Comparing Classroom Instruction to Individual Instruction as an Approach to Teach Avatar-Based Patient Monitoring With Visual Patient: Simulation Study

Abstract

Background: Visual Patient is an avatar-based alternative to standard patient monitor displays that significantly improves the perception of vital signs. Implementation of this technology in larger organizations would require it to be teachable by brief class instruction to large groups of professionals. Therefore, our study aimed to investigate the efficacy of such a large-scale introduction to Visual Patient.

Objective: In this study, we aimed to compare 2 different educational methods, one-on-one instruction and class instruction, for training anesthesia providers in avatar-based patient monitoring.

Methods: We presented 42 anesthesia providers with 30 minutes of class instruction on Visual Patient (class instruction group). We further selected a historical sample of 16 participants from a previous study who each received individual instruction (individual instruction group). After the instruction, the participants were shown monitors with either conventional displays or Visual Patient displays and were asked to interpret vital signs. In the class instruction group, the participants were shown scenarios for either 3 or 10 seconds, and the numbers of correct perceptions with each technology were compared. Then, the teaching efficacy of the class instruction was compared with that of the individual instruction in the historical sample by 2-way mixed analysis of variance and mixed regression.

Results: In the class instruction group, when participants were presented with the 3-second scenario, there was a statistically significant median increase in the number of perceived vital signs when the participants were shown the Visual Patient compared to when they were shown the conventional display (3 vital signs, P<.001; effect size -0.55). No significant difference was found for the 10-second scenarios. There was a statistically significant interaction between the teaching intervention and display technology in the number of perceived vital signs (P=.04; partial η²=.076). The mixed logistic regression model for correct vital sign perception yielded an odds ratio (OR) of 1.88 (95% CI 1.41-2.52; P<.001) for individual instruction compared to class instruction as well as an OR of 3.03 (95% CI 2.50-3.70; P<.001) for the Visual Patient compared to conventional monitoring.

Conclusions: Although individual instruction on Visual Patient is slightly more effective, class instruction is a viable teaching method; thus, large-scale introduction of health care providers to this novel technology is feasible.

Keywords: avatar; computer-assisted; diagnosis.

Figure 1

Screenshots of the presented scenarios showing conventional monitoring (A) and avatar-based monitoring with the Visual Patient (B).

Figure 2

Vital sign parameters of the Visual Patient with a legend showing how each parameter is visualized. A: Visual Patient display when no vital sign data are received. B: Desaturated, hypothermic patient with ST-segment deviation. C: Visual Patient with all vital signs in a safe state and high brain activity (open eyes). D: Hypertensive, hyperthermic patient with high central line pressure.

Figure 3

Box plots of the vital signs that were correctly perceived with both the Visual Patient and conventional monitoring. Participants were shown scenarios for either 3 or 10 seconds. Group differences were assessed by Wilcoxon signed-rank test. The whiskers indicate the 5th and 95th percentiles.

Figure 4

Stacked bar graph indicating the perception of presented vital signs after the 3-second scenario. Percentages were calculated from the 4 possible answers to each vital sign: too high, normal, too low, and did not perceive. Depending on the presented scenario, the answers were rated as correct, incorrect, or not seen.

Figure 5

Marginal means of the perceived vital signs by the 2 instruction groups estimated by 2-way mixed ANOVA.

Figure 6

The auditorium in which the introduction to the Visual Patient was conducted.