In military training contexts, fast and long term decisions are intermixed where survival and security are prioritized. Simulation-based training, here applied to ground patrols in Afghanistan, can provide preparation for mission critical and life critical operations prior to exposure to real danger. Optimising the effectiveness of simulation-based training raises the need for more detailed representations of the competences required, both for simulation design and for evaluating simulation effectiveness. These needs are here considered in terms of three research questions . The first research question asks how objects trigger dialogue in observational tasks. Eye gaze tracking and recorded dialogue provide a foundation for proposing the cognitive operational structures behind how objects and dialogue are structured when people work together when collaborating in simulation-based training sessions. The objects are tracked along with related observational tasks and the communication between people in a team in ground vehicles and in the Tactical Operations Centre (TOC). The second research question asks how the results of simulation-based training for emergency situations can be described and evaluated. The last research question asks how debriefing and learning create and refine cognitive comprehension, the competency developed in a group. Low level visual cognition in a tactical environment is explored using an eye gaze tracking system integrated with a simulation environment. The integrated system has been evaluated, its accuracy characterized, and the system was then used to evaluate hypotheses related to visual queuing and target selection. The research questions are then explored more broadly based upon two exploratory field studies of simulation-based training sessions held for military staff before leaving for ISAF in Afghanistan. Study methods here include eye gaze tracking, video and audio recording, behavioral observation and retrospective questions. The field studies were conducted at the Swedish Life Guard Regiment sub-departments: International Training Unit(IntUtbE), pre-deployment training for Peace support operations, and Swedish Armed Forces International Centre (SWEDINT), with their Simulation, Modeling and Practical Platform. Based upon data obtained in the field studies, cognitive models of decision processes involved in operational task performance are developed to provide a basis for answering the research questions. Cognitive modelling begins with the Belief, Desire and Intension (BDI) model. This model is then modified in several steps to cover different levels of decision making revealed by the field studies, including an intrapersonal and organizational layer, an educational layer, a layer where objects are build into the algorithm as a basis for purposive behavior, and finally a team competency layer built largely during debriefing sessions. These models can be used to evaluate simulation-based training effectiveness, to provide feedback both in real time and retrospectively to trainees and teams, and potentially could be used in operational systems to provide real-time information about individual and group state during operations, for decision enhancement, and potentially as elements of the implementation of automated operational forces.

The U.S. military uses pattern recognition training to observe anomalies in human behavior. An examination of the pattern recognition training literature for Warfighters reveals a gap in training to discern patterns of human behavior in live environments. Additionally, the current state of warfare is evolving and requires operations to change. As a result, pattern recognition training must accommodate new practices to improve performance. A technique used to improve memory for identifying patterns in the environment is Kim's game. Kim's game establishes patterns to identify inanimate objects, of which information retains in memory for later recall. The paper discusses the fundamental principles of Kim's game applied to virtual Simulation-Based Training. The virtual version of Kim's game contains customized scenarios for training behavior cue analysis. Virtual agents display kinesic cues that exhibit aggressive (i.e., slap hands and clench fist) and nervous behaviors including wring hands and check six. This research takes a novel approach by animating the kinesics cues in the virtual version of Kim's game for pattern recognition training. Detection accuracy, response time, and false positive detection serve as the performance data for analysis. Additional survey data collected include engagement, flow, and simulator sickness. All collected data was compared to a control condition to examine its effectiveness of behavior cue detection. A series of one-way between subjects design ANOVA's were conducted to examine the differences between Kim's game and control on post-test performance. Although, the results from this experiment showed no significance in post-test performance, the percent change in post-test performance provide further insight into the results of the Kim's game and control strategies. Specifically, participants in the control condition performed better than the Kim's game group on detection accuracy and response time. However, the Kim's game group outperformed the control group on false positive detection. Further, this experiment explored the differences in Engagement, Flow, and Simulator Sickness after the practice scenario between Kim's game group and the control group. The results found no significant difference in Engagement, partial significance for Flow, and significant difference for Simulator Sickness between the Kim's game and control group after the practice scenario. Next, a series of Spearman's rank correlations were conducted to assess the relationships between Engagement, Flow, Simulator Sickness, and post-test performance, as well as examine the relationship between working memory and training performance; resulting in meaningful correlations to explain the relationships and identifying new concepts to explain unrelated variables. Finally, the role of Engagement, Flow, and Simulator Sickness as a predictor of post-test performance was examined using a series of multiple linear regressions. The results highlighted Simulator Sickness as a significant predictor of post-test performance. Overall, the results from this experiment proposes to expand the body of pattern recognition training literature by identifying strategies that enhance behavior cue detection training. Furthermore, it provides recommendations to training and education communities for improving behavior cue analysis. ?

Feedback is essential to guide performance in simulation-based training (SBT) and to refine learning. Generally outcomes improve when feedback is delivered with personalized tutoring that tailors specific guidance and adapts feedback to the learner in a one-to-on environment. Therefore, emulating by automation these adaptive aspects of human tutors in SBT systems should be an effective way to train individuals. This study investigates the efficacy of automating different types of feedback in a SBT system. These include adaptive bottom-up feedback (i.e., detailed feedback, changing to general as proficiency develops) and adaptive top-down feedback (i.e., general feedback, changing to detailed if performance fails to improve). Other types of non-adaptive feedback were included for performance comparisons as well as to examine the overall cognitive load. To test hypotheses, 130 participants were randomly assigned to five conditions. Two feedback conditions employed adaptive approaches (bottom-up and top-down), two used non-adaptive approaches (constant detailed and constant general), and one functioned as a control group (i.e., only a performance score was given). After preliminary training on the simulator system, participants completed four simulated search and rescue missions (three training missions and one transfer mission). After each training mission, all participants received feedback relative to the condition they were assigned. Overall performance on missions, knowledge post-test scores, and subjective cognitive load were measured and analyzed to determine the effectiveness of the type of feedback. Results indicate that: (1) feedback generally improves performance, confirming prior research; (2) performance for the two adaptive approaches (bottom-up vs. top-down did not differ significantly at the end of training, but the bottom-up group achieved higher performance levels significantly sooner; (3) performance for the bottom-up and constant detailed groups did not differ significantly, although the trend suggests that adaptive bottom-up feedback may yield significant results in further studies. Overall, these results have implications for the implementation of feedback in SBT and beyond for other computer-based training systems.

Yes / Angiography is a minimally invasive diagnostic procedure in endovascular interventions. Training interventional procedures is a big challenge, due to the complexity of the procedures with the changes of measurement and visualization in blood flow rate, volume, and image contrast. In this paper, we present a novel virtual reality-based 3D interactive training platform for angiography procedure training. We propose a multi-fluid flow approach with a novel corresponding non-slip boundary condition to simulate the effect of diffusion between the blood and contrast media. A novel syringe device tool is also designed as an add-on hardware to the 3D software simulation system to model haptics through real physical interactions to enhance the realism of the simulation-based training. Experimental results show that the system can simulate realistic blood flow in complex blood vessel structures. The results are validated by visual comparisons between real angiography images and simulations. By combining the proposed software and hardware, our system is applicable and scalable to many interventional radiology procedures. Finally, we have tested the system with clinicians to assess its efficacy for virtual reality-based medical training. / National Natural Science Foundation of China grant number 61402278, the Shanghai Natural Science Foundation of China grant number 14ZR1415800, Research Program of Shanghai Engineering Research Center of Motion Picture Special Effects grant number 16dz2251300, Shanghai University Film Peak Discipline, and Shanxi Natural Science Technology Foundation grant number 2016JZ026.

The purpose of business training programs is to improve performance, which improved performance changes leadership behaviors based on the knowledge, skills, and abilities (KSAs) learned in training. One of the most common criticisms of leadership training is the tendency to focus on teaching theory but not on applying theory into practice, that is, transfer of learning. Research usually ends at the point of identifying, describing, or measuring factors that influence transfer. Ongoing research must identify what constructs in the transfer of learning process should be effectively changed or managed. There is a gap in research on the degree to which performance improvement through KSAs learned in a simulation training program actually transfer to the work environment. Additional research is needed that examines the relationship between transfer of learning and intent to transfer, which are critical outcomes in the field of human resource management and development. The purpose of the study was to examine the relationship between intent to transfer and four constructs in the transfer of learning process during a simulation-based leadership training program. Participants completed self-report assessments that measured the relationships between intent to transfer and four constructs: ability, motivation, work environment, and learner readiness. A correlational design was administered using a population of mid-level managers in a telecommunications organization.

Laparoscopic bariatric procedures are complex minimally invasive operations with a potential for substantial morbidity and mortality along the early part of a surgeon’s learning curve. Simulation-enhanced training can improve a surgeon's technical and non-technical performance and lessen the learning curves in the operating room. Unfortunately, despite the convincing evidence supporting the use of simulation in surgical education, there is still a gap in translation of knowledge and technical skills from the research environment into clinically relevant training curricula. The objective of this thesis was to design and validate a comprehensive simulationenhanced training curriculum that addressed cognitive knowledge, technical and non-technical skill in laparoscopic bariatric surgery. This objective was achieved using three experimental studies. The first study employed a modified Delphi methodology and an international panel of experts in surgical and medical education to develop a consensus-based framework for design, validation and implementation of simulation-enahnced training curricula in surgery. The second study used a modified Delphi methodology and an international panel of experienced bariatric surgeons to develop an objective scale for assessment of operative skill in laparoscopic gastric bypass procedure. This scale was feasible to use and had high inter-rater and test-retest reliability, as well as evidence of construct and concurrent validity. The third study used the previously developed consensus-based framework to design a comprehensive simulation-enhanced training curriculum for laparoscopic bariatric surgery. A prospective, single-blinded randomized controlled trial was used to compare the effectiveness of this curriculum in comparison to conventional surgery training. Surgery residents who were trained in this curriculum demonstrated superior technical skills, superior non-technical skills and enhanced safety in the operating room.

Laparoscopic bariatric procedures are complex minimally invasive operations with a potential for substantial morbidity and mortality along the early part of a surgeon’s learning curve. Simulation-enhanced training can improve a surgeon's technical and non-technical performance and lessen the learning curves in the operating room. Unfortunately, despite the convincing evidence supporting the use of simulation in surgical education, there is still a gap in translation of knowledge and technical skills from the research environment into clinically relevant training curricula. The objective of this thesis was to design and validate a comprehensive simulationenhanced training curriculum that addressed cognitive knowledge, technical and non-technical skill in laparoscopic bariatric surgery. This objective was achieved using three experimental studies. The first study employed a modified Delphi methodology and an international panel of experts in surgical and medical education to develop a consensus-based framework for design, validation and implementation of simulation-enahnced training curricula in surgery. The second study used a modified Delphi methodology and an international panel of experienced bariatric surgeons to develop an objective scale for assessment of operative skill in laparoscopic gastric bypass procedure. This scale was feasible to use and had high inter-rater and test-retest reliability, as well as evidence of construct and concurrent validity. The third study used the previously developed consensus-based framework to design a comprehensive simulation-enhanced training curriculum for laparoscopic bariatric surgery. A prospective, single-blinded randomized controlled trial was used to compare the effectiveness of this curriculum in comparison to conventional surgery training. Surgery residents who were trained in this curriculum demonstrated superior technical skills, superior non-technical skills and enhanced safety in the operating room.

Bakgrund: Barn identifieras som en grupp som är extra känsliga för att drabbas av vårdskador. För att minska risken för vårdskador behöver personalen kunna samarbeta i team samt ha bra redskap för att kommunicera. Simulering beskrivs som en metod där träning av detta utförs i en säker miljö som efterliknar verkligheten. Syfte: Att beskriva vårdpersonals upplevelser av simuleringsträning vid vård av akut sjuka barn på barnklinik. Metod: En kvalitativ intervjustudie genomfördes på en barnklinik på ett medelstort sjukhus i Sverige. Intervjuerna analyserades med en innehållsanalys enligt Graneheim och Lundman (2004). Resultat: Deltagarna i studien uppgav att simuleringsträningen gav dem en större kännedom om vad som förväntas av dem i deras yrkesroll vid vård av akut sjuka barn. Denna kännedom gav dem en trygghet och skapade ett lugn i en akut situation med ett sjukt barn. Att träna i multiprofessionella team skapade en möjlighet för personalen att utveckla teamarbetet. Att kommunicera på ett tydligt sätt och att förmedla sina tankar var en stor lärdom från simuleringsträningen. Deltagarna uttryckte att det är under reflektionen, där de får se på film hur de agerat och sedan diskutera teamets arbete, som de lär sig mest. Slutsats: Att träna simulering gav deltagarna en större trygghet i de svåraste situationerna inom vården av akut sjuka barn. Genom förbättrad kommunikation och större kunskap om sina egna och andras uppgifter i ett team upplevde deltagarna att teamarbetet utvecklades efter simuleringsträning. De förbättrade kunskaperna kom efter att deltagarna hade genomfört ett scenario och sedan diskuterat och reflekterat över sitt agerande i reflektionen. / Background: Children are identified as an extra vulnerable group to be affected by mistakes in the healthcare. To be able to reduce this risk, the healthcare staff must be able to cooperate in teams and have good communication skills. Simulation based training is described as a method where teamwork and communication is trained in a safe environment that resembles reality. Aim: To describe the healthcare staff’s experiences of simulation based training when caring for acute ill children in a pediatric clinic. Method: A qualitative interview study was implemented at a pediatric clinic at a medium-sized hospital in Sweden. A content analysis according to Graneheim and Lundman (2004) was performed to analyze the interviews. Results: According to the participants simulation based training gave them more knowledge about what was anticipated of them in there profession when caring for acute ill children. This knowledge gave them a feeling of security and calmed them down in an acute event with an ill child. Training in multiprofessional team created an opportunity to develop team work. To communicate in a distinct way and to mediate thoughts was a great lesson learned from simulation based training. The participants expressed that they learned the most during the reflection, where they saw on film how they acted during the simulation, and then got to discuss how the team worked. Conclusion: Simulation based training gave the participants a greater security when caring for the most severely acute ill children. Through improved communication and a greater knowledge of their own and others tasks in a team, the participants experienced that the teamwork improved after simulation based training. The improved knowledge came after the participants had done a scenario and then discussed and reflected about their acting during the reflection.

Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a simulation-based staff educational program was developed and implemented by ICU staff (n=20). Following the implementation of the simulation-based program, adherence to CVC maintenance guidelines improved from 41.5% to 87.9%. A sample t-test showed that this improvement was statistically significant and the CLABSI rate declined to 1.24 per 1,000 catheter days in the 4-week period following implementation of the program. Findings show that introducing a simulation-based training program might help to reduce CLABSI rates in the ICU setting and contribute to positive social change by improving health outcomes in ICU patients with a CVC.

The U.S. Army Training and Doctrine Command*s Army Learning Concept 2015 and Army Training Concept 2025 are documents that discuss the need for an adaptive soldier learning model with a flexible training delivery methodology. The U.S. Army has been investing in serious gaming technology for the past two decades as a cost effective means to teach tactics and strategy. Today, the U.S. Army is seeking to expand its application of virtual environment training to areas such as cultural awareness and human network analysis for the infantry soldier. These new expanded applications will require a higher level of non-determinant behavior inside the virtual environment. To meet more of the training needs of the war fighter, the U.S. Army is looking beyond first person perspective games to the cooperative and social gaming experience offered by the MMOG (Massively Multiplayer Online Game) and the VWT (Virtual World Technology). Altogether, these classes of games have the potential to teach leadership skills, social acclimation skills, cultural awareness and practice skills, and critical thinking skills for problem solving in a cost effective manner. Unfortunately, even today there is a paucity of scientific research to support whether this potential may be realized or not. A literature review was performed which covers current concepts in the usage of virtual environments for military individual and team training in the U.S. Army infantry soldier domains. There are many variables involved with the lifecycle of the virtual training activity including the acquisition, information assurance and cyber security, deployment, proper employment, content development and maintenance, and retirement. This discussion goes beyond the traditional topics of graphics and game engine technology and delves deeper into concepts of the importance of proper usage of the environments by the trainees. This dissertation is composed of three studies with two subject pools: experienced soldiers and novice soldiers. The participants in the studies were randomly assigned to one of two training conditions. The training conditions were either a traditional slide-show in a classroom or a virtual environment based training system. The participants were then provided with training for a room clearing tasks in each of the conditions. The independent variables are training condition and soldier condition. The dependent variables are individual performance, team performance, stress questionnaire scores, and workload questionnaire scores. A number of relationships are explored in this dissertation. The first objective of these studies is to attempt to identify any effect the training conditions have on either individual performance or team performance. Lastly, these studies attempt to identify if there is any difference the training conditions have on novice versus experienced subjects* performance during a live assessment.