Design specifications and capabilities of a 3D simulation software for clinical education of physiotherapy students in the neurology department | BMC Medical Education

In this study, a scenario was compiled for a patient with the diagnosis of stroke. In the record-reading section of the 3D software, the user can read the patient’s medical record in text format. In the second section, the muscle strength examinations and requirements are defined in the form of animation, text, and audio. Then, the content validity of the designated scenario was assessed by a questionnaire that contained the required items for various capabilities of the software in each section. Eleven university physiotherapy professors with Ph.D. degrees and an average educational experience of 20.81 years completed the questionnaire.

Based on CVR, the approved items for the first section included displaying information about reflex, motor, and sensory examinations, as well as gait patterns and the disease diagnosis. However, concerning the possibility of displaying cranial nerves, the experts did not approve of the necessity for displaying the information about the examination of the 1st ,9th ,10th, and 12th cranial nerves. The necessity for displaying all items in the second section was approved by the experts.

One of the most important phases for designing simulation and educational software is to compile scenarios in detail [22, 23]. Consistent with our research, Ulrich F. and his colleagues (2021) conducted a study that emphasised the actual teaching environment in order to generate various scenarios. Consequently, the pertinent educational materials were developed in partnership with experts in physiotherapy education. The scenarios encompassed educational topics such as: (a) the significance of the supine position; (b) commonly used abbreviations; (c) proper placement of equipment; (d) accurate configuration and preparation of the medical bed; (e) correct positioning of the neck and knee rest; (f) techniques for achieving a locked knee in the supine position; and (g) strategies for managing patient restlessness [24]. In line with our study, significant scenarios were identified prior to the finalisation of the software’s design and content determination [25].

Almost the same as our research, a framework was presented that aims to introduce a novel and flexible method for teaching in a simulation-based training environment in the medical sciences. The presented virtual operative assistant was validated for a complex neurosurgical procedure [26]. In another study [27], similar to ours, there have been some training scenarios that are related to anatomy education. Users can engage in simulations where they can teleport to locations inside a virtual human body, resize and view objects from any angle, and sketch in a 3D environment to test their comprehension. Correspondingly, a framework for generating scenarios based on data was proposed for the purpose of game-based training. The findings indicated that taking into account the temporal aspect of events is crucial for evaluating scenarios, and the suggested framework effectively generates scenarios for game-based training [28]. Sequencing processes and events in scenarios enables the meticulous development of application software and ensures the design is based on sound principles. In our project, we systematically and scenario-orientedly compiled measures related to medical record reading and physiotherapy examinations to be used in the software development stage.

Skills other than record reading and examining the patient’s muscle strength will be taught using the scenario that has been compiled. A specific scenario for an inpatient setting was defined for the current study so that students could gain experience managing a stroke patient during their first visit. In addition, not only can they apply their theoretical knowledge—which was intended for outpatient settings—but they can also examine six distinct segments in the upper and lower limbs in the proper positions according to the patient’s circumstances. Training items such as the possibility of displaying the current disease, vital signs, the state of mind, the state of the cranial nerves, the status of reflexes, motor system examinations, sensory system examinations, cerebellar examinations, the walking condition, and all the other training items that are necessary to evaluate the patient’s muscle strength are included in the developed scenario and the presented model.

Similar to our study, a visual platform was created to imitate gamified training situations using rapid prototyping and VR software design patterns. Scripting scenarios is the essential approach for creating and representing designs and models. A visual scripting module has the ability to create training applications using a node-based scripting system. The VR editor allows users/developers to customise and create new VR training scenarios directly within the virtual environment [29].

We used a conceptual model for the 3D training software and UML diagrams for its analysis and design. UML consists of a series of graphic diagrams, and in this study, use-case, activity, and sequence diagrams were depicted. As can be seen in the diagrams of the physiotherapy simulation software, the student has been identified as the main factor in this software [30]. Among the operations that are considered in these diagrams, we can point to entering the neurology department, medical record reading, muscle strength examinations of upper and lower limbs, and exiting the software [31]. Since the use case depicted diagram could not fully show the components of activities, the activity diagrams were also used to model the workflow between the components of physiotherapy clinical education simulation software; for operations such as entering pages (training homepages, medical record reading, physiotherapy examinations, and exiting the software), activity diagrams have been depicted.

Due to the sequence diagrams’ importance, a sequence diagram has been drawn for the physiotherapy clinical education simulation software, which included entering the pages of the training, record reading, physiotherapy examinations, and exiting the software.

Strengths and limitations

To the best of our knowledge, the current study is the first survey of experts to determine the information components and functional capabilities of the 3D software, which broadens the applicability of our findings. The unwillingness of some professionals who were referred to universities to cooperate is one of the study’s most important shortcomings. The absence of relevant, useful literature was another significant barrier, yet our work inventiveness was incredibly high as a result of this dearth.

Implications for practice

In very recent years, traditional teaching approaches and learning methods have been supplanted by simulation-based learning tools. The need for computerized simulations is becoming more and more widespread worldwide, so modern countries are greatly affected by this problem. As a result, we suggest that developing nations provide an appropriate setting for this research. Though the cost, time, location, and methods of implementation vary widely based on the specifics of the application, the majority of them are costly and need adequate space. It is advised that governments budget for this kind of training and associated costs.