nato_hfm_rtg_215_workshop_proceedings documents/nat… · web viewworkshop proceedings human...

WORKSHOP PROCEEDINGS

Human Factors &Medical Panel Meeting on Advanced Training Technologies for Medical Healthcare Research Technology

Group 215 (HFM-RTG-215)

Location:Office of Naval Research Global (ONRG) London

2 Providence Court, London22 – 23 May 2012

Prepared by:Jacob Hodges, Q&P Ltd

This work relates to Department of the Navy Contract # N68171-12-P-9001.

1. Introduction

On 22-23 May 2012, the Office of Naval Research Global (ONRG) London hosted the NATO Human Factors & Medical Panel Meeting on Advanced Training Technologies for Medical Healthcare Research Technology Group 215 (HFM-RTG-215) for CAPT (USN-Ret) Russell Shilling (Defense Advanced Research Projects Agency (DARPA) and COL Karl Friedl, USA/MD (U.S. Army Telemedicine & Advanced Technology Research Center (TATRC)). The purpose of the meeting was to review the existing documentation that formally established this RTG and to make changes as needed to the guiding document throughout the 3-year duration of this RTG.

The HFM-RTG-215 Meeting was attended by 12 representatives from Canada (Defence Research and Development Canada (DRDC), University of Toronto), Sweden (Swedish Armed Forces Centre for Defence Medicine), France (French Military Biomedical Research Institute), United Kingdom (University of Birmingham), and the United States (i.e., Air Force Materiel Command (AFMC)/722 Human Performance Wing (HPW), Defense Advanced Research Projects Agency (DARPA), DoD/VA Extremity Trauma and Amputation Center of Excellence, U.S. Army Telemedicine & Advanced Technology Research Center (TATRC), Naval Postgraduate School (NPS), and the Office of Naval Research Global (ONRG)).

2. Background Information

The use of advanced modeling and simulation (M&S) technologies for training has been common and widespread in the military for decades. The medical community has been a relatively recent entrant into the simulation world, but the use of M&S in medical training and education is progressing rapidly and the medical community is now one of the more enthusiastic adopters of these technologies. Medical simulation is necessary across both civilian and military domains to refresh skills, test competencies, and provide training to rural areas. In the military, medical M&S provides the unique opportunity to train skills that are not available in the civilian systems and are only provided as on-the- job training in combat zones and during relief efforts. With the development of valid representations of the human patient, we now have the opportunity and responsibility to provide less expensive, more flexible, scalable training and education methodologies. More recently, these same simulation and game technologies have been adapted for treatment, training, and outreach for military personnel and their families.

Rapid advances in M&S efforts have afforded the ability to develop medical outreach tools using the latest computer graphics, natural language processing, web content and artificial intelligence technologies. Using these methods, M&S provides the means to educate military personnel, families and colleagues about the impact of physical and psychological injury. Increasingly these technologies can be deployed on stand-alone PC’s, the internet, and game-consoles. Although, M&S can significantly influence the next generation of healthcare training, education, outreach, and advocacy, all these issues require extensive attention to educational design principles, human factors issues, and extensive attention to rigorous validation to assure that platforms are both safe and efficacious.

One goal of this effort is to bring the concept of M&S for medical training into reality and to make certain we adopt rigorous design and validation criteria to our on-going programs. We are also devoted to developing innovative programs that are not only validated for safety and efficacy, but also combine aspects of entertainment to encourage healthcare professionals, military personnel and their families to use the platforms being developed. These goals can be achieved by leveraging relevant videogame-


based technologies and other computer-based concepts in order to create compelling applications. M&S tools can be used to teach health care professionals, military personnel and their families about medical treatment options and educate them about the signs and symptoms of psychological health, traumatic brain injury and other medical issues that might arise from deployment. These same technologies can also be leveraged to encourage healthy behaviors and resilience strategies PRIOR to deployment.

3. Presentations/Discussions

Day 1 – 22 May 2012

a. Dr. Clayton Stewart, the ONRG Technical Director, opened the meeting by welcoming all participants to ONRG London. He was followed by Jacob Hodges, ONRG Host, who provided administrative details.

b. CAPT Russell Shilling, USN-Ret, from the Defense Advanced Research Projects Agency (DARPA), opened the meeting by providing a brief overview of the current meetings objectives.

c. COL Karl Friedl, from U.S. Army Telemedicine & Advanced Technology Research Center (TATRC), discussed the importance of Modeling and Simulation (M&S) in Medical Healthcare, the HFM-RTG-215 Program of Work (POW), importance of this meeting and the need to develop a ‘next steps with tangible results’.

d. Each of the HFM-RTG-215 participants briefly introduced themselves and their organization.

e. CAPT Russell Shilling briefly discussed numerous programs developed with the support of DARPA Funding. Examples included the Stress Simulator, Walking in My Shoes, Helping Our Heroes, Making Mars, several Rehabilitation Games (i.e., Making Mars and Treasure of Bell Island), Sesame Workshop: Families Near and Far, and the Graphic Novel Authoring Tool (GMAT) that was developed through an ‘Art Therapy Small Business Innovative Research (SBIR). Russell also briefly highlighted several Educational Games (e.g., Inspiration for Engage: FOLD-IT, Robo Ball, Vampire Vision, Refractions and Rumble Blocks), Teaching Computer Programming (i.e., Operation Reset) and showed several videos.

f. Professor Robert Stone, the Director of the Human Interface Technology Team from the University of Birmingham, provided a printout and presentation on the Virtual Environments for Restoration & Rehabilitation. His presentation included video clips and references to research efforts relating to restorative environments, Virtual Environment (VE) technologies and how they can be exploited to support clinical deployments, the Virtual Restorative Environment (VRET) Project, two VE projects under development for experiments, and continued research and development (R&D) activities aimed at both intensive/critical care and recovery ward levels.

g. COL Rachael Evans, USA, the Research Director for the DoD/VA Extremity Trauma and Amputation Center of Excellence, presented a discussion on the Assessment and Treatment of Injured Service Members in a Virtual Reality Environment. It included video clips on the Military Performance Lab, the Purpose of the Center of Excellence, Clinical Goals, Milestones in Virtual Reality, Balance Training, Patience Characteristics, Patient Training, Training Results, Challenging Walking Stability, Gait Training, Gait Training Results, Adaptive Sports, Clinical Goal to Develop a Health and Functional


Outcome Assessment Toolkit, Task Domains, Metrics and Outcomes and the Application of a Mild Traumatic Brain Injury Rehabilitation Program in a Virtual Reality Environment: A Case Study.

h. Major Marie-Hélène Ferrer, from the French Military Biomedical Research Institute, presented Training and Simulation Experiments in the French Military Joint Service, which included video clips and examples of their training programs. Her presentation concluded the Missions of the Medical Support of Armed Forces, Training (i.e., Initial and Continuing Education), Personals, Lectures, Workshops, Field Exercises (i.e., Initial and Continuing Education), Information and Communication Technologies (ICT), RBA Website, E-Learning Platform, Mobile Learning Environment (MoLE) Project, Virtual Simulation – Serious Games, ICT for Rehabilitation, Protocol, Theoretical Foundations of Training, Memory Efficiency, Prospects: The ASTER Project and The SOAP Project.

i. Major Mike Christian, from the Defence Research and Development Canada (DRDC), provided a discussion on a Letter to the Ministry of Defence from the People for the Ethical Treatment of Animals (PETA), DRDC Context (i.e., Pulling out of Afghanistan and Budget Cuts), Activities (e.g., Canada-wide inventory of medical-simulation assets, formation of a standing committee on medical-simulation assets, and the identification of initial research priorities for medical-simulation) and Challenges (e.g., aligning medical-simulation kits with training demands, restructuring funding sources away from operational budgets, identifying medical-simulation technologies, and medical-simulation governance issues).

j. LtCol Lars Lundberg, Professor at the Swedish Armed Forces Centre for Defence Medicine, discussed two critical areas of concern; specifically, Preventable Deaths on the Battlefield and Lifesaving Surgical Procedures. In his discussion of Preventable Deaths on the Battlefield, his discussion focused on extremity bleeding, tension pneumothorax and airway occlusion. The Lifesaving Surgical Procedures discussion focused on the surgical procedures required for each of the aforementioned areas.

k. Jacob Hodges, the ONRG Learning, Education and Training Associate, presented The Mobile Learning Environment (MoLE) Briefing: An Update. The presentation included a video of the MoLE Project Vision, Introduction, Participants, Project Overview, Research Efforts, Working Groups (i.e., Medical Content, Technology & Transition, and Testing & Evaluation), MoLE Interim Results, Application Demonstration, MoLE Statistics, Application Access, Proof of Concept Assignment, ‘In App’ Evaluation, Test Limitations, the Global Medical Application Future and the DD J7 JCW JKO Architecture.

l. Maj Connie Winik, from the Air Force Materiel Command (AFMC)/722 Human Performance Wing (HPW), discussed Simulation Research Activities (i.e., C-STARS Baltimore Simulation Center Military Trauma Training Program: Training for High-Performance Training Teams and Use of Simulation in Aeromedical Evaluation (AE) Training: An Integrated Review), the lack of patient outcome studies with respect to comparing simulated trained skills and outcomes and the direct comparison of training effectiveness from high fidelity patient simulator vs. live animal model training.

m. Paul Chatelier, Naval Postgraduate School, presented a Human Factors & Medical Panel (HFM-RTG-215) Overview by briefly highlighting the requirement for a three-year plan. His presentation included a recap of the RTO Mission, The Place of RTO in NATO, the RTO Organisation, R&T Priorities, HFM Relationships in NATO, Major Technical Activities and the HFM Panel Members and HFM Panel Scope.

n. COL Karl Friedl also provided a presentation on Medical Simulation in Training – Medic Initiatives. He briefly talked about the Medical Education Training Center, Graphic Study Tools for Dental


Technicians, TC3 Simulation for Medics, the Immersive Naval Officer Training System (INOTS), Virtual Humans and the Joint Technical Coordination Group (JTCG1).

Day 2 – 23 May 2012

a. The second day consisted of open discussions on the ‘way ahead’, future meetings and deliverables for the meeting.

b. A meeting was proposed in early 2012 at the Medical Education Training Center (METC) that would focus on ‘Virtual Rehabilitation’.

c. An extensive discussion was held on ‘Identifying the State-of-the-Art in Medical Training’. After considerable collaborations, TATRC agreed to start developing the matrix so that the team could collaborate to identify (1) what we have, (2) what we don’t have, (3) what we know, and (4) what are the deficiencies. It was also recommended that the study identify, at a minimum, the priorities so that the report would show what is most needed.

It was recommended that one section of the report identify the cost-benefit of the items (e.g., cost, currently in development, etc), capabilities of the medical training equipment, training effectiveness (if available), and what is ‘needed’ vs. ‘what is missing’ in supporting medical healthcare professionals.

In responding to a request that one section of the document identify how each country conducts Medical Training, TATRC stated they would take the ‘first cut’ on the Technology List; however, there needs to be a literature review to support the educational evidence to support training effectiveness, and an Inventory of Medical Training Equipment is needed from the Allies to determine exactly how much has been invested in the use of Medical Simulator Training.

Last, but not least, the importance of how the study was designed was needed to ensure there is a standardized approach by all parties involved and that the study should focus on educating the medical healthcare professional (i.e., first responders) and optimizing training effectiveness.

d. Paul Chatelier provided meeting participants with a draft of the NATO Mobile Education & Training Technologies for Healthcare and other Military Professionals Technical Activity Program (TAP) that is projected to start in late 2012. He stated that the Proposed TAP is going through the fast-track and sought any assistance. Canada recommended new keywords be added (i.e., disaster response, on-demand training, etc), and DARPA briefly discussed DARPA’s Mobile Technology efforts within the Afghanistan Area of Operations.

e. During Bob Stone’s presentation on ‘Early Restoration & Rehabilitation Environment Research,’ it was stated that TATRC and DARPA would be interested in a US-UK Research Project on the “Effectiveness of Post-Operative Restoration and/or Rehabilitation”. This discussion also confirmed by Maj Connie Winik regarding the lack of patient outcome studies that provides metrics on effectiveness.

f. A discussion was held on establishing an Advanced Training Technologies for Medical Healthcare Community of Interest (CoI) so that the HFM-RTG-215 members could collaborate, share documents, review reports and interact on issues related to HFM-RTG-215 issues.


4. Action Items

a. Virtual Rehabilitation Meeting : In responding to the discussion on ‘Virtual Rehabilitation,’ Col Rachael Evans provided an email to meeting participants that recommended the meeting take place sometime during the week of 14 or 28 January, and that these weeks are best for the Center for the Intrepid. [Action: All Meeting Participants; PoC: Col Rachael Evans]

b. Mobile Education & Training Technologies for Healthcare and Other Military Professionals : Each meeting participant was asked to review the (Draft) TAP and provide feedback to Paul Chatelier, as well as identify a potential lead for the activity. [Action: All Meeting Participants; POC: Paul Chatelier]

c. Advanced Training Technologies for Medical Healthcare Community of Interest (CoI): The team approved a (Closed) Community of Interest be established with by-invitation only participants. Immediately following the meeting, the following email was provided, by Jacob Hodges, to all participants seeking their input before activating the CoI. [Action: All Meeting Participants; PoC: Jacob Hodges]

(1) Name of Community of Interest : Advanced Training Technologies for Medical Healthcare

(2) Community of Interest Description : A goal of this Community of Interest (CoI) is to collaborate on using Modeling and Simulation (M&S) for medical training and to encourage via data and other examples rigorous design and validation criteria to our nation’s on-going programs. This CoI will collaborate on developing innovative programs that are not only validated for safety and efficacy, but also combine aspects of motivation via entertainment to encourage healthcare professionals, military personnel and their families to use this technology.

(3) CoI Logo: NATO

d. Effectiveness of Post-Operative Restoration and/or Rehabilitation : It was recommended that a collaborative research project be considered that would investigate was to measure outcomes to assess the effectiveness of restorative and rehabilitation. [Action: DARPA, TATRC, 711HPW and : Bob Stone; PoC: Maj Connie Winik (711 HPW)]

e. Literature Review : In responding to the literature review, Col Karl Friedl 18 documents related to Medical Training, Simulation, etc. These documents will be stored on the Community of Interest. (PoC: Jacob Hodges]


TECHNICAL ACTIVITY PROGRAM (TAP)

ACTIVITY REFERENCE NUMBER HFM- ET XXX Mobile Education & Training Technologies for

Healthcare and other Military Professionals

APPROVAL2012

TYPE AND SERIAL NUMBER RTG

STARTTBD

LOCATION (S) AND DATES TBDENDTBD

COORDINATION WITH OTHER BODIES HFM/MSG/NTG/

NATO CLASSIFICATION OF ACTIVITY UNCLASSIFIED UNLIMITEDNon-NATO Invited

Yes

PUBLICATION DATA Workshop Report UNLIMITED DIST.

KEYWORDS (13)

I. BACKGROUND AND JUSTIFICATION (Relevance to NATO):

Mobile Learning (education & training) has continued to spawn an enormous number of conferences, meetings, workshops and smart phone applications. NATO HFM has sponsored advanced distributed learning research technology and computer based learning research groups for a decade. Recently the use of modeling and simulation for medical and health care professionals has become one of the more recent activities sponsored by NATO. Given the state of the art in mobile devices, the medical and health care profession has begun to rely on “APS” and smart hand held devices for intelligent dialogue, job aides, rehearsal training and data base access.

II. OBJECTIVE(S):

To identify the many capabilities as well as opportunities for the use of mobile devices for medicine and healthcare education, training, and performance aiding. We will also have to focus on how these “m-devices” will provide the most cost-effectiveness techniques from research all the way into the various elements of the training communities. One goal is to compile information in a practical, usable form of “what works” and why it works.

III. TOPICS TO BE COVERED:

Pedagogical approaches, models and theories for m-Learning m-Learning in and across formal and informal settings Strategies and challenges for integrating m-Learning into broader medical educational scenarios User Studies that focus on metrics and cost-benefit of mobile devices Learner mobility, device robustness and education and training transitions afforded by mobile

learning Socio-cultural context and implications of m-Learning Mobile social media and user generated content Enabling m-Learning technologies, applications and uses Evaluation and assessment of m-Learning


Research methods, ethics and implementation of m-Learning Innovative m-Learning approaches Tools, technologies and platforms for m-Learning

IV. DELIVERABLES: Workshop with demonstrations Compendium of capabilities such as authoring systems, assessment methods, APS, etc. Final Report Miscellaneous, other deliverable(s) : TBD

V. TECHNICAL TEAM LEADER AND LEAD NATION:

Chairman & Co-Chairman: TBDLead Nation: TBD (those who demonstrated interest are USA; CAN; FRA; ..)

VI. NATO NATIONS WILLING/INVITED TO PARTICIPATE: CAN, DEN, FRA, USAPfP Nations: TBD when RTG establishedMD Nations: TBD when RTG established ICI Nations: TBD when RTG established Contact Nations: TBD when RTG established

VII. NATIONAL AND/OR NATO RESOURCES NEEDED (Physical and non-physical Assets): TBD

VIII. RTA RESOURCES NEEDED (e.g. Consultant Funding): Normal RTA Resources Needed

Additional Information:Panel Mentor: CAPT Paul Chatelier, USN (Ret), USA


Figure 1 - NATO HFM-RTG-215 Meeting Participants


nato_hfm_rtg_215_workshop_proceedings documents/nat… · web viewworkshop proceedings human...

Documents