The virtual peripheral nerve academy: education for the identification and treatment of peripheral nerve disorders

Abstract

Millions of people around the globe suffer peripheral nerve injuries caused by trauma and medical disorders. However, medical school curricula are profoundly deficient in peripheral nerve education. This lack of knowledge within the healthcare profession may cause inadequate patient care. We developed the Virtual Peripheral Nerve Academy (VPNA) as a reusable virtual learning environment to provide medical students with detailed education on the peripheral nervous system (PNS). Students are introduced to the PNS through virtual 3D rendering of the human body, wherein they visualize individual nerves through dissection and observe normal motor and sensory function associated with each nerve. PNS structures that are absent from traditional texts are included in this visualization, ranging from the innervation of joints to the normal anatomic variation required for differential diagnosis of pain after an injury. Detailed modules on peripheral nerve disorders allow students to observe pathophysiological mechanisms, associated symptomatology, and appropriate treatments. Students are briefed on a patient clinical case, then interact with a patient avatar to learn the appropriate diagnostics, including physical exam maneuvers and electrodiagnostic testing. Interactive modules on peripheral nerve surgeries detail surgical techniques. The VPNA data and analytics dashboards allow medical students and course instructors to assess skill improvement and identify specific learning needs. The built-in learner management system and availability on both computer-based and virtual reality platforms facilitate integration into any existing medical school curricula. Ultimately, this immersive technology enables every medical student to learn about the peripheral nervous system and gain competency in treating real-life nerve pathologies.

Keywords

Virtual reality / peripheral nervous system / nerve / surgical education / medical education / simulation / plastic surgery

References

[1] Taylor CA,Rice JB.The incidence of peripheral nerve injury in extremity trauma.Am J Phys Med Rehabil2008;87:381-5

[2] Campbell WW.Evaluation and management of peripheral nerve injury.Clin Neurophysiol2008;119:1951-65

[3] Jeffcoate WJ,Ince P.Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures.Diabetes Care2006;29:1784-7

[4] Miscio G,Brunani A,Baudo S.Obesity and peripheral neuropathy risk: a dangerous liaison.J Peripher Nerv Syst2005;10:354-8

[5] Callaghan BC,Li Y.Diabetes and obesity are the main metabolic drivers of peripheral neuropathy.Ann Clin Transl Neurol2018;5:397-405 PMCID:PMC5899909

[6] Hashemi S, Cheikh I, Dellon AL. Prevalence of upper and lower extremity Tinel signs in diabetics: crosssectional study from a united states, urban hospital-based population.J Diabetes Metab2013;4:3

[7] Ducic I,Al-Attar A.Algorithm for treatment of postoperative incisional groin pain after cesarean delivery or hysterectomy.Obstet Gynecol2006;108:27-31

[8] Khoshmohabat H,Alvandi AA,Mohebi HA.Effect of ilioinguinal neurectomy on chronic pain following herniorrhaphy.Trauma Mon2012;17:323-8 PMCID:PMC3860626

[9] Lee CH.Surgical management of groin pain of neural origin1.Journal of the American College of Surgeons2000;191:137-42

[10] Dellon AL,Krackow KA.Partial denervation for treatment of persistent neuroma pain after total knee arthroplasty.Clin Orthop Rel Res1995;316:145-50

[11] Wan EL,Tolson H.Injury to perineal branch of pudendal nerve in women: outcome from resection of the perineal branches.J Reconstr Microsurg2017;33:395-401

[12] Wang E,Byerly S.Optimal timing for repair of peripheral nerve injuries.J Trauma Acute Care Surg2017;83:875-81

[13] Gordon T,Raji MA.The basis for diminished functional recovery after delayed peripheral nerve repair.J Neurosci2011;31:5325-34 PMCID:PMC6622714

[14] Höke A.Introduction to special issue: challenges and opportunities for regeneration in the peripheral nervous system.Exp Neurol2010;223:1-4 PMCID:PMC3071992

[15] Carlson BM,Faulkner J.Studies on the regenerative recovery of long-term denervated muscle in rats.Restor Neurol Neurosci1996;10:77-84

[16] Höke A.Mechanisms of disease: what factors limit the success of peripheral nerve regeneration in humans?.Nat Clin Pract Neurol2006;2:448-54

[17] Scheib J.Advances in peripheral nerve regeneration.Nat Rev Neurol2013;9:668-76

[18] Kadakia RJ,Issar NM.Health literacy in an orthopedic trauma patient population: a cross-sectional survey of patient comprehension.J Orthop Trauma2013;27:467-71

[19] Way CW Jr. Is there a surgeon shortage?.Mo Med2010;107:309-12

[20] Doescher MP. The crisis in rural general surgery: can research drive policy change? WWAMI rural health research center; 2009. Available from: https://familymedicine.uw.edu/rhrc/presentations/the-crisis-in-rural-general-surgery-can-research-drive-policy-change/ [Last accessed on 14 Jul 2022]

[21] Lee CH.Prognostic ability of Tinel sign in determining outcome for decompression surgery in diabetic and nondiabetic neuropathy.Ann Plast Surg2004;53:523-7

[22] Garrison DR.Role of instructional technology in the transformation of higher education.J Comput High Educ2009;21:19-30

[23] Moro C,Raikos A.The effectiveness of virtual and augmented reality in health sciences and medical anatomy.Anat Sci Educ2017;10:549-59

[24] O’Sullivan DM,Proctor K.The use of virtual reality echocardiography in medical education.Pediatr Cardiol2021;42:723-6

[25] Shetty S,Grantcharov TP,Duffy AJ.Perceptions, training experiences, and preferences of surgical residents toward laparoscopic simulation training: a resident survey.J Surg Educ2014;71:727-33

[26] Mitrousias V,Hantes ME,Arvanitis DL.Anatomy learning from prosected cadaveric specimens versus three-dimensional software: a comparative study of upper limb anatomy.Ann Anat2018;218:156-64

[27] Bartlett J,To K,Khanduja V.Virtual reality simulator use stimulates medical students’ interest in orthopaedic surgery.Arthrosc Sports Med Rehabil2021;3:e1343-8 PMCID:PMC8527266

[28] Qualter J,Oliker A.The biodigital human: a web-based 3D platform for medical visualization and education.Stud Health Technol Inform2012;173:359-61.

[29] Kantar RS,Ramly EP,Flores RL.Educational resources in craniofacial surgery: the case for user-friendly digital simulators.J Craniofac Surg2020;31:931-3

[30] Stern C,Napier Z.Integration of surgical simulation in plastic surgery residency training.Stud Health Technol Inform2012;173:497-9

[31] Smith DM,Cutting CB.Applications of virtual reality in aesthetic surgery.Plast Reconstr Surg2005;116:898-904; discussion 905