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A landmark event for the future of learning and teaching

Sharing and mixing up the latest trends from neurosciences, artificial intelligence, and advanced simulation allows us to establish a new paradigm for education and training. A landmark event was possible thanks to Stefano Gustincich, Deputy Director for Technologies for Life Science at the Italian Institute of Technology in Genoa and Full Professor in Applied Biology at SISSA Trieste, and to Marco Monga, the IIT’s HR Director—in cooperation with Daniela Persano, President of AIDP Liguria which is the regional chapter of the HR Directors Society of Italy. The two main speakers: Roxane Gardner, Senior Director of Clinical Programs at The Center for Medical Simulation in Boston (, and Luiz Pessoa, Director of the Maryland Neuroimaging Center and Visiting Professor University of Turin.

Prof. Roxane Gardner, MD, MPH, DSc

Healthcare Simulation Based Education & Virtual Environments

The brain capacity to learn and the new technologies

Recent research focused on brain function observation highlights that the brain’s capacity to learn does decrease over the years not because of the effect of a reduction in functional activity, but because of the increase of neurons’ inhibitory action, in a process of overturning hierarchies between excitatory neurons against inhibitors. With mature age, the human brain assumes a condition of greater resistance to change, consolidating known practices.

The development of behavioral competencies can be so only if it is lived as a process of the evolution of a part of the “self”, observable (also by others) as a difference compared to a previous state. Emotion is a fundamental glue of the learning process, acting as the propellant for the brain dynamic that leads to the construction of new synapses, which are welded together through the brain’s cognitive functions. Emotions help to remember, so a process of change must activate emotional states to reinforce a process of experience consolidation in the mind.

The dematerialization of the learning environment is allowed by new technologies that offer options to improve the usability of traditional e-learning methods. These new technologies may well be combined with experiential activities and coaching, that trigger emotions in support of learning, followed by instruments of self-training to enjoy it without time or place constraints. The first technology that may contribute to the development of the new generation of training methods and tools is augmented reality. This is definitely the technology with the most promising developments expected in the short term.

Healthcare simulation-based education and virtual environments

Within such an innovative framework, Prof. Gardner’s key-note speech provided a number of insights spanning from the history of medical simulation to today’s most innovative practices: from the milestones of the patient safety movement to simulation as a reflective and deliberative practice, from the cognitive aids improving the professional performance to the impact of different tasks on the brain, or the Catecholamine modulation of prefrontal cortical cognitive function as a challenging research field–just to name a few.

Simulation as a Reflective and Deliberative Practice

Patient Safety Movement Timeline

Cognitive Aids Improving the Professional Performance

Impacts of Different Tasks on the Brain

Focusing on augmented and virtual reality for advanced simulation, Prof. Gardner’s speech highlighted the ongoing exploratory projects within the e-REAL set up at the Center for Medical Simulation in Boston.

  1. Critical conversations: speech analysis real-time or post-hoc as formative assessment and to inform the instructional design of future training programs.
  2. Artificial intelligence avatars for teaching and learning in health professions.
  3. Visual emergency manual: check-lists virtualized and displayed on screens or walls within the surgical theatre, with vocal and tactile management.
  4. Haptic feedback for surgery: virtual environments and tools that provide tactile feedback for surgical procedures training.
  5. Improving teamwork and crisis resource management for labor and delivery clinicians: educational strategies based on dynamic visualization to enhance situational awareness, contextual intelligence, and cognitive retention.

Center for Medical Simulation & e-REAL Collaboration

Main Exploratory Projects

e-REAL: immersive and interactive simulation

e-REAL–which stands for Enhanced Reality Lab–is a powerful tool based on Enhanced Reality technologies, designed for lifelong learning, capacity building, educational events, interactive edutainment, and immersive experiences. e-REAL integrates things, tools and objects from the real world within a multisensory scenario, based on short case-studies developed by visual storytelling techniques. Learners are completely immersed in a 3D or holographic scenario where they can interact with the contents by natural gestures–without the constraint of wearing glasses, gloves or headsets.

Because brain activity from thoughts, visualization, evocation of memories and emotions should be able to contribute to the learning process, visualization can be interactively linked to the learners to allow for better use of the neural processes. So e-REALtechnology is being used, enabling learners to interact with dynamic images and videos reproducing realistic scenarios.

For example, during the Labor & Delivery program, learners are shown short dynamic images and videos displayed in a virtual, mixed environment 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, and a multitude of other 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.

The e-REAL 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. A simulation environment like this is very useful 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 the next step.