Sep 29, 2018 @ 01:25 PM

e-REAL to Improve Teamwork and Crisis Resource Management for Labor and Delivery Clinicians at the Center for Medical Simulation in Boston

The ongoing applied research

Improving teamwork and crisis resource management for Labor and Delivery clinicians is a very relevant goal. Brain activity from thoughts, visualization, evocation of memories and emotions should be able to contribute to the learning process, mainly during the early stage of a simulation based program. With the rich variety of technological innovation currently available in medical simulation, visualization can be linked in interactive ways to the learners in order to allow for the better use of the neural processes.

At the Center for Medical Simulation in Boston (CMS:, e-REAL technology is being used for such porpouse--enabling learners to interact with dynamic images and videos reproducing realistic scenarios.

There is an applied research ongoing, performed by a team coordinated by Roxane Gardner from CMS and Fernando Salvetti from Logosnet. Two are the main questions, related to the latest discoveries from neurobiology of learning: 1) Is  visual storytelling enabling more situational awareness, contextual intelligence and cognitive retention? 2) Does the association between visual storytelling and the check-list called “Name-Claim-Aim” (designed by CMS)  facilitate situational awareness and teamwork?


Learners are shown short dynamic images and videos displayed in a virtual, mixed environment (e-REAL) and they are challenged  to recognize a situation requiring rapid intervention, communication, knowledge sharing, decision-making and management of unforeseen events--taking into consideration critical contextual factors such as a lack of time, scarcity of resources and tools, a multitude of impactful factors.

Learners are asked to follow the check-list “Name-Claim-Aim” in order to manage the crisis by coordinating the team roles and efforts. The dynamic images and videos  feature real situations within complex scenarios that present a “more than real” wealth of information: this is augmented and virtual reality in a mixed environment, that adds value to the individual cognitive maps by enabling a multilayer vision and some systems thinking.


This simulation-based research is in the early development phase. In order to assess such a prototypal system, we are preparing a qualitative evaluation to perform with a user panel. Moreover, for a further assessment, we are planning to introduce non-invasive technologies to monitor patterns of neural activity during the program delivery because the application of computational and quantitative behavioral approaches combined with functional brain imaging can reveal important information about the strategies employed by human brains to acquire, store, and retrieve information in a variety of tasks and settings. Functional changes in neural circuitry are associated with learning occur best when the learner is actively engaged.

Early findings

Our early findings show that an interactive mixed reality learning environment like e-REAL could be an effective simulation tool for L&D. The system offers realistic scenarios that can be easily reconfigured to generate many different situations, including extreme and dangerous ones. All the actions performed are logged allowing instructors to immediately identify errors and difficulties of the trainees. Such information can also facilitate an effective debriefing. Simulation environments like ours are rich venues for the learning process and for storing information into memories based on experiences (learning by doing). Establishing a toolbox of evidence-based practices for medical education that applies current knowledge of the neurobiology of learning will be our next step.

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