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Acadicus Simulation Pulse with Mitch Luker, NWTC

Mitch Luker, Nursing Simulation Coordinator at NWTC, discusses how they’re using virtual simulation to help address critical shortages of clinical sites. They also describe how they’re substantially reducing simulation costs, expanding access, and improving student engagement to prepare nursing students for the real world.

This is AI generated transcript.  Please forgive any typos!

Hi, My name is Mitch Luker, and my job right now is to bring simulation up to best practice for us, because we were kind of among the groups who started doing simulation and we did a good job, but there were a few areas we needed to clean up. And also part of our responsibility is getting virtual reality as part of our program for students.

Excellent. And what was the interest in virtual simulation, virtual reality, versus the typical traditional simulation that you’ve been doing?

So for us, the big thing was we were looking for ways to increase capacity, because as most nursing programs have problems with, is that we just don’t have enough clinical spots. We’re in a smaller community of less than 200,000 people. So even though we have several hospitals and long-term care facilities, it’s still not enough because we’re competing with four or now five other programs for clinical sites and that gets really challenging. So then we went into doing simulation and that helped, but again, we ran out of space in our simulation lab and it was gonna become too big an expense to add more simulation lab space.

So we started looking at other solutions that we could do and virtual reality was something that was kind of being sort of talked about and explored and looked at amongst the nursing education community. And then what we found was that there wasn’t a lot out there. And so we kind of had to start doing a lot of our own legwork and figuring out what we could do. And that’s when we started finding that there were really good options out there for virtual reality. And that’s how we landed with the Catechist because it was a program that we felt was robust enough that would give us quality clinical outcomes because a lot of other ones felt more like it was more of a benefit to doing something with a theory class versus a clinical use.

So that’s where we started partnering with the catechist along with four other colleges through our Open RN grant that we got from the Department of Education.

Excellent. Well, what I like about that is that there’s a lot of schools that I think come to virtual simulation because it’s the cool, shiny new thing. And they want to try it out and they just, it’s like more of a marketing or recruitment thing, which is fine, but you know, it’s really sort of a solution in search of a problem.

Whereas the way that you’re describing it, it was a problem that you had. And so you were looking for solutions and virtual reality helped fit that. So you were able to solve a problem using virtual simulation.

Yeah, we used the nursing process, you know, which is kind of like the scientific method. You have to identify the problem first. And so, you know, we assessed ourselves to figure out what, where we were having issues, and then we diagnosed the problem to figure out what we needed to do, and then we started working on our plan.

And now we’re implementing our plan, and we’re gonna evaluate it and see how it goes. So it’s one of those things where if you do the process backwards, you’re not gonna get the result you want. You have to work the process in the appropriate order. And the first thing is always, as we tell our students, assess, assess, assess, and figure out, you know, what’s going on. And so, you know, we really did a lot of looking at, you know, where’s the problem? Where do we have the issues? And, you know, we were looking at capacity as being a problem for us because, you know, like most nursing programs, we had a waiting list of students and we couldn’t get them in quicker.

And it’s not because we didn’t have educators. It’s not because we couldn’t, you know, offer more classes. We could offer all the classes, we could hire educators. The problem really came down to is when it comes to clinical time, what do you do with these people? Because there’s only so many spots you can put people in, you know, a long-term care facility or in hospitals, you know, especially, you know, even before the pandemic, you know, hospitals, they don’t want you there with, you know, three clinical groups on one unit, because you don’t have, you can’t, you know, there’s not, you’re, you’re overwhelming the staff on the unit. And that’s really not where we want to be. And they don’t want that happening either.

So the question became, what do you do? And so that’s where you have to kind of, we had to figure out, okay, what’s the next step? And we, so we were like, okay, simulation, that’s what everybody does. And we were like, yep. And we were utilizing our Sim Lab. It’s not a hundred percent replacement, of course, because it’s not the same as working with an actual patient, but it’s a great adjunctive, you know, educational tool to use.

So we got to the point where we were having trouble using that space because you just run out of, we have, we have four big sim labs and then we have some low fidelity mannequins so we can kind of do it in classrooms and stuff. But then we kind of got to the point where, you know, the mannequins get expensive and you have to replace them every three to four years and you have warranty contracts that you have to keep up with and pay and it just gets pricey and plus it’s kind of hard to train faculty to know which one do you turn on first?

Do you turn on the mannequin first or do you turn on the monitor or the computer? And it just gets to be a lot and if someone doesn’t do a process just right then you end up everything crashes down and then you have to call the person the manager of the sim lab and say hey this isn’t working now what do we do and it just got to be problematic and then it was just expensive to build the space we did an update and built our four labs a few years ago and that costs several million dollars. And I haven’t figured out yet how to plant money in the ground and have it grow on the trees.

So you can’t just keep spending the money. So you have to figure out how to be cost effective while offering something that is quality enough that you can feel confident that your students are getting what they need. And that was the real challenge was finding cost-effective quality simulation that we could do that wasn’t gonna break the bank.

Yeah, and it seems like a lot of solutions will offer sort of pre-programmed scenarios that you can go through. And to a certain extent, there are some of those in Acadicus that are self-guided or that students can go in and interact with. But it doesn’t really seem like that was the solution you’re looking for. You were looking for, you know, live simulation that as best as we can with virtual simulation replicates that real-world experience where you’ve got multiple participants. You have a live, you know, actor that’s actually speaking like a live person rather than the pre-programmed solutions where you’re getting the analytics and the dashboard of analytics, you’re really, it’s more about the live debriefing, the value of the instructor that you were looking for.

Yeah, because a lot of products we looked at had great scenarios and they were good, but they didn’t feel like clinical experience. They felt more like something that you were doing as like homework from a theory course, where you would have maybe talked about congestive heart failure during one of your courses, and then they would go do this self-guided clinical, you know, or congestive heart failure, and it felt more like something you would do as a learning thing that was, you know, building on your theory knowledge.

Whereas we wanted something that was more like clinical. And that’s why we came to Acadicus was because it gave us the opportunity to have some self-guided where it could be more of that adjunct onto a theory course, but also gave us the freedom to be able to build, construct, and create scenarios that were a more suitable clinical use. And so, one of the things that we’re looking to do as we build this program is while virtual reality is wonderful, it can’t replace in-person simulation and it can’t replace in-person clinical. But what it can do is it can be a psychologically safety building tool where so when we’re starting to do clinical, we can have students come into our VR lab, they can do a scenario about congestive heart failure. Then they can go to the sim lab and do an in-person congestive heart failure simulation.

So you’re getting the same topic, but you can change the scenario to be more about the psychomotor and the actual, like putting your hands on the patient. And then they can go to the clinical site and provide care to patients. And so by doing that in that way, students aren’t as fearful going to in-person simulation because they’ve at least heard the concepts, they’ve talked about them, they’ve debriefed on them, and they’ve had some time to reflect.

And then when they go to the hospital or to their long-term care facility, they’re now getting another chance to do those same type of things, but on real patients. But because they’ve now had the concept of coming into the room, interviewing the patient, doing an assessment in virtual reality where they can feel really safe. And then they can do it in the sim lab where again, it’s a place to make mistakes, learn your lessons.

So that way when you get to the real patient, it’s a lot less intimidating. And that’s really what we were trying to build is, how do we help students feel more comfortable because when a student doesn’t feel safe, they’re not gonna learn as well. You can’t absorb things. Because how many times have you ever been in fight or flight mode? Because if you’ve ever had a car accident, and people will say, it’s just a blur.

They don’t really remember anything. And so if students are in that mode in clinical, what are they absorbing? Nothing, because it’s a blur to them. So we’ve got to get them feeling comfortable, feeling safe. And this was a great way that we felt was going to help us do that for our students.

And how has their reaction been to it so far in the simulations that you’ve run? How do the students take to it? Do they enjoy it? Are they intimidated by it? Like what’s their reaction to it?

So usually the first thing I get when they come in the room is they’re all like, oh my gosh, this is so cool. And they’re excited to come in and try something new and different because used to Kahoot, like Kahoot was something that was really popular and students thought it was the coolest thing and now they’re like, oh, another Kahoot. Oh, another, like they just, they get bored with things. And you know, the students were getting, they’ve never known the world without a smartphone, let alone cell phones, but they’ve never known the world without smartphones because yes, they weren’t born before they were out, but they probably don’t have memories of life before 2007.

And so, I mean, they’re used to technology. They’re used to, you know, the newest, latest, greatest thing, and they get bored. I mean, that’s why we see the death of apps. People just get bored of the app because it’s like, oh, look, here’s another thing. And so they’re looking for the latest and greatest thing because they’re wired into things. I mean, we are truly talking about true digital natives who they’re used to having smart boards in classrooms. You know, I grew up in a time when we literally had chalkboards. We didn’t have whiteboards with markers. It was chalkboards that squeaked and every once in a while you get the oh, that was really all that noise and they don’t know the world without smart boards and iPads and smart TVs and streaming services and so they look for this and they get really excited about coming in and getting to experience new Technology that’s going to help them learn and then once they get in it, of course, first you gotta kind of get them past the, what I call the wow moment, because they come in and they put on the headset and they start experiencing the VR and the realisticness of it and they get like the, oh, and they just want to play for a little bit. So you’ve got to let them have a play time to kind of, you know, fiddle with things and, you know, get comfortable. And, you know, they’re just getting more and more excited as they, you know, oh, look, I can grab this, oh, I can do this.

And, you know, they wave at each other and just kind of play around. And then when we get into this scenario, I find that it’s almost kind of like being behind a screen on a review site. Because, you know, you feel more free when you don’t feel like you’re literally standing in front of everyone. Because it’s kind of like if I have to give a report up in class to my fellow peers, I’m gonna read my paper and I’m gonna do it as fast as possible and pray that it’s over as quickly as it can be.

Whereas in the VR scenario, because you feel a little more, like even though you see your peers with you in their avatar states, but you feel a little more free to share and talk, so I find like even in pre-brief, I don’t have to work as hard to pull information from my students. They chat more, they share their thoughts and ideas, and they just feel more comfortable in that space. And I don’t know how much of it is, you can’t really see me, so I don’t have to, and I can’t see you looking at me with your judgmental eyes.

You know, I can’t see my instructor’s eyes piercing through my soul. They’re just, we’re just here and we’re hanging out. And so then, once we get going, I find that they’re more willing to take risks with their knowledge and try things out that maybe they’re not quite sure about, but they feel good about. And so they’ll try it out and they’ll do things that if we were in a regular simulation, where I’m normally like, okay, what do you do next?

And they just sit there and stare at me, and they’re like, your eyes are piercing my heart. I don’t wanna say anything because I’m afraid I might drop dead. And so by being able to get them to be able to share more and talk more, they just feel more comfortable. And then, you know, we’ll do the debrief afterwards and they feel like they, even when we take the headset off to debrief because we’re usually in the same room.

And so I don’t have to debrief in the VR space. So we usually will debrief in our, just our, the room that we’re in, in our lab. And I find that then they, they actually kind of, because of the, they’ve kind of had this shared experience of doing a virtual reality together, then they’re more willing to talk and share. And they are, because they’ve kind of broken down that barrier by talking to each other in virtual reality, that now they’re less scared to share in person. And then I’ve had instructors who, because we’ve done somewhere, we’ll do a short little scenario and then they’ll go to another station and the instructor that followed me was doing like a critical thinking exercise that tied into the scenario we were doing in virtual reality and her response later was like how did the students like it what do you think and she’s like I love it because when they came to me they were more they were thinking more critically about things because they referenced things that happened in the VR scenario and it stuck with them more.

And they were able to use that knowledge right afterwards in this critical thinking exercise we were doing. So the students so far liked it, and the faculty who I’ve worked with on it have really enjoyed it as well. On that note, the faculty, because of the broad geographic region that your campus or your school covers, do you have faculty that can join from remote locations to run simulations for students that are on campus? We’re working on it. We’re actually going to one of our remote campuses and we’re going to work on establishing our first VR lab there.

So we are, you know, we’re going in with this all in and we’re going to use it and we’re really looking to try to have where you go to school is not going to be a prohibitive factor in getting to use new technology for your learning.

Do you see a future where instructors will be able to run simulations from home, theoretically, if they’re located in remote areas rather than driving into a campus? If students are on campus, the instructors could really be anywhere using the simulation manager to run a scenario.

Absolutely. And as we are developing our program and as we’re learning about things, we’re keeping that in mind.

And also, how do we help students who live far away? Because there’s times we have students who will drive two hours to come to us for their nursing education. And how great would it be if they didn’t have to drive the two hours to campus for a simulation, if they could be at home and you know if we can just check them out the equipment and let them have it at home for you know that period of clinical, that would be fantastic especially with winter in northern Wisconsin. You know sometimes weather can be really prohibitive. So what if we could say, okay, part of your clinical course is you’re going to have this virtual reality setup that you’re going to be able to take home with you and do clinical. Because what if, like, if we have a major snowstorm, instead of canceling clinical for the day, we’re going to do virtual reality.

And we’re going to have quality scenarios that are going to help you learn and give you tools that you can use in your in-person clinical. What if we could do virtual reality coaching so that our students in Marinette or Sturgeon Bay or Shawano who would normally have to drive an hour or possibly more to come in to get coaching, what if they could do coaching in virtual reality where they could have someone come in run through lessons with them. You know we have great like markers that you can use now in virtual reality to draw things out and write things out so students could actually have a whiteboard that they could work out math problems on or that you could draw pictures, or you don’t have to draw a picture, you could import a heart or a brain and you could talk about things and disease processes or you could even have a patient room set up like a sim lab, like a traditional sim lab.

And today we’re gonna talk about congestive heart failure and how we’re going to care for this patient And we’re going to talk about electrolyte imbalance or whatever and you could do that in a virtual world and actually have props and mannequins and things to use And you can do it from anywhere Yeah, that’s that’s huge and as you’re going about building out the the actual hardware in space for these VR labs What are some of the things you’re up against? I know that a lot of schools are really, they understand the value, the faculty and the students are excited, but now we need to build a VR lab to support this.

Whereas some of them started off with a few laptops and headsets and then they just set it up for simulation day and then they put it away. But it sounds like you’re more interested or you’re starting to work toward having a permanent presence with high powered PCs and VR headsets. What has that process been like? So we were one of those places that started off with some laptops and headsets, thinking like, oh, mobility will be great. And then we learned that because of what we were trying to accomplish, that was not the best way.

So again, first start off with your assessment. What is it that you want to accomplish? And so we found that setting up the VR space and then tearing it down in classrooms all the time, just too time consuming. Faculty were never gonna do it because no one’s gonna take an extra hour to come in. And plus you don’t always have access to a classroom an hour before your class to set it up because there’s people teaching in that room up until 10 minutes before you start class.

So how are you gonna realistically do that? So we learned that lesson pretty quick. So then we had to start pivoting and figuring out what we were doing. And the next thing we came up with was like, okay, let’s look at establishing a lab. And so, you know, we started saying, okay, what do we need? Well, our clinical groups are eight students. So if we’re gonna do a full clinical for eight students, we need to have eight stations.

And then we’re like, okay, but we need a ninth station for an instructor or for myself to be running the simulation with them. So we started kind of figuring out, okay, what’s the need? And so for us, nine stations was the way to go. We started looking at like, okay, are the small monitors big enough or do we need something different? And so what we kind of have come up with is we’ll have eight stations with 45 inch monitors above them so that if I’m teaching and they’re in the VR space, I can quickly look at everybody’s screen and see where they’re at and what they’re doing.

So if they get stuck, if they don’t know what to do, I can jump in and help them by seeing what they’re seeing without having to get right up to their little small monitor. So, and then on the instructor station, we’re putting a larger monitor, so that way then, if I want to do some tutorial or showing things, everyone can see the screen very easily. And, you know, we’ve looked at, you know, because sometimes, you know, in these scenarios, you have to get down like on your knees on the ground, because if the patient’s laying on the ground, you know, the headset knows where you are in space and that you need to get down there. So like we’re making softer edges on our tables. We’re getting, you know, instead of having regular desk chairs, we’re getting kind of a stool chair. So that way students can be at their normal height. So that way then again, because the headset knows where you are in space and if you’re sitting in a regular office chair, you’re gonna be at belly button level for the people that you may be working with.

And so to make it more like it’s real, so we, and we learned this by, we established one lab in our trades and engineering section, and then I was using that space to kinda help me kinda figure out what I needed. And I just kinda kept taking notes on, this was an issue, this was an issue, and now we’re, as we’re building our actual health sciences, virtual reality lab, we’re taking all those lessons that we’ve learned about what not to do or where the problems were and fixing them.

So like we’re not gonna have small little, like we’re actual tables, we’re actually gonna build shelves on the wall and so that all that fits there is the keyboard and the mouse. Because we don’t need a regular deep desk because students aren’t going to be sitting there using the keyboard and mouse. They’re going to be using their headset and their controls. So I don’t need to have that kind of desk space like you normally would have. So it’s almost going to kind of look like a Starbucks where you’re going to have the shelf around the wall kind of like it would be a coffee bar or something. And then we’re going to have something special, like we’re looking at having chairs with a desk piece on it.

So if we have someone with a visual impairment who can’t do a VR because they get migraines or motion sickness or their glasses won’t fit inside the headset, then what we can do is they can scoot back a little bit and use the big monitor on the wall and use their keyboard and mouse to navigate the scenario and still participate with their peers. So we’re just kind of taking all the pieces that we need and we’re saying, okay, how do we make this work? And right now we have a really solid plan, and this fall we’ll actually be unveiling and start using our new virtual reality lab in health science.

That is so awesome. I can just imagine. It’s like you’re going into a regular classroom with PC hardware, but it’s really like a holodeck that you can transform into all these different environments and different patients and run just really any kind of simulation you can imagine at that point. Could you talk a little bit about the cost differences? If you were to build out a traditional sim lab versus the VR lab. Obviously, the VR lab does require an initial investment to get it up and running. But over time, like how does that compare with what a physical sim lab would entail? So, based off of current, you know, estimates that we’ve been getting and stuff, we’re looking at around about $80,000 initial investment for our VR lab.

Now, that’s including a lot of bells and whistles because of course the college is like, well, if we’re investing in this, let’s make it a show place. Let’s make it something that, you know, we’re proud to have people come by and be like, look at what we have. And so, you know, we’re looking at, you know, they’re putting up, like, on the outside of the room, they’re gonna have some special infographic stuff about virtual reality and they’re going to have a monitor out there so people can see what we’re doing on the screens. Um, you know, that’ll, it’ll mirror our screens in the room. So people don’t have to come in to see it. So if they’re doing a tour and we’re doing a scenario, they don’t have to disturb us. So, I mean, we’re looking at about an $80,000 investment where if you look at buying a single mannequin is over $150,000. That’s not even building the space to put the mannequin. That’s just buying a traditional high-fidelity simulator. And I mean, I would say it’s substantially cheaper.

And, you know, with Acadicus, a yearly subscription is far less than buying a simulator every three years. Because if you buy a simulator every three to four years at $150,000, that’s about $50,000 a year. Way cheaper than that, even at 50,000 a year where Acadicus is far less expensive than that. And I can have patients who are not only Caucasian or African American, but you guys have done a great job with creating pediatric patients, patients who are Asian, and have many diverse backgrounds.

And I’ll just say that a lot of the mannequins I see out there like the ones that are african-american they don’t look really african-american they look more like magic marker like they’re not it doesn’t feel representative of people and on top of that good luck finding one that is of you know hispanic background or Asian background or who you know you’re really limited on what you can get for that and so then your scenarios feel less authentic and within virtual reality we have that because you guys listened and you made patients who were diverse and I like that part because when we have as we have changing populations in our area I feel like our students are gonna be able to feel represented in their scenarios that they’re seeing.

And it’s gonna feel represented in a respectful manner, not in a manner that, cause I’ll just say I am embarrassed to ever use our African American simulator because it feels disrespectful to people because of just the way it looks. It just doesn’t have an authentic look to the patient. And, because it literally looks like they took the Caucasian patient and dipped it in brown magic marker dye, like that’s all it is.

And you can’t change the facial features. You can’t change anything with these other mannequins that are so expensive. So for an $80,000 initial investment, like the laptops we bought years ago, we buy the high-end ones so that way they’re a little future-proof and they last. So we’ve had these laptops now for over four years and they still function perfectly with Acatecus and other software that we’re using. So it’s one of those things that you come out far cheaper with virtual reality than you do with a traditional sim lab. And one of the things that you also can get from that is that the patients are, they’re not depreciating over time.

Like they’re not getting wear and tear, they’re getting smarter over time, right? So like I always think back to, if you look at what our patient population in Acadicus looked like a year or two or three years ago, it’s like apples and oranges compared to what they’re capable of now. And then I really like to think about where’s that going in the next two, three, four, five years? You look at so much new technology and animation fidelity and so much that we can do with PC VR because we have that high fidelity, high graphics capability.

We’re really going to be able to push the limit on realism. And it’s the patient, but it’s also the environment. You know, if you were to choose to build a physical sim lab, you can really only represent one type of environment. And the rest of it is like, okay, let’s just everybody pretend like we’re in an ICU. Whereas within virtual simulation, you can click a button and now you’re actually in an ICU and you’re hearing alarms and beeping and it feels very authentic.

So it’s authentic environments as well, that really open up those possibilities. Well, and you bring up a good point about, so if I want the newest, latest, and greatest mannequin, I have to shell out $300,000. By subscribing with Acadicus, I just automatically get the latest and greatest patient that’s new. I don’t have any extra investment. So like our Acadicus Gen2 patients have been released, I’m not paying extra money to get the newest and latest and greatest.

I pay my subscription and I can plan my budget around that. You know, I know it’s going to cost this much. I don’t have, and it’s not, and I really hate the subscription per student method that you see so much in many other products out there because it’s like, oh, well, you have to buy a license per student to do anything and then you know if you buy more than it’s cheaper but you know if you’re a smaller program who can’t afford that and you don’t want to pass that cost on to your students you know it’s hard to budget that and figure out because it depends on how many students you have registered at a time on how much it’s going to cost and that’s just not you know especially in education where money is always tight and so you know knowing that I’m gonna have this dollar amount every year for how many every years and I don’t have to worry about trying to figure out okay well now let me start planning and well if we take in this many students I’ve got a budget for this much and if we take in this many students and I got a budget nope I can use pre-made ones.

I can collaborate with my peers. Because if I wanted to meet, let’s say that there was another, we have several campuses, but if I had two campuses that wanted to meet, instead of doing even just a Zoom call, or we use Teams, hey, let’s meet in Acadicus. Like we can go in and we can create the scenario together. So you can be, you know, an hour away from me and the other person can be an hour away from both of us and we can still meet in a space and design a simulation and build the space together.

So I can say, okay, instructor John, you wanna do a VR scenario, let’s build it together. So we all come in there and then I can start, okay, here’s our bed, here’s our patient, here’s your equipment, here’s this, and now let’s write up the scenario and put it where what we’re gonna have for students, what the instructors need, and we can just work on it there together and they don’t have to drive an hour to a Sim Lab where we can, again, where we have a limited capability of doing different scenarios. Because what if we want to work on a home health scenario for our community health classes? I can’t do that.

Like we take our hospital rooms and like you said we pretend we’re at their house and try to do that but you know you don’t have separate rooms where because if the patient was in the bedroom and you were going to talk with the wife in the living room, I can’t do that in my Sim Lab, but I can do it in virtual reality. So I can have those different experiences that are beyond the hospital.

Absolutely. Well, and also, working together with different schools or different campuses within your school is one really powerful unlock, but then also being able to collaborate with other nursing programs all around, you know, all across the country at this point. There’s so many nursing schools that are coming into the program.

What I get excited about is the opportunity for collaboration across those different schools, because they all have, they all do things differently. And that’s one of the most exciting parts about my job is I get to talk to, you know, people that are running nursing programs all over the place, all over the country, and they all have slightly different approaches. And I think when they start, you know, Sim Labs right now are often very siloed where they’re all doing their own thing their own way, but potentially getting into this virtual network Sim Lab where you can actually just as easily say, as joining a Zoom call, say, like you say, let’s jump into Acadicus.

Let me show you how we’re running that scenario. Or we came up with a new multiple casualty scenario that’s really cool, you should check it out. And we saw that even happening at IMSH. We were just there in Orlando and some of our existing customers were meeting with us and started talking to each other and they’re comparing notes and, oh, I saw you had that scene, could I borrow that? And just that opportunity for inter-nursing school collaboration could be pretty powerful too.

Oh yeah, and you know, because we always hear like competition makes you great and blah, blah, blah, blah, blah. And I’m like, well, that’s a lie Because I don’t think competition makes things great. I think collaboration makes us great. It’s when we work together and when we put our heads together because When you’re working in a silo, you don’t learn new things. You don’t get new ideas. You’re trying to think of them on your own, but you’re gonna get stuck because your brain is always gonna stretch so far unless you have someone else. It’s kind of like when you first wash your sheets and they come out of the dryer and you try putting them on, they’re really tight and sometimes I have to be like, hey husband, come over here and help me with getting this sheet stretched over because it keeps popping up another corner while I do it.

I need someone else to help me stretch my brain sometimes so that I can get new ideas and the flood that can come from that because sometimes they’ll say something that is so innocuous that doesn’t seem like a big deal, but they’ll say something and I’m like, Oh my gosh, what a new great idea. And I’m totally like, my brain just starts firing like crazy because I’m like, it just opens up a whole new thought process that I never considered before. So by having that chance to easily confer with people and discuss and you know like oh what else are you doing here and that helps me tremendously and normally the only time you get to do that is at things like IMSH or at an Axel where you see other simulationists then but you know even like I don’t get to go to other campuses of other colleges in our area and meet with their sim people and chat with them. Because I have a job, they have a job who has that kind of time.

And when I do have the time off, I don’t want to do more work. I want to be doing the things I want to do when I’m not working. Like it, it’s one of those things that you’re just not like, you know what? I’m going to take this Saturday and go meet with other people and talk about work. Like, that’s not what I want to do. But what if you could easily meet with people in a virtual world during your work time where you’re not having the travel and the parking and the scheduling? You can be like, hey, let’s meet up on a Tuesday at 4 p.m. as we’re winding down our day and we can throw on our headsets and chat. And so that’s one thing that the collaboration is much easier to do when you don’t have to deal with the logistics of being all over a city, state, or even country.

So I think that’s another exciting piece about, as technology has grown in this area, we’re just gonna be able to work so much more together and hopefully egos will not be a prohibitive factor to that. We just have to understand there’s different ways of doing things. Our way is not the only way. And to consider different ideas because this is all new and we are working on establishing the best practices for virtual reality. And you know, the only way that we’re going to learn these lessons is by talking to each other.

Absolutely. Well, and I would say, too, that there’s, I often encounter two different types of people that come to virtual simulation or just that are in nursing education at all. You know, some of them are of the mindset of just, I got to do my job. I’ve got a day job. I’m overworked. I’m tired. I don’t want to have to learn new things. And they just need to crank students through the program and just get them their simulation experiences just so they can check a box in the curriculum.

And it’s, I, unfortunately, it seems like the majority of nursing educators come with that attitude. And that’s unfortunate. But then there are nursing educators who are extremely passionate about the work that they do the way you are. And that’s, for a product like Acadicus, we can’t build Acadicus without passionate nursing educators like you guiding our development.

Like everything that we build, we don’t build anything because we think it’s cool. We build it because nursing educators are telling us, this is the content that I need and here’s what I need it to do. And we’re trying as best we can to build it around those needs so that we get out of the way and we’re just providing you with the tools you’re asking for, the environments, the patients, the equipment, the functionality. And so when you find a passionate educator it is rare. It’s becoming increasingly scarce at this point, which is a little bit scary given the amount of shortages and issues that we’re having in the industry. So all of that said, I think it’s important to be able to form network connections between those passionate nurse educators.

Because you’re right, the ones that are just there to crank students through a program, they’re not as interested in collaborating. They don’t care as much. They just want a program that’s gonna do it for them. They can just offload simulation. But the ones that are passionate about it, not just about education, but also keeping in mind that this is about the patient. This is all, at the end of the day, we can’t forget about the fact that we’re trying to increase patient safety.

We’re trying to reduce errors. We’re trying to create a better situation for a patient that’s in the hospital. And when the person comes into care for them, the kind of training that they’ve gotten will matter to the outcome. And so being able to connect these passionate educators, not just in the schools, but also in practice, in the hospitals, in the clinics, and getting their expertise there, I feel like that unlocks a new dimension that we couldn’t otherwise do when we’re all sort of working on our own.

I love that you brought that up. Yeah, it’s about the patient because, you know, and this is where a lot of people talk about, you know, student success and student success is very important, but why is it important because of the patients? And so, yes, it’s about the students, but it’s about the students because they’re going to be touching patients and they need the best that they can get on their education.

And I think back to when I started nursing many years ago, I’m right at 20 years that I’ve been working in healthcare now, and the patients we saw then, I remember people that were older nurses at that point being like, patients are way sicker than we used to have. And I think back to when I started nursing about 20 years ago to now, we’re seeing even sicker patients than whenever I started 20 years ago. And we’re seeing different disease processes that they’re on med surg now where they used to be in ICU.

And as our climate is changing and we’re getting warmer and warmer, that means that more chances for bacteria and more chances for, like I was just reading a study talking about the increase of fungal infections that they’ve seen over the past several years because fungus can live better in the warmer climate that is occurring. And so we’re seeing new types of infections. We’re seeing more superbugs.

And we need to be able to give students scenarios that address the more sick population that we’re facing. And after a pandemic and now we’re seeing the effects of that on people. We’re seeing a greater increase of mental health issues and we need to have tools that allow us to arm our students so that they can deal with the rapidly changing patient populations that we’re having. And you can’t do that in just traditional sim all the time because it there’s not the flexibility to be able and I love in-person sim I think it’s a fantastic tool, but it has limitations and you have to find a way to give your students what they need so that way they can help patients to the best of their ability.

And the only way to do that is to have more flexible tools at your disposal that are gonna let you meet those needs. So kind of on that point, I was thinking also about the future for virtual simulation being, as new superbugs or best practices are emerging, I’d like to think that someone could build a scenario. We could build a scenario together with an SME that addresses something brand new that just came up. It’s some new topic, new superbug, new best practice.

And if you could hypothetically build a scenario and then share it in one click of a button, every single school using Acadicus can instantly be able to run that simulation so it can disseminate new ideas and best practices very quickly. And I think that’s another possibility with this network model. And just thinking back to, you know, when COVID hit and we think about how many changes and updates to practices there were.

And within Acadicus, because you do have control over the content, you can make it change based on what’s happening in your area, in your space with your providers. And so maybe there’s a provider in your area who’s changing the way that they do you know knee replacement care after surgery. You could easily go into Katakus and make a change to that order set, make a change to the dressing that you’re using, make a change and you can meet the needs. Whereas when you’re dealing with other companies you know they’ll tell you like, oh yeah, we can make changes, we can customize for you.

It’s gonna take six to eight weeks to get it processed and you owe us 20 grand to do it. Whereas I can go in and make my own changes. I can take a scenario that’s already there. So if we had a new replacement scenario, which Acadicus doesn’t have yet, we’ll work on it. But as we’re creating these scenarios and maybe I need to change something because I have a provider who wants certain things to happen or they use a certain kind of drain or they use, you know, they just have whatever their own personalized order sets are and you want to, you know, incorporate that into your scenario, then you can do that.

And you don’t have to wait six to eight weeks for a programmer at another company to do that and then pay them that extra money on top of it. So that’s where the flexibility and the changeability is great. Or if you’re looking at how your students are performing on your exams and you’re seeing that they’re struggling with a certain topic. Years ago when I was teaching at another college, we had an issue where our students weren’t scoring well on their exams about death and dying. And so I wrote a simulation and we did all the steps to get it up and going and our students improved. Well, instead of having to worry about fitting that into a regular Sim Lab schedule, because that was a problem for us, we had all of our regular scheduled sims and it was hard to find extra time.

So then we were trying to figure out, okay, well, what sim do we cut out so we can do the death and dying one, because we were running out of, you know, we didn’t have the space to do it always. And so, having virtual reality where I could go in, build the scenario, and work through it, and I don’t have to worry about extra space. I mean, yes, eventually, at some point, we may have to look at building a second VR lab, but again, still way cheaper than if I had to expand my actual sim lab.

So, and again, we’re not replacing in-person sim, but it’s that way to use it as a, not only just a clinical replacement, but also a teaching strategy for our theory courses and our lab courses. So, you know, if I want students to work on practicing their respiratory assessment skills, you know, let’s build some scenarios where they can come in and do a pediatric lung assessment and work on that and then do an elderly patient who’s maybe confused.

And so instead of them just practicing on a mannequin in the skills lab all the time, let them come into the VR lab and have some patient scenarios that they can work on.

Yeah, that’s a great observation. I think that makes a lot of sense. And kind of going back to a point that we were discussing earlier in terms of, you know, representing the diversity of different scenarios, but also of different patients, one of the things that is important, I think an important differentiator with Acadicus is the ability to authentically represent a variety of different patient types across the broad spectrum of diversity.

And it’s very difficult for current sim labs, especially in smaller rural areas, to be able to provide access to an authentic representation of a diverse patient population that these students would likely face if they were working in other areas, other regions. And so, again, with that network model, what I think about is if someone finds a great patient actor that does a great job of playing our Hector Gonzalez patient, that actor could be available to every single school to run their scenarios using that actor.

And hopefully we could get to a point where the people that are playing these patients are genuinely, authentically representing that across even different illnesses or neurodiversity or anything that they can represent authentically and students have access to that in a way that they may not ever experience, even in a clinical. You know, you get a clinical placement, but you’re not always gonna see all those different cases. You’re not gonna suddenly get access to all these different experiences, but we can provide that.

Well, even if, you know, you think about, so in Green Bay, it’s a smaller population. Like I said, we’re less than 200,000 people. And there’s not a great deal of diversity. You know, that’s changing over time. But you know, that rate doesn’t just happen overnight, you don’t have that increase of diversity overnight, it takes years to get there. But what if I could get as we call them standardized patients? What if I could get a standardized patient from Milwaukee or Dallas, Texas, or California, Washington, I mean all over the place.

And you know, because if there’s someone who’s really good and then I don’t have to, we don’t have to have them as an employee even because you know, they could be working from, you know, Oregon and play a patient for us and we could pay them kind of like how we use MARDI at hospitals now for translation services. Used to, the model was that you would pay a translator to come and sit there 24 hours a day, and if they weren’t being used, they just sat there and got paid anyway. And then for the 10 minutes that they were being used, they would come in, they would be used for like 10 minutes when the physician came, and then whenever the nurse would go in, they would help during then.

But you know, they were probably totally translating, you know, probably about two hours a day out of 24 hours. Then we went with Marty, which is a computer that you roll in the room. When you need it, you use it and then you turn it off. And then it goes back out in the hallway and you only pay per minute that you’ve used it. So then you’re only paying for the two hours of time instead of 24 hours of time. Well, what if you could do that same type of model where, you know, maybe even it’s not through Acadicus, but we’re just going to put an open call out to areas that have standardized patients and, hey, we’re looking for these people and, you know, we’re going to pay, we’ll let, we’ll contract you out as an independent contractor and we’ll pay you during the time that we need you.

And I mean, that could be a career for someone that we could say, hey, we’re using so-and-so and they’re awesome for this patient, or we’re using so-and-so for this kind of patient. And so then we could be employing someone who’s not even in our area, but does a really good job playing that patient for us. Because if I have to pay for someone who I’m only gonna use for a few hours a day, and then I’m trying to find other work for them to do to justify their employment.

So they’re stocking shelves or they’re doing this, but what if we could take someone who’s really good at playing that and let them just independently contract out and play it for several schools all at once? And that’s way more cost effective. And it also, I mean, you could be working with students who are medical students, people who are nursing students who have an interest in playing the standardized patient role for different things, who have some, but I don’t think they need a medical background because most patients don’t have medical backgrounds.

So, I mean, it could just be someone who’s a theater student who is willing to take the time and learn about, here’s the type of things that you would need to be able to say and do. I mean, there’s standardized patient programs out there for you to get certified as a standardized patient. And so let those people work more, instead, because it’s hard to find a job as a standardized patient and get employed at a school because they’re not gonna need you every day, all day.
But if you could be employed out across the country all at one time, far more effective.

The idea of having a live patient actor can be an objection for some schools, because they’re just looking to virtual reality again to offload simulation. They just don’t want more work. They just want to be able to offload it. But it’s something we’re staying true to just because of the fact that the schools we talk to that are employing it this way are experiencing great success with it, because when the student puts on a headset or they join in desktop mode and they talk to the patient and the patient responds in a meaningful human way, that still matters, right? You know, no matter how sophisticated AI is getting and voice recognition, there’s lots of really cool things and it’s advancing rapidly, but there’s a magic to live communication with a person that we still think is important and it certainly plays out when you look at the student reaction.

When you see a well-run simulation and there’s a patient actor in there that’s really representing the patient in a live way, they’re responding to what the student is saying, they’re learning. It’s a much higher degree of engagement than you would otherwise see if they’re just trying to figure out, what does the program want me to say? Because again, if we’re getting back to the fact that, we’re trying to improve care for patients. We’re not just trying to figure out how to make nursing education easier. It’s really about trying to get to a point where they’re better at communicating with patients. And the patients right now are not AI. These are real patients, and they’re real people, and they speak in real ways. And you need to be able to practice that communication. And we still think that’s important. So again, it can be an objection like some schools are like, oh well I still have to have a patient actor, you know, like why can’t I just you know Set it and forget it But it’s something we’re hanging on to and I and I just I hope that there’s still value in being able to have students practicing with live patients well, I think that and it’s kind of something you said just triggered in my mind thinking about, again, what are you wanting out of your VR experience?

If you’re wanting it as an offloading thing, then that’s fine. There’s tools out there for that. But that’s really not, you have to ask yourself, what’s the value of that? If it’s just to decrease faculty frustration or to help them offload some time or whatever, then look at what your faculty model looks like. Are you, you know, is there something else you can offload to give your faculty some quality time? You know, and that’s something that I know we talk about at our program is, you know, where can we make cuts that make more sense?

So we always have to fill out course reports at the end of every semester. And one of the things that I was like, okay, I’m having to hand calculate all this stuff and figure it out, and it’s a pain in the rear end. It takes hours to do, and it’s just problematic. So we then went to our LMS and we said, hey, is there a way that the LMS can do this calculation for us? And they’re like, well, yeah, you just have to do this.

And I’m like, that’s all it takes. And it was inputting our student learning outcomes and competencies and those kinds of things into the LMS. Once they got loaded in, it generated all of our course reports. So then faculty could literally click a button, get all of their calculations for their test analysis done instantly with the threshold that we wanted to examine and then they just had to put in what they had done and what they’re doing differently based on the results of this information.

So I mean, are there other places where you can respect your faculty and cut out some of their busy work that they can do better with their virtual reality? And again, it’s up to you on what your needs are. If your needs are that you need to help students more in theory courses, you know, Acadicus could be right for you, but maybe it’s not. And maybe you need something that’s more of a gamification type learning versus simulation learning.

Because some of them call themselves simulation, but I’m like, really, this is more of a gamification. It’s not truly a simulation. Because simulation has that live moment to it. And like, I’ve seen some VR things out there that literally, if you don’t say a specific word, like you don’t get the credit for it. And so all students are gonna do is work on memorizing, here’s the key things that if I say, I get credit in my assignment, and are they actually learning?

And that answer is, sort of, but it’s not really gonna help them in the long run. It’s a temporary fix that’s gonna give them a very minute boost that’s really not quality, in my opinion.

Yeah, that makes sense to me. One of the things I wanted to ask about was one of the initial reasons why we started building Acadicus was we’re hearing about shortages in nursing and healthcare across the board in medicine. And wondering what your thoughts are on whether or not virtual simulation could play a role in helping to alleviate those shortages.

Absolutely, because that’s how we landed with Acadicus. Where we are, because our problem was, we couldn’t, we were running out of admission slots for our students because we didn’t have clinical space. So if we can even increase by 25% our clinical slots because of using simulation, virtual reality simulation, and in-person clinical, you know, we can get more students in and get more graduating. Because when you look at the research, the research out there shows us that we’re graduating the same number of nurses that we always have. And we lose a very large percentage that don’t complete the nursing education because it’s really hard to become a nurse.

You always hear that it’s one of the most difficult undergraduate degrees to complete because of the amount of knowledge you have to assimilate really quickly. And not only do you have classes where you go and learn information, but then you have lab classes where you go and learn skills and then you have clinical and you have paperwork to do. And I mean, there’s just a lot to do, and it’s difficult. I still remember the PTSD that I got from my undergraduate nursing. It was really difficult. And so, you know, we have to have new techniques to help students learn better because I believe the last national average I saw was 54% of nursing students complete their nursing education on time. And I don’t know if that stat holds up still, but I mean, I can’t imagine that it’s gotten better through the pandemic But I can imagine that that number has gotten worse and so We have to find ways to help students learn and When you’re cramming that information, you know that amount of information in their head That quickly how much do they actually retain because especially if it’s a lecture class like oh my gosh I can’t tell me times I slept through lecture class.

Because they’re boring. Because you’re sitting there and, you know, if you don’t have an engaging lecturer, ugh, like I found Sunflower Seeds were my best friend in nursing school because it was something I could do to help keep me awake because some of my nursing instructors, no offense to them, they were not engaging. Some were great, but man, most of them were just dry and boring. So we’ve got to find new ways to help students engage and remember things.

And the beginning research into VR is showing that students are learning at a rate of up to four times faster and retaining information up to four times longer. Now that’s initial research. That’s not been like, we’re not confirming that we’re not saying that that is a hundred percent true all the time but the initial research is starting to show that students are learning better and retaining longer with virtual reality and it’s because you’re making learning an experience in that moment because like I often tell people if I ask you John what did you have for breakfast three weeks ago today you probably can’t tell me unless you’re one of those people who has the same thing every morning for breakfast.

But if I ask you what kind of birthday cake you had last year, so we’re going back even further, you can tell me because that was a special event. It sticks out in your mind because it wasn’t the mundane, boring, regular stuff that you always do. And so we have to have ways to make learning special and stick out in the mind and make it easier to recall. I know that as a learner, if you tell me just to read something, I’m not gonna do it. I’m gonna skim it and I’m gonna be like, well that’s enough. Because I’m not a reading learner. That’s not how I learn the best. I learn best from, you know, having discussions and, you know, applying knowledge in the moment, which we know that adult learners like. They want to apply their knowledge. They want to use it at the moment. They want to solve problems. Reading and listening to lectures does none of that. Why not do something where I could watch my instructor as they’re talking about the material, and yeah, there could be a PowerPoint that I’m following along with so I can take notes on and I’m getting the important points, but instead of having to watch the PowerPoint go across the screen and just seeing those words, why not have it be done in a VR lab and you could record the screen and then post it in your LMS.

And now your lecture has movement, it has dynamics, it’s engaging, and it can be like I can see you using the knowledge in the moment as you’re caring for this patient. You know, I think with pharmacology, that’s one of the hardest subjects for students because there’s so many medications and the number keeps growing. And they have to learn pharmacology. 30 hours to learn thousands of medications. Now we teach in classes which is a far smaller number but still that’s a lot of information to cram into 30 hours of class. So therefore what do you do? So what if you could do, okay, we’re going to talk about beta blockers now, and here’s my metoprolol, it’s one of our gold standard drugs for this. When I give that, and then you could change the vital signs and show that the heart rate goes down, the blood pressure goes down, respirations decrease.

You could show that on the patient, and you could show that on the vital sign monitor, and you could talk about, before I give this medicine, I need to do this and this and this and show students what to do. So not only are they getting the visual part of, because I mean we’ve debunked learning styles, like we found that it’s not really a thing. It kind of is, but not really. But what if I could show, have the visual part of the PowerPoint that students are following along with, they’re getting the audio of hearing me talking, but then they’re also getting the kinesthetic and the movement by watching me talk about that in their lecture. And then they could come in to a VR lab and we could, I mean, I can make a scenario for them where they could come in and, okay, let’s talk about giving this medication and then what do you think is going to happen? So they could answer and I could be like, well, let’s give it and see what happens.

And then I could change the vital signs and they could watch it happen in front of them. I mean, there’s so many ways to use this and that’s gonna help more students graduate and that’s gonna help them be better nurses for all of our patients. And it’s going to give them the opportunity to succeed and to feel more confident in their ability to provide care to patients.

Jon:Absolutely. Another area along those similar lines that I think about a lot is, you know, like for example, we have the simulation where the students have to deescalate a patient that’s upset, you know, and he’s really angry and he starts yelling at you when you come into the room and you’ve got to, you know, use therapeutic communication skills to de escalate. You know, what if we had a world renowned expert on de escalating upset patients come in and do a 3D recorded lecture on, you know, here’s five things you’re going to want to keep in mind.

Here’s some tactics, techniques, you know, practical knowledge that you can apply. And because we can capture those demonstrations in 3D, it can be available to every student using the platform anytime they want. They can watch it over and over again. They can watch it from different angles. They can, and again, you know, the early efficacy data is incredible in terms of, like you’re saying, like three, four, five times, you know long higher retention rates and even if it’s a quarter of that it’s Accelerated learning in a very very meaningful way and you’re connecting with experts that you may not otherwise have access to in an environment Where you’re leveraging embodied cognition and things that are helping you remember and learn in a much more effective way.

Because right now the only method that is shown to Have greater learning efficacy than virtual reality is teaching the material yourself Which we’ve all sat through enough student presentations to know that they’re not good teachers You know they don’t have that skill set because we’ve said that those presentations where you’re like oh This is painful But you applaud them and you say good job and you know because they’re just not used to exercising those muscles of teaching.

And that’s fine. So, I mean, that’s not and they don’t like doing it. You know, I understand they learn a lot from it, but they don’t like doing it. It puts them off. It makes them and it kind of promotes that us versus them mentality because they’re like, oh, then shark makes you do this all the time and I hate them for it. But so if the second best thing we have right now is virtual reality, use it. You know, if I mean, because if you’re going to get that greater efficacy in their learning, use the tools, you know, and yeah, it’s new, it’s different. I understand that new and different is scary, but we’re grown-ups, we’re adults, and the only way that we’re going to get better is by testing it, by pushing ourselves, testing our boundaries, getting into those scary spaces, and you know, going for it. And like I tell students all the time, like you know what, this is new. I don’t have all the bugs worked out. We may hit a road bump here and there and that’s okay because we’re learning and we’re growing and we’re trying to make this a great tool for you. So I always have them do a survey afterwards. What did you like? What didn’t you like? What would you want to do differently? What topics would you like to see? I always do a survey because I tell them that they can’t leave the room until they do the survey. So I kind of hostage them until they give me what I want but so You know because that’s the thing is that and everything is that they love it They talk about how much they like it, you know and when I have a student who’s come in for a second time, they’ve always I get all the time like I still remember that from the last time we were here and Like oh this really I mean days They tell me how much they like it and how much they learn from it.

And then I’ve actually had students who’ve come back to me and said, I went to clinical the other day and I got to use what we talked about in VR. And I’m like, wait, you remember it? Because literally I’ve had times where I’ve taught a class and I know I taught the material. Like in their fundamentals class, I know I taught the material.

And then I would see them in clinical in that very first clinical, because I love the first semester of learning, because that’s when students are the biggest sponges. By the end of it, they’re kind of jaded and cynical, and they’re like, oh, you’re here just to make sure I don’t kill anybody, right? And I’m like, yeah. So I love the beginning. That’s my favorite part of teaching those first semester students when they’re establishing that.

So I know I’ve covered that material in their foundation class really well. And then they come to clinical and they’re like, I’ve never heard of that. And I’m like, yes you have. I taught you that. Because you were in my class. I know you’ve had that information. But they don’t remember it because it’s not memorable learning.

Because it’s a lecture or it’s, you know, it’s just, it doesn’t stick with them because they’re trying to learn a million other things at the same time. And, but I’ve had them do things in VR and they come back and be like, oh, I did it, I remember this and you talked about that and da, da, da, da. And I’m like, and I remember just my mind kind of melting out of my ears a little bit. Because I’m like, okay, we’ve got to give them something that makes it stick out. Because, I mean, not only do they have, you know, three or four classes for nursing, but then they sometimes have a co-requisite.

They have a job, they have families, they have, you know, just life happens at times, and sometimes it’s hard to compete for their attention and their memory. And so I wanna use whatever tool I can to get the edge when I’m competing for their memory and their recall and their learning. Because I mean you’re also competing with TikTok and YouTube and Snapchat and all the other things out there in the world. And so using this has been. I mean it’s great to help them be able to recall and make learning exciting because I don’t want boring classes for my students. I don’t want them to be doing a checkbox.

I want students to be excited to come to class and to get different experiences. Why do they not want to participate in lectures? Because they can’t remember anything that you had them read or the lecture you had them listen to already. Whereas if we can do a VR and apply the knowledge and then talk about what we did in the VR, they’re gonna do so much better with that. Yeah, excellent points. And I just, the last thing I wanted to touch on was, and we’ve been kind of talking about this throughout the whole conversation, but the future of virtual simulation.

What do you see as the future and what kinds of new possibilities might emerge as a result of this technology as we go forward? I think we’re only limited by our willingness to build it. I can see this going in so many different ways. I could see it being used in theory courses, not just as a clinical replacement, but looking at integrating into theory courses. So I actually wrote a scenario that’s being developed right now with the catechist, that’s a pharmacology scenario. So that way then, let’s say you have an exam coming up and you wanna do a review session.

So you can bring your little laptop in. So this is where laptops are a bonus at times, because you can bring the laptop in, you can plug it up to your smart board, your projector, whatever you’re using for your screen. And you could hook that up and you could have the headset set in there and you could say, okay, John, let’s go and find, we have to give this patient a ACE inhibitor.

So go find me the ACE inhibitor on, you know, out of these medications that we have here. So that you find it and then you say, okay, now go assess your patient for what you need to know to be able to give this medicine, determine if it’s safe. So, you know, they could go and they could do the assessment right there, and they could do all the stuff they’ve got to do, and then you could have like a mini lecture moment where you talk about, OK, so with the ACE inhibitors, what do we need to know?

What’s important? What’s the side effects that we have to watch out for? So they could do the education with their patient right there in VR. And then we could take the headset off and we could say, OK, now, Jill, I want you to come up and I want you to go and find me the calcium channel blocker out of these medications. You could change the vital signs on the patient and let them reassess a new patient with different meds and you could use that as a review session. I think you could do this.

There’s so many things. how willing you are to push yourself in your creativity and your willingness to collaborate with others that are looking at different ways of using this as well. I think that where we get hung up is we think, oh, we have to use this the way it was like, whatever we bought, boop, here’s the box it’s in, I’m gonna use that box. And I don’t like boxes. I wanna look at different ways. I mean I think that you know when I look at our next generation NCLEX as that’s coming out and we’re gonna have to figure out new ways to help students do well in those.

So you could build scenarios that are very next generation NCLEX based where you know they’re having to look at prioritizing. I’m actually working right now with one of our faculty members. We’re developing a scenario That it’s in the four base place space. So what we’re gonna do is we’re gonna give students Before they ever come to the VR we’re gonna give them all the information about the patients and We’re gonna say who you’re gonna see first second third and fourth and one of the things that students kind of don’t always get is You know, yes this patient’s been here a long time, but they’re really sick. But they think the new person who just walked in the door is the priority patient. So then they’re going to go in and they’re probably going to choose the wrong patient for their first assessment or their second assessment. And they’re going to put the person who’s been here a long time probably on the back burner. And then as they do the assessments, and they’re like, oh man, this person is really sick, and, because they didn’t catch it.

And then we’re gonna have them reflect and talk about it. So it’s not like we’re even using it, because that’s gonna be more of an independent one, that they’re gonna come in, do the assessment, learn the information, and then they’re gonna go and write reflections and think about it. And then they’re gonna use that in their theory course to talk about those situations. So, because like we’re going to put in a patient like a GI patient with an NG tube, we’re going to have a chronic kidney failure patient. We’re looking in so we’re building these we’re looking at these different scenarios, and not purposely trying to deceive them, but seeing can they catch the issue in their report information and make those decisions? Or do they learn the lesson on the back side and then reflect on that and talk about it and then use that in their theory course.

I mean there’s so many different things that you can do with this and again I think that the more that people talk and share and work together I think that it’s just going to grow and as you know as more people use Acadicus and say, hey, here’s what we need, like you mentioned earlier, the more that nursing educators speak up about, hey, here’s the things that we’re seeing, here’s the things that would be nice. Like right now, I’m so excited that you guys are producing the birthing scenario, because we have a really hard time getting students into labor and delivery units, and then it’s even harder to pray.

I mean, you’re literally praying that like, please let someone have a baby today. Because you never know on, you may only get one delivery that day because everybody’s just in labor and they won’t give up the baby. You know, they’re hanging on to it for dear life. And so, let’s have a scenario they can do before they go to the sim lab and do it. And so now, you know, if they do happen to get something when they’re at the clinical site, they feel that much more comfortable because now they’ve had two scenarios that are safe to learn in, and then they get their chance to go and see something.

And so I think it’s only limited by how faculty are willing to incorporate this in and use it and get creative. And the great thing is, that I’m seeing that faculty are being more willing to use it and to consider it as we go. So as you’re expanding the program and you’re onboarding faculty with it, how are you going about doing that? And what are some of the challenges and opportunities that you’re experiencing there? Well, people hate change. They don’t like change. Change is hard and I get that. So what I’ve kind of found is, first I just, at first I was kind of just dropping hints. So like as we were in meetings I’d be like, oh yeah we’re working on that with VR. And then I just kind of walk away from it and so I just kind of kept talking about it and then I just kind of increased how much I would talk about VR at times and then I kind of started with people who I knew that were easier to adopt change so I would kind of find the people who like whenever there’s a new thing coming up at the at our college that would usually be the ones that would raise their hand and try things out, or that during team meetings I would hear them talking about new things they were doing.

And I would, and I started kind of working with them, and I would be like, hey, would you be willing to try something like this? And they would usually say yeah, and every once in a while I’d get a, well, I don’t know. And I would kinda, you know, like, well, why don’t you come by and we’ll get you in a headset and we’ll let you see what we’re talking about. And usually once you can get them in a headset, that usually helps get them bought in.

And then there’s some who still, you know, I don’t think I can do this in my class. And they would, you know, of course, give me the stink face and they would have their you know, I don’t want an attitude So then I use peer pressure from their students because and I I’m honest about it. I tell him like yeah, I would I would get I would say okay John you’re willing to do this. So let’s bring your clinical group in and do it and then students talk. So if Jill is not willing to do VR but you are so your students come in and they get the experience. So then your students are talking about like oh my god we had this super cool experience it was great and we learned so much blah blah blah blah blah. So then they’re talking to Jill’s students well then Jill is hearing her students are being like, how come we don’t get to do this?

Why don’t we get to do it? And so then it becomes a, well, now my students are complaining and they’re being cranky because I’m unwilling to do something. I’m unwilling to push myself and try something new and learn something different. So then it kind of almost pushes them to do it more. And then once they get in and they realize it’s not that scary and it’s not that terrifying then they’re then they’re bought in and So like find your early adopters and you know, you don’t have to launch to everyone all at the same time start small Find your few people that are willing to try things and you and do it as a pilot and you know That’s how I got by with that is I would say okay let’s pilot this with a small group of students in a in this portion and we’ll see how it goes and as you pilot things and the word starts spreading people buy in and they start you know kind of like oh okay this is cool and this works and it’s not that terrifying and so the biggest thing is you know don’t try to solve all your problems in one move You have to you know You have to learn to crawl before you can walk and you have to walk before you can run And I know it’s trite and it’s been said a billion and a half times But it’s really true and that’s the been the biggest thing is because I when we started off I tried to solve all the world’s problems like I was trying to solve world hunger and and find peace, world peace, and all this stuff, all with, and I was like, this is not possible.

And I got overwhelmed and it kind of made me want to shut down a little bit. And so then I just had to step back and say, okay, one thing at a time. So we started small. Like, okay, I’m gonna do a few days of clinical replacement for people. Or I would have faculty who needed a day off during clinical. And so I would say, hey, if you want to take a day off of clinical, because you’re having a, you know, you have to go to the doctor or you have an issue and you would normally cancel the clinical and make it up a different day, instead of canceling it, send them to me. I’ll take your students and we’ll do a VR day. And I would start there and I would just use it here and there for people.

And then now it’s becoming more like I actually get emails from faculty. I’m like, hey, I have a big meeting that I have to go to for state curriculum on this day. Can you cover my clinical for me? And so now people are actually reaching out and new people are reaching out. So I’m getting new faculty who are saying, hey, you can do this and help me out. So then after I have their students, their students come back and be like, Oh my god, it was so cool.

We learned so much. And now they’re willing to do it again, and again and again. And the word is spreading and it’s growing. And that’s why now there’s like such a big impetus to get our lab created and open by September because it’s also a respectful thing for faculty because I don’t want to take a day off and then have to, because either I have two choices, I either make it up on another day or I have them do a simulation with another faculty and then I have to grade all this paperwork or I have like and it can create way more work for faculty so it’s not really worth taking the day anymore. And you’re just like, eh, I’ll just do clinical and I can’t, you know, but now we have a meaningful clinical replacement for people where they can come in and they can do a VR situation and they can, you know, have the pre-brief and the post-brief, the debrief.

And, you know, there’s meaningful use of this. And as people are like, oh, well, you know, so-and-so did it and it went well so maybe I’ll try it now. So big pieces of advice don’t solve world hunger and try to get world peace. Find your early adopters work with them and let them help be your peer pressure to those who you know just don’t want to do it. And you know now since we’re building this lab, like my associate dean has said, we are going to require every single semester to have at least one virtual reality scenario that they’re going to complete. And so, because now that we’ve been doing it, it’s working well, people are liking it, And the leadership of the college is seeing the value and they’re putting the money into it.

They’re saying, okay, now you’re gonna have to do it. And the same thing happened with regular simulation. In the beginning, no one wanted to do sim, because it’s not the same as doing Quantico. And now people love sim and we use it all the time. And it’s kind of just considered part of standard nursing education, you do simulation. And this is just the next step of that. We’re just gonna be doing it in a different way. And those who are scared of technology are going to have to put on their brave pants and give it a whirl.

And hopefully we can keep it simple enough where initially, like you say, trying to solve all the problems initially, I think faculty can get a little intimidated if they put on the headset and they’re trying to learn how to do everything and they’re trying to learn how to manage the simulation. But what I try to encourage them to think about is that you don’t have to do any of that. Really, if you’ve got your VR lab set up, you could hypothetically have everything logged in so that all they’re doing is sitting down and assessing the student’s performance and doing a debriefing and pre-briefing exactly the same way they would with physical sim, they’re just sitting at a computer instead of in the control room where they would probably be sitting behind a computer anyway.

It’s really the exact same kind of a thing and you don’t have to learn all these bells and whistles. It can be very, very simple if you need it to be. Absolutely. and that it’s giving, it’s breathing some new life into things that get a little stale and a little mundane. And, you know, I think one of the biggest things that I really appreciate the most about virtual reality is, and I don’t think it gets talked about nearly enough, is the fact that you can use this as a way to build psychological safety, that you can build confidence, because you feel safer in your headset than you do in a sim lab.

Because, you know, like when I talk to students, what I always hear from them is that, you know, the thing that scares them the most about simulation is the fact that I’m literally sitting right there staring at them the entire time. Whereas in clinical they don’t get that experience because I have eight students that are spread all over the place. I can’t sit and stare at you all the time. But in Sim Lab because I’m only having two or three of you there, I’m literally sitting there and staring at you the entire time. So while I am sitting there and staring at them in VR, but they don’t see it. They don’t feel it because they’re so immersed in their headset.

And it’s that, I mean, building that safety and that confidence and exposing them to simulation in a way that feels safe, I think is one of the most important advantages. And again, we don’t discuss it near enough. We look at the learning out of it. But I think about like, even when I was in school, we didn’t have a simulation. But when I had to do checkoffs or go into clinical and stuff, you know, it was so intimidating and I think that if I would have had exposure to things beforehand in a way that made me feel safer, I would probably have enjoyed it a lot more instead of being as terrified. Because there was a lot of fear with that exposure. I mean, you just feel very exposed in a Sim Lab.

And so, and especially when it’s not something you feel the most confident in. It’d be like if someone asked me to, like if someone right now said, go to the Sim Lab and do the birthing scenario, I would be like, mm-mm. Like I would be terrified. Because that’s not my background. I don’t have that exposure. It would be like a whole new world to me. And I would literally if an instructor was sitting there grading me while I was working through that I would panic. So what good is it besides increasing my need for therapy? Because that’s the only thing I’m going to get out of that moment. So you know, but if I could do a VR one where I could be, I could practice it and I don’t feel like literally my instructor is staring me down, even though they are watching everything I’m doing. I would feel way more comfortable going up to the Sim Lab then and doing the birthing scenario because I’m like, okay, I’ve seen the steps. I’ve worked through it. Now, yes, I’m not getting the same tactile response with doing, you know, rubbing, you know, checking the fundus or I think that’s what you do.

I don’t really know what you do with birthing babies. But, you know, I’ve at least then seen it, been exposed to it, I’ve heard it. And so it’s not as scary to me. Because like I’ve tried recording simulations in with my phone and posting it in our learning management software. So that way then students can kind of see a version of a scenario that’s similar. And they still don’t get that much out of it. But when I have them do a VR first, and then we go and do a simulation in person, they’re way more comfortable and relaxed.

And they learn so much more. And so I think that that’s really an important piece of this, you know, and I hope that as more research continues that we start looking at how it impacts, like why do we get better learning out of it? How much of it is, I feel more comfortable learning in this moment than I did so exposed? Yeah, absolutely. You know, and I think that it’s true for communicating with each other as, you know, collaborators in a simulation. If the students are working together on something, it’s true for communicating with the patient, but also the family member, and it’s those soft skills, I don’t know, this term soft skills, I’m not sure if that’s the right way to say it, but it is, it’s like about communication when you’re engaging with the family members, there’s a right way and a wrong way to talk to the family members, and if you’re in a mediated virtual environment, I think the students feel safer where they’re more inclined to take risks and to communicate in a way that they may not otherwise do so with physical in-person. So it helps them prepare for that physical in-person encounter. Well, most students today, like I grew up in a time when I would just go knock on my neighbor’s door and be like, you know, can Aaron come out and play? And you know, like I we were forced to be in front of people talking to them.

And nowadays, our generations coming up, they had play dates. They had scheduled time with friends. They didn’t just go and knock on the neighbor’s door to hang out and be friends and do stuff. Because think about nowadays, no one phone calls each other. You text each other, at least first. Like if someone calls my phone and they haven’t texted me I’m like have you lost your mind you are calling me without texting me first? But yet we expect students to be able to talk to people in person right off the bat. Why? They haven’t had to do it that much. Yeah they do it in school to a degree but then even that’s a controlled situation.

And I just, I think that we have to remember that our audience has changed. And unfortunately, most nursing educators are quite a bit older and they don’t consider the changing world. They think about it in the world of which they grew up in. And they don’t appreciate the differences of socialization that has occurred over the years. You know, if nursing doesn’t keep changing, how we approach things, we’re gonna continue to struggle. And I mean, we’re already looking at it. I read a report that said that by 2030, there’s gonna be over 300,000 nursing positions in the US that just can’t be filled.

Because there literally will not be enough physical nurses to fill the spots. And you think, okay, 300,000 divided over the whole US, but that’s still, I mean, one shortage is too many. And we’re already having those problems. I mean, the pandemic has seriously made it where nurses are leaving the profession left and right. And we have to find ways to help get people engaged in this in a meaningful way. And I mean, like I said, one shortage is too many.

And I worry about what’s going to happen with health care when we just literally don’t have people to take care of our patients. So we have to find creative ways to help more students graduate, help them be successful. because I’ve had some great students who were going to be amazing nurses, but because they, life happened and they couldn’t keep up with the program, and we didn’t teach them in a way that helped them learn, we lost them. And that makes me really sad. So I’m looking forward to, as we keep evolving this and adapting it and growing it, I’m looking forward to having less and less students that have to go home and tell their family that they failed, and that I want them to go home and say, I’m graduating, I’m gonna be a nurse, I’m gonna make a difference in people’s lives.

And that to me is the thing that really pushes me to keep working with this, is that I want more people to be able to realize their dream, become a nurse, and make a difference. That’s outstanding. Yeah. Well said. Well said. Is there anything in this conversation that you’d like to add that we haven’t yet covered? You know, for those who are considering adopting VR technology, don’t do it just because it’s cool.

Do it because it’s meaningful. Yes. Don’t do it just because of marketing. Don’t do it just because of, well everybody else is doing it, so we should be doing it. Do it because you really want to and that you care about it, and then find other people who care about it. Build a community.

You know, I’ve been talking with, you know, several different people through groups. And like, I don’t talk to just nursing school educators that are using VR. I look at other educators in different areas. Because if we get stuck in just the nursing group, then again, we’re limiting our ideas tremendously. And find your passion in this. And if you’re not passionate about it, that’s okay to not be passionate about it.

And if you’re a leader in a school, find someone who’s passionate. Really look for that person who, especially if they’re a little socially awkward and they tend not to talk a lot, they’re probably actually gonna really enjoy technology because those of us who are a little introverted and that don’t want to, you know, they might really do well with this because they might feel safe in it. But do it because you care about it and that you want your students to do well.

So make sure you’re keeping the right priorities in this adventure.

Yeah, well said. Well said. Well, this has been fantastic, Mitch. I can’t thank you enough for this. Like I say, you know, with everything we’re doing, we’re trying to, as best we can, listen and absorb what the experts who are using the software want and need in the content and in the platform features. So this kind of a conversation is so valuable for not just other schools that are interested in implementing virtual simulation, but our team is gonna watch this too.

And they’re paying attention, we’re taking notes, we’re trying to be very good listeners. And this is very valuable to hear your insights. And I know that there’s a lot of other schools that will be very interested to hear it. Not just new schools too, if it’s schools that are already implementing it, again, there’s a lot of value in these little subtle nuances and how you go about implementing it that make a big difference.

So I appreciate all of your time sharing this with us and hopefully we’ll be able to do another episode once you’ve got the VR lab set up. We’d love to take a tour and maybe I can visit you in person and we can do a tour.

Absolutely. So once we, because like I said, we’re looking at a September opening for the new fall semester. So as we get it up and running, we’ll be happy to have you come up and let you hang out and we can hopefully maybe even get some students in there and let them do stuff and you can even interview them and talk to them about their experiences. You’ll be surprised at how passionate they are about it because it really does make an impression on them. Thank you for having me on..

Jon: It’s our pleasure! Thank you very much, enjoy the rest of your day and we’ll see you on the virtual frontier.



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