3DiTeams

3DiTeams (also known as 3Di TEAMS) is a first person video game developed by the Duke University Medical Center and Virtual Heroes, Inc., and used for medical education and team training. The 3DiTeams Project was conceived by Dr. Jeffrey M. Taekman and Jerry Heneghan and is managed by the Human Simulation and Patient Safety Center (HSPSC) at Duke University Medical Center, Durham, North Carolina. Dr. Taekman, M.D. is an Assistant Professor of Anesthesiology and the Assistant Dean for Educational Technology within the Duke University School of Medicine. Dr Taekman also serves as chairman of the Society for Simulation in Healthcare's Serious Games / Virtual Environments Special Interest Group. Co-Principal Investigator for the project is Melanie C. Wright, Ph.D. who is an Assistant Professor human factors engineer in Anesthesiology. Additional assistance is provided by Noa Segall, Ph.D. and Gene W. Hobbs, C.H.T.. Recently, the Duke team received funding for the Immersive Learning Environment @ Duke (also known as ILE@D)-- an interactive virtual environment for healthcare distance education.

The Virtual Heroes, Inc. team was lead by the chief technical officer Randy Brown and executive producer Henry F. Schwetzke. The programming team was technical director Gerke M. Preussner, Gabriel Scott, Ed Sirko, and Jay Nakai. The design team was Troy Bowman and Steven Cattrell. The artistic team was art director Tad Irish, director of visual development Takayoshi Sato, artists Sebastian Penedo, David Jones, Andrew Allen, Heather Cerlan, and Thomas Miller. Software quality assurance was provided by manager Franklin A Crawford IV, Tony Sturtzel and Sean Sayers.

The project was unveiled to the general public in a workshop entitled "3DiTeams – Team Training in a Virtual Interactive Environment" hosted by the American Society of Anesthesiologists Annual Meeting in San Francisco, California on October 16, 2007. Since that time, it has been the subject of presentations for the Second Annual TeamSTEPPS Consortium Meeting, the Fourth Annual Games for Health Conference, First Annual North Carolina Advanced Learning Technology Summit, and Leadership Symposium on Digital Media in Health Care.

Purpose
The Joint Commission on Accreditation of Healthcare Organizations recognizes lapses in teamwork and communication as a root cause in nearly 70 percent of sentinel events.

The game is intended for training and exercising of medical teams of practitioners of many levels of clinical expertise. The scope of practice of the tools in the game are geared toward care of a trauma patient and the interpersonal communications that surround the patient's care.

Training
The training is based on the United States Department of Defense Patient Safety Program and Agency for Healthcare Research and Quality's TeamSTEPPS curriculum. The player starts the training in an "independent leaning phase" where they are introduced to the teamwork and communication skills and apply the skills by identifying the behaviors in a series of short videos.

The second phase of learning is the "collaboration / team coordination phase" where up to 32 players enter the virtual training environment. Taking place in a fictional field hospital or hospital emergency room, the player begins each mission outside of the care area awaiting the patient's arrival. The players act in their predetermined role as a doctor, nurse, technician, or observer as the instructor begins a briefing for the upcoming patient interaction. Once the patient has arrived, the team enters the room and begins to assess and treat the patient. The instructor's user interface allows them to manually control the patients vital signs in response to the player actions or by allowing the embedded physiology engine to control patient's response. Once the patient is stabilized and a telephone handoff takes place between the care team and the receiving care team. The team then reassembles outside the patient care area to perform a debriefing or After Action Review (AAR) of their care. Gameplay ends when team leader dismisses the team.

The final phase of learning is accomplished by an instructor lead AAR of the teams communication skills during their interaction. Video playback of the scenario is used to allow the players to observe and reflect on their own behaviours as well as those of the team.

Known Issues

 * The player may be unable to move within the virtual environment pressing and holding the right mouse button.
 * Blood products are not seen as being delivered to the patient unless a pulmonary artery catheter has been inserted in addition to the IV line.
 * Occasionally the AAR may freeze when pausing play unless the AAR's are viewed in a windowed mode.

Development status
In 2006, the Telemedicine and Advanced Technologies Research Center (TATRC), a division of the United States Army Medical Research and Materiel Command, funded a one year $249,530 award to support the "3DiTeams: Gaming Environment for Training Healthcare Team Coordination Skills" study. Taekman and Wright were also awarded a 2-year $291,248 grant from the NIH Agency for Healthcare Research and Quality for their study on "Virtual Health Care Environments Versus Traditional Interactive Team Training." The project compares the 3DiTeams simulations with traditional interactive team training.

The project continues under the name "Immersive Learning Environment @ Duke" (ILEAD) with funding provided by The Nanaline H. Duke Fund.