Virtual Reality Adaptation of Be EPIC: Pre-Implementation Studies of Person-Centered Dementia Care Training

The COVID-19 pandemic has underscored the importance of person-centered dementia care and working conditions that support such care in long-term care (LTC) home settings. Personal support workers (PSWs), known also as certified nursing assistants, provide the most direct formal care for persons living with dementia. However, little is known about the working conditions that enable person-centered care. Accordingly, the purpose of this study was to examine the working conditions and the impact of those conditions on PSWs in LTC homes. PSWs (N=39) employed at one of five LTC homes in southwestern Ontario, Canada participated in a series of one-hour focus groups before, during, and after Be-EPIC, a person-centred communication training program for formal caregivers of persons living with dementia. Using an interpretive description investigative framework, textual data from focus group conversation transcripts were open-coded into categories. Overarching themes were interpreted inductively. Study credibility was enhanced through investigator triangulation. Three themes emerged related to working conditions of PSWs: dementia care is complex, lack of trained staff to provide person-centered dementia care, and residents’ families are not situated in the residents’ care circle. Four themes emerged related to the impact of current working conditions of PSWs: occupational burnout, poor resident care, frustrated and disengaged families, and PSWs leave their role. The findings offer opportunities for employers to ameliorate working conditions to support person-centered care. We conclude with specific workplace recommendations that respond to the complexity of dementia care and the associated occupational stresses PSWs experience in the current LTC environment.

Be EPIC-VR is a person-centered communication (PCC) training program designed for healthcare providers working in dementia care. It is the first virtual reality (VR) program to use conversational artificial intelligence to train users to communicate with avatars depicting persons living with dementia (PLWD). The current study examined the acceptability and preliminary efficacy of Be EPIC-VR training. Participants included eight personal support workers from four home care and long-term care settings. Focus groups were conducted both immediately after VR sessions and after completing the Be EPIC-VR training program. Data analyses used framework analysis. The theme, relevant training supporting learning, reflected the acceptability of Be EPIC-VR. Be EPIC-VR’s innovative design facilitated significant learning gains, highlighting the benefits of experiential design, accessibility of training components, relevance regardless of career level, and group feedback on learning outcomes. The theme supporting preliminary efficacy was applying newly learned knowledge and skills with PLWD. Four subthemes emerged that mapped onto Be EPIC-VR’s foci. First, participants used the cues from the environment when interacting with PLWD. Second, participants, including those with English as a second language, reported applying PCC strategies which helped in understanding PLWD’s needs and addressing care refusal. Third, they noted an increase in self-efficacy in dementia care, which strengthened relationships with PLWD. Finally, they reported incorporating the preferences of PLWD during care interactions. Be EPIC-VR training emerges as a promising tool for enhancing skills of personal support workers, suggesting that immersive, VR-based training programs can foster empathetic, knowledgeable, and person-centered care approaches.

Personal support workers (PSWs) in long-term care (LTC) homes comprise over half of the workforce responsible for providing care to people living with dementia. Compared to other healthcare professionals, PSWs receive the least education, which fails to equip them with the necessary competencies for quality dementia care. To provide optimal care to people living with dementia, PSWs need to be offered opportunities for continuous education that addresses their specific learning needs. Therefore, this study identified and examined the dementia-specific learning needs of PSWs in LTC. Interpretive description guided the secondary qualitative analysis of 22 focus groups with ‘mid-career’ PSWs (n = 39) in LTC. The analysis identified specific learning needs along with ways in which those needs are best met. The learning needs include: 1) addressing responsive behaviours, 2) person-centered communication and attitudes, 3) delirium, and 4) dementia as a chronic condition. Learning needs were most commonly attributed to limited preparation during formal PSW education and a lack of continuous training opportunities throughout their career. Learning needs are best met through experiential methods involving peer learning, feedback, and evaluation within a supportive environment. For the learning needs to mediate practical outcomes, there needs to be an openness to dementia education and a good teamwork culture within LTC. The data generated from this research study will be essential to developing future continuing education for PSWs, contributing to knowledge about dementia care within LTC settings, and improving the quality of care provided to people living with dementia.

Personal support workers (PSWs) in long-term care (LTC) homes comprise over half of the workforce responsible for providing care to people living with dementia. Compared to other healthcare professionals, PSWs receive the least education, which fails to equip them with the necessary competencies for quality dementia care. To provide optimal care to people living with dementia, PSWs need to be offered opportunities for continuous education that addresses their specific learning needs. Therefore, this study identified and examined the dementia-specific learning needs of PSWs in LTC. Interpretive description guided the secondary qualitative analysis of 22 focus groups with ‘mid-career’ PSWs (n = 39) in LTC. The analysis identified specific learning needs along with ways in which those needs are best met. The learning needs include: 1) addressing responsive behaviours, 2) person-centered communication and attitudes, 3) delirium, and 4) dementia as a chronic condition. Learning needs were most commonly attributed to limited preparation during formal PSW education and a lack of continuous training opportunities throughout their career. Learning needs are best met through experiential methods involving peer learning, feedback, and evaluation within a supportive environment. For the learning needs to mediate practical outcomes, there needs to be an openness to dementia education and a good teamwork culture within LTC. The data generated from this research study will be essential to developing future continuing education for PSWs, contributing to knowledge about dementia care within LTC settings, and improving the quality of care provided to people living with dementia.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Cataract surgery is the most common incisional surgical procedure in ophthalmology and is important in ophthalmic graduate medical education. Although most ophthalmology training programs in the United States (US) include virtual reality (VR) training for cataract surgery, comprehensive reviews that detail the impact of VR training on ophthalmology trainee performance are lacking. To assess the impact of VR training for cataract surgery on the operating performance of postgraduate ophthalmology trainees, measured by operating time, intraoperative complications, postoperative complications, supervising physician ratings, and VR simulator task ratings. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), Ovid MEDLINE, Embase.com, PubMed, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 14 June 2021. We included randomized controlled trials (RCTs) comparing VR training to any other method of training, including non-VR simulation training (e.g., wet laboratory training), didactics training, or no supplementary training in postgraduate ophthalmology trainees. We used standard Cochrane methodology. Primary outcomes were operating times in the operating room and intraoperative complications. Secondary outcomes were operating times in simulated settings, simulator task ratings, and supervising physician ratings, either in the operating room or simulated settings. We included six RCTs with a total of 151 postgraduate ophthalmology trainees ranging from 12 to 60 participants in each study. The included studies varied widely in terms of geography: two in the US, and one study each in China, Germany, India, and Morocco. Three studies compared VR training for phacoemulsification cataract surgery on the Eyesi simulator (VRmagic, Mannheim, Germany) with wet laboratory training and two studies compared VR training with no supplementary training. One study compared trainees who received VR training with those who received conventional training for manual small incision cataract surgery on the HelpMeSee simulator (HelpMeSee, New York, NY). Industry financially supported two studies. All studies had at least three domains judged at high or unclear risks of bias. We did not conduct a meta-analysis due to insufficient data (i.e., lack of precision measurements, or studies reported only P values). All evidence was very low-certainty, meaning that any estimates were unreliable. The evidence for the benefits of VR training for trainees was very uncertain for primary outcomes. VR-trained trainees relative to those without supplementary training had shorter operating times (mean difference [MD] -17 minutes, 95% confidence interval [CI] -21.62 to -12.38; 1 study, n = 12; very low-certainty evidence). Results for operating time were inconsistent when comparing VR and wet laboratorytraining: one study found that VR relative to wet laboratory training was associated with longer operating times (P = 0.038); the other reported that two training groups had similar operating times (P = 0.14).One study reported that VR-trained trainees relative to those without supplementary training had fewer intraoperative complications (P < 0.001); in another study, VR and conventionally trained trainees had similar intraoperative complication rates (MD -8.31, 95% CI -22.78 to 6.16; 1 study, n = 19; very low-certainty evidence). For secondary outcomes, VR training may have similar impact on trainee performance compared to wet laboratoryand greaterimpact compared to no supplementary training, but the evidence was very uncertain. One study reported VR-trained trainees relative to those without supplementary training had significantly reduced operating time in simulated settings (P = 0.0013). Another study reported that VR-trained relative to wet laboratory-trained trainees had shorter operating times in VR settings (MD -1.40 minutes, 95% CI -1.96 to -0.84; 1 study, n = 60) and similar times in wet laboratory settings (MD 0.16 minutes, 95% CI -0.50 to 0.82; 1 study, n = 60). This study also found the VR-trained trainees had higher VR simulator ratings (MD 5.17, 95% CI 0.61 to 9.73; 1 study, n = 60). Results for supervising physician ratings in the operating room were inconsistent: one study reported that VR- and wet laboratory-trained trainees received similar supervising physician ratings for cataract surgery (P = 0.608); another study reported that VR-trained trainees relative to those without supplementary training were less likely to receive poor ratings by supervising physicians for capsulorhexis construction (RR 0.29, 95% CI 0.15 to 0.57). In wet laboratory settings, VR-trained trainees received similar supervising physician ratings compared with wet laboratory-trained trainees (MD -1.50, 95% CI -6.77 to 3.77; n = 60) and higher supervising physician ratings compared with trainees without supplementary training (P < 0.0001). However, the results for all secondary outcomes should be interpreted with caution because of very low-certainty evidence. AUTHORS' CONCLUSIONS: Current research suggests that VR training may be more effective than no supplementary training in improving trainee performance in the operating room and simulated settings for postgraduate ophthalmology trainees, but the evidence is uncertain. The evidence comparing VR with conventional or wet laboratory training was less consistent.

PD58-10 VIRTUALLY COMPETENT: A COMPARATIVE ANALYSIS OF VIRTUAL REALITY AND DRY-LAB ROBOTIC SIMULATION TRAINING

An essential first step to implementing virtual reality programming in home care and long-term care settings is to assess organizational readiness by determining factors that enhance the likelihood of its successful implementation. Be EPIC-VR is one such virtual reality program that supports dementia-specific, person-centered communication training for frontline healthcare workers. Guided by the Consolidated Framework for Implementation Research (CFIR), the current study aimed to identify factors influencing Be EPIC-VR’s implementation in home care and long-term care settings. Semi-structured interviews were conducted with nine managers from home care and long-term care settings in Canada. Transcripts from these interviews were analyzed using the Framework Analysis’ five-step ongoing, iterative process: familiarization, identifying a thematic framework, indexing, charting, and mapping/interpretation. Textual data were open-coded and organized deductively (using CFIR’s pre-set codes) and inductively (for emergent codes) into themes and subthemes. Four themes emerged as factors contributing to organizational readiness including 1) openness to virtual reality as a training tool, 2) staffing and training logistics, 3) organizational culture supporting staff development, and 4) external pressures for organizational sustainability. These findings will guide how the Be EPIC-VR implementation team collaborates with organizational decision makers to ensure that Be EPIC-VR is a good fit for those organizations, to prepare for its implementation, and to optimize the likelihood of success. The study findings offer valuable insights for researchers and practitioners working to implement new virtual reality interventions in home care and long-term care settings.

In formal care organizations, personal support workers (PSWs) provide the most daily direct care to people living with dementia. PSWs receive the least comprehensive education and have the fewest opportunities for continuing education compared to nurses and physicians. PSWs need to be provided with opportunities for continuous education programs tailored to their specific learning needs to improve dementia car Conducted in accordance with the JBI guidelines for scoping reviews, this review examined the ways in which PSWs are included within dementia-specific learning needs assessments and how their learning needs are assessed. Eligible studies were published in English between 2000 – 2023. Scopus, PubMed, MEDLINE, CINAHL, Embase and PsycINFO databases were searched in July 2023. Seventeen studies were included in the review. PSWs represented the entirety of the sample populations in only two studies. Within the remaining fifteen studies, PSWs comprised less than half of the sample population in seven studies. Furthermore, the learning needs of PSWs were not analyzed separately from other professionals in eight studies. Learning needs in dementia care were only explored broadly in five studies. Surveys represented the primary data collection method (n = 13), with nine using them as the sole data collection method This review presents a critical need to explore PSW perspectives on dementia-specific learning needs. Improved understanding of the gaps in PSWs’ knowledge, attitudes, and/or skills related to dementia care is urgently needed to better inform and focus discipline specific and concentrated PSW training in the future.

Virtual reality simulation uses computer-generated imagery to present a simulated training environment for learners. This review seeks to examine whether there is evidence to support the introduction of virtual reality surgical simulation into ear, nose and throat surgical training programmes. 1. To assess whether surgeons undertaking virtual reality simulation-based training achieve surgical ('patient') outcomes that are at least as good as, or better than, those achieved through conventional training methods.2. To assess whether there is evidence from either the operating theatre, or from controlled (simulation centre-based) environments, that virtual reality-based surgical training leads to surgical skills that are comparable to, or better than, those achieved through conventional training. The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 6); PubMed; EMBASE; ERIC; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 27 July 2015. We included all randomised controlled trials and controlled trials comparing virtual reality training and any other method of training in ear, nose or throat surgery. We used the standard methodological procedures expected by The Cochrane Collaboration. We evaluated both technical and non-technical aspects of skill competency. We included nine studies involving 210 participants. Out of these, four studies (involving 61 residents) assessed technical skills in the operating theatre (primary outcomes). Five studies (comprising 149 residents and medical students) assessed technical skills in controlled environments (secondary outcomes). The majority of the trials were at high risk of bias. We assessed the GRADE quality of evidence for most outcomes across studies as 'low'. Operating theatre environment (primary outcomes) In the operating theatre, there were no studies that examined two of three primary outcomes: real world patient outcomes and acquisition of non-technical skills. The third primary outcome (technical skills in the operating theatre) was evaluated in two studies comparing virtual reality endoscopic sinus surgery training with conventional training. In one study, psychomotor skill (which relates to operative technique or the physical co-ordination associated with instrument handling) was assessed on a 10-point scale. A second study evaluated the procedural outcome of time-on-task. The virtual reality group performance was significantly better, with a better psychomotor score (mean difference (MD) 1.66, 95% CI 0.52 to 2.81; 10-point scale) and a shorter time taken to complete the operation (MD -5.50 minutes, 95% CI -9.97 to -1.03). Controlled training environments (secondary outcomes) In a controlled environment five studies evaluated the technical skills of surgical trainees (one study) and medical students (three studies). One study was excluded from the analysis. Surgical trainees: One study (80 participants) evaluated the technical performance of surgical trainees during temporal bone surgery, where the outcome was the quality of the final dissection. There was no difference in the end-product scores between virtual reality and cadaveric temporal bone training. Medical students: Two other studies (40 participants) evaluated technical skills achieved by medical students in the temporal bone laboratory. Learners' knowledge of the flow of the operative procedure (procedural score) was better after virtual reality than conventional training (SMD 1.11, 95% CI 0.44 to 1.79). There was also a significant difference in end-product score between the virtual reality and conventional training groups (SMD 2.60, 95% CI 1.71 to 3.49). One study (17 participants) revealed that medical students acquired anatomical knowledge (on a scale of 0 to 10) better during virtual reality than during conventional training (MD 4.3, 95% CI 2.05 to 6.55). No studies in a controlled training environment assessed non-technical skills. There is limited evidence to support the inclusion of virtual reality surgical simulation into surgical training programmes, on the basis that it can allow trainees to develop technical skills that are at least as good as those achieved through conventional training. Further investigations are required to determine whether virtual reality training is associated with better real world outcomes for patients and the development of non-technical skills. Virtual reality simulation may be considered as an additional learning tool for medical students.

Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a virtual reality simulator is an option to supplement standard training. To determine whether virtual reality training can supplement or replace conventional laparoscopic surgical training (apprenticeship) in surgical trainees with limited or no prior laparoscopic experience. We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and grey literature until March 2008. We included all randomised clinical trials comparing virtual reality training versus other forms of training including video trainer training, no training, or standard laparoscopic training in surgical trainees with little or no prior laparoscopic experience. We also included trials comparing different methods of virtual reality training. We collected the data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, conversion rate, operating time, and hospital stay. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the standardised mean difference with 95% confidence intervals based on intention-to-treat analysis. We included 23 trials with 612 participants. Four trials compared virtual reality versus video trainer training. Twelve trials compared virtual reality versus no training or standard laparoscopic training. Four trials compared virtual reality, video trainer training and no training, or standard laparoscopic training. Three trials compared different methods of virtual reality training. Most of the trials were of high risk of bias. In trainees without prior surgical experience, virtual reality training decreased the time taken to complete a task, increased accuracy, and decreased errors compared with no training; virtual reality group was more accurate than video trainer training group. In the participants with limited laparoscopic experience, virtual reality training reduces operating time and error better than standard in the laparoscopic training group; composite operative performance score was better in the virtual reality group than in the video trainer group. Virtual reality training can supplement standard laparoscopic surgical training of apprenticeship and is at least as effective as video trainer training in supplementing standard laparoscopic training. Further research of better methodological quality and more patient-relevant outcomes are needed.

Personal support workers (PSWs) in long-term care (LTC) homes provide the most care to people living with dementia, yet receive the least education compared to other healthcare professionals. Informed by adult learning theory, this study investigated PSW perspectives of their dementia-specific learning needs while working in LTC. Interpretive Description guided the secondary qualitative analysis of focus groups with ‘mid-career’ PSWs (n = 39) in LTC. Focus groups were conducted before, during, and after PSWs participated in a dementia-specific training program. Learning needs were attributed to limited preparation during formal PSW education and a lack of continuous education opportunities. The learning needs include understanding dementia, addressing responsive behaviors, person-centered communication and attitudes, and delirium. Learning needs are best met in supportive environments with experiential methods that involve peer learning, feedback, and evaluation. Successful outcomes of learning can be mediated through an openness to dementia education and a good teamwork culture. The study findings underscore the importance of ongoing dementia education tailored to the needs of PSWs, with implications for future training programs aimed at improving dementia care.

There is significant literature on workplace empowerment that focuses on individuals in positions of power rather than those who lack it. However, there is limited research on empowerment of home care workers, such as personal support workers (PSW) who work in dementia care. Empowerment is an active process based on a multifaceted model consisting of four components: meaning, self-determination, impact and competence. This study explored the roles of education and employer support in empowering PSWs to care for persons with dementia who live at home. Empowerment was investigated using semi-structured interviews with PSWs (N=15). A phenomenological approach was to understand the lived experiences of home-care based PSWs who work with persons with dementia. Components of empowerment were reflected through five emerging themes: “providing best care”, “autonomy”, “employer support”, “career long learning”, and “experiential learning”. The theme “providing best care possible” support the component of meaning, which included the motivation for training among PSWs and their value of aging in place. The theme “autonomy” supported the component of self-determination, which focused on PSW workload and feelings regarding their control working in home care versus long term care. The theme “employer support” supported the component impact, which included both PSW compensation and their perceived lack of emotional support. Finally, the themes “career-long learning” and “experiential learning”, were linked with impact and competence components, respectively. Overall, these findings support relationships between education and employer support in empowering PSWs who care for persons with dementia who live at home.

IntroductionThe rapid growth of the ageing population underscores the critical need for dementia care training among care providers. Innovative virtual reality (VR) technology has created opportunities to improve dementia care...

Metaverse references an immersive three-dimensional digital space, conceptions about its specific nature and organization have changed over time, and more strongly emphasize the evolution from considering the metaverse as an extended version of a single virtual world to a wide network of an infinite number of interconnected worlds. The aim of this article is to describe the potential of the metaverse in health care. One potential feature of a doctor's office in the metaverse could be the use of virtual reality technology to create immersive, personalized treatment environments for patients. The doctor may also be able to use virtual reality tools to demonstrate treatment options or procedures, or to provide educational materials to the patient. There are several potential applications of the metaverse in medicine, including the use of virtual reality and other immersive technologies for patient care. Some examples of these applications include: Virtual reality exposure therapy for anxiety disorders; Virtual reality-based cognitive behavioral therapy for depression; Virtual reality-based rehabilitation and physical therapy; Virtual reality pain management; and Virtual reality education and training. There are several potential benefits to delivering clinical care in the metaverse. Metaverse may allow for more efficient and convenient access to care, particularly for patients who live in remote or underserved areas. These platforms will contribute for more personalized and immersive treatment experiences, as virtual reality technology can be used to create tailored environments and experiences for patients. There may also be concerns around patient privacy and security, as well as the potential for cyber-attacks.