No abstract

Simulations are a pedagogical means of enabling a risk-free way for healthcare practitioners to learn, maintain, or enhance their knowledge and skills. Such simulations should provide an optimum amount of cognitive load to the learner and be tailored to their levels of expertise. However, most current simulations are a one-type-fits-all tool used to train different learners regardless of their existing skills, expertise, and ability to handle cognitive load. To address this problem, we propose an end-to-end framework for a trauma simulation that actively classifies a participant's level of cognitive load and expertise for the development of a dynamically adaptive simulation. To facilitate this solution, trauma simulations were developed for the collection of electrocardiogram (ECG) signals of both novice and expert practitioners. A multitask deep neural network was developed to utilize this data and classify high and low cognitive load, as well as expert and novice participants. A leave-one-subject-out (LOSO) validation was used to evaluate the effectiveness of our model, achieving an accuracy of 89.4% and 96.6% for classification of cognitive load and expertise, respectively.

Simulation-based training has been proven to be a highly effective pedagogical strategy. However, misalignment between the participant’s level of expertise and the difficulty of the simulation has been shown to have significant negative impact on learning outcomes. To ensure that learning outcomes are achieved, we propose a novel framework for adaptive simulation with the goal of identifying the level of expertise of the learner, and dynamically modulating the simulation complexity to match the learner’s capability. To facilitate the development of this framework, we investigate the classification of expertise using biological signals monitored through wearable sensors. Trauma simulations were developed in which electrocardiogram (ECG) and galvanic skin response (GSR) signals of both novice and expert trauma responders were collected. These signals were then utilized to classify the responders’ expertise, successive to feature extraction and selection, using a number of machine learning methods. The results show the feasibility of utilizing these bio-signals for multimodal expertise classification to be used in adaptive simulation applications.

Background: In resuscitation medicine, effectively managing cognitive load in highstakes environments has important implications for education and expertise development. There exists the potential to tailor educational experiences to an individual's cognitive processes via real-time physiologic measurement of cognitive load in simulation environments.Objective: The goal of this research was to test a novel simulation platform that utilized artificial intelligence to deliver a medical simulation that was adaptable to a participant's measured cognitive load. Methods: The research was conducted in 2019. Two board-certified emergency physicians and two medical students participated in a 10-minute pilot trial of a novel simulation platform. The system utilized artificial intelligence algorithms to measure cognitive load in real time via electrocardiography and galvanic skin response. In turn, modulation of simulation difficulty, determined by a participant's cognitive load, was facilitated through symptom severity changes of an augmented reality (AR) patient. A postsimulation survey assessed the participants' experience. Results: Participants completed a simulation that successfully measured cognitive load in real time through physiological signals. The simulation difficulty was adapted to the participant's cognitive load, which was reflected in changes in the AR patient's symptoms. Participants found the novel adaptive simulation platform to be valuable in supporting their learning. Conclusion:Our research team created a simulation platform that adapts to a participant's cognitive load in real-time. The ability to customize a medical simulation to a participant's cognitive state has potential implications for the development of expertise in resuscitation medicine.Aaron J. Ruberto: study concept and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript.