Technological Improvements

By far the most frequently discussed topic with all groups involved suggested improvements to the technology. Despite most participants describing themselves as pro-technology a majority also focused how on the simulated activity could be improved upon, rather than commenting upon what it already did. These issues have been split into generic areas which are referred to in Table 3.1 below:

Suggested Improvement Number of times mentioned by participants

Further questions of patient 9

Augmented Reality difficulties 5

Inactive areas 4

Positioning of patient 3

More cases/patients 3

Interface improvements 2

More physical examinations 2

Making an ‘urgent’ blood request 1

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Facial expressions 1

Referral button 1

Table 3.1 Suggested improvements from the first phase of app testing

The most commonly cited improvement was the ability to ask further questions of the virtual patient. The scenario was deliberately designed with a multiple choice question scenario with nine limited questions which could be asked. Further questions were suggested surrounding medicine use, colour/consistency of sputum and further detail with regard to presenting complaint.

“ I’d like to ask about Recent changes in his meds because it said he’d seen the doctor three days ago, so I’d like to talk about those three days” [P001]

“So definitely around sputum colour, consistency because that will differentiate between pneumonia and an acute exacerbation because the WCC is raised anyway” [PY02]

The programme was designed on the Unity platform with an augmented reality base, this allows the user to point a mobile device at a pre-defined picture which is then represented in 3D on the screen. This aspect of technology was not always favourably commented upon by participants.

“Disappeared to at the moment. Doesn’t seem to be there.” [PY03]

“ Do you think it’s easy to use?} Yeah, apart from when we were changing the angle. He [avatar] actually ended up lying across the floor at one point {laughter}.” [N001]

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As could be expected with any technology at the beta-testing stage there were some technical glitches which resulted in inactive areas of the app. These included a lack of response to questioning, some blood results which should have had dynamic values which were fixed, and certain physical examinations which were inactive. Students seemed to cope well with this and used compensatory mechanisms to account for the lack of information.

“It gave me someone to care about. Which was quite good. We just couldn’t use him very much.” [D003]

“And I think there was also, am I right, there were, I think there were some inactive areas…”

[PY03]

Positioning of the patient has been mentioned previously as a way of improving the

interactivity and realism of the programme. Participants also thought that more cases would improve the realism, educational efficacy and engagement with the app.

The interface was widely appreciated as easy to use, although after conducting a ‘physical examination’ such as auscultation of the chest the app tended to revert to the ‘home’ screen rather than one stage up at the ‘chest examination’ screen. One participant cited this as an interface issue and suggested a few routes of improvement:

“There were, I think there were a few interface issues that we had sort of had on the day and that was, I think it was…perhaps the user interface where you sort of, you went into something and then you had to come out of something to go into somewhere yes so there wasn’t a sort

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of free flow of [mm-hmm] interface, which I guess might have been easier or might be easier to use” [PY03]

“I like the idea of an interface where if you’re going to, if you have to switch backwards and forwards and for it, probably a new iteration actually finding out from the new software coming from Apple where they’ve got a permanent sort of tag box along where you can flick in and out, making it much more easier, ‘cause I think when you go into some of these you sort of go, you probably go back and out rather than [yes] being able to just flick between them. Or being able to, you know, whether you can swipe left, swipe right so you sort of maximise that interface might be more, probably more intuitive to use.” [PY03]

Other suggested improvements tended to surround patient management e.g. by being able to request urgent bloods, conduct further physical examinations, and refer to another

practitioner. One further comment from a nurse concentrated on the avatar being able to express more emotions.

“As you said, this is just early stage of the development. Obviously, over time, as you go on and add more conditions, you’ll adapt with it, so when you do the tests and stuff like that and when you do the examinations, it’s a bit more responsive and maybe facial expressions or something like that.” [N001]

In summary participants reacted positively to the technological concept of the app, and found it easy to use, some reservations and improvements were expressed particularly with regard to the communicative aspects of the simulation as a whole.

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