<h1 class="ltx_title_section"><cite class="ltx_cite" data-bib-text="@article{Gaba_1995,
doi = {10.1518/001872095779049435},
url = {http://dx.doi.org/10.1518/001872095779049435},
year = 1995,
month = {mar},
publisher = {{SAGE} Publications},
volume = {37},
number = {1},
pages = {20--31},
author = {David M. Gaba and Steven K. Howard and Stephen D. Small},
title = {Situation Awareness in Anesthesiology},
journal = {hum factors}
}" data-bib-key="Gaba_1995" contenteditable="false"><a href="#Gaba_1995">Gaba 1995</a></cite> <cite class="ltx_cite" data-bib-text="@article{Gillespie_2013,
doi = {10.2147/jmdh.s40710},
url = {http://dx.doi.org/10.2147/jmdh.s40710},
year = 2013,
month = {mar},
publisher = {Dove Medical Press Ltd.},
pages = {109},
author = {Brigid Gillespie and Fairweather and Chaboyer and Karleen Gwinner},
title = {Building shared situational awareness in surgery through distributed dialog},
journal = {Journal of Multidisciplinary Healthcare}
}" data-bib-key="Gillespie_2013" contenteditable="false"><a href="#Gillespie_2013">Gillespie 2013</a></cite>Literature review<br></h1><div><br></div><div>Compare to traditional training, virtual reality simulation-based training[<cite class="ltx_cite" data-bib-text="@article{reznek2002virtual,
title={Virtual reality and simulation: training the future emergency physician},
author={Reznek, Martin and Harter, Phillip and Krummel, Thomas},
journal={Academic Emergency Medicine},
volume={9},
number={1},
pages={78--87},
year={2002},
publisher={Blackwell Publishing Ltd}
}" data-bib-key="reznek2002virtual" contenteditable="false"><a href="#reznek2002virtual">Reznek 2002</a></cite>,<cite class="ltx_cite" data-bib-text="@article{seymour2002virtual,
title={Virtual reality training improves operating room performance: results of a randomized, double-blinded study},
author={Seymour, Neal E and Gallagher, Anthony G and Roman, Sanziana A and O’Brien, Michael K and Bansal, Vipin K and Andersen, Dana K and Satava, Richard M},
journal={Annals of surgery},
volume={236},
number={4},
pages={458--464},
year={2002},
publisher={LWW}
}" data-bib-key="seymour2002virtual" contenteditable="false"><a href="#seymour2002virtual">Seymour 2002</a></cite>,<cite class="ltx_cite" data-bib-text="@article{freeman2001virtual,
title={A virtual reality patient simulation system for teaching emergency response skills to US Navy medical providers},
author={Freeman, Karen M and Thompson, Scott F and Allely, Eric B and Sobel, Annette L and Stansfield, Sharon A and Pugh, William M},
journal={Prehospital and Disaster medicine},
volume={16},
number={01},
pages={3--8},
year={2001},
publisher={Cambridge University Press}
}" data-bib-key="freeman2001virtual" contenteditable="false"><a href="#freeman2001virtual">Freeman 2001</a></cite>,<cite class="ltx_cite" data-bib-text="@article{gallagher2005virtual,
title={Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training},
author={Gallagher, Anthony G and Ritter, E Matt and Champion, Howard and Higgins, Gerald and Fried, Marvin P and Moses, Gerald and Smith, C Daniel and Satava, Richard M},
journal={Annals of surgery},
volume={241},
number={2},
pages={364--372},
year={2005},
publisher={LWW}
}" data-bib-key="gallagher2005virtual" contenteditable="false"><a href="#gallagher2005virtual">Gallagher 2005</a></cite>] have proven to have advantages in term of of convenience and repeat-ability and is a valid approach for improving an operator familiarity with procedures that requires hands on experiences.<br></div><div> <br></div><div><div>Decision making[<cite class="ltx_cite" data-bib-text="@inproceedings{Vannaprathip_2016,
doi = {10.1145/2856767.2856807},
url = {http://dx.doi.org/10.1145/2856767.2856807},
year = 2016,
publisher = {Association for Computing Machinery ({ACM})},
author = {Narumol Vannaprathip and Peter Haddawy and Siriwan Suebnukarn and Patcharapon Sangsartra and Nunnapin Sasikhant and Sornram Sangutai},
title = {Desitra},
booktitle = {Proceedings of the 21st International Conference on Intelligent User Interfaces - {IUI} {\textquotesingle}16}
}" data-bib-key="Vannaprathip_2016" contenteditable="false"><a href="#Vannaprathip_2016">Vannaprathip 2016</a></cite>] has already proven itself to be a viable training that fit perfectly with the form and the interaction allowed within our system. Using serious game approaches of in-game narrative style combine with visual and audio cue we can create an interactive tool that teach emergency and stressful situation handling very effectively and using gamification technique, we hope to maximize engagement and memory retention <cite class="ltx_cite" data-bib-text="@article{tsui2014septris,
title={Septris and SICKO: implementing and using learning analytics and gamification in medical education},
author={Tsui, J and Lau, J and Shieh, L},
journal={Educause Review,(March)},
pages={1--7},
year={2014}
}" data-bib-key="tsui2014septris" contenteditable="false"><a href="https://www.authorea.com/users/95993/articles/113645/_show_article#tsui2014septris">Tsui 2014</a></cite>,<cite class="ltx_cite" data-bib-text="@article{Chittaro_2015,
doi = {10.1109/tvcg.2015.2391853},
url = {http://dx.doi.org/10.1109/tvcg.2015.2391853},
year = 2015,
month = {apr},
publisher = {Institute of Electrical {\&} Electronics Engineers ({IEEE})},
volume = {21},
number = {4},
pages = {529--538},
author = {Luca Chittaro and Fabio Buttussi},
title = {Assessing Knowledge Retention of an Immersive Serious Game vs. a Traditional Education Method in Aviation Safety},
journal = {{IEEE} Trans. Visual. Comput. Graphics}
}" data-bib-key="Chittaro_2015" contenteditable="false"><a href="https://www.authorea.com/users/95993/articles/113645/_show_article#Chittaro_2015">Chittaro 2015</a></cite>.<br></div><div><br></div><div>In order to convey the emergency and possible panic inducing situation which can happen during a medical operation and not normally taught with traditional training method, we use VR for the training to achieve highest immersion. <br></div><div><br></div><div>Using VR related in emergency training has been done before for example <cite class="ltx_cite" data-bib-text="@article{freeman2001virtual,
title={A virtual reality patient simulation system for teaching emergency response skills to US Navy medical providers},
author={Freeman, Karen M and Thompson, Scott F and Allely, Eric B and Sobel, Annette L and Stansfield, Sharon A and Pugh, William M},
journal={Prehospital and Disaster medicine},
volume={16},
number={01},
pages={3--8},
year={2001},
publisher={Cambridge University Press}
}" data-bib-key="freeman2001virtual" contenteditable="false"><a href="https://www.authorea.com/users/95993/articles/113645/_show_article#freeman2001virtual">Freeman 2001</a></cite> but most of VR based studies are training of procedures under relatively normal situation. The trainee normally knows what to expect to do in the training. Our study want to focus on how an operator would and should handle the unexpected emergency situation that can occurs during the surgery procedure that require precision, in which the mishandling of the sudden emergence could be costly to the patience.<br></div><div><br></div><div>we select cardboard for the easy accessibility, mass adaptation and portability. The decision is based from the same as how a game designer/marketing would choose the platform.<br></div><div><br></div><div>Following <cite class="ltx_cite" data-bib-text="@inproceedings{Vannaprathip_2016,
doi = {10.1145/2856767.2856807},
url = {http://dx.doi.org/10.1145/2856767.2856807},
year = 2016,
publisher = {Association for Computing Machinery ({ACM})},
author = {Narumol Vannaprathip and Peter Haddawy and Siriwan Suebnukarn and Patcharapon Sangsartra and Nunnapin Sasikhant and Sornram Sangutai},
title = {Desitra},
booktitle = {Proceedings of the 21st International Conference on Intelligent User Interfaces - {IUI} {\textquotesingle}16}
}" data-bib-key="Vannaprathip_2016" contenteditable="false"><a href="#Vannaprathip_2016">Vannaprathip 2016</a></cite>'s Desitra, We choose endodontics surgery decision making simulation as the base for our application due to the compactness of the surgery that at the same time also has multiple possibility of emergency situation that can happen during the surgery. <br></div><div><br></div><div>Taking lesson from <cite class="ltx_cite" data-bib-text="@inproceedings{Pearson_2003,
doi = {10.4271/2003-01-3065},
url = {http://dx.doi.org/10.4271/2003-01-3065},
year = 2003,
month = {sep},
publisher = {{SAE} International},
author = {Gary M. Pearson and David J. Tomlinson},
title = {Voice Recognition and Speech Synthesis in an {ATC} Simulation Environment},
booktitle = {{SAE} Technical Paper Series}
}" data-bib-key="Pearson_2003" contenteditable="false"><a href="https://www.authorea.com/users/95993/articles/113645/_show_article#Pearson_2003">Pearson 2003</a></cite>'s study of how voice recognition can be used to effectively created a responsive, direct voice input simulation, we use google voice recognition library in our simulation to create a responsive assistance that the operator can ask for equipment during the operation.<br></div><div><br></div><div>Our recreation of the operating room and the ambient are not based on the as-realistic-as possible approach but as <cite class="ltx_cite" data-bib-text="@article{Bowman_2007,
doi = {10.1109/mc.2007.257},
url = {http://dx.doi.org/10.1109/mc.2007.257},
year = 2007,
month = {jul},
publisher = {Institute of Electrical {\&} Electronics Engineers ({IEEE})},
volume = {40},
number = {7},
pages = {36--43},
author = {Doug A. Bowman and Ryan P. McMahan},
title = {Virtual Reality: How Much Immersion Is Enough?},
journal = {Computer}
}" data-bib-key="Bowman_2007" contenteditable="false"><a href="#Bowman_2007">Bowman 2007</a></cite> has found, focusing more on convincing the user of being in the computer generated world is a better approach.<br></div><div><br></div><div><cite class="ltx_cite" data-bib-text="@article{Cristancho_2016,
doi = {10.1016/j.amjsurg.2015.03.010},
url = {http://dx.doi.org/10.1016/j.amjsurg.2015.03.010},
year = 2016,
month = {jan},
publisher = {Elsevier {BV}},
volume = {211},
number = {1},
pages = {64--69},
author = {Sayra M. Cristancho and Tavis Apramian and Meredith Vanstone and Lorelei Lingard and Michael Ott and Thomas Forbes and Richard Novick},
title = {Thinking like an expert: surgical decision making as a cyclical process of being aware},
journal = {The American Journal of Surgery}
}" data-bib-key="Cristancho_2016" contenteditable="false"><a href="#Cristancho_2016">Cristancho 2016</a></cite><br></div><div><cite class="ltx_cite" data-bib-text="@article{Maher_2013,
doi = {10.1016/j.amjsurg.2012.10.007},
url = {http://dx.doi.org/10.1016/j.amjsurg.2012.10.007},
year = 2013,
month = {feb},
publisher = {Elsevier {BV}},
volume = {205},
number = {2},
pages = {169--174},
author = {Zoë Maher and Richard Milner and Jane Cripe and John Gaughan and Joel Fish and Amy J. Goldberg},
title = {Stress training for the surgical resident},
journal = {The American Journal of Surgery}
}" data-bib-key="Maher_2013" contenteditable="false"><a href="#Maher_2013">Maher 2013</a></cite><br></div><cite class="squire-citation ltx_cite" data-bib-text="@article{Sarker_2008,
doi = {10.1007/s00464-008-9774-6},
url = {http://dx.doi.org/10.1007/s00464-008-9774-6},
year = 2008,
month = {mar},
publisher = {Springer Science $\mathplus$ Business Media},
volume = {23},
number = {1},
pages = {197--203},
author = {Sudip K. Sarker and Saif Rehman and Meera Ladwa and Avril Chang and Charles Vincent},
title = {A decision-making learning and assessment tool in laparoscopic cholecystectomy},
journal = {Surgical Endoscopy}
}" data-bib-key="Sarker_2008" contenteditable="false" style="cursor: pointer"><a class="au-cite-link" href="#Sarker_2008">Sarker 2008</a></cite><br></div><div><br></div>
