Virtual Simulation System Research Articles

Dynamic Modeling and Simulation Analysis of Virtual Product Design and Creation Based on OSG Artificial Intelligence Platform

The creation of Koji Pottery art is a creative act that has risen rapidly in recent years. The difference in the proportion of ingredients in the glaze directly affects the roughness, luster, and glaze of the glazed surface of the work. The curve of heating and cooling is also the key to the success or failure of the work. Therefore, taking the Koji tea bowl shape as a research example, a virtual reality simulation system and an OSG (OpenSceneGraph) artificial intelligence platform are used to construct a Koji tea bowl shape simulation model, and then the physical production is performed according to the model. After the design and production of the Koji tea bowl shape, the RTM (resin transfer molding) model is used to evaluate the process quality standard requirements of the Koji bowl shape. According to the RTM model test results, the homogeneity test results show that the result is much larger than 0.10, from which it can be inferred that the Koji tea bowl shape has reached the national process quality standard requirements. At the same time, the OSG artificial intelligence platform uses the iterative random sampling method to extract and display the abnormal data in the simulation model, which greatly improves the success rate of ceramic creation. In this paper, the creation and simulation of virtual ceramics based on OSG artificial intelligence platform are deeply studied and analyzed, and the related processes are improved, which reduces the difficulty of software operation and improves the creation efficiency.

Validation of a novel virtual reality simulation system with the focus on training for surgical dissection during laparoscopic sigmoid colectomy

BackgroundMastery of technical skills is one of the fundamental goals of surgical training for novices. Meanwhile, performing laparoscopic procedures requires exceptional surgical skills compared to open surgery. However, it is often difficult for trainees to learn through observation and practice only. Virtual reality (VR)-based surgical simulation is expanding and rapidly advancing. A major obstacle for laparoscopic trainees is the difficulty of well-performed dissection. Therefore, we developed a new VR simulation system, Lap-PASS LP-100, which focuses on training to create proper tension on the tissue in laparoscopic sigmoid colectomy dissection. This study aimed to validate this new VR simulation system.MethodsA total of 50 participants were asked to perform medial dissection of the meso-sigmoid colon on the VR simulator. Forty-four surgeons and six non-medical professionals working in the National Cancer Center Hospital East, Japan, were enrolled in this study. The surgeons were: laparoscopic surgery experts with > 100 laparoscopic surgeries (LS), 21 were novices with experience < 100 LS, and five without previous experience in LS. The participants’ surgical performance was evaluated by three blinded raters using Global Operative Assessment of Laparoscopic Skills (GOALS).ResultsThere were significant differences (P-values < 0.044) in all GOALS items between the non-medical professionals and surgeons. The experts were significantly superior to the novices in one item of GOALS: efficiency ([4(4–5) vs. 4(3–4)], with a 95% confidence interval, p = 0.042). However, both bimanual dexterity and total score in the experts were not statistically different but tended to be higher than in the novices.ConclusionsOur study demonstrated a full validation of our new system. This could detect the surgeons' ability to perform surgical dissection and suggest that this VR simulator could be an effective training tool. This surgical VR simulator might have tremendous potential to enhance training for surgeons.

Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures.

Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt implantation were high. This led experts to question the surgical indication for iNPH and, over the next 20 years, cerebrospinal fluid (CSF) shunt surgery for iNPH fell out of favor and was rarely performed. However, the development of programmable-pressure shunt valve devices has reduced the major complications associated with the CSF drainage volume and appears to have increased shunt effectiveness. In addition, the development of support devices for the placement of ventricular catheters including preoperative virtual simulation and navigation systems has increased the certainty of ventriculoperitoneal shunt surgery. Secure shunt implantation is the most important prognostic indicator, but ensuring optimal initial valve pressure is also important. Since over-drainage is most likely to occur in the month after shunting, it is generally believed that a high initial setting of shunt valve pressure is the safest option. However, this does not always result in sufficient improvement of the symptoms in the early period after shunting. In fact, evidence suggests that setting the optimal valve pressure early after shunting may cause symptoms to improve earlier. This leads to improved quality of life and better long-term independent living expectations. However, in iNPH patients, the remaining symptoms may worsen again after several years, even when there is initial improvement due to setting the optimal valve pressure early after shunting. Because of the possibility of insufficient CSF drainage, the valve pressure should be reduced by one step (2–4 cmH2O) after 6 months to a year after shunting to maximize symptom improvement. After the valve pressure is reduced, a head CT scan is advised a month later.

A Real-time Cutting Model Based on Finite Element and Order Reduction

Telemedicine plays an important role in Corona Virus Disease 2019 (COVID-19). The virtual surgery simulation system, as a key component in telemedicine, requires to compute in real-time. Therefore, this paper proposes a real-time cutting model based on finite element and order reduction method, which improves the computational speed and ensure the real-time performance. The proposed model uses the finite element model to construct a deformation model of the virtual lung. Meanwhile, a model order reduction method combining proper orthogonal decomposition and Galerkin projection is employed to reduce the amount of deformation computation. In addition, the cutting path is formed according to the collision intersection position of the surgical instrument and the lesion area of the virtual lung. Then, the Bezier curve is adopted to draw the incision outline after the virtual lung has been cut. Finally, the simulation system is set up on the PHANTOM OMNI force haptic feedback device to realize the cutting simulation of the virtual lung. Experimental results show that the proposed model can enhance the real-time performance of telemedicine, reduce the complexity of the cutting simulation and make the incision smoother and more natural.

Research on the design of intelligent virtual simulation experimental teaching platform based on augmented reality

This research developed a product virtual simulation system based on augmented reality technology. The special database of product components was established, and the augmented reality product database of rice cooker was constructed and modified by the user and the enterprise design and production database. The HoloLens head-mounted device and MR Hand-eye interaction technology were used to realize the real-time simulation of the running state of the product design, and the prototype system was assembled. The Unity3D engine adopts the target method based on special features for the 3D display of products, which is a display environment with high requirements for user experience. The experimental simulation platform system has the advantages of strong portability, strong expansibility, realistic rendering effect and high program execution efficiency, which provides a good 3D panoramic display experience and usability experience for students' experiments and enterprise users after future industrialization.

Cloud‐based virtual simulation system of wave motion characteristics

AbstractThe traditional wave motion characteristic experiment has some problems, such as the loose connection between theory and experimental teaching, limitations of the experiment due to its site and time, and poor sense of participation and interaction. Focusing on the above problems, a virtual simulation experiment system for wave motion characteristics is designed and developed. The system uses virtual reality technology, cloud platform technology, and wave simulation technology. Taking the real laboratory as the prototype, the scene structure, instrument function, and water movement are simulated with high precision. The multimode fusion teaching method has expanded the experimental content, enriched the micro‐observation function and data collection categories, enhanced the interaction of the experimental process, and created a high‐quality immersive online teaching experience for the students. Since its inception, the experiment system has served six cycles of instruction and obtained good feedback from the teachers and students. During the period of the pandemic, it provides great support to experimental teaching and serves as a good supplement to the existing teaching system. Adhering to the “student‐centered” teaching principle, the teaching team will improve the experimental system constantly, cultivate the students' independent thinking and innovation abilities, help the students with their own personalized development, and contribute to the training of excellent engineers.

A Distributed Virtual Reality System Based on Real-Time Dynamic Calculation and Multi-Person Collaborative Operation Applied to the Development Of Subsea Production Systems

To train inexperienced workers for the construction, production, and maintenance of subsea production systems, a virtual reality simulation platform was developed. The entire framework, software, and hardware platforms of the system were designed and introduced. A multi-person collaborative simulation was achieved based on the high-level architecture protocol. The real-time dynamic calculation software Vortex was used to add physical properties to each geometrical model and set collision detections and motion constraints so that the VR system can reflect the real motion response of the structures in real-time during virtual simulation. Visual simulation software Vega Prime and Vortex were integrated to realise the real-time rendering and drawing of virtual ocean engineering scenes. Thus, a virtual simulation system with large-scale complex scenes based on real-time dynamic calculation and multi-person collaborative operation was established. A typical ocean engineering case of subsea manifold installation was simulated using the virtual simulation system, and the detailed simulation flow was explained. A multibody dynamics system of the ship-cable-subsea manifold was established using Orcaflex to obtain the accurate motion response of the subsea manifold during lowering. In the virtual simulation process, the obtained hydrodynamic calculation results can provide an important guideline and reference to the operators. The developed simulation system is a suitable tool for training ocean engineering workers and realistically simulating ocean operation cases.

Hierarchical and smoothed topographic path planning for large-scale virtual simulation environments

Virtual simulation systems ought to make the most of agents’ realistic behaviors so that users feel immersed in virtual scenarios that mimic the real-world environment. Usually used for training and instruction purposes, agent-based simulations have additional requirements to be considered by the Artificial Intelligence solutions often explored in the development of computer games. To provide a valuable impression of how the simulated agents navigate in the real-world terrain, one of the key requirements indicates that topographic terrain characteristics need to be considered in the path planning tasks. It means that important aspects of the agents’ navigation capabilities have to be properly handled by the used pathfinding algorithms. This problem is even more challenging when large-scale terrain scenarios are considered in state-of-the-art simulation systems as the path planning may be too time-consuming when handling terrain representations with large search spaces. To approach the challenge of computing safe and realistic path solutions for agents inserted in simulation-based learning environments, this work discusses a hierarchical pathfinding algorithm named HPATheta*, showing how to compute terrain relief-aware smoothed paths in reasonable computing time when dealing with path planning in large-scale real-world virtual terrains. Using different simulated real-world virtual terrains, the proposal is validated by performing an extensive experimental campaign with the use of large-scale virtual terrain representations. The experimental results indicate that the proposed approach is able to efficiently address the targeted problem, showing better results compared to other similar path planning algorithms.

The Construction of Basketball Training System Based on Motion Capture Technology.

Motion capture is a cross-cutting application field developed in recent years, which comprises electronics, communications, control, computer graphics, ergonomics, navigation, and other disciplines. The accurate application of basketball technical movements in the basketball game is very important. Therefore, it is of great significance to capture and standardize athletes' movements and improve their training. Unfortunately, there are numerous issues in traditional classroom teaching that largely helps to train the athletes. To solve the issues of traditional basketball classroom teaching, a virtual simulation system for students' sports training is designed in this paper. Firstly, the information of basketball dribbling movement is captured and simulated in three dimensions. Secondly, we compare it with the standard database to judge the irregularities of athletes' movements, and carry out digital processing on athletes' movements and skill improvements statistics in combination with system functions. Thirdly, we set up a gradual training cycle. Finally, the Kinect-based capture technology is adopted to obtain the activity information of different joints of the human body. Through processing the motion data, relevant motion analysis data are fed to the established motion model, to realize the comparative analysis of motion pictures. In our experiments, we observed better training of the physical education.

Using a SPOC-based flipped classroom instructional mode to teach English pronunciation

As a concept established on MOOC, SPOC has been used by many instructors in universities. Although SPOC-based flipped classroom instructional modes have been applied in many disciplines including English learning in China, no empirical study has tried to disentangle the application of the modes in teaching English pronunciation. This study reports the application of an instructional mode combining SPOC and flipped instruction in teaching English pronunciation for college students majoring in English Education. The effectiveness of this mode was assessed in terms of students’ mastery of knowledge in English pronunciation, accuracy of students’ pronunciation and students’ satisfaction to the class. The freshmen enrolled in a university in 2018 were labeled as the controlled group and those enrolled in 2019 and 2020 comprised the experimental groups. Results showed that the experimental groups significantly outperformed the controlled group in the mastery of knowledge and the accuracy of pronunciation. In addition, the improvement in students’ pronunciation was not as much as that in their degree of mastering the knowledge. All students in experimental groups indicated a high degree of satisfaction to the teaching mode. These results prove that SPOC-based flipped classroom instructional mode not only can attain positive perceptions from students but also can be helpful for improving students’ learning of knowledge in pronunciation and correctness of pronunciation. However, more input and practice opportunities are still needed to make a better enhancement in students’ English pronunciation, which can be expected to be achieved by virtual simulation systems for English pronunciation training.

Augmented reality-based visual-haptic modeling for thoracoscopic surgery training systems

BackgroundCompared with traditional thoracotomy, video-assisted thoracoscopic surgery (VATS) has less minor trauma, faster recovery, higher patient compliance, but higher requirements for surgeons. Virtual surgery training simulation systems are important and have been widely used in Europe and America. Augmented reality (AR) in surgical training simulation systems significantly improve the training effect of virtual surgical training, although AR technology is still in its initial stage. Mixed reality has gained increased attention in technology-driven modern medicine but has yet to be used in everyday practice. MethodsThis study proposed an immersive AR lobectomy within a thoracoscope surgery training system, using visual and haptic modeling to study the potential benefits of this critical technology. The content included immersive AR visual rendering, based on the cluster-based extended position-based dynamics algorithm of soft tissue physical modeling. Furthermore, we designed an AR haptic rendering systems, whose model architecture consisted of multi-touch interaction points, including kinesthetic and pressure-sensitive points. Finally, based on the above theoretical research, we developed an AR interactive VATS surgical training platform. ResultsTwenty-four volunteers were recruited from the First People's Hospital of Yunnan Province to evaluate the VATS training system. Face, content, and construct validation methods were used to assess the tactile sense, visual sense, scene authenticity, and simulator performance. ConclusionsThe results of our construction validation demonstrate that the simulator is useful in improving novice and surgical skills that can be retained after a certain period of time. The video-assisted thoracoscopic system based on AR developed in this study is effective and can be used as a training device to assist in the development of thoracoscopic skills for novices.

Orthodontic simulation system with force feedback for training complete bracket placement procedures

BackgroundA virtual system that simulates the complete process of orthodontic bracket placement can be used for pre-clinical skill training to help students gain confidence by performing the required tasks on a virtual patient. MethodsThe hardware for the virtual simulation system is built using two force feedback devices to support bi-manual force feedback operation. A 3D mouse is used to adjust the position of the virtual patient. A multi-threaded computational methodology is adopted to satisfy the requirements of the frame rate. The computation threads mainly consist of the haptic thread running at a frequency of >1000Hz and the graphic thread at >30Hz. The graphic thread allows the graphics engine to effectively display the visual effects of biofilm removal and acid erosion through texture mapping. Using the haptic thread, the physics engine adopts the hierarchy octree collision-detection algorithm to simulate the multi-point and multi-region interaction between the tools and the virtual environment. Its high efficiency guarantees that the time cost can be controlled within 1 ms. The physics engine also performs collision detection between the tools and particles, making it possible to simulate paint and removal of colloids. The surface-contact constraints are defined in the system; this ensures that the bracket will not divorce from or embed into the tooth during the adjustment of the bracket. Therefore, the simulated adjustment is more realistic and natural. ResultsA virtual system to simulate the complete process of orthodontic bracket bonding was developed. In addition to bracket bonding and adjustment, the system simulates the necessary auxiliary steps such as smearing, acid etching, and washing. Furthermore, the system supports personalized case training. ConclusionsThe system provides a new method for students to practice orthodontic skills.

ASSESSMENT OF VISUAL ENVIRONMENT NECESSARY FOR BUSINESS CONTINUITY IN EMERGENCIES (PART 1) ： A STUDY OF VISUAL ENVIRONMENT ASSESSMENT USING HEAD MOUNTED DISPLAY VIRTUAL REALITY SYSTEM

Natural disasters that had recently happened in Japan, including Great East Japan Earthquake in 2011, destroyed social infrastructure especially electricity systems for more than several months. During this period, electric supply tremendously decreases and caused many problems to emergency response, lifeline infrastructure management, life supporting related activities in hospitals and refugee accommodations and also government administrative business. In order to sustain these basic activities, we need minimal lighting systems to facilitate workers in offices maintaining these activities. However, most of lighting research on emergency, Boyce et al., Akizuki among others, concentrate on emergency escape lighting system. Mochizuki et al. studied the impacts of shortage of electricity on office lighting environment during Great East Japan Earthquake aftermath. To our knowledge, there are no studies analyzing the minimum lighting system required in offices during emergency period. Appropriate assessment of visual environment for business in disaster effected areas is required. Thus, the purpose of this paper is to develop a virtual reality simulation system (VRS) which can provide real focal-ambient lighting environment for workers in the office and to find the minimum lighting environment required to continue working for more than 10 days during emergencies. 2400 observations from 20 participants (9 students and 11 office workers, 9 female and 11 male) assessing 30 VR scenes on 4 business continuing periods (1 day, 3 days, 10 days, over 10 days) were obtained in the experiment. We found the following results from the experiment: 1. VRS can provide focal-ambient lighting environment for experiment participants more realistically than other devices. It has high 96.7% accuracy representation percentage of real environment luminance-chromaticity values of VR scenes and provides 360 degrees experience of real visual environment at 3 degrees of freedom to participants. 2. Minimum lighting on working surfaces can be as small as 75 lux for more than 10 days office work in emergency. 3. Ambient lighting is strongly required to keep comfortable room brightness and focal ambient lighting system for the workers. At working surface illuminance of 75 lux, 100% of participants can continue to work for more than 10 days with ambient light and only 85% of participants can continue to work for 10 days without ambient light. 4. There may exist some possibilities that student participants of experiments may not have strong tolerance against less lighting than office workers. Office workers can work for 10 days with 15 lux on working surface while students require twice this illuminance of 30 lux. i.e. we need to study more about the effects of participants’ attributes on experiment results. 5. 360 degrees Brightness Estimation Image can be used to assess how much ambient and focal brightness is required in the given visual environment. 6. Ambient visual environment is confirmed to be strongly correlated with how much light is available in desk surroundings, walls, and ceilings and not with horizontal surfaces such as floor discussed in the literature.

Virtual Reality Design and Realization of Interactive Garden Landscape

It is very important to study and explore the application of virtual reality technology in landscape garden design, especially in the current environment of triple network integration and Internet of Things construction, to promote and facilitate the rapid development of digital landscape garden design in China. In this paper, we study the implementation method of virtual landscape gardening system and establish a virtual environment based on the ancient city of Yangcheng. On the computer platform, we study and realize a virtual roaming system of medium complexity with more complete roaming functions. Using the Quest3D software platform, a desktop-type virtual garden simulation system was developed, focusing on the virtual reality modeling technology method and virtual system implementation. The experimental results show that the GPU-accelerated drawing method based on GLSL can significantly improve the drawing frame rate of 3D garden landscape vegetation scenes with a small amount of scene data and has a certain feasibility. Based on the OpenSceneGraph (OSG) graphics rendering engine, the visualization of various types of 3D landscape models is realized, and the spatial layout of various types of landscape with parametric control is realized through digital vector layers, which flexibly manage and organize various garden elements and reasonably organize the spatial topological relationship between various types of landscape in 3D space. By integrating cross-platform ArcGISEngine components, the basic data of garden scenes including terrain data and vector data are managed. Through scene view cropping and hierarchical detail modeling technologies, the drawing efficiency and rendering real time of the garden landscape are improved. It realizes interactive 3D scene browsing and provides a six-degree-of-freedom all-round display of the overall landscape.

Indifferent or Enthusiastic? Virtual Audiences Animation and Perception in Virtual Reality

In this paper, we present a virtual audience simulation system for Virtual Reality (VR). The system implements an audience perception model controlling the nonverbal behaviors of virtual spectators, such as facial expressions or postures. Groups of virtual spectators are animated by a set of nonverbal behavior rules representing a particular audience attitude (e.g., indifferent or enthusiastic). Each rule specifies a nonverbal behavior category: posture, head movement, facial expression and gaze direction as well as three parameters: type, frequency and proportion. In a first user-study, we asked participants to pretend to be a speaker in VR and then create sets of nonverbal behaviour parameters to simulate different attitudes. Participants manipulated the nonverbal behaviours of single virtual spectator to match a specific levels of engagement and opinion toward them. In a second user-study, we used these parameters to design different types of virtual audiences with our nonverbal behavior rules and evaluated their perceptions. Our results demonstrate our system’s ability to create virtual audiences with three types of different perceived attitudes: indifferent, critical, enthusiastic. The analysis of the results also lead to a set of recommendations and guidelines regarding attitudes and expressions for future design of audiences for VR therapy and training applications.

Digitalised remote-delivery of AVATr Simulation in Psychiatry: a unique success in COVID-19 pandemic

AimsSurrey and Borders NHS Foundation Trust's AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient Simulation System, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents. Actors are filmed responding to several domains of clinical questions, further categorised into three narrative-modes of being ‘Engaged, Neutral or Disengaged’, to build a bank of scenarios. During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ‘out-of-body' perspective, immersed in a custom-designed interactive virtual environment. The simulation facilitator engages with the learner and determines the appropriate choices of responses for the Virtual Patient and if needed, can prompt with explorative cues to continue the narrative-linked conversation. AVATr model pioneered in United Kingdom the use of an innovative ‘self-observational approach’ in Psychiatry training. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. The use of Facilitated-Debrief and Peer-Debrief in sessions, render another layer to the simulation experience.MethodDuring the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams.ResultThe hybrid model of AVATr has received tremendous feedback, as it now simulates video-consultations that a vast majority of Psychiatry trainees, especially community-based, undertake due to COVID-19 restrictions. The format of AVATr simulation sessions has remained unchanged, and the remote delivery has been particularly successful as it allows trainees to log in from different remote locations to come together for an interactive training session, without any physical restrictions.ConclusionSince 2015, our simulation platform has been utilised for Post-Graduate Medical Education, to enhance essential professional skills and stimulate professional growth. Currently the hybrid model of AVATr is being expanded to Nursing, Psychology and Allied Health Professional (AHP) clinical training streams, along with Undergraduate Medical Education, to address identified gaps in face-to-face training amidst COVID-19 pandemic.

Using Operator Gaze Tracking to Design Wrist Mechanism for Surgical Robots

This article assessed how surgical robot parameters influenced operator viewpoint during a simulated surgical procedure. Surgical robots are useful tools in minimally invasive surgery. However, even with robots, suturing is difficult because the needle is sometimes obscured by tissue or manipulators and is thus not always visible during the procedure. This is especially true in pediatric surgery, where the surgical environment is smaller than in adult surgery. Hence, surgeons must carefully track the instruments and tissues to understand and predict their current and expected situations. In this article, we used gaze-tracking techniques to analyze the location and timing of the gaze of participants while they manipulated a virtual robotic surgical simulation system. To differentiate between the ideal and actual viewpoint trajectories, we conducted experiments with and without obstacles (i.e., simulated tissue and the manipulator arm). In the obstacle condition, we modulated the wrist length of the manipulator to bring it into view. In the no-obstacle condition, the participants mostly watched the suture needle tip. In the with-obstacle condition, the participants spent less time watching the instruments and more time watching the target point. The amount of time spent watching the target point increased as wrist length increased. Given this tradeoff relationship, we examined the proportion of time the participants spent looking at the instruments or target points by wrist length. We calculated the Pareto solutions and clarified the relationship between wrist length and the watching parts.

Effect of digital virtual simulation system for preclinical teaching of access and coronal cavity preparation

Objective: To investigate the effectiveness of a digital virtual simulation training system applied in the preclinical teaching of access and coronal cavity preparation. Methods: Twenty dental undergraduate students from Peking University School and Hospital of Stomatology were recruited and divided randomly and equally into two groups according to the random number method after being unified with theory training, including access and coronal cavity preparation skills assessment form and Simodont system operation manual. Tests for access and coronal cavity preparation skills by using standard simulation plastic teeth were performed and the scores were recorded as baseline for each student. Students in group of virtual simulation priority were trained using Simodont virtual simulation system, while those in group of phantom-simulator priority were trained using conventional phantom-simulator system. Access and coronal cavity preparation skills of standard simulation plastic teeth were assessed once again and recorded as the second scores for the two groups. Furthermore, the two groups of students exchanged training systems and were assessed and graded once more as the third scores. Finally, all students were asked to fill up a Teaching Questionnaire after the training. The data were then collected and analyzed. Results: For the group of virtual simulation priority, after the training by using Simodont virtual simulation system and conventional phantom-simulator system, the mean score of access and coronal cavity preparation (16.00±1.49) was significantly higher than the baseline score (13.30±1.41) (P<0.05). For the group of phantom-simulator priority, after the training by using conventional phantom-simulator system and Simodont virtual simulation system, the mean score of access and coronal cavity preparation (15.60±1.26) was also significantly higher than the baseline score (13.00±1.89) (P<0.05). Furthermore, in the group of virtual simulation priority, of which the students were trained by using Simodont virtual simulation system first and then conventional phantom-simulator system, the score of access and coronal cavity preparation was significantly higher than the score of training by using conventional phantom-simulator system only (14.30±1.77) (P<0.05). In the group of phantom-simulator priority, of which the students were trained by using conventional phantom-simulator system first and then Simodont virtual simulation system, the score of access and coronal cavity preparation was significantly higher than the score of training by using Simodont virtual simulation system only (14.10±1.45) (P<0.05). Moreover, in the group of virtual simulation priority, the score of training by using conventional phantom-simulator system after using Simodont virtual simulation system was significantly higher than that of training by using Simodont virtual simulation system only (P<0.05). The results of the questionnaire showed that the students fully agreed that "the Simodont virtual simulation system has the characteristics of repeatability, multi-dimension and multiple practice, and provides me with more attention to details" [80% (16/20)], however "it needs to be improved and upgraded to be close to the conventiaonl phantom-simulator system" [90% (18/20)]. Conclusions: Compared with using the conventional phantom-simulator system only, the preclinical teaching effectiveness of access and coronal cavity preparation could be effectively improved by using Simodont virtual simulation system combined with the phantom-simulator training system and might influenced by the training sequence.

Virtual Reality Technology and Remote Digital Application for Tele-Simulation and Global Medical Education: An Innovative Hybrid System for Clinical Training

Objective. Although simulation-based medical education is fundamental for acquisition and maintenance of knowledge and skills; simulators are often located in urban centers and they are not easily accessible due to cost, time, and geographic constraints. Our objective is to develop a proof-of-concept innovative prototype using virtual reality (VR) technology for clinical tele simulation training to facilitate access and global academic collaborations. Methodology. Our project is a VR-based system using Oculus Quest as a standalone, portable, and wireless head-mounted device, along with a digital platform to deliver immersive clinical simulation sessions. Instructor’s control panel (ICP) application is designed to create VR-clinical scenarios remotely, live-stream sessions, communicate with learners and control VR-clinical training in real-time. Results. The Virtual Clinical Simulation (VCS) system offers realistic clinical training in virtual space that mimics hospital environments. Those VR clinical scenarios are customizable to suit the need, with high-fidelity lifelike characters designed to deliver interactive and immersive learning experience. The real-time connection and live-stream between ICP and VR-training system enables interactive academic learning and facilitates access to tele simulation training. Conclusions. VCS system provides innovative solutions to major challenges associated with conventional simulation training such as access, cost, personnel, and curriculum. VCS facilitates the delivery of academic and interactive clinical training that is similar to real-life settings. Tele-clinical simulation systems like VCS facilitate necessary academic-community partnerships, as well as global education network between resource-rich and low-income countries.

A Natural Language Processing-Based Virtual Patient Simulator and Intelligent Tutoring System for the Clinical Diagnostic Process: Simulator Development and Case Study.

BackgroundShortage of human resources, increasing educational costs, and the need to keep social distances in response to the COVID-19 worldwide outbreak have prompted the necessity of clinical training methods designed for distance learning. Virtual patient simulators (VPSs) may partially meet these needs. Natural language processing (NLP) and intelligent tutoring systems (ITSs) may further enhance the educational impact of these simulators.ObjectiveThe goal of this study was to develop a VPS for clinical diagnostic reasoning that integrates interaction in natural language and an ITS. We also aimed to provide preliminary results of a short-term learning test administered on undergraduate students after use of the simulator.MethodsWe trained a Siamese long short-term memory network for anamnesis and NLP algorithms combined with Systematized Nomenclature of Medicine (SNOMED) ontology for diagnostic hypothesis generation. The ITS was structured on the concepts of knowledge, assessment, and learner models. To assess short-term learning changes, 15 undergraduate medical students underwent two identical tests, composed of multiple-choice questions, before and after performing a simulation by the virtual simulator. The test was made up of 22 questions; 11 of these were core questions that were specifically designed to evaluate clinical knowledge related to the simulated case.ResultsWe developed a VPS called Hepius that allows students to gather clinical information from the patient’s medical history, physical exam, and investigations and allows them to formulate a differential diagnosis by using natural language. Hepius is also an ITS that provides real-time step-by-step feedback to the student and suggests specific topics the student has to review to fill in potential knowledge gaps. Results from the short-term learning test showed an increase in both mean test score (P<.001) and mean score for core questions (P<.001) when comparing presimulation and postsimulation performance.ConclusionsBy combining ITS and NLP technologies, Hepius may provide medical undergraduate students with a learning tool for training them in diagnostic reasoning. This may be particularly useful in a setting where students have restricted access to clinical wards, as is happening during the COVID-19 pandemic in many countries worldwide.