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*Research supported by CESERT grant

The Use of a Mixed Reality Breast Simulator with an Innovative Feedback System (Touch Map) to Enhance Breast Examination Skills.

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*Research supported by CESERT grant

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  1. The Use of a Mixed Reality Breast Simulator with an Innovative Feedback System (Touch Map) to Enhance Breast Examination Skills Angela Gucwa MD, Aaron Kotranza BS, Andrew Raij PhD, Brenda Rosson RN, John Beatty MD, Candelario Laserna MD, Mary Anne Park RN, MSN, Carla Pugh MD, PhD, Kyle Johnsen PhD, Benjamin Lok PhD, D. Scott Lind MD *Research supported by CESERT grant

  2. Background • 10% of palpable breast cancers are not detected by radiography. • 4.6 - 10.7% of breast cancers are identified by clinical breast examination (CBE) alone. • “Fear of missing a lesion” as #1 cause of anxiety • 50% of medical students performing CBE

  3. Standardized Breast Curriculum • Transfer of skills from silicone models to live patients. • Use of standardized patients (SP) to teach CBE improves student learning. • SP usually have normal anatomy • Constructive feedback improves performance of CBE.

  4. Hypothesis • Implementation of an OBJECTIVE and IMMEDIATE feedback system using a MRH improves the thoroughness of CBE • Reflected in learners of higher professional levels

  5. Our Previous Work Validation of Virtual Patients (VP) • To teach history-taking and examination skills • To decrease anxiety in sexual history-taking 3. To decrease anxiety in intimate examinations

  6. Mixed Reality Human (MRH) Virtual Patient Life-sized Mannequin

  7. Breast Simulator • Foam rubber breast overlying a silicone implant • 24 pressure sensors • Interchangeable masses • Breast Masses • M1 periareolar, deep, hard • M2 UOQ, superficial, soft

  8. Methods • Baseline survey completed • 10 minute interview and CBE on a MRH patient with a breast complaint • Feedback of CBE performed • Percentage of breast examined • Color-coded Touch Map (Figure) • Green = Area palpated • Red = Area missed • Second interaction with a different MRH patient

  9. 28 participants 19 medical students 4 surgery residents 5 faculty CBE Coverage 24 of 28 participants improved MRH1 80.92% ± 11.12% MRH2 88.26% ± 9.42% Results * p value<0.05, data analyzed by repeated measures ANOVA

  10. Most Commonly Missed Areas Percentage of Participants Missing Area of Examination * p value<0.05, data analyzed by repeated measures ANOVA

  11. Palpation of Masses During CBE Percentage of Participants Palpating Masses * p value<0.05, data analyzed by repeated measures ANOVA

  12. Participants Palpating M1 Participants Palpating Both Masses Number of CBE on Real Patients Masses Palpated by Patient Experience† Number of CBE on Real Patients †Reported as percentage of participants * p value<0.05, data analyzed by repeated measures ANOVA

  13. Conclusions • CBE thoroughness and palpation of breast lesions are improved with feedback. • Application to higher levels of learners • Supraclavicular, NAC, and parasternal regions most commonly overlooked during CBE. 3. Experience in CBE correlates with improved detection of lesions. • Irrespective of experience, participants improved with feedback

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