VR provides an opportunity
to interpret multiple scenarios and
patient conditions.
Finally, with a VR application, students
can replay the activity until they feel
confident in their understanding of the
task. They can watch the clinician place
the probes on the patient, then go back
and see what is being imaged. Moreover,
the ultrasound output is annotated with
text, arrows and circles corresponding
to the presentation of the instructor.

By preloading much of the instruction
into an online format, the need for faceto-face instructor time is substantially
reduced. This allows more people to be
trained while reducing the hands-on time
required with the device.
SIMULATING THE EXPERIENCE
To capture the experience of operating
ultrasound equipment, three different
media components were combined
to simulate the clinical environment:
360-degree video of the clinician and
patient interactions shown from two
distinct camera angles; a top-down view
with graphic, anatomical overlays; and
streaming video of the ultrasound output
timed to coincide with exactly how the
instructor is interacting with the patient.
A 360-degree video camera was placed
opposite the clinician at eye level,
continuously recording the clinician
as he or she interacts with the patient
and mirroring the student's subjective
perspective. The output from the
ultrasound device was captured on a
digital video recorder, and the video
was moved to a portable USB drive.
Lastly, a ceiling-mounted camera was
built into the lab to record the same
patient encounter from a top-down
perspective. With an overhead view
of hand positioning and movement, a

Each MP4 video file - representing a
specific patient encounter - was imported
into CenarioVR, a VR authoring tool for
creating immersive learning courses.
Each video scenario was enhanced
with additional instructional elements on
the top-down view of the patient, such
as drawings of anatomical elements
that appear when selected. Questions,
annotations, buttons and hotspots were
included to enforce key concepts and
quiz the students on probe placement.
Once each scenario was finalized with
interactions and assessments, the course
was published in two formats: HTML5 for
viewing on a computer's browser, as well
as CenarioVR Live and mobile for viewing
on a phone in a Google Cardboard or
Oculus Go headset.
A PROMISING OUTCOME
Despite modifications that could be made
to improve the immersive experience for
students, the VR course is proving to be
effective. Since rolling out the immersive
learning module in the spring of 2019,
each student reported they had a more
efficient training experience with the
ultrasound probes. As a result, Vanderbilt
will continue to expand ultrasound
training to support its growing nursing
school enrollment while keeping costs
down by making the training more
efficient and scalable.
Jeffry Gordon, Ph.D., is a professor of
educational informatics at Vanderbilt
University School of Nursing. Christie
Calahan is the director of marketing at
Trivantis. Email the authors.

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