A technology-aided multi-modal training approach to assist abdominal palpation training and its assessment in medical education

• Main Author: Asadipour, Ali
• Published: University of Warwick 2015
• Subjects: 612.8; QP Physiology
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.682934

Kinaesthetic Learning Activities (KLA) are techniques for enhancing the motor learning process to provide a deep understanding of fundamental skills in particular disciplines. With KLA learning takes place by carrying out a physical activity to transform empirical achievements into representative cognitive understanding. In disciplines such as medical education, frequent hands-on practice of certain motor skills plays a key role in the development of medical students' competency. Therefore it is essential that clinicians master these core skills early on in their educational journey as well as retain them for the entirety of their career. Transferring knowledge of performing dexterous motor skills, such as clinical examinations, from experts to novices demands a systematic approach to quantify relevant motor variables with the help of medical experts in order to form a reference best practice model for target skills. Additional information (augmented feedback) on certain aspects of movements could be extracted from this model and visualised via multi-modal sensory channels in order to enhance motor performance and learning processes. This thesis proposes a novel KLA methodology to significantly improve the quality of palpation training in medical students. In particular, it investigates whether it is possible to enhance the existing abdominal palpation skills acquisition process (motor performance and learning) with provision of instructional concurrent and terminal augmented feedback on applied forces by the learner's hand via an autonomous multimodal displays. This is achieved by considering the following: identifying key motor variables with help of medical experts; forming a gold standard model for target skills by collecting pre-defined motor variables with an innovative quantification technique; designing an assessment criteria by analysing the medical experts' data; and systematically evaluating the impact of instructional augmented feedback on medical students' motor performance with two distinct assessment approaches(a machine-based and a human-based). In addition, an evaluation of performance on a simpler task is carried out using a game-based training method, to compare feedback visualisation techniques, such as concurrent visual and auditory feedback as used in a serious games environment, with abstract visualisation of motor variables. A detailed between-participants study is presented to evaluate the effect of concurrent augmented feedback on participants' skills acquisition in the motor learning process. Significant improvement on medical students' motor performance was observed when augmented feedback on applied forces were visually presented (H(2) = 6:033, p < :05). Moreover, a positive correlation was reported between computer-generated scores and human-generated scores, r = :62, p (one-tailed) < :05. This indicates the potential of the computer-based assessment technique to assist the current assessment process in medical education. The same results were also achieved in a blind-folded (no-feedback) transfer test to evaluate performance and short-term retention of skills in the game-based training approach. The accuracy in the exerted target force for participants in the game-playing group, who were trained using the game approach (Mdn = 0:86), differed significantly from the participants in control group, who trained using the abstract visualisation of the exerted force value (Mdn = 1:56), U = 61, z = -2:137, p < :05, r = -0:36. Finally, the usability of both motor learning approaches were surveyed via feedback questionnaires and positive responses were achieved from users. The research presented shows that concurrent augmented feedback significantly improves the participants' motor control abilities. Furthermore, advanced visualisation techniques such as multi-modal displays increases the participants' motivation to engage in learning and to retain motor skills.