NAWCTSD Applies Simulation Expertise for Future Medical Training

By Terri Bernhardt

Exciting and innovative medical training research is happening at the Naval Air Warfare Center Training Systems Division (NAWCTSD) and is likely to grow in the future. Mr. Matthew Lineberry, Research Psychologist, NAWCTSD leads a number of the command’s medical thrusts that are instrumental in leading the Navy into blue waters. One completed project worth noting, in support of the Combat Casualty Training Consortium (CCTC), sponsored by USAMRMC and TATRC, was named runner-up for Best Research Abstract at the International Meeting for Simulation in Healthcare 2012. “We supported knowledge elicitation and trainee performance assessment development in support of CCTC,” stated Lineberry. “With the help of instructors of two of the most critical combat trauma procedures – emergency airway and controlling hemorrhage – we refined the trainee performance assessments and identified which simulator cues were critical for learning and teaching each procedure. In this way, we’re better able to optimize training for these procedures moving forward.”

NAWCTSD understands the importance of collaboration. They work in close contact with the other Services, academic partners at UCF, M&S industry partners, and medical institutions. “In the medical domain, collaboration and coordination is facilitated by the fact that medicine is relevant across the services and outside of the DoD,” stated Mr. Lineberry. “The ‘tent’ for collaboration in medical training technology is very large, and that benefits everyone.”

Two current NAWCTSD efforts sponsored by the Naval Aviation Enterprise Chief Technology Office promise to enhance medical training of the future: Technology and Research for Application of the Spacing Effect (TRASE) and Promoting Expert Reasoning in Science Education Using Simulation (PERSEUS).

TRASE involves development and evaluation of adaptive algorithms for prediction and mitigation of knowledge decay using computer- or mobile devise-based memorization applications. This has applicability for medicine, where memorization of treatment protocols, contraindications, and other facts are critical for quality and safety of care. Mr. Lineberry explains: “Doctors, nurses, and medics not only need to master procedural skills but also need to memorize a huge bank of information. For example, according to TC3 guidelines, there are four contraindications against giving morphine or fetanyl to a wounded soldier during tactical field care. If a medic doesn’t remember those contraindications instantly – under the stress of battle – their care can be compromised. To help medics and other professionals, we’re refining algorithms that predict when they are likely to forget each piece of information out of a “deck” of facts or procedures they have to memorize. That way, rather than learning something once and never seeing it again, they can be quizzed and refreshed on information at precisely the day on which they would get the biggest memory ‘boost’ from it.”

Meanwhile, PERSEUS is an experimental effort to determine the optimal degree of instructional support to provide to learners exploring highly-complex human physiology simulations. “Experts have developed very sophisticated mathematical models of human physiology,” said Mr. Lineberry. “So rather than crude relationships in medical simulations – ‘if the patient bleeds, their blood pressure goes down’ – we could model all the complex ways that the body tries to compensate, how effects cascade to other systems, etc.” Such accurate modeling can be valuable for helping students develop expertise on how the human body works. However, as was learned in aviation simulation, realism can sometimes overwhelm novices and ironically hinder learning. “If you want students to explore and learn concepts in such a complex system, we need to figure out the right kind of instructional support to provide. Instructional researchers disagree on this. Many advocate limiting students’ exploratory learning in favor of more direct instruction. Others argue you should toss students in the ‘deep end’ and let them explore so long as you help them manage the inevitable frustrations that occur when the student can’t immediately find the solution they’re looking for. Our study is comparing these two approaches head-to-head to see what types of learning each is best for – and long-term, to help us get the most out of medical simulations for education.”

Screen shot of HumMod, a physiology engine studied in the PERSEUS project.

NAWCTSD also manages contractual efforts sponsored by the Office of Naval Research (ONR) to provide visualization and analysis of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) research. “PTSD and TBI are obviously huge priorities for the DoD,” stated Lineberry. “This project seeks to visualize current research and suggest how it can be coordinated for the greatest possible gains.” Performers on this project are also looking at training technologies that therapists can use to help PTSD and TBI patients recover and thrive.

Two mobile device applications that NAWCTSD helped develop – the Medical Team Performance Assessment Tool (MTPAT) and Team Effectiveness Accelerator (TEA) – are helping medical teams deliver higher-quality care. “The TRICARE Management Activity (TMA)’s Patient Safety Program is charged with improving safety across the DoD medical space,” said Lineberry. “To help teams get the most from training, TMA supported development of mobile applications that reinforce sound principles of teamwork. With our industry partners, we delivered the MTPAT and TEA, which are now available throughout the government and even to non-government medical institutions.” Anyone interested in these tools for medical team training can contact patientsafety@tma.osd.mil for more information.

Medicine is obviously a high-stakes field, and even with the advances to date, the potential for training technology to improve patient outcomes is still enormous – and Central Florida stands to be a world leader in the realization of that potential. “Lessons learned from simulation in military domains such as aviation are very applicable in medical simulation,” stated Lineberry. “At the same time, I have no doubt that advances in medical training technology will bring about innovations and breathe new life into the more established simulation domains. The development of Medical City just miles away from Team Orlando’s Research Park – along with other major facilities such as the Nicholson Center – make the Central Florida area ripe for highly productive collaboration.”

NAWCTSD takes pride in a workforce that has diverse science and technology expertise. “By applying the science of learning and human performance – cognitive psychology, human factors, psychometrics, and so forth – we’re able to put intelligence into the design and use of training technology to maximize trainee learning,” stated Mr. Lineberry. “Also, by being rigorous about testing how effective our training interventions are, we’re able to catch instances where ‘common sense’ about training is actually incomplete or false, and we can focus development on the aspects of training that have the biggest impact.”

Matt Lineberry has been with NAWCTSD for two years and has recently completed all requirements toward a Ph.D. in Industrial and Organizational Psychology from the University of South Florida. He will be presenting for the second year at the Medical Technology, Training & Treatment conference (MT3) in Orlando this May on Navy medical training efforts and research design issues for medical simulation.