Healthcare professionals are tasked with learning and retaining an enormous amount of knowledge and skills. Whether the task is to master human anatomy and physiology, the symptoms associated with a broad range of diseases and disorders, or the skills associated with performing some routine or non-routine medical procedure, healthcare professional undergo an enormous amount of training to ensure excellence when treating patients. In addition, healthcare professionals are expected to apply this knowledge and these skills under a broad range of challenging situations including time pressure, social stress, and other sub-optimal conditions.

As all healthcare professionals know, the brain is hardwired to forget
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Unfortunately, and as all healthcare professionals know first-hand, the brain is hardwired to forget. This has been known implicitly for centuries, but was formalized scientifically in 1885 when Hermann Ebbinghaus embarked on a journey to characterize and quantify the time-course of learning and memory, and in the process discovered the “forgetting curve”.

A typical forgetting curve is displayed below. The y-axis denotes the retention rate that ranges from 0 to 100%, and the x-axis denotes time. The blue dot in the upper left represents the initial level of learning. In this example, we assume that the learner obtained 100% of the knowledge initially. The red curve is the forgetting curve. Notice that the rate of forgetting is rapid initially and then tapers off over time. The retention rates of 60% after 20 minutes, 40% after one day, and 15% after a week are hypothetical but are in line with many scientific studies. Although the retention rates depend upon the nature of initial training and the type of information studied, the shape remains the same.

What this means is that you can train to perfection today, but you will immediately start to forget and ultimately will retain only a small portion of the information. This is a serious problem in any training setting, but is especially problematic in healthcare. The last thing that you want is for your healthcare professional to forget some critical piece of knowledge.

The neuroscience of information and skills retention and the problem of forgetting are fascinating. In this report, we discuss these issues and show how traditional approaches to training that rely predominantly on text, and some healthcare simulation or hands-on training exacerbate the problem. We then discuss the neuroscience of learning with immersive technologies like virtual reality (VR) and augmented reality (AR), and show why their grounding in experience is advantageous for guarding against forgetting. We show that the ability for endless study and practice enhances “Training for Retention”, and builds situational awareness in healthcare.

First, we need a brief primer on the neuroscience of learning.

“Learning is an experience. Everything else is just information”

Albert Einstein

This is an insightful quote from Albert Einstein that is supported by the neuroscience of learning. But why? What is it about experience that is so rich that it is fundamental to learning, and why is information so much less effective?

As outlined in the figure below, the human brain is comprised of at least four distinct learning systems. As Einstein so eloquently stated, the experience is at the heart of learning. Importantly, it is also at the foundation of VR and AR. The experiential system has evolved to represent the sensory aspects of an experience, whether visual, auditory, tactile or olfactory. Every experience is unique, adds rich context to the learning and is immersive. The critical brain regions associated with experiential learning are the occipital lobes (sight), temporal lobes (sound), and parietal lobes (touch).

You can train to perfection today, but you will immediately start to forget and ultimately will retain only a small portion of the information
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The cognitive system is the information system. It processes and stores knowledge and facts. Cognitive information comes in the form of text, graphics, or video and is processed using working memory and attention. Critically, these are limited resources and form a bottleneck that slows learning with more information coming in and available to the learner (the green arrows) than can be processed (the red arrow). This system encompasses the prefrontal cortex and hippocampus.

The behavioral system in the brain has evolved to learn motor skills. It is one thing to know what to do, but it is completely different (and mediated by different systems in the brain) to know how to do it. Processing in this system is optimized when behavior is interactive and is followed in real-time (literally within milliseconds) by corrective feedback. Behaviors that are rewarded lead to dopamine release into the striatum that incrementally increases the likelihood of eliciting that behavior again in the same context. Behaviors that are punished do not lead to dopamine release into the striatum thus incrementally decreasing the likelihood of eliciting that behavior again in the same context. Real-time feedback is critical because striatal activation decays quickly (within a few 100 milliseconds) following initiation of behavior. If a correct behavior is elicited, but feedback is delayed, even by a second or two, the dopamine will be released into the striatum, but striatal activation (driven by the behavior) will be so weak that no learning will occur. Similarly, if an incorrect behavior is elicited, but feedback is delayed, the striatal activation (driven by the behavior) will be so weak that the system won’t know what behavior to unlearn.

The behavioral system in the brain has evolved to learn motor skills
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The emotional learning system in the brain has evolved to facilitate the development of situational awareness — the ability to read nuance in a situation and the uncanny ability to know what comes next – as well as empathy and understanding of our and others’ behaviors. Whereas one can have all of the facts and figures available and can have a strong behavioral repertoire, in the end, one has to extract the appropriate information and engage the appropriate behavior in each distinct situation. The critical brain regions are the amygdala and other limbic structures. The detailed processing characteristics of this system are less well understood than the cognitive and behavioral skills learning systems, but emotional learning is at the heart of situational awareness, and strongly affects both cognitive and behavioral skills learning. An individual with strong situational awareness can accurately read any situation, adapts quickly and knows what to do in each situation, and has the behavioral repertoire to engage each situation with the appropriate set of behaviors.

Using anatomy and physiology training as an example, let’s explore the traditional approach to training. You start with textbook and classroom study, then transition to some hands-on training or a cadaver lab. Because of the cost associated with hands-on and cadaver lab training, invariably classroom and textbook training is emphasized.

From a neuroscience perspective, this traditional approach starts by engaging the cognitive system as you sit in class and study textbooks. The human body is a 3-dimensional structure that functions as a dynamic system. Thus, the goal is to obtain a 3-dimensional, dynamic representation in your brain. Although the best way to achieve this goal is to present the learner with a 3D dynamic training tool, instead you start with textbooks or slide shows that are filled with 2D static images. The learner must convert a series of 2D static images into a 3D dynamic mental representation in the brain that accurately reflects the human form. The cognitive effort needed to do this is enormous. Given the fact that working memory and attention are limited capacity resources, this process with is slow, challenging, and error-prone.

In the laboratory, further cognitive training occurs, and the behavioral system is also engaged as the healthcare professional practices particular tasks. At some point, the professional is deemed “ready” and they are sent out to a clinic or hospital where the real learning occurs, on-the-job. Healthcare professionals often lament at how little of their classroom and laboratory training actually transfers to the real world. The brain tells us why. All of the training has been sequential and disjointed. It would be much better to emphasize experience and to train knowledge and skills simultaneously.

The goal is to obtain a 3-dimensional, dynamic representation in your brain
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Now consider an immersive approach to the same training. Consider an AR or VR tool for teaching anatomy and physiology where a highly accurate 3D dynamic representation of the 3D dynamic human form is presented. The learner can move and rotate the virtual body and when certain body parts are “touched” a description of the part and its function is provided. Layers of virtual tissue can be removed so that the inner workings of the body can be explored.

From a neuroscience perspective, this immersive approach engages the experiential, cognitive and behavioral learning systems in synchrony. This broad-based neural activation leads to a highly interconnected, context-rich set of learning and memory traces. These highly interconnected memory traces will be slower to decay over time leading to better long-term retention. Because immersive training tools are available 24/7 the healthcare professional can have unlimited practice, and can test themselves under adverse conditions such as time pressure that will engage the emotional learning centers in the brain to begin to build situational awareness.

Immersive technology trains for retention and builds situational awareness that is critical in healthcare
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Immersive tools can also be used to train the behavioral skills necessary in healthcare. These can range from something simple like the care and maintenance of a central line, to something complex like heart surgery. Although any tool of this sort must be vetted with extensive clinical testing, the potential is clear. Imagine a VR or AR system in which a virtual patient is present. You go through the steps of central line care or heart surgery. The haptics are such that you “feel” the skin push back against your scalpel.

Much like with the anatomy and physiology training tool, this immersive approach engages the experiential, cognitive and behavioral learning systems in synchrony. This broad-based neural activation leads to a highly interconnected, context-rich set of learning and memory traces that are slow to decay and lead to better long-term retention. Because immersive training tools are available 24/7 the healthcare professional can have unlimited practice and can train and test themselves under a broad range of environmental conditions. This engages emotional learning centers and builds the situational awareness that is so critical in healthcare. Imagine training for the rare, but potentially life-threatening, situation in which an emergency medical technician needs to deliver a baby in the back of a van with minimal medical equipment available. Imagine training under chaotic conditions in which a healthcare professional must perform some medical procedure in a crowded hotel lobby with dozens of panicked onlookers. Imagine time is of the essence.

Immersive tools can be used to train behavioral skills in healthcare
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Although these may be rare situations, training under these conditions is critical for developing a broad-based knowledge and skill set. The best healthcare professional is one who is confident in their abilities and knows that they can handle almost any challenge. This instills confidence in the professional, but more importantly, this confidence shows and enhances patient satisfaction and confidence in the healthcare profession.

Gone will be the days of on-the-job training. With immersive technologies, healthcare professionals can start day 1 on the job with a strong knowledge-based and behavioral repertoire that has been honed and testing in immersive environments. Immersive technology trains for retention and builds situational awareness that is critical in healthcare.

For companies looking to get into Immersive technologies, our VR Consultancy service offers comprehensive support in the strategic deployment of Virtual, Augmented and Mixed Reality

Todd Maddox is Science, Sports and Training Correspondent at Tech Trends, and the CEO of Cognitive Design and Statistical Consulting. Follow him on Twitter @wtoddmaddox

The post Immersive Training for Retention appeared first on Tech Trends.

In many high-pressure situations such as emergency medicine, law enforcement, firefighting, air traffic control and the military the litmus test for success is behavioral performance.

It is one thing to know “what” to do, and to have the ability to verbalize the appropriate steps to achieve some aim, but it is another to know “how” to do it, and to generate the appropriate behaviors in the correct sequence quickly and accurately. The ability to verbalize is important for communication, but the ability to behave appropriately is often the difference between life and death.

With experience-based learning, broad-based brain activation occurs in synchrony, and results in multiple, interconnected memory traces that are less susceptible to forgetting
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Not only does one want to master the appropriate behavioral repertoire, but one must be able to generate these behaviors under time or social pressure, when all the necessary senses are unavailable (e.g., when in a smoke-filled room), or when some of the optimal tools are unavailable (e.g., when some medicine or medical tools are absent). In other words, one wants to obtain behavioral situational awareness.

The ability to verbalize is important for communication, but the ability to behave appropriately is often the difference between life and death
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Traditional approaches to emergency medical, law enforcement, firefighting, air traffic control and military training start with textbook and classroom study, then later introduce real-world practice, often through simulation. From a learning science perspective—the marriage of psychology and brain science—this means that you begin by training a cognitive understanding of the problem before training a behavioral understanding. This sequential approach to training, where you become proficient with the cognitive (textbooks and classroom) then become proficient with behavioral (real world or simulation) is suboptimal.

Learning science suggests that a better approach is to engage cognitive learning systems in the brain, such as the prefrontal cortex and medial temporal lobes, simultaneously with behavioral learning system in the brain such as the basal ganglia. Taken a step further, the optimal approach is to engage these cognitive and behavioral systems in the brain within an experience. To quote Albert Einstein, “Learning is an experience. Everything else is just information.” By engaging cognitive and behavioral systems within an experience, one broadly recruits the prefrontal cortex/medial temporal lobes (cognitive), basal ganglia (behavioral), and sensory experiential regions such as the occipital, temporal and parietal lobes. Critically, this broad-based brain activation occurs in synchrony, and results in multiple, interconnected memory traces that are less susceptible to forgetting.

A sequential approach to training, where you first become proficient with the cognitive, then with behavioral, is suboptimal
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One reason for traditional, sequential approaches to training is that real-world and simulation training is expensive, time-consuming and not scalable. Thus, the reasoning is that an initial focus on cognitive training will “bootstrap” the learner and require less real-world and simulation training to achieve behavioral mastery. The problem with this reasoning is that behavioral learning systems are distinct from cognitive learning systems in the brain and they have very different processing characteristics. Cognitive learning systems in the brain are ineffective at “bootstrapping” behavioral learning systems in the brain, which explains why learners often feel like they are “starting from scratch” when they begin real-world or simulation-based behavioral training.

By training on a broad-range of situations under different levels of emotional stress, the learner can develop the situational awareness needed to read the current situation and to anticipate future
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This is where virtual reality (VR) offers an ideal solution. With VR you can train the cognitive and behavioral learning systems in the brain within a context-rich experience. This broadly engages cognitive, behavioral and experiential learning systems in the brain in synchrony resulting in faster and more stable learning. Relative to real-world or simulation training, VR training is cost-effective, time-effective, and scalable. This allows the learner to obtain essentially limitless training on a broad array of situations. This is necessary to obtain mastery and expertise.

A better approach is to engage cognitive learning systems in the brain, such as the prefrontal cortex and medial temporal lobes, simultaneously with behavioral learning system in the brain such as the basal ganglia
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The range of situations that can be trained is essentially infinite. One can train on routine situations such as patrolling a peaceful demonstration or takeoff and landing under ideal weather conditions and non-routine situations such as crowd control during an escalating riot or takeoff and landing during a fast-moving weather pattern. One can train safely on dangerous situations such as an emergency C-section or infiltrating an insurgent hideout. Finally, one can train in situations that would be too expensive to train extensively with simulation such as a large war exercise or a massive viral outbreak. All of these situations can be trained under time pressure or under no time pressure, in loud and chaotic environments versus those free of distraction, or with adequate or inadequate preparation and equipment.

With VR you can train the cognitive and behavioral learning systems in the brain within a context-rich experience
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By training on a broad-range of situations under different levels of emotional stress, the learner can develop the situational awareness needed to “read” the current situation and to anticipate future, choosing the right course of action now and being prepared to change course in an instant if need be.

The range of situations that can be trained with immersive technologies is essentially infinite
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These high-pressure situations are ones that require preparedness before entering the workforce. One cannot afford to rely on on-the-job training in emergency medicine, law enforcement, firefighting, air traffic control, the military or any number of other jobs. They are too important for society and one wrong move can be the difference between life and death. When done right, VR offers the promise of effective training that will leave the learner job-ready from day one. The professional willing to undertake these high-stakes jobs deserves this level of preparedness and so does the public that they serve.

For companies looking to get into Immersive technologies such as VR/AR/MR/XR our Virtual Reality Consultancy services offer guidance and support on how best to incorporate these into your brand strategy.

Todd Maddox is Science, Sports and Training Correspondent at Tech Trends, and the CEO of Cognitive Design and Statistical Consulting. Follow him on Twitter @wtoddmaddox

The post The Brain Science of Simulation Training with Virtual Reality appeared first on Tech Trends.

Contagious yawning is a well-documented phenomenon in which people – and even some non-human animals – yawn reflexively when they detect a nearby yawn. Another aspect of this is that when people are in company, the presence of others also causes most of us supress that reflex (or at least try to).

The presence of an actual person in the testing room had a more significant effect on yawning than anything in the VR environment
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Contagious yawning is a well-documented phenomenon in which people – and even some non-human animals – yawn reflexively when they detect a nearby yawn
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So when studying the psychological effects of being immersed and interacting with others in Virtual Reality, researchers at the University of British Columbia decided to use yawning patterns as a benchmark to compare people’s behaviours in real-world face-to-face interactions as opposed to VR. And as often happens with such research – specially in what is still a relatively new field – the results were mixed and somewhat surprising.

To instigate contagious yawning in a VR environment, the team from UBC, along with Andrew Gallup from State University of New York Polytechnic Institute, had test subjects wear an immersive headset and exposed them to videos of people yawning. In those conditions, the rate of contagious yawning was 38 per cent, which is in line with the typical real-life rate of 30-60 per cent.

Researchers at the University of British Columbia decided to use yawning patterns as a benchmark to compare people’s behaviours in real-world face-to-face interactions as opposed to VR
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If the gap between VR and real life could be closed, scientists would be able to examine the link between the brain, behaviour, and the human experience in both actual reality and altered realities
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However, when the researchers introduced social presence in the virtual environment, they were surprised to find it actually had limited impact on subjects’ yawning. Subjects yawned at the same rate, even while being watched by a virtual human avatar or a virtual webcam. It was an interesting paradox: stimuli that trigger contagious yawns in real life did the same in virtual reality, but stimuli that suppress yawns in real life did not.

The presence of an actual person in the testing room had a more significant effect on yawning than anything in the VR environment. Even though subjects couldn’t see or hear their company, just knowing a researcher was present was enough to diminish their yawning. Social cues in actual reality therefore appeared to dominate and supersede those in virtual reality.

“People expect VR experiences to mimic actual reality and thus induce similar forms of thought and behaviour,” said Alan Kingstone, a professor in UBC’s department of psychology and the study’s senior author. “This study shows that there’s a big separation between being in the real world, and being in a VR world.”

Which is not really surprising, as we’re of course consciously aware that what we experience in Virtual Reality is different and separate from our experience of reality itself. However, there have also been numerous studies that show how psychological effects experienced virtually do carry on to our off-world behaviour.

Yet as VR becomes an increasingly popular research tool in psychology and other fields, these findings show that researchers also need to account for its limitations, the study concludes.

When the researchers introduced social presence in the virtual environment, they were surprised to find it actually had limited impact on subjects’ yawning
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“Using VR to examine how people think and behave in real life may very well lead to conclusions that are fundamentally wrong. This has profound implications for people who hope to use VR to make accurate projections regarding future behaviours,” said Kingstone. “For example, predicting how pedestrians will behave when walking amongst driverless cars, or the decisions that pilots will make in an emergency situation. Experiences in VR may be a poor proxy for real life.”

If that gap between VR and real life could be closed, scientists would be able to examine the link between the brain, behaviour, and the human experience in both actual reality and altered realities that span place and time, Kingstone added.

We’re of course consciously aware that what we experience in Virtual Reality is different and separate from our experience of reality itself
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Scientific research like this is extremely welcome as we continue to navigate our way through these immersive technologies and our effects in our brains, but as is often the case, it leaves us with a lot more questions than answers. For example, would the use of better, more realistic avatars affect the subject’s sense of social engagement with the experience? We know that this aspect of meaningful social interaction is one of the most challenging aspects of developing the technology, which is probably why we haven’t seen a Facebook equivalent in the Social VR space emerge as yet. And all this probably means that we might be seeing a lot more exciting research about yawning in VR…

This article originally appeared on VRScout

Scientists Use Yawning To Study Social Presence In VR via @alicebonasio https://t.co/0nuI1POFix pic.twitter.com/9Lms2q9s14

— VRScout (@VRScout) January 26, 2019

As VR becomes an increasingly popular research tool in psychology and other fields, these findings show researchers need to account for Limitations
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For companies looking to get into Immersive technologies our VR Consultancy service offers comprehensive support in strategic deployment of Virtual, Augmented and Mixed Reality

Alice Bonasio is a VR Consultant and Tech Trends’ Editor in Chief. She also regularly writes for Fast Company, Ars Technica, Quartz, Wired and others. Connect with her on LinkedIn and follow @alicebonasio on Twitter.

The post Studying Social Presence in VR appeared first on Tech Trends.

Limbix is building up immersive content that therapists can use to treat phobias, depression and anxiety.

There are over 300 peer-reviewed studies that show VR is an effective tool for treating mental health disorders such as anxiety, depression, trauma, and addiction.

It’s no wonder, therefore, to see a host of companies developing therapeutic content that leverages immersive technology. From helping passengers chill out during long-haul flights to AI-powered virtual therapists, this is a very promising space indeed.

It’s no wonder we're seeing a host of companies developing therapeutic content leveraging immersive technology
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There are over 300 peer-reviewed studies that show VR is an effective tool for treating mental health disorders such as anxiety, depression, trauma, and addiction
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One such company is Limbix, which has been collaborating with experts through academic research partnerships to create content for use by therapists in a broad range of applications such as Exposure Therapy, Mindfulness, Experiential Education and Skills Training.

They raised $3M in funding so far in a seed round led by Sequoia Capital. Since then, the Palo Alto-based company has managed to establish an impressive host of partnerships with high-profile organizations and researchers to guide their content creation process and document the efficiency of the VR experiences they set out to create.

“After over a year of research and interviews, we have not only confirmed interest in VR but also learned there are opportunities for the technology to support therapy and patient care in other ways,” says Elise Ogle, a researcher who previously worked at Stanford’s Virtual Human Interaction Lab, designing experiences such as the highly acclaimed Becoming Homeless, before taking on her current role as Program Manager at Limbix earlier this year.

In the mental health space, Ogle explains, there are fundamental issues with access to care and stigma that can keep people from receiving the care that they need. “VR is an innovative technology that patients are excited to use and can serve as a tool that healthcare providers can use to improve patient care,” she adds.

Limbix has been collaborating with experts through academic research partnerships to create content for use by therapists
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One example of what this can look like is a project focusing on adolescent depression intervention, which came about when Harvard researchers found that web-based intervention methods could be very effective at decreasing depressive symptoms.

The researchers at the Laboratory for Youth Mental Health at Harvard then wanted to find out how VR intervention would compare to this, and partnered with Limbix – as well as researchers from other institutions such as the Mood Disorders Laboratory at University of Texas at Austin and the Lab for Scalable Mental Health at Sony Brook University – to develop an experience which, in a single-session, provides intervention by teaching the subjects to adopt a growth mind-set which has been found helpful in overcoming depression.

Researchers at the Laboratory for Youth Mental Health at Harvard wanted to find out how VR would compare to web-based intervention
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“The goal of this experience is not only to bring insight into depression — and let adolescents know they aren’t alone in their struggles — but also to teach adolescents how to process and work through their feelings and challenges,” says Ogle, explaining that they are now nearly finished with obtaining IRB approval and will be starting a clinical study early in the new year.

Another clinical study due to begin in January is led by Dr. Barr Taylor from Stanford University/Palo Alto University and Dr. Michelle Newman from Penn State, who were also using VR as a part of exposure therapy treatment for patients with social anxiety.

“We focused on 2 different types of social scenarios that a person with social anxiety would likely have to experience in person, but could benefit from exposure to and practice with these situations in VR. In these scenarios, as they practice interacting with others in these social situations, they will learn to process their feelings of anxiety,” says Ogle.

Patients in the VR therapy group will be exposed to scenarios ordered according to their own personal ‘fear hierarchy’ by working their way from what makes them least anxious, then gradually upping the tension to what makes them most anxious.

As they practice interacting with others in social situations, patients learn to process their feelings of anxiety
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Patients in the VR therapy group will be exposed to scenarios ordered according to their own personal ‘fear hierarchy’
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The two situations they initially designed were a job interview and a social gathering with strangers. For each situation they filmed a number of scenarios to be used by the researchers to build that fear hierarchy for each patient.

Examples of the first type of situation included answering tough questions in front of varying interviewers, participating in a group interview, and a more casual interview, while situation two required patients to get a stranger’s attention at a party, send food back they hadn’t ordered, and answer standard ‘getting to know you’ questions from a stranger. The plan is to continue building a comprehensive content library of VR experiences to aid the treatment of a broad spectrum of mental health disorders

As well as having health benefits, this immersive technology also represents a sizeable market opportunity
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The plan is to build a content library of VR experiences to aid the treatment of a broad spectrum of mental health disorders
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As well as the health benefits, this technology also represents a sizeable market opportunity, as it could be deployed across a range of patient care areas such as Behavioral Health Centers, Clinics, Addiction Treatment Centers, and even schools. Limbix have already started opening up product access to paying customers and will use their feedback to guide further development as they scale.

This article originally appeared on VRScout

Therapists Using VR To Treat Mental Health Issues via @alicebonasio https://t.co/iPi1ApezQw pic.twitter.com/4X3zJ34Plq

— VRScout (@VRScout) December 27, 2018

For companies looking to get into Immersive technologies our VR Consultancy service offers comprehensive support in strategic deployment of Virtual, Augmented and Mixed Reality

Alice Bonasio is a VR Consultant and Tech Trends’ Editor in Chief. She also regularly writes for Fast Company, Ars Technica, Quartz, Wired and others. Connect with her on LinkedIn and follow @alicebonasio on Twitter.

The post Virtual Reality Improving Mental Health appeared first on Tech Trends.