VR trains clinicians about treatments for pediatric trauma

MONTREAL – A new Virtual Reality (VR) system has been created by a team at McGill University that enables doctors, residents, nurses and other clinicians to master the challenges of pediatric trauma. By using VR headsets and the new software, learners can participate in educational sessions “anytime, anywhere”, instead of travelling to workshops that are only conducted in a few teaching hospitals in Canada.

“Rural doctors are extremely interested in learning more about trauma procedures for children,” said Dr. Dan Poenaru, professor of Pediatric Surgery at McGill University and co-developer of the new system, known as PeTIT VR (short for Pediatric Trauma Innovative Training in VR). “They’re frightened by the thought of a two-year-old who is in a car accident. If they don’t know how to manage this patient, they’re in trouble.”

In addition to rural physicians, many surgeons, urban GPs and nurses are interested in learning more about the best practices in pediatric trauma care. Traditionally, they’d have to travel to specialized workshops in centres like Montreal.

“The problem is that it’s expensive to go to these courses,” said Dr. Poenaru. “The simulation centres use expensive, high-fidelity manikins, and they need to be staffed. It ends up costing participants about $2,000 for a two-day course, plus they have to pay for their transportation and hotel.”

By contrast, PeTIT VR allows them to collaborate with others from their own workplaces or homes. “They can be in their own bedrooms, if they want,” quipped Dr. Poenaru. Moreover, the VR software and hardware costs only hundreds of dollars, instead of the thousands required to attend specialized courses.

Dr. Poenaru led the drive to create the VR system in collaboration with a colleague, Dr. Fabio Botelho, a Global Paediatric Surgery Fellow from Brazil who is doing a PhD at McGill. The two physicians were discussing the limitations of teaching pediatric trauma surgery to others and realized there must be a better way.

Their solution was to develop virtual reality software that could support learners wherever they’re located, at lower cost, without having to travel.

The other team members are Elena Guadagno, MLIS, and Harvey Beardmore, from the Division of Pediatric Surgery, Montreal Children’s Hospital.

“Just think of the implications for lower income countries,” said Dr. Poenaru. “These skills are in great demand, but clinicians can’t afford to go to workshops. And their hospitals can’t afford to buy high-fidelity manikins.”

Using systems like PeTIT VR, running on the Internet, it all becomes relatively low-cost.

To devise the software, Drs. Poenaru and Botelho reached out to a company with experience in VR and medical training called i3 Simulations, of London, UK. The company had already been developing training systems for many other medical scenarios.

PeTIT VR is built in partnership with McGill University Research Institute, McGill University, and i3 Simulations Limited.

Devi Kolli, CEO of i3 Simulations, emphasizes the importance of pediatric surgery, and noted how the new software will be able to help clinicians and, of course, patients and families.

She pointed out that preventable medical errors are still a major problem in Canada and worldwide, and that surgical errors are major contributors. It’s been shown that better training and continuous improvement through virtual simulation-based learning can enhance the skills of clinicians and reduce medical errors.

Moreover, a preliminary test of the system by physicians from various educational backgrounds showed that clinicians liked using PeTIT VR. A survey of 11 clinicians from eight countries using PeTIT VR reported that 87 percent found PeTIT VR useful for training, and 93 percent said they would use PeTIT VR if it was implemented at their hospital.

Moreover, 81 percent preferred PeTIT VR over traditional mannequin simulators, and PeTIT VR was rated highly effective for training teamwork and communication skills.

The group plans to do more testing and surveys, but in the meantime, they feel PeTIT VR is ready for prime time and they have begun to offer it to other clinicians in Canada.

Dr. Poenaru asserted that PeTIT VR is the first VR system for pediatric trauma training that ties multiple users together in a team. Until now, he said, VR systems for this application have only supported a single user at a time.

He explained that this feature is incredibly important, as trauma care requires provider teams and communication is the key to better outcomes. Trauma teams, he said, are typically staffed by two physicians, two nurses, and a respiratory technologist.

“Technical skills are important, and we teach them, but the weakness in trauma care today is on the “soft” side, in non-technical skills like communication and leadership. That’s where most of the errors occur,” he said.

So, the PeTIT VR system emphasizes teamwork in the trauma bay, and helps doctors, nurses and technologists work together.

“If a nurse notices that I made a mistake in a drug that I ordered, she should have no problem in telling me,” Dr. Poenaru said.

“These soft skills are not adequately taught in medical schools or in most hospitals,” he added. “In creating PeTIT VR, we decided to focus on teaching how to work together.”

Dr. Poenaru said the PeTIT VR records everything that happens in the simulated trauma session, then can analyze the quality of the actions and of the communication. For instance, it can be programmed to ensure there is proper “closed loop communication” between team members.

“It’s a very important concept in acute care today,” said Dr. Poenaru. “When one member of the team asks for something or needs something to be done, another must acknowledge that it has been done. That way, you make sure that nothing has been missed or forgotten.”

He said the software has the potential to automatically assess the performance of team members, showing them what they did well and what needs improvement.

On this score, Dr. Poenaru said the team is progressing to leverage generative AI, an exciting new development.

He explained that by using generative AI, software can simulate whole teams, enabling one person to engage in a training session with the sense that there are three others in the room.

This means that clinicians can learn technical and team-building skills while on their own, at any time and from any place.