title: Design, Realization, and First Validation of an Immersive Web-Based Virtual Patient Simulator for Training Clinical Decisions in Surgery.
abstract: BACKGROUND
  Immersive patient simulators (IPS) allow an illusionary immersion into a synthetic world where the user can freely navigate through a 3-dimensional environment similar to computer games. Playful learning with IPS allows internalization of medical workflows without harming real patients. Ideally, IPS show high student acceptance and can have positive effect on knowledge gain. Development of IPS with high technical quality is resource intensive. Therefore most of the "high-fidelity" IPS are commercially driven. Usage of IPS in the daily curriculum is still rare. There is no academic-driven simulator that is freely accessible to every student and combines high immersion grade with a profound amount of medical content.
  
  
  OBJECTIVE
  Therefore it was our aim to develop an academic-driven IPS prototype that is free to use and combines a high immersion grade with profound medical content. In addition, a first validation of the prototype was conducted.
  
  
  METHODS
  The conceptual design included definition of the following parameters: amount of curricular content, grade of technical quality, availability, and level of validation. A preliminary validation was done with 25 students. Students' opinion about acceptance was evaluated by a Likert-scale questionnaire. Effect on knowledge gain was determined by testing concordance and predictive validity.
  
  
  RESULTS
  A custom-made simulator prototype (Artificial learning interface for clinical education [ALICE]) displays a virtual clinic environment that can be explored from a first-person view similar to a video game. By controlling an avatar, the user navigates through the environment, is able to treat virtual patients, and faces the consequence of different decisions. ALICE showed high students' acceptance. There was positive correlation for concordance validity and predictive validity. Simulator usage had positive effect on reproduction of trained content and declarative knowledge.
  
  
  CONCLUSIONS
  We successfully developed a university-based, IPS prototype (ALICE) with profound medical content. ALICE is a nonprofit simulator, easy to use, and showed high students' acceptance; thus it potentially provides an additional tool for supporting student teaching in the daily clinical curriculum.
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany. Electronic address: robert.kleinert@uk-koeln.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Kleinert
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Heiermann
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Roger
authors.initials: R
authors.lastname: Wahba
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany; Department of Radiology, University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: De-Huan
authors.initials: DH
authors.lastname: Chang
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.affiliation: Department of General, Visceral and Cancer Surgery of the University of Cologne, Center of Integrated Oncology of the University of Cologne, Transplant Center Cologne, Cologne, Germany.
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Stippel
mesh_terms: D000328:Adult; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D020407:Internet; D008297:Male; D000066908:Simulation Training / Q000379:methods* / Q000458:organization & administration; D014584:User-Computer Interface; D055815:Young Adult
keywords: ALICE; Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; immersion; immersive patient simulators; procedural knowledge; validity; web-based learning