MediSim Pro, a medical training feedback application
Summary
This was a semester long project we did for the course 'Introduction to Interaction Design'. The objective was to get an overview of the design thinking methods and develop design sensibilities.
We were introduced to this topic by collaborating with the University of Michigan Medical School Department of Learning Health Sciences (DLHS).
MediSim Pro, is an application for ACLS (Advanced Cardiovascular Life Support) instructors to evaluate trainees and provide them feedback.
Team
Our team of 5 all from diverse perspectives and expertise across a range of fields which included psychology, public health, data analytics, engineering, and architecture
Tools
Google Suite, Google Survey, Miro, Figma, Mural, Zoom
Role
Ideation, Research, Journey mapping, Interviewing, Competitive analysis, Paper Prototyping, Creating Style guide, Hi-fi prototype
Process
We followed this step by step path to reach the goal as directed by our instructors. Since this project was assigned to us we had little understanding about the users and their needs.
Every project has a slightly different process molded to its context, timeline and focal area. This project focused on studying and designing the interactions for the given context, and not so much on initial user research and empathy.
Background
There are two types of life-saving training programs to prevent fatalities: BLS and ACLS. Basic Life Support (BLS) is for anyone, including lifeguards, teachers, babysitters, and coaches, teaching fundamental life support skills. ACLS, on the other hand, is an advanced program typically for medical professionals, building upon BLS.
ACLS certification involves two components: an online module and hands-on training. The online module must be completed before in-person training, which takes place at certified clinical simulation centers like the University of Michigan Clinical Simulation Center. Certification expires every two years, requiring professionals to retake the test. The American Heart Association (AHA) sets criteria for assessing ACLS trainees.
'There are more than 356,000 out-of-hospital cardiac arrests that occur annually in the United States, and around 90% of them are fatal'
-American Heart Association
VISIT TO THE SIMULATION CENTER
Visiting the simulation center provided valuable insight into the training environment and helped us visualize the roles of instructors and trainees. The University of Michigan Clinical Simulation Center (CSC) is part of the Department of Learning Health Sciences.
KEY OBSERVATIONS
The simulation center featured a diverse range of mannequins, representing various ages, genders, and conditions, enabling learning and skill development for different scenarios.
These mannequins had sound and touch sensors, manipulated by instructors to simulate real-life situations, such as a baby crying.
The simulation room had surveillance for video recording feedback and one-way mirror observation rooms with microphones for real-time assessment.
Following each training session, there was a debriefing room where instructors and trainees discussed the training experience.
Currently, feedback is provided in person during debriefing sessions.
NEEDFINDING PROCESS
To understand user needs, we conducted interviews with medical professional in different roles and levels of experience. We also did literature review to find qualitative and quantitative data on feedback systems, ACLS and simulation, feedback were some of the key words. ACLS Training at the University of Michigan Medical School includes a 2-fold extensive process as explained below :
In the first part, trainees assume various roles mimicking real-life cardiac arrest scenarios, such as medication provider, main compressionist, note-taker, and team leader. There can be up to seven roles, including an airway manager, a defibrillator operator, and a backup member.
The second part of training occurs in the debriefing room, where instructors watch the simulations with assigned roles and provide real-time feedback to all trainees immediately after each session.
COMPETITIVE ANALYSIS
This experience shed light on the variations in ACLS training methods across institutions, including the types of skills assessed. While technical skills were universally evaluated, communication and psychomotor skills were not consistently assessed. Our competitor analysis offered a valuable framework for structuring our student-teacher feedback platform system.
PROBLEM ANALYSIS
Through user interviews, surveys, and literature research, we identified key user pain points. This crucial step involved synthesizing data and framing the problem, enabling us to pinpoint problem areas and align on a common goal.
WHAT IS THE PROBLEM?
Limited time to give feedback after ACLS training
Currently, the feedback is provided by synchronously communicating by being in the room or in the debriefing room after the procedure.
There is no standardized way of giving feedback, the method varies from instructor to instructor.
Having no proper feedback method is causing confusion among trainees, instructors and peers. Since ACLS is a fast-paced procedure where the feedback at the right time is crucial in learning it the right way, it is important to get the feedback at the moment.
The feedback given by communicating synchronously distracts the trainee from doing the next steps in the procedure.
Instructors have to utilize the memory of simulation to give feedback.
SYNTHESIS
In a high-intensity medical setting, time is precious. Medical staff, including ACLS instructors, face challenges in delivering immediate, comprehensive feedback to all participants due to time constraints and potential emergencies. The feedback covers technical skills based on AHA checklists and non-technical skills, including time-sensitive aspects like closed-loop communication and pressure-sensitive parameters. Our target users encompass University of Michigan trainees, instructors, and healthcare staff, both new and returning.
'THERE IS NO FORMAL RUBRIC TO ASSESS THE NON TECHNICAL SKILLS, SO THERE IS LITTLE EMPHASIS ON THESE SKILL SETS'
-AN ACLS INSTRUCTOR
'FEEDBACK IS MAINLY FOCUSED ON THE TECHNICAL SKILLS'
- ACLS TRAINEE
'EVERY INSTRUCTOR DELIVERS THE DEBRIEF DIFFERENTLY, DEBRIEF TIMES VARY'
-MEDICAL STUDENT
PROBLEM FRAMING
SKETCHES
As a team, we individually put our thoughts on paper by making simple sketches on solutions we each could come up. We realized that we came up with varied solutions to our problem area. Understanding each other's perspective further helped us iterate on making the solution better.
Typing out a comment while the session is active in procedure.
Timestamping in the video recording to comment
Toggle between AHA checklist, non technical skills and communication skills
Toggle between trainees to give them feedback
HIghlighting trainees in video recording to direct a particular feedback
Time stamping the video timeline with audio and text based comments
STORYBOARDING
After making the individual sketches, we had a group discussion where we exchanged our ideas. We then amalgamated a few of the concepts into this one story. It explains how our users will interact with our system.
Instructor assign trainees to their respective roles through the app.
Trainees working through the algorithmic scenarios given by the instructor.
The conversation between the team leader and the trainees form a loop, which is one of the important training criterias.
Instructor provides feedback in real time via the app based on observations of the trainees.
Trainees receive access to feedback once instructor releases the data through the application and they see the detailed note and feedback from the instructors
QOC (QUESTIONS, OPTIONS, CRITERIA)
Here we took some of the critical decision based on QOC. This method made it easy to weigh many criterias against multiple options. It helps in eliminating the options that is less preferred over the other. Brainstorming over each of the design decisions, this helped in justfying and substantiate our decisions.
Design decisions made based on QOC :
Regarding the simulation page layout, we decided to place the participant's tab on the left side, making it easier for instructors to switch between them with their left hand while managing other tasks with their right hand.
As for the platform choice, we opted for a tablet for instructors due to its portability and larger screen. For participants, we initially considered a mobile app for convenience, but due to higher development and maintenance costs and lower frequency of use, we decided on a web application. It's cost-effective and aligns with participants' familiarity with web-based operations, especially considering they access it once every two years.
STORYMAPPING
Using our personas, we created story maps for each user, categorizing their activities into onboarding, scheduling, and debriefing. These maps provided a detailed view of user activities, helping us design application spaces to maximize use cases and outcomes by identifying specific task sequences.
Trainee
Instructor
USER FLOW DIAGRAM
Before jumping into making the low fidelity prototype, we finalized our flow diagram. Here we could visualize the interactions that would be needed to perform and transition between various activities on the application.
Hi Fi Prototype
We came up with the final outcome based on iterating Lo and Mid fi prototype.
trainee view.mp4Trainee view on desktop screen
instructor view.mp4Instructor view on tablet screen
Style guide
Stype guide for the tablet applicant
Style guide for the desktop application
REFLECTION
How does our design aid in solving the problem?
Our final design focuses on two key functionalities.
Firstly, instructors have a digital evaluation list for simulations, including communication evaluations and real-time feedback. Instructors can assign roles to participants, each with their own checklist. After the simulation, instructors can review, edit, and upload reports to aid in debriefing or later review.
Secondly, trainees can access past reports and register for new simulation sessions. These features are designed to support instructors in providing feedback and help participants enhance their learning experience, aligning with our primary goal.
How is our design unique as compared to the competitors?
We've introduced digital tablet and website versions of our feedback system, offering enhanced efficiency, standardization, and eco-friendliness compared to traditional paperwork.
Our integrated workflow system streamlines ACLS training from registration to simulation and feedback, ensuring an intuitive experience.
Detailed criteria for technical and communication skills provide trainees with comprehensive performance insights.
Our application allows seamless switching between trainees and tasks during the procedure, minimizing feedback time gaps.
LEARNINGS
This felt like an overwhelming task especially because I was absolutely unaware about ACLS training.
Balancing interactions and information to ease cognitive and physical loads initially posed a challenge.
This project expanded my skills and introduced me to new challenges.
I'm grateful to my incredible team and instructors for their support and collaboration.