Cullen Jackson, PhD has been with us for ten years and contributed his skill in human factors engineering to our QSI and Education Divisions. He is an Instructor in Anaesthesia at HMS, Associate Director for Research in the Center for Education Research, Technology, and Innovation (CERTAIN), and the Director for Innovation & Research in the Shapiro Simulation and Skills Center at BIDMC. Dr. Jackson earned his ScM and PhD in Psychology at Brown University. His research centers on “understanding people and the environments in which they work to optimize overall system performance by applying theories and techniques from human factors engineering (HFE).” (HFE is the application of human factors knowledge to the design and development of equipment, products, work systems, management systems and tasks.) Dr. Jackson starts a new position this summer as Clinical Professor of Industrial Engineering with a specialty in healthcare human factors at Clemson University in South Carolina. He spoke to us about his work in Virtual Reality (VR) and the implication of this kind of work for both health care quality and medical training.
Starting with the department:
I started as Director of Innovation back in 2014, and when the department was re-organized, I formally joined the re-imagined Quality, Safety and Innovation Division. My previous job was conducting defense research to improve human/systems performance, and there was a grant that allowed me to collaborate with Dr. Talmor and others at the hospital. Danny decided to bring me on to integrate human factors engineering (HFE) into the department. I did mostly simulation-based training in the defense industry, and as I learned about OR anesthesia, critical care and pain medicine, I found ways to apply my non-physician lens to these areas, and partnered with various folks to come up with projects to improve quality and patient safety.
His current work in VR:
I am Co-PI on an NIH-funded project to develop and assess a VR-based simulation environment for training non-technical skills for surgical teams. We’ve created a virtual OR to allow anesthesiologists, surgeons, CRNAs and OR nurses to work on skills like teamwork, decision making and critical thinking. That project is parallel with a CERTAIN initiative to study using VR to teach clinical procedures. The larger question is how can virtual reality facilitate medical education and is it effective? Can we benefit from a VR system that teaches central venous catheterization, tracheotomy, cricothyrotomy, donning and doffing of PPE, or teamwork? Beyond my NIH project, we’re working with industry partners to understand how effective these VR systems are. For example, Drs. Shiri Savir and Sara Neves are studying whether a VR system (developed by Vantari VR) is as good as using physical mannequins to teach central venous line placement to first year residents. Initial results are promising, but it will take a while to see how big a game changer VR will be.
Benefits of VR:
If outcomes are comparable with what we are doing now in physical simulation-based education, maybe we should use VR because there are additional benefits to using it. Our current task trainers cannot change the sex, race, ethnicity of the mannequin or make the procedure harder or easier, whereas we can do that in VR. People can also learn from different locations if they have a headset and computer and access to the technology. We have ongoing studies on outcomes so hopefully we will have some answers in the not too-distant future.
Concerns about VR:
Of course, there is something important about interacting with other people. With VR, we can interact with other people—albeit through a digital representation—who behave and react to each other. The disadvantage is you can’t see body language and other important social cues. From a training and education standpoint, there is a benefit to working together, which we do during in-person clinical work. The challenge is in translating the in-person environment in high-fidelity VR that simulates our environment, so it is comparable to training in the sim center or the Center for Medical Simulation (CMS). If it doesn’t translate well, is it because of the technology or because it is better to train in person? There are more questions than answers right now and we are in a natural experiment globally—thanks to the explosion of remote work due to the pandemic—to see how this shakes out.
My new role at Clemson:
I will be teaching in the Dept. of Industrial Engineering, doing research similar to what I am doing here and working with undergraduate and graduate students. Also, one of my roles is to strengthen the department’s relationship with Prisma Health, a large health care system based in Greenville, SC. They are an innovative, forward looking organization interested in integrating more human factors engineering into their clinical systems, so I’ll be responsible for strengthening those ties through partnerships with our department.
Favorite thing about working in our department:
I really like the people I’ve worked with all these years, and I include all the people I have worked with in nursing, surgery and the sim center. I’ll really miss those relationships. Since I still have a grant here, I’ll have a toe in the door and will continue to work with folks in the department and the sim center to keep my NIH project going for another year and a half.