- Email: [email protected]
Clinical simulation: Dare we venture into the uncanny valley?
Accepted Manuscript Clinical simulation: Dare we venture into the uncanny valley? Debbie Roberts, Nathan J. Roberts PII:
S1471-5953(14)00048-1
DOI:
10.1016/j.nepr.2014.04.002
Reference:
YNEPR 1869
To appear in:
Nurse Education in Practice
Received Date: 4 April 2014 Accepted Date: 10 April 2014
Please cite this article as: Roberts, D., Roberts, N.J., Clinical simulation: Dare we venture into the uncanny valley?, Nurse Education in Practice (2014), doi: 10.1016/j.nepr.2014.04.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Clinical simulation: Dare we venture into the uncanny valley?
Dr Debbie Roberts. Reader in Nursing, Glyndwr University.
RI PT
Institute of Health Sciences. Mold Road. Wrexham.
SC
LL11 2AW Tel: 01978 293212
Mr Nathan J. Roberts Senior Lecturer in Computing.
Mold Road. Wrexham.
AC C
EP
LL11 2AW
TE D
Glyndwr University.
M AN U
E mail: [email protected]
ACCEPTED MANUSCRIPT Clinical simulation: Dare we venture into the uncanny valley?
It is accepted that scenarios on which simulation is based should represent the reality of the clinical world, where students are enabled to learn through active participation in situation which they will likely encounter in the real world. Rich and Nugent (2010) call for nurse educators to abandon
RI PT
the out-dated pedagogy of clinical learning based on specified time frames to cover specific content, in favour of flexible curricula that make best use of innovative methods such as technology mediated teaching strategies, together with clinical and virtual simulation. It is generally accepted that scenarios on which virtual simulation or immersive learning is based
SC
should represent the reality of the clinical world, where students are enabled to learn through active participation in situations which they will likely encounter in the real world.
M AN U
In terms of simulated learning the fidelity or similarity to the real world, is important and educators are required to develop authentic replicas of a range of clinical encounters. Fidelity refers to aspects of both the environment and psychological fidelity; in other words the physical characteristics of the environment and the emotional connection or feelings evoked by the learning stimulus are equally important. Bacon et al, (2011: 70) state that “Research in neuroscience and psychology shows a strong connection between cognition
TE D
and emotion. Cognition plays an important role in creating emotions. Emotions, in turn, cause a wide range of effects on attention, perception and cognitive processes involved in decision making, problem-solving and learning. Often the word affect is used instead of emotion and indicates that a wider range of factors than those classically considered as
EP
emotions are involved.”
High-fidelity simulators are computer-driven mannequins, controlled by sophisticated
AC C
physiological and pharmacological models, which define their features and characteristics (Schoening et al., 2006). Whilst mannequins can be programmed to replicate a range of physiological signs and symptoms (Roberts and Greene 2011); their visual appearance is not perfectly realistic; and according to colleagues in computing this is in order to avoid straying into the uncanny valley. The uncanny valley is term coined by Masahiro Mori who observed that as robots appear more human-like, they seem more familiar until a point is reached where subtle deviations from human norms render them eerily strange and creepy (MacDorman 2006). Mori is purported to have suggested that cartoon-like depictions of humans are appealing, in that same way that real photographs are appealing; but inbetween there is a gap which remains inherently disturbing (Hanson, Olney, Pereira and
ACCEPTED MANUSCRIPT Zielke 2005). MacDorman (2006) explains that Mori refers to the dip in familiarity and the corresponding surge in strangeness as the uncanny valley. Furthermore, Seyama and Nagayama (2007) suggest that this notion is not limited to robots, but applies to any humanlike object, including dolls, masks, facial caricatures, avatars in virtual reality, and characters in computer graphics movies. It is perhaps not surprising then that mannequins specifically
RI PT
designed for use within clinical simulation are physiologically real but not aesthetically real. Indeed, Seyama and Nagayama (2007) go on to explain that designers should seek only a moderate level of realism within robots, and furthermore designers should give due consideration to the emotional and psychological impact on humans of robots that
SC
communicate, cooperate and coexist with us. The experiment conducted by Seyama and Nagayama (2007) demonstrated the uncanny valley as predicted by Mori, but emerged only
M AN U
when images of faces involved abnormal features; particularly when the eyes were out of proportion with the rest of the facial features. They go on to suggest that humans have learned to recognise a range of various eye sizes which are evident amongst humans and which are regarded as acceptable; and that this serves as a judgment criterion of abnormality.
TE D
The underlying implications of investigations into the concept of the uncanny valley are, according to MacDorman (2006) that by building robots with increasing human likeness is leading to insights in human perception and face to face interaction which he suggests may ultimately lead to a mechanism for bringing behavioural sciences and cognitive
EP
neuroscience closer together. As this work progresses, nurse educators would be well advised to be aware of the emerging results, since there may be implications for nurse
AC C
patient interaction, which may shed light onto whether we should invest time and effort in re-designing more realistic mannequins. Within the computing literature the notion of the uncanny valley is somewhat contentious. Hanson, et al. (2005) suggest that greater investment into the development of intelligent and highly expressive depictions of humans as robots can only be beneficial since it provides “a powerful mirror that can help address the question of “what is human” (p24). Hanson and colleagues are investing in developing new materials: porous elastomers that stretch and compress much more like soft facial tissue; termed Frubber; in order to achieve more realistic facial expressions as computer hardware actuates the ‘skin’ along vectors aligned with natural musculature of the face. They argue that when designing robots, any level of
ACCEPTED MANUSCRIPT realism can be socially engaging if the aesthetic is well designed. Rather than an uncanny valley, Hanson et al. (2005) theorise a Path of Engagement to represent a bridge of good aesthetic; whereby rather than triggering fearful reflexes; dream-like or surreal feelings are evoked; thus people find such well designed robots strange but not frightening. Specifically, Hanson and colleagues are applying theory to social artificial intelligence and cognitive
RI PT
experiments whereby robots have cameras within their eyes able to perceive faces and facial expressions and can affect eye contact with people; initiate a smile and accurately detect thousands of words and phrases in order to ‘speak’ appropriate greetings. Again, this work could potentially result in a new wave of re designed, responsive, ultra-realistic
M AN U
is used within learning and teaching in nursing.
SC
enticing mannequins with the potential to revolutionise the way in which clinical simulation
Bacon L., Windall G., and MacKinnon L. 2011. The development of a rich multimedia training environment for crisis management: using emotional affect to enhance learning. ALT-C 2011 Conference Proceedings. ISBN 978-91-977071-4-5 (print), 978-91-977071-5-2
TE D
(online) 2011 Association for Learning Technology. DOI: 10.3402/rlt.v19s1/7780 p67-78. Hanson D., Olney A., Pereira IA, and Zielke M. 2005. Upending the Uncanny Valley. AAAI 2005 The 2nd International Conference on Knowledge Capture, Pittsburgh, Pennsylvania,
EP
USA.
MacDorman, K. F. (2006). Subjective ratings of robot video clips for human likeness,
AC C
familiarity, and eeriness: An exploration of the uncanny valley. ICCS/CogSci-2006 Long Symposium: Toward Social Mechanisms of Android Science (pp. 26–29). July 26, 2006. Vancouver, Canada.
Rich KL. and Nugent KE. 2010. A United States perspective on the challenges in nursing education. Nurse Education Today. 30. 228-232. Roberts D & Greene L. 2011. The theatre of high fidelity clinical simulation. Nurse Education Today. 31(7): 694-698. Roberts, N.J., Grout, V. & Worden, J.(2007), ‘Adaptable and Collaborative Virtual Learning Environments Supporting Soft Skills. Paper presented to the Third Collaborative
ACCEPTED MANUSCRIPT Research Symposium on Security, E-Learning, Internet and Networking 14th-15th June 2007. Plymouth: Plymouth University. Schoening, A.M., Sittner, B.J., Todd, M.J., 2006. Simulated clinical experience: nursing students' perceptions and the educators' role. Nurse Educator 31 (6), 253–258.
AC C
EP
TE D
M AN U
SC
Artifical Human Faces. Presence. 16 (4):337-351.
RI PT
Seyama J. and Nagayama RS., 2007. The Uncanny Valley: Effect of Realism on the Impression of
S1471-5953(14)00048-1
DOI:
10.1016/j.nepr.2014.04.002
Reference:
YNEPR 1869
To appear in:
Nurse Education in Practice
Received Date: 4 April 2014 Accepted Date: 10 April 2014
Please cite this article as: Roberts, D., Roberts, N.J., Clinical simulation: Dare we venture into the uncanny valley?, Nurse Education in Practice (2014), doi: 10.1016/j.nepr.2014.04.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Clinical simulation: Dare we venture into the uncanny valley?
Dr Debbie Roberts. Reader in Nursing, Glyndwr University.
RI PT
Institute of Health Sciences. Mold Road. Wrexham.
SC
LL11 2AW Tel: 01978 293212
Mr Nathan J. Roberts Senior Lecturer in Computing.
Mold Road. Wrexham.
AC C
EP
LL11 2AW
TE D
Glyndwr University.
M AN U
E mail: [email protected]
ACCEPTED MANUSCRIPT Clinical simulation: Dare we venture into the uncanny valley?
It is accepted that scenarios on which simulation is based should represent the reality of the clinical world, where students are enabled to learn through active participation in situation which they will likely encounter in the real world. Rich and Nugent (2010) call for nurse educators to abandon
RI PT
the out-dated pedagogy of clinical learning based on specified time frames to cover specific content, in favour of flexible curricula that make best use of innovative methods such as technology mediated teaching strategies, together with clinical and virtual simulation. It is generally accepted that scenarios on which virtual simulation or immersive learning is based
SC
should represent the reality of the clinical world, where students are enabled to learn through active participation in situations which they will likely encounter in the real world.
M AN U
In terms of simulated learning the fidelity or similarity to the real world, is important and educators are required to develop authentic replicas of a range of clinical encounters. Fidelity refers to aspects of both the environment and psychological fidelity; in other words the physical characteristics of the environment and the emotional connection or feelings evoked by the learning stimulus are equally important. Bacon et al, (2011: 70) state that “Research in neuroscience and psychology shows a strong connection between cognition
TE D
and emotion. Cognition plays an important role in creating emotions. Emotions, in turn, cause a wide range of effects on attention, perception and cognitive processes involved in decision making, problem-solving and learning. Often the word affect is used instead of emotion and indicates that a wider range of factors than those classically considered as
EP
emotions are involved.”
High-fidelity simulators are computer-driven mannequins, controlled by sophisticated
AC C
physiological and pharmacological models, which define their features and characteristics (Schoening et al., 2006). Whilst mannequins can be programmed to replicate a range of physiological signs and symptoms (Roberts and Greene 2011); their visual appearance is not perfectly realistic; and according to colleagues in computing this is in order to avoid straying into the uncanny valley. The uncanny valley is term coined by Masahiro Mori who observed that as robots appear more human-like, they seem more familiar until a point is reached where subtle deviations from human norms render them eerily strange and creepy (MacDorman 2006). Mori is purported to have suggested that cartoon-like depictions of humans are appealing, in that same way that real photographs are appealing; but inbetween there is a gap which remains inherently disturbing (Hanson, Olney, Pereira and
ACCEPTED MANUSCRIPT Zielke 2005). MacDorman (2006) explains that Mori refers to the dip in familiarity and the corresponding surge in strangeness as the uncanny valley. Furthermore, Seyama and Nagayama (2007) suggest that this notion is not limited to robots, but applies to any humanlike object, including dolls, masks, facial caricatures, avatars in virtual reality, and characters in computer graphics movies. It is perhaps not surprising then that mannequins specifically
RI PT
designed for use within clinical simulation are physiologically real but not aesthetically real. Indeed, Seyama and Nagayama (2007) go on to explain that designers should seek only a moderate level of realism within robots, and furthermore designers should give due consideration to the emotional and psychological impact on humans of robots that
SC
communicate, cooperate and coexist with us. The experiment conducted by Seyama and Nagayama (2007) demonstrated the uncanny valley as predicted by Mori, but emerged only
M AN U
when images of faces involved abnormal features; particularly when the eyes were out of proportion with the rest of the facial features. They go on to suggest that humans have learned to recognise a range of various eye sizes which are evident amongst humans and which are regarded as acceptable; and that this serves as a judgment criterion of abnormality.
TE D
The underlying implications of investigations into the concept of the uncanny valley are, according to MacDorman (2006) that by building robots with increasing human likeness is leading to insights in human perception and face to face interaction which he suggests may ultimately lead to a mechanism for bringing behavioural sciences and cognitive
EP
neuroscience closer together. As this work progresses, nurse educators would be well advised to be aware of the emerging results, since there may be implications for nurse
AC C
patient interaction, which may shed light onto whether we should invest time and effort in re-designing more realistic mannequins. Within the computing literature the notion of the uncanny valley is somewhat contentious. Hanson, et al. (2005) suggest that greater investment into the development of intelligent and highly expressive depictions of humans as robots can only be beneficial since it provides “a powerful mirror that can help address the question of “what is human” (p24). Hanson and colleagues are investing in developing new materials: porous elastomers that stretch and compress much more like soft facial tissue; termed Frubber; in order to achieve more realistic facial expressions as computer hardware actuates the ‘skin’ along vectors aligned with natural musculature of the face. They argue that when designing robots, any level of
ACCEPTED MANUSCRIPT realism can be socially engaging if the aesthetic is well designed. Rather than an uncanny valley, Hanson et al. (2005) theorise a Path of Engagement to represent a bridge of good aesthetic; whereby rather than triggering fearful reflexes; dream-like or surreal feelings are evoked; thus people find such well designed robots strange but not frightening. Specifically, Hanson and colleagues are applying theory to social artificial intelligence and cognitive
RI PT
experiments whereby robots have cameras within their eyes able to perceive faces and facial expressions and can affect eye contact with people; initiate a smile and accurately detect thousands of words and phrases in order to ‘speak’ appropriate greetings. Again, this work could potentially result in a new wave of re designed, responsive, ultra-realistic
M AN U
is used within learning and teaching in nursing.
SC
enticing mannequins with the potential to revolutionise the way in which clinical simulation
Bacon L., Windall G., and MacKinnon L. 2011. The development of a rich multimedia training environment for crisis management: using emotional affect to enhance learning. ALT-C 2011 Conference Proceedings. ISBN 978-91-977071-4-5 (print), 978-91-977071-5-2
TE D
(online) 2011 Association for Learning Technology. DOI: 10.3402/rlt.v19s1/7780 p67-78. Hanson D., Olney A., Pereira IA, and Zielke M. 2005. Upending the Uncanny Valley. AAAI 2005 The 2nd International Conference on Knowledge Capture, Pittsburgh, Pennsylvania,
EP
USA.
MacDorman, K. F. (2006). Subjective ratings of robot video clips for human likeness,
AC C
familiarity, and eeriness: An exploration of the uncanny valley. ICCS/CogSci-2006 Long Symposium: Toward Social Mechanisms of Android Science (pp. 26–29). July 26, 2006. Vancouver, Canada.
Rich KL. and Nugent KE. 2010. A United States perspective on the challenges in nursing education. Nurse Education Today. 30. 228-232. Roberts D & Greene L. 2011. The theatre of high fidelity clinical simulation. Nurse Education Today. 31(7): 694-698. Roberts, N.J., Grout, V. & Worden, J.(2007), ‘Adaptable and Collaborative Virtual Learning Environments Supporting Soft Skills. Paper presented to the Third Collaborative
ACCEPTED MANUSCRIPT Research Symposium on Security, E-Learning, Internet and Networking 14th-15th June 2007. Plymouth: Plymouth University. Schoening, A.M., Sittner, B.J., Todd, M.J., 2006. Simulated clinical experience: nursing students' perceptions and the educators' role. Nurse Educator 31 (6), 253–258.
AC C
EP
TE D
M AN U
SC
Artifical Human Faces. Presence. 16 (4):337-351.
RI PT
Seyama J. and Nagayama RS., 2007. The Uncanny Valley: Effect of Realism on the Impression of