Students Experience Virtual Reality Training to Develop Palpatory Skills

The OUCOM virtual haptic back project combines mechanical engineering with computer science to create a tactile learning experience for osteopathic medical students.

By Belinda Bombei

Medical students at The Ohio University College of Osteopathic Medicine (OUCOM) are experiencing a revolutionary opportunity to study the human back and related conditions and treatments utilizing the school’s self-developed Virtual Haptic Back (VHB).

Haptics is the study of human tactile sensation, or the psychological reaction to physical touch. Using haptic interfaces, students can obtain feedback on force and touch from the virtual system, allowing them to receive and better understand the body’s responses to various forces and touches. The focus of the VHB project is to improve palpatory diagnosis and using two PHANToM® 3.0 haptic interfaces, students can see the inner workings of the human back as close to real life as possible.

This innovative project allows students to explore a realistic virtual human back with accurate graphical and haptic (force and touch feedback) representations. Supported by the Osteopathic Heritage Foundation of Columbus, the Ohio virtual haptic back system is a 3D model with two-fingered palpitation. Students can practice unsupervised with increasing difficulty and audio and graphical feedback. Academically, the VHB is extremely useful because of its ability to provide objective feedback on student performance and to measure progress and provide assessments for grading purposes.

The OUCOM VHB model is currently the only product in the world that can be used to train and monitor student progress in palpatory diagnosis. Through its advanced technology, students can learn the right techniques, pressure points, and size of force required for various physical and manipulate treatment options.

One of the greatest challenges faced by osteopathic educators is that palpatory skills are tough to teach, train, and assess. The skills required cannot simply be acquired from a book or other knowledge-based content. Students need hands-on training. This makes them better equipped to manage various, and sometimes tough to detect, back ailments. This is why Ohio’s VHB is so innovative and vital because it provides greater opportunity for the improvement of manual detection skills, key to osteopathy.

Future Directions
Meng-Yun Chen, a doctoral student working with Bob Williams, Ohio University professor of mechanical engineering, is developing new software to make the Virtual Haptic Back technology more lifelike and more useful by adding simulated movement to the software. In an interview with ACOFP, Dr. Williams stated that they have initiated an AOA grant on September 1, 2008 to support Meng-Yun Chen’s VHB improvements including lumbar modeling, more realistic and complex somatic dysfunctions, and motion testing for the first time.

Dr. Williams, John Howell, Professor of Physiology at OUCOM, and others have developed a variety of different virtual backs measured from real human subjects of various age, gender, and body type - what Dr. Howell calls a “family of haptic backs.” They also have the methods to generate any number of different backs for future work. The importance of having a family of haptic backs available is that it allows students to practice their skills on a variety of simulated patients from young to old, and from underweight to overweight.

The team is working with the university’s Technology Transfer Office to obtain a patent on the VHB setup allow them to create a less costly version of the current VHB, which runs at more than $150,000. As of October 2008, OUCOM is still waiting for approval.

According to Dr. Howell, “Due to early evaluations, the VHB has been integrated into the OUCOM curriculum, for first year students, in their first quarter of schooling. For the past three years we have been doing large-scale studies with all first year students (greater than 100 per year) as our study cohort. One major benefit is that the VHB may help increase confidence in palpatory diagnoses early in the career of these students, when they are traditionally uncertain of their tactile skills - the VHB provides immediate feedback for improved training.”

“The quantitative data from the students,” says Dr. Howell “indicates that generally students improve using the VHB (less errors and faster diagnosis times as they use the VHB more). The subjective data from the students generally indicates that the students believe that the VHB is a strong tool for augmenting their palpatory diagnosis education.

This will allow more students to test the software and provide input for changes and improvements, as well as gather more data on the software’s effectiveness in teaching.”

To make using the haptic interface more like traditional osteopathic diagnosis and treatment, OUCOM purchased a right-handed haptic glove to provide feedback to the thumb and first three fingers and intend to integrate this with the PHANToM 3.0 haptic interface for more complete tactile feedback. With gloves, students can touch the virtual back and manipulate it in a way that is almost the same as what they would do to a real patient.

Dr. Williams believes that VHB technology is not solely applicable to the back, but can be used for other exams such as a breast exam, where DO’s use their fingers to check for lumps and other abnormalities. Haptic software would make teaching this and other diagnostic techniques easier and more predictable for osteopathic teachers, and would enable osteopathic medical students to practice without “live” patients and outside the traditional classroom.

OUCOM has brazened a path in virtual software simulation that has led to the improved training of osteopathic medical students as VHB exposes them to the closest thing to a real life situation as possible.

Belinda Bombei is the medical editor and writer for OsteopathicEditor.com and has over 15 years of experience, including five years of experience editing, writing and designing websites for the osteopathic profession.