Medical procedures often involve the use of the tactile sense to manipulate organs or tissues by using special tools. Doctors require extensive preparation in order to perform them successfully; for example, research shows that a minimum of 750 operations are needed to acquire sufficient experience to perform medical procedures correctly. Haptic devices have become an important training alternative and they have been considered to improve medical training because they let users interact with virtual environments by adding the sense of touch to the simulation. Previous articles in the field state that haptic devices enhance the learning of surgeons compared to current training environments used in medical schools (corpses, animals, or synthetic skin and organs). Consequently, virtual environments use haptic devices to improve realism. The goal of this paper is to provide a state of the art review of recent medical simulators that use haptic devices. In particular we focus on stitching, palpation, dental procedures, endoscopy, laparoscopy, and orthopaedics. These simulators are reviewed and compared from the viewpoint of used technology, the number of degrees of freedom, degrees of force feedback, perceived realism, immersion, and feedback provided to the user. In the conclusion, several observations per area and suggestions for future work are provided.

Background Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients. Objective This paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers. Methods The system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system. Results The system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group. Conclusions The proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal organs. The initial user study proved its applicability and usefulness.

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Although visualization remains a primary mode of interaction in simulations, touch is the most common way people use to interact with the physical objects. A greater sense of immersion in a learning environment can be reached when the user is able to feel and manipulate objects as compared to only seeing or listening. Despite the affordances of haptic technologies, which could serve as scaffolds for deep conceptual learning, their true potential in education has not been fully harnessed and little research has been done to investigate its effectiveness for learning difficult concepts. This study explores the potential of haptic technologies in supporting conceptual understanding of difficult concepts in science, specifically concepts related to electricity and magnetism. A pretest-posttest study identified if students improved their conceptual understanding of electricity and magnetism concepts. Specifically, this study identified (a) how students, with different physics background, conceptually interpreted the tactile learning experience in the context of the visualization, and (b) students' perceptions on the use of haptic technologies for their learning, as well as their perceived usefulness and ease of use. Our results suggest that overall students significantly improved their conceptual understanding about electric fields for distributed charges after being exposed to a visuohaptic simulation guided activity. Regarding students' prior coursework, students with high school-only physics background outperformed students who have been previously exposed to college-level physics courses 8% higher in the posttest average score. Similarly, students overall agreed that they enjoyed using the haptic device for learning and found the technology as easy to interact with. Implications for teaching and learning are provided as well as venues for future work.

Technological advances have been the main driver of enhancing human–computer interaction and interactive simulations have experienced exponential growth in recent years. However, visual and auditory channels are usually the only ones considered for educational simulations even though the sense of touch is also an important one. Touch allows us to recognize and interact with our surroundings. A common way to develop a visuo-haptic simulation in the area of interactive systems is by using a graphic and physics-based engine orchestrated with a haptic rendering framework. However, new solutions, such as professional game engines, have enabled the development of high-quality applications in much shorter time. In this paper, a novel architecture for fast development of interactive visuo-haptic applications in game engines is discussed. To validate the proposed architecture, the Haptic Device Integration for Unity (HaDIU) plugin was implemented. Simulations were implemented to verify the operability of haptic devices. Each scenario was properly modelled and has different haptic objectives. Furthermore, to validate that the usage of this approach provides better visualizations than an existing single purpose application, an experimental study was performed. Results suggest that by using this approach faster development of interactive visuo-haptic simulators can be achieved than using traditional techniques.