Veterinary Haptics

Dr Sarah Baillie, inventor of the Haptic Cow, has recently been awarded the Times Higher Education's Most Innovative Teacher of the Year 2009 (see ViEW News article about the award) for her work with haptic simulators. Over 80 university teachers from around the UK and all Higher Education disciplines were entered for the award. More information is available on the RVC website, the Times Higher Education website, in the awards article and on YouTube (7min 50s into the clip)

NEWS ITEMS and GENERAL INFORMATION

** January 2010: TOUCHaptics - Our NEW website for anyone interested in haptics www.touchaptics.com

** Summer 2009: Royal Society Summer Science Exhibition 'Do you feel like a vet?' (read our report)

** February 2009: Haptic simulator used in anatomy teaching for first time

** January 2009: Feline Abdominal Palpation Simulator poster wins prize in 'Simulator Design' section at Medicine Meets Virtual Reality 17, Long Beach, California.

The Haptic Cow

Watch a BBC video of the Haptic Cow at Cutting-edge Science

The Haptic Cow is the most well known of the veterinary haptic simulators but there is much more to veterinary haptics: To find out more see the 'Haptic Projects' links (in the box at the top on the right).
For a list of our publications click: Publications & Presentation.

The Haptic Cow is a virtual reality (VR) simulator developed by a veterinarian (Sarah Baillie). Sarah has been working and teaching in veterinary practice for many years and also has a Masters and PhD in Computing Science. The Haptic Cow was developed to help train veterinary students to palpate a cow's reproductive tract, to perform fertility examinations and to diagnose pregnancy. The simulator uses haptic (touch feedback) technology and has a PHANToM haptic device (from SensAble Technologies) positioned inside a fibreglass model of the rear-half of a cow. When being trained with the Haptic Cow, the student palpates computer- generated virtual objects representing the uterus, ovaries, pelvis and abdominal structures. The teacher provides instruction and feedback while following the student's hand movements inside the cow on the computer monitor. The Haptic Cow is being used by several of the UK vet schools.

The Haptic Cow Simulator

Simulator Design

The virtual anatomical models have been created by Sarah Baillie, a veterinary surgeon who, after many years in practice, retrained in computing science. There has also been regular input from other experienced clinicians. This approach has led to the development of a range of models that feel convincingly realistic (Baillie et al, 2003) and new models are being added all the time. There are simulations that represent: typical fertility cases; early and advanced pregnancies; and examples of less common and pathological conditions.

Simulator Validation

The simulator has been validated i.e. shown to be an effective teaching tool (Baillie et al [1], 2005). Students taught with the simulator performed significantly better when examining real cows and set the task of locating the uterus than a control group i.e. skills learned in the simulated environment transferred to the real task. It is important that students have the skills to find and identify the uterus because these are prerequisites for performing a full fertility examination, diagnosing pregnancy and even putting a scanner in the right place.

Using the Haptic Cow

The Haptic Cow was first used in farm animal teaching at Glasgow in 2003 (during Sarah Baillie's PhD) and extensive feedback was gathered from students (Baillie et al [2], 2005). It is now in use at several vet schools in the UK.

At the Royal Veterinary College (RVC), London, Sarah Baillie has been investigating ways to extend the use of the Haptic Cow in the curriculum. This has led to its use at several stages:

• In 3rd year it is used to teach the basic skills in preparation for farm animal practicals and EMS (extramural studies / workplace training). Peer tutors (students) have been trained to deliver this teaching.
• There is also an automated, self-teaching, version whereby the haptic device moves the student’s hand along a pre-recorded path (an examination performed by a vet). Students can use this version on their own - and book the training via the cow's own Outlook calendar.
• In anatomy teaching: students earlier in the course use the Haptic Cow to learn about bovine abdominal anatomy using the simulator.
• In the Farm Animal Clinical Rotation the Haptic Cow is used in a role-play exercise: the Simulated Fertility Visit (see next section below).

In the 18 months from April 2007, the ‘sign in’ book has recorded that over 900 students at the RVC have used the simulator.
The 'Simulated Fertility Visit' role-play tutorial

The Simulated Fertility Visit

In clinical rotations, the Haptic Cow is used to run a small group role-play tutorial: the Simulated Fertility Visit. A member of staff has the role of the ‘farmer’ and students take turns as the ‘vet’ and examine a series of virtual cows for pregnancy diagnosis and with fertility problems. The students get to ‘think on their feet’ and practise communication skills, history taking, and have to make a diagnosis and decide on the treatment or action plan. All must be delivered in a way that the ‘farmer’ understands. This way of using the simulator represents a safe, ‘trial and error’ learning environment and obviously mistakes do not carry serious consequences...

The Simulated Fertility Visit has proved a very popular way of using the Haptic Cow with students (full report currently in preparation). An example of a typical quote from student feedback forms:

“Integrating information on the status of the cow, with the findings of the palpation and then deciding on a course of action - it was a brilliant opportunity to develop this skill.”

What is Haptics?

Haptic technology allows a person to interact with a 3D computer-generated virtual environment through the sense of touch. We use haptics to develop simulators for teaching veterinary palpation-based examinations and procedures. When the clinician palpates an animal, a judgement is being made about an organ or structure's shape, size, softness and position, and this information is used to help make a diagnosis. Using the simulators, students can practise a range of examinations in different species and improve their manual skills. One example, the Haptic Cow, is used to teach bovine fertility examinations. Students learn to palpate (and actually get the impression of feeling) the virtual uterus and ovaries. And, as this is a computer simulation, with the ‘click of a button’ another cow can be presented, which could be pregnant or have an ovarian cyst.

Why Use Haptics in Veterinary Training?

Teaching procedures and tasks that are internal and unsighted is particularly difficult. For example, when performing bovine fertility examinations the vet’s hand is inside the cow and out of sight, so how can the student copy? In turn, the vet can’t see what the student is doing or know what he or she is touching, so providing effective guidance is difficult. Students also need to learn to use the right amount of pressure when feeling structures – enough but not too much. However, it is difficult to know, or for a clinician to describe, how much pressure is being used. We are using haptic simulators to help us address these teaching challenges.

The Veterinary Haptics Team at the Royal Veterinary College

The first of our veterinary simulators, the Haptic Cow, was developed by Sarah Baillie. Sarah is a veterinary surgeon who worked in practice for many years (1986 – 2006) but also has a Masters (2001 – 2003) and PhD (2003 – 2006) in Computing Science. Her combination of skills – in clinical work, teaching and computing – has proved invaluable when developing the simulators.

The haptics work at the RVC now involves a team: Sarah Baillie, Neil Forrest (haptics software developer) and Tierney Kinnison (LIVE research assistant); as well as regular help and input from vet students and clinicians. We also have collaborations with other haptics groups in the UK and abroad.

View our list of publications and presentations (at the bottom of Sarah Baillie's homepage) for details.

What is the Equine Colic Simulator?

The Haptic Horse, or Equine Colic Simulator, is similar to the Haptic Cow; a haptic device is positioned inside a fibreglass rear-half on an animal (see picture: in this case the fibreglass cow with a horse's tail, a rug on, and some bandages!). But the software, i.e. the virtual model, is equine. There are simulations of the normal abdomen (including the aorta, caecum, spleen, kidney, bladder, etc.) and colic cases such as pelvic flexure impactions, dilated loops of small intestine, nephrosplenic entrapment and other displacements of the large colon.

The Equine Colic Simulator (at BEVA 2005)

Validation

This simulator has also been validated (Rendle & Baillie, 2008); simulator-trained students were more systematic in their examinations and more able to differentiate normal from abnormal. These findings were reported at the International Meeting for Simulation in Healthcare (IMSH) 2008 (Poster Adobe PDF), winning 1st prize in the Technology Section.

The simulator is now used in the equine clinical rotations at the Royal Veterinary College, London.

Introduction

The Feline Abdominal Palpation Simulator is a mixed-reality simulator: VR plus a physical model. Virtual models of the chest and abdomen are superimposed on a toy cat. The simulator was developed using ProtoHaptic - a rapid prototyping tool created by Neil Forrest - when Becky Parkes, a vet student, joined the haptics group for a summer project.

The Feline Abdominal Palpation Simulator

Simulator Design

The simulator uses two PHANToM Premium haptic devices placed either side of a toy cat. The thumb and middle finger of one hand, or the middle fingers of both hands, are used to feel the chest (ribs and intercostals muscles) and abdominal structures (kidneys and bladder). The fur of the toy provides tactile information to the rest of the hand. Veterinary surgeons have helped in the development of the virtual models. The combined approach - VR and toy cat - was reported to improve the face validity (realism) considerably.

Further work is underway to include other abdominal organs, lymph nodes, tumours and a heartbeat.

The project has been presented at AVTRW 2008 and was reported in the Veterinary Record news section (Vet Rec., May 2008; 162: 573). Presented at Medicine Meets Virtual Reality 17 in January 2009 (paper: Parkes, Forrest & Baillie, 2009).

Poster: winner of he Simulator Design section at MMVR 2009.

Background

This simulator takes a new approach by using haptic computer games to teach the generic core skills needed in veterinary palpation and other veterinary procedures e.g. recognising shapes, judging degrees of softness and firmness, detecting changes in an object’s size, fine motor control. The ‘core skills’ were identified from a questionnaire sent to clinicians and each core skill is associated with its own haptic game. Students score points, lose lives and win stages, as in any computer game, which helps to make simulator training engaging and fun.

The Core Skills Trainer

The aim is that students play all the games and ‘acquire’ each of the core skills that, in combination, will help to ‘build the clinician’. Once achieved, this gives the ‘rite of passage’ to other tasks where the learned skills can be applied in clinically relevant mini-procedures such as identifying canine prostatic disease or pregnancy diagnosis in the cow.
Playing the Core Skills Simulator games

This simulation is designed for either the PHANToM Premium or Omni haptic device and will shortly be launched as a teaching tool (for more information contact: Sarah Baillie). The 'Core Skills Trainer is also being customised for demonstrations at college Open Days and visits to schools.

Currently students from the RVC are user testing the games and feedback shows they find them helpful and fun. A typical quote says:

"It was really interesting and challenging, it made you think with your hands which you don't do normally!"

Initial 'proof of concept' development funding provided by Heptagon.

Games4Schools

A customised version has been designed specifically for school students and aims to provide an engaging introduction to veterinary medicine and science. It includes several games that demonstrate the principles of the Core Skills Trainer. It is currently being used by the college's Education Liaison group and was very popular at the Royal Society Summer Science Exhibition 2009.

Funding from the Animal Care Trust.

Introduction

We are extending the use of haptic simulations by investigating the applications earlier in the curriculum in anatomy teaching. This project aims to enable students to learn about topographical anatomy using the haptic simulators, experience the 'feel' of a variety of organs and structures, and practise some basic dissection skills.

** UPDATE ** The Jim Bee project team completed 2 busy days teaching the 1st year students at the RVC with 2 Haptic Cow simulators. The aim was to get students to think about bovine abdominal anatomy 'as seen from the tail'. The simulation was set to represent some of the structures normally palpable in the abdomen when felt per rectum e.g. the rumen, a pulsing aorta, etc.

Nearly 200 hundred students used the simulators over a 2 day period. Feedback gathered via an online questionnaire is currently being analysed and will be presented at AMEE 2009 in Malaga in September.

Using the Haptic Cow to Teach Abdominal Anatomy

During the large animal practicals in the preclinical anatomy course, students dissect sheep and horses but not cows, due to various restrictions on access to material. Therefore, the Haptic Cow teaching is currently being adapted so that it can be used to learn the anatomical position and feel of certain structures in the abdomen (see UPDATE above).

Creating a Library of Feel

In order to assist students in remembering how organs and structures feel, a ‘library of feel’ is being developed. This is a collation of the haptic effects already developed for the existing simulators with some new ones. The aim is to provide a comprehensive haptic library across species, tissue types and structures. Using the simulation, students will be able to compare the feel of: a cow’s uterus with its rumen or bladder; the skin of one species with another; muscle with fat; a lymph node with a cyst or abscess; etc.

** UPDATE ** The project will be presented at AMEE 2009 in Malaga in September. Library objects will be made available shortly. Any enquiries contact Sarah Baillie.

Dissection Skills

A simulation is being developed to capture aspects of an expert’s technique when performing a dissection and the recording will be played-back to students. The aim is that this will enable students to experience, and learn from, the expert’s technique. This will be a mixed-reality simulator, with a virtual model of the skin and underlying structures superimposed on e.g. a toy dog.

Funding for current project provided by: RVC 'Jim Bee' grant.
Project team: Sarah Baillie, Stephen Frean, Neil Forrest and Tierney Kinnison

Introduction

Haptics enables us to measure certain aspects of an expert's technique. This is particularly useful when there is something that the experts themselves find difficult to explain or articulate. For example, when a student asks: "How do I find the cow's uterus?" (i.e. move my hand?) and "How much force is OK?" (i.e. what's safe?). We have been using the Haptic Cow and other simulations to help answer such questions and help to improve our teaching. Some examples are described below.

Automated Haptic Cow

Recordings have been made of the path a vet's hand took when performing bovine fertility examinations in the simulated environment. These recordings form the basis of a new version of the Haptic Cow, which is automated. The haptic device ‘drags’ the student’s hand along the expert’s path while audio instructions explain the moves and identify the structure being palpated. Students can book a training session via the cow's own Outlook calendar. Training with this version of the Haptic Cow has been shown to equip students with useful transferable skills i.e. simulator trained students performed better than a control group when set the task of finding the uterus in real cows (full report currently in preparation).

Developing the “Ouch”ometer

Recordings were made using the haptic device of ten farm animal vets palpating simulations representing a cow's uterus at each of the following stages of pregnancy: not-pregnant, early pregnant (7 – 8 weeks), and late pregnant (5 – 6 months). The pressure (force) and motions used for each diagnosis were measured and significant consistencies were found between the individuals (Baillie et al, 2008). The information is being used to provide additional guidance to students, for example they can try to copy the ballottement patterns (hand movements) the vets used. Also the Haptic Cow has now been ‘calibrated’ to let students know if they have pressed too hard. The simulator conveys the bovine equivalent of “Ouch” i.e. an audible “Moo”!

Stiffness Perception

We have used the haptic device and psychophysical tests to compare the perceptual abilities of vets and students when trying to determine the stiffness (softness or firmness) of a virtual surface. This has relevance to clinical diagnoses that depend on judgements about how soft or hard an object feels e.g. a 'pregnant' uterus versus 'not pregnant' or 'endometritis'.
The Stiffness Perception Experiment

In the experiment, participants felt virtual pads of different stiffness values and, using a psychophysical method, their ability to distinguish between the stiffness stimuli was measured. A comparison has been made between twelve experienced clinicians and fourteen 3rd year vet students. The clinicians ‘scored’ significantly higher; indicating stiffness perception is a clinically relevant learned skill (full report currently in preparation). The results establish metrics for this particular skill, stiffness perception. The metrics will enable us to track progress to expertise and identify those for whom additional training would be beneficial.

Violin and Viola Bowing

While at Glasgow, Sarah Baillie was involved in a project to develop a prototype haptic bowing simulation with the aim of providing an environment in which novices could practise certain bowing exercises (Baillie et al, 2005). The user holds the pen attachment to the PHANToM and can bow across virtual strings. The aim is to provide computer assistance in the form of movement restriction thereby helping the player to maintain the correct action and to focus on problem areas.

A Haptic Model for Violin and Viola Bowing

The Horse Ovary Palpation Simulator (HOPS)

Another equine simulator, the Horse Ovary Palpation Simulator, was developed by Andrew Crossan at Glasgow. In the simulated environment, the student performs an examination of the ovaries and follicles. The size and position of the follicles can be varied to represent different stages of the mare's cycle. Details of the research undertaken in this project can be found at Andrew Crossan's homepage. Dr Crossan developed HOPS during his PhD at Glasgow and has collaborated with Sarah Baillie on several projects.