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Funding Your VR Lab + Blood Transfusion Simulations 

Episode 41: June 21st, 2024
Hosted by Bill Ballo, Rick Casteel, Mitch Luker, and Jon Brouchoud.

Jon Brouchoud: Welcome to Simulation Pulse Live, episode number 42, I believe. 42? 42. Maybe 41. I gotta, I always should, I need to look this up ahead of time. This is how I open up the, and every time I’m like, I’m not sure what episode it is. Like, that’s going to be how we, yeah, 41, 41. Episode 41, not 42. That’s next Friday. So. We might have a pretty short one today. I think we don’t. There’s, you know, it’s obviously summer months. Everybody’s pretty busy. Just a couple of one thing I wanted to touch on. Let me just make sure that my attendees open was we just had a fundraiser to with a school that’s interested in purchasing a catechist. And obviously budgets are cut from anybody you talk to, you know, budgets across the board in higher education are getting cut in a big way. And so they decided to have a gulf fundraiser, they actually had a live auctioneer that was auctioning off, you know, the hey, that kind of auctioneer type thing. And They were able to raise money and we set up a VR station to show people what we were doing and had a couple of students putting on headsets to show what it was like. And I thought it was just an interesting way to think about funding the purchase of VR simulation software to actually have a barbecue gulf fundraiser with an auction to help raise money. So I thought that was kind of interesting.

Bill Ballo: That’s pretty cool.

Jon Brouchoud: Yeah, yeah. So, you know, and it just kind of made me think, and the only thing I really wanted to talk about today was just this idea that, you know, we hear a lot from these schools that are looking at buying or want to buy a catechist, but because budgets are getting cut, we’re seeing a lot of people, they’re coming to us and saying, you know, we really want to buy a catechist, but we just got our budget slashed and we don’t have the capital to work with. So we can’t buy a catechist. And then other schools come to us and they’re saying, you know, our budget’s got cut. We have to buy a catechist because they see it as a way to save money, you know, to actually like save cost over some of the other investments they make. So it’s just kind of an interesting dichotomy. Like some people see it as something that’s something that’s going to cost extra. That’s a new thing that’s going to cost more. And some people see it as a way to actually resolve and help manage some of those budget cuts because you’re able to save so much money over traditional methods. So. That’s kind of an interesting situation I observed this week.

Bill Ballo: Yeah, it’s a dichotomy. It’s an interesting dichotomy. It’s a weird position sometimes to be in because, you know, a lot of times you’re thinking, OK, we need to get simulations. We need to get this piece of equipment, that piece of equipment, those kind of things. And so you’re thinking about it in terms of the small purchases. OK, I got to buy this thing for a thousand. I got to buy this thing. But that adds up really quickly. And if you’re buying a bunch of mannequins, or you’re buying a bunch of mannequin parts and pieces and those kind of things, it adds up really quickly. And you don’t realize how quickly it adds up. And then at that point, you’re like, gee, I guess I could have just bought a catechist. Like, why didn’t I do that? So yeah, it’s interesting to see that happen. Yeah.

Jon Brouchoud: Welcome, Mitch. Hey, Mitch.

Mitch Luker: Hey, sorry, I was in my headset and didn’t see the time.

Rick Casteel: Like, oh, gosh, rocket time, isn’t it?

Jon Brouchoud: I was just telling these folks about the idea of a gulf fundraiser as a method of raising capital, raising cash to be able to purchase a catechist and then further sort of, you know, discussing this idea that some schools are coming to a catechist and as a way to save money to actually, because of the fact that their budgets are getting cut, they see it as a way to reduce costs. And some of them see it as an extra cost. So they can’t afford to buy it because our budgets got cut. So there’s this interesting dichotomy and that’s what we were just starting to talk about in terms of some schools just not really understanding that it can be a cost-saving measure or actually how that would operationalize as a cost-saving measure versus others that are just, yeah, like we can’t afford it because it’s a new thing, you know. So how do we communicate that to our customer base that there’s an opportunity to actually save money using VR simulation?

Mitch Luker: Well, what I’m doing, what I was working on earlier is an actual case for that. So blood administration is something that students cannot touch in clinical at all, period, because it is illegal to do. And doing it in our skills classes is really expensive. Just buying the blood back to have for students to use, they’re about a hundred bucks a piece. for just an empty bag. There’s nothing in it. It is just a bag that has all the blood labels and stuff on everything on it. And so when we had to discontinue doing that in our skills class, and we kind of just made it more theoretical. So students never get to actually do the process of hanging blood. And so by doing this in VR, my students now are actually going to get to go through the process, work through it, and I’m not going to be spending every semester a ton of money on blood bags. But not to mention that, but also the tubing that you have to use, because there’s specialized tubing for that. Gloves, needles, syringes, IV caps, IV catheters, all those other pieces of equipment, when you put it all together, I have to buy at least one, if not two or three per student. Well, whenever I can then do it in VR, I don’t have to buy all those things. I can just hit reset or reload the simulation. And now my students get to do it and they’re not having to pay for those supplies two to three times over for a skill that they won’t get any other way.

Jon Brouchoud: And what was the name of that? delivering blood, giving blood, like, is that’s basically administration.

Mitch Luker: That’s like a bag of blood for a patient. So like when someone has a low hemoglobin and they’re having symptoms and stuff, we would give them a blood transfusion. And that’s a really expensive skill to work on with students and to train them on. And like I said, they cannot touch it in clinical. They can observe and see as the nurse does. But again, we don’t do that that often anymore. It used to be a very common, it was the number one prescribed treatment within hospital systems for years. And I was a part of a group that worked on working to decrease that in the US because of the risk associated, because it is a very high risk. It’s very high risk. And, you know, so that’s why students can never touch it at all.

Jon Brouchoud: And so when you’re approaching this and you’ve got a need in your curriculum, and you’re looking at ways to save money, you know, you can’t, it’s like one of those things where like all of these individual niche things, you can’t just go on the market, you can’t go into the Oculus Home Store and look up the blood administration app. right? And then just like download and buy it and whatever, you know, there’s really, you know, I think that’s one of the things that we found is, is our sort of our little unique space in this market is that we capture these real narrow niche things that just a lot of other schools just aren’t really, you know, there’s not a big enough market for a customer, you know, for a company to spend millions of dollars building an app to do it. You know, so, but you can use it using the sandbox of equipment and content and patients and stuff and IV poles and all the stuff we already have. So you actually went in there and built this yourself, right? This is a catechism. We didn’t build it. Like we, this is the first time we’re hearing about it. So we, we had known, you know, it’s nothing that we’re creating, but you were able to use the existing assets to create the simulation. Is that, that’s kind of correct. Yeah.

Mitch Luker: And, um, So we’re doing, with every student in advanced skills this summer, this is our pilot, and normally our students have to do a quiz, and it’s a quiz that I wrote, and it’s really hard, because it should be, because this is a very dangerous process, so we need to make sure that they are competent in this skill. So now I’m gonna be comparing pre-Acadicus, post-Acadicus scores. to see how our students do and to show, you know, just that this is what VR can do. But yeah, I built this all completely with things that were already in the catechist ready to go. And the other thing is, is every hospital has its own policies about what you do to hang blood. What are your steps? What are the rules? And so if I went and bought some generic you know, that said, oh, yeah, we have blood administration, but it’s only going to follow a certain set of guidelines. I can’t follow the rules and guidelines of my hospital systems that I work with in my area. And, you know, they don’t vary greatly, but they do vary to a point that it is significant when you’re trying to produce nurses to go in the workforce.

Bill Ballo: Yeah. And and to dovetail off of that, actually, so our nursing our nursing faculty wanted a transfusion reaction scenario. And so we put the time and the money into developing the sequencer to go along with that transfusion reaction. So now, like Mitch is saying, your students can learn that skill of hanging blood. And for our students, our faculty wanted what happens when it goes wrong. You don’t want to simulate that in the real world. You don’t want that to happen. I shouldn’t say simulate, because that’s not simulating. You don’t want it to happen in the real world. You know, so this is something that’s completely simulated. We can just, and the nice thing about this too, and John, you mentioned things like Oculus and stuff like that. So the problem with, let’s say we did find something, John, and it was perfect. And it was absolutely what we wanted. It was blood administration. It did the transfusion reaction, like the whole thing. It covered everything Mitch was creating, everything that Madison College created. It is absolutely perfect. And it’s $10. You’re like, oh man, $10. I can spend 10 bucks. There’s no problem. So you go and you get it for $10. Cool. But now you have a problem. How do you scale it? Because Oculus knows if you log into your account on multiple headsets, And then you try to play that game, so to speak, on multiple headsets, Oculus knows right away. And they’re like, nope, you can’t do that. Believe me, I’ve had that problem. You voted for one account on one headset. You got it. And that’s it. And now I doubt something that good, complex, whatever, would only cost 10 bucks. It’s going to cost you more than that. And then you’re buying little niche things all the way around, where Mitch and I are just creating these niche things. that we want in a catechist. We just build it in there. We’re like, okay, yeah, this is a very small market that’s going to want the blood transfusion reaction, or like Mitch said, hanging blood and that kind of stuff. Okay, that’s all I got. I use it once and I’m done. And I spent $30. And by the way, like me, at the college, we have 40 MetaQuest headsets. So now on each of those headsets, I’m going to have to go and load that game for $10, $20, $30? Not going to happen.

Jon Brouchoud: And the minute anything changes about that procedure, or like you say, like Mitch said, any different school, every hospital, everybody has a different way. Every instructor within the school and hospital has a different way to communicate and train this. This way you can do it in your words, the way you want to do it, the way the best practices are. You know, so if something comes out, there’s a research, you know, journal publishes something that says, here’s a better way to do this. you can go in there in an afternoon and just redo your lesson. And now you’ve got a current lesson. It’s in your control. Like you’re not subject to waiting for the SMEs in another application to come up with it. It’s sort of like you do whatever you want. It’s your assets to do whatever you’d like with it.

Mitch Luker: Well, and that’s how I built it. I built it as three different. So actually, I built three scenarios to do this. So there’s the first part of the simulation, which is, OK, we’re going to assess our patient and determine if blood administration is appropriate. Then we have the second phase, which is, okay, blood administration is appropriate. Now let’s hang the blood. And then we have the third phase, which is the reaction. So just like with Bill, we actually have the reaction phase and they have to manage a blood transfusion reaction. And, um, the nice thing is, is that like you said, I can go in and, oh, you know what, now there’s a new standard for how we’re going to treat that blood transfusion reaction. I don’t have to email a company say, Hey, can you change out one med, wait the how many of a week to get it back? And they’re going to make me pay for that.

Jon Brouchoud: Yep.

Mitch Luker: I just go in and be like, Oh, I grabbed the medic medication creator. I can be like, Oh, Don’t need that drug anymore. Now I need to make my new drug. Now I have my new drug ready to go and I can just make the change. And that’s the nice part is that. I think I built three scenarios, I think in total it took me about two and a half hours to build. So. Not a lot of time to make changes. And, you know, as I start doing this next week, I’m going to find things that don’t work right. Or they’re going to be, I’m like, Ooh, I need to change that. I’ve been testing it and trying to make sure everything’s good, but you know, there’s always still going to be things to tweak for a while. And I just go in and tweak it and I fix it. I don’t have to worry about someone else doing it. I just go in and make the changes.

Bill Ballo: And if you’re using, I don’t know if you’re using the sequencer for the reaction, but the thing about the sequencers is what I don’t want people to think is like, oh, well, if you use the sequencer, it’s set in a certain thing and I can’t change it. No, you can still change it. So if Mitch looks at the sequencer and goes, yeah, I want that pulse rate to be higher. Well, fine, you can use the sequencer to go on to the next sequence and then you can change the pulse rate still in the vital signs for the patient. So it’s not even like the scenario itself or the sequencer is baked in to where you can’t use it for anything but what it’s sequenced for. Mitch may say, well, I think this heart rate’s gonna be higher. So Mitch moves the heart rate higher. Cool. Like, you know, you sort of get to do it your way in there. And, you know, that’s kind of what’s really cool. Our EMS program just, so our EMS program is sort of starting back up with virtual reality. I was doing the virtual reality for the EMS program, and then I left the EMS program to be in our Center for Excellence and Teaching and Learning. And so our EMS program has started back up. And they just came in this past week, Monday, and they had scenarios. So their scenarios are very short. The EMTs, they do 15-minute scenarios, and then they go out to debrief. 15-minute scenarios out to debrief. And there’s a lot going through. So they do four scenarios total. And in all of those scenarios, there were certain things that the students were looking for, like, why isn’t this here? Why isn’t that here? And the instructor said, hey, we really should put a nebby in there, because they’re going to be looking for the nebulizer. And I’m like, oh, OK. Yeah, no problem. I’ll get that in there. And then I went home that night, and I was like, nebulizer, put it down. I’m going to put it there, and we’re good. They’re like, we should probably put the EpiPen in there too. Oh, okay, EpiPen, grab it, put it in there. And that’s just like, I don’t have to call John, I don’t have to call Stephan, I don’t have to call Rick and be like, hey, so I need this, this, and this. And oh, and by the way, put it over here and then I’ll never be able to move it again. Yeah, so that was, that’s it. They said, we want this, this and this. And I went, okay, no problem. I’ll get it set up for you.

Mitch Luker: You know what the hardest part is? Remembering to always go back and hit save. There’s numerous times I’ll go in and make a change and My brain, I’m so used to auto-save on everything anymore that I forget to go in and save. And so I’ll go back in and be like, oh my God, it’s not there again. Dang. So I go back in, add it, and then I’m like, save, save, save.

Rick Casteel: I know for me, the thing that seems to happen inevitably, right, is you tend to land when you enter a space in the hall and then open a door and go in. And then you do some things and I’ll always forget to close the darn door. And then you come back in and you’re like, the doors, you know.

Bill Ballo: Yeah, I’ll do that like if I’m making a 3D recording, you know, I move something like I do a 3D recording and then I go in there and I move something and I hit save and then I’m like, oh no, no, you know, I messed it up, I messed it up. But usually the fix is easy because you just take it and put it back where it was and then hit save again and now you’re done. So usually the fix is easy. But yeah, you can get frustrated on that. And I did it very early on when I was making a lot of those videos that I put on TikTok and stuff like that. Very, very early on, I had a lot of that where I would where I would move something or something like that. And I just went, oh, no. You know, so.

Jon Brouchoud: Yeah. Yep. Well, we’re a relatively narrow sample size here, right? We’ve got two schools represented in two different parts of the state. But I wager that it just so happens that both of these schools are working with blood administration and transfusion, right? You’re both working on the same thing. And I don’t think that was a coordinated thing like, hey, let’s get together and work on this. You’re both working on this individually. With our small sample size, 100% of our sample size is developing this, but obviously not every school is. But I bet there’s probably hundreds of schools in the United States alone that are trying to figure out the exact same thing that would benefit from the exact same result, especially if you start measuring the outcomes, which you’re working on. You’re both in your own ways working on collecting data and measuring the efficacy of it. Once we know that this works and it provides real value and it saves real money, then there’s hundreds of schools that need this right now, you know, and they’re all trying to figure it out. And part of the shared network is this opportunity to be able to compare notes. And I bet you some of them have somebody on staff that’s a blood transfusion expert, you know, that’s been doing this for years, you know, and might have their own take on things and spin it in one direction to say, well, you know, one thing we might want to do is X, Y, Z. And so that that could eventually sort of expand this beyond, you know, just The schools that are working on it get it started, but then eventually there’s this community effect that I’m hoping starts to happen. That’s how real world healthcare is, right? I mean, you’re publishing research, you’re sharing it in journals, you know, it’s a collaborative, open process. You know, there’s not a lot of like mine kind of attitude I find in a lot of medical and healthcare education. It’s very open and collaborative. And so, yeah, if you guys are both working on this, then I imagine there’s probably hundreds of other instructors that are going, how are we going to teach this? I wish there was a way we could save money. I wish there was a way we could do this in VR.

Bill Ballo: Yeah, and it was just interesting to hear that Mitch was talking about that, like, you know, blood transfusion and said, obviously it’s a problem. Obviously it’s a problem. Now I didn’t know the extent of the problem. Mitch just enlightened me to the extent of the problem, you know, that, that it really is hard. Cause like, I think like for our EMS people, the really hard thing is OB stuff, like getting OB contacts that they have to get, they had to get OB and neonatal contacts. And we know we can send them to a NICU and that kind of stuff. But you know, there’s no guarantee on the amount of contacts. You don’t know what you’re going to get. Sure. Oh. Now, and back in 99, when I went through medic, wait, 98, whatever, it was a long time ago. When I went through medic. Back in the 20th century, when I went through medic. The late 1900s. I did have somebody say, you were born in the 1900s, weren’t you? I’m like, ouch. Yes. Yes, in the 70s to. So, so, like, when I went through medic school. I had the most wonderful OB nurse ever. She took me under her wing. She was just fantastic. She taught me everything I needed to know. She explained everything that was going on. She talked to the family for me. I got to see three births. I eventually delivered three in the field. And I know for a fact that that experience that I had with that OB nurse, and I’d love to, I can’t remember her name, I know for a fact that that was instrumental in my ability to deliver those three babies in the field. I know it was instrumental in it. When I talked to my colleagues, when I talked to the other students, they all went, yeah, no, we didn’t have anything like that. No. As a matter of fact, we did have births going on that day. They didn’t let me know it was happening because they had me sitting in a room watching a video. And I was like, what? Really? That’s crazy. Really? And I heard a lot of that. Now, it wasn’t all of them, but I heard a lot of that. And I was like, wow. So that’s carried with me throughout my career. And when we were starting, when we were talking about a catechist and we were talking about what are we going to develop first, that was one of the first things we went to. because very much like, you know, blood transfusion and that kind of stuff. It’s that stuff that’s, it can be high complexity. It can be very dangerous and it’s stuff you don’t mess around with. And that’s one thing you don’t want to mess around with, man. You don’t want to mess around with, you know, what happens with a childbirth. So that’s just it. Like we have that ability to then go. And I just did it today. We had a bunch of nurses come in there doing some sort of a, I don’t know, some sort of a conference or something at Madison College. And during the registration process, Jonathan, one of our nurses, was going down and getting all these nursing instructors to come up and check it out. And I had like nine people in VR this morning just having some fun. And then I was like, all right, we’re going to birth some babies. And a couple of them were like, not my thing. Like, no, you’re doing it. So we had some fun with that. And that’s that kind of ability to use it for all of the stuff that you normally couldn’t get done in the field.

Rick Casteel: Can I tell my OB experience from school back in the 80s? Nothing to do with VR, obviously, right? But I just always have to tell this. So I’m in nursing school, local community college, I’m in the same county where I graduated high school. And so I’m on my OB rotation, and we’re doing postpartum care, and we get our assignments, right? And walk in to introduce myself to my patient that day, right? And we know postpartum what we’re, you know, supposed to do and check. And I walk in and it is a girl I graduated high school with two years earlier. Oh, boy. There’s like. I went in, I said, oh, hi, I just wanted to say, hi, hope you’re doing OK. Turned around, walked right back out to my instructor and I said, I need another patient. There is just no way I went to high school with this woman. There’s no way I can do this. And fortunately, she understood. And I got reassigned.

Mitch Luker: Oh, man. I was in nursing school for my rotation. I couldn’t get a female patient that would let me go into her birth because they didn’t want a guy in there. even though their OBGYN was a male physician. And that was a challenge because no one would let me be a part of anything. And I understand that. If I was having certain things done down in that area, I wouldn’t want a bunch of other people around in this, that, and the other. And so being able to provide opportunities that are really hard. I used to manage an operating room. We don’t want students in the OR. Every person that is in that space is an infection risk. And you get infections in your OR, that is publicly reported data. Anyone can go and look and see what your infection rates in your operating rooms are. And so, you know, operating rooms don’t let students come anymore, really. It’s really hard. I can just make it in a catechist.

Rick Casteel: Yeah. I mean, one of the things I know we’ve found out or I’m sure a lot of other folks did during COVID, right? When we kind of did that lockdown and, you know, we were limiting or restricting visitations and everybody was masking. Yes, COVID was a huge issue, but guess what went down? Flu, nosocomial infections, post-surgical infections, right? We fixed all that other stuff while we were so worried about COVID. So remember our infection control, we would have a standup every morning about what was going on. And it was like, well, yeah, COVID’s a big problem, but all our other stuff is, you know, way down here. Keep up the good work.

Bill Ballo: Yeah. Look, there’s no more RSV. We got rid of it. Yeah. Yeah. You didn’t see that. It’s true. It’s true. You know, one thing for us and you mentioning COVID just makes me think of like, you know, John and I in like April or May, it would have been April of 2020, John, where we started talking about, we need to set up some EMS simulations. Like our EMS people were not getting respiratory like you, you know, we talk about how it can be hit and miss in some of our OB stuff. you know, OB, yeah, I guess we can kind of get around, use simulation, that kind of stuff. But with EMS, like there’s a certain number of everything that EMS students have to, you know, get experience from. So you have numbers that you have to hit, and there are 15 of this and 20 of that and so on and so forth. And when the hospitals, first of all, lock down and say no students, Well, that’s a big problem because where do most of our paramedic students get their experiences is going into the ER, right? They’re gonna do ride time, but they’re not gonna get as much during their ride time as they will in an ER, even in a few days. And when they did allow students to go into the ER, no respiratory patients. Ha, ha. How do you get your numbers? And respiratory and cardiac are the highest numbers. Usually you have to see 50 of those, you know, minimum of 50 of respiratory and cardiac patients. So how do you get that? And, you know, I think by, I want to say by June or July, John, if I remember correctly, we had now an ER set up with four respiratory patients. And one was a COVID pneumonia who was very resistant. And then we had a respiratory and a cardiac arrest and nobody was working cardiac arrests either. Like none of our students were working cardiac arrests. So we got our students six to seven good contacts by shifting and it was easier to shift because we didn’t have to like, okay, we have to bake this in, or we have to draw this out, or we have to pull, like we just went here, put this patient here, put that patient there. That was back when we were using Simon too, John, like stick Simon there. Okay, cool. We can show needle decompression on Simon. We can show him getting better. Cool. Let’s use him for that. Now, let’s use this one for this. So that was the flexibility. And if you think there’s not a possibility of that happening again, I mean, it’s out there. There’s always that possibility.

Jon Brouchoud: I know nobody wants to talk about it, but it’s there. It’s slowly. Yeah. We’re all kind of. Yeah. And then what happens when the sim labs are closed down too? It’s like, I think there’s just a few schools I think that really were able to continue doing what would sort of, I mean, be consistently consistent with high fidelity simulation. You know, it’s facilitated, it’s live, it’s multiple participants, you’re working together collaboratively. It’s all these things that we know are so great about simulation. You’re still doing it. SIM labs are closed, all the clinical sites are closed, there’s no other options, but you just kept rocking and rolling by working with what you had available. And I don’t think any of the studies that I’m seeing suggest that there’s any sort of, you know, any lower in efficacy in terms of what students are learning. All I ever see is they’re learning faster, they’re remembering longer, they enjoy it more, they’re more engaged. You know, there’s only these positive signs. Anybody that does a survey, if they’re using VR simulation in their lab, if they’re doing any kind of survey and gathering any kind of data, they’re finding that it’s working better. So here we have a situation, worst case scenario, pandemic comes, shuts down the lab, shuts down the clinical sites. But the students are still getting really good, high quality simulation. That’s pretty incredible. on the fly, like adapted, like you just came up with it, right? It didn’t exist. It didn’t exist. But we got together. We’re like, hmm, we’ve got this problem. How can we use VR simulation to solve it? And then with a little bit of working together and you working pretty much on your own, just building all these scenes, it’s like you were able to just get up and running. Students are back in simulation again.

Bill Ballo: And one point we even talked about renting out the equipment to the students if it got bad enough, like if it got bad enough where they they could not at all period come to campus. then we could rent the equipment to the student, allow them to use it at home if we absolutely had to do that. Now, we were OK in that we didn’t have to do that. And the truth is, even if we were talking pandemic, we can put the great thing about it is you can put John can be in room one, Rick can be in room two, Mitch can be in room three, I can be in room four, and we can be completely isolated from each other, and we can still all be in the same simulation.

Jon Brouchoud: Yep.

Bill Ballo: Yep. That’s impactful.

Mitch Luker: So, you know, well, and there’s even a way, I mean, so you talk about these things though, but let’s say, okay, you need to do birthing. So then you have to buy a birthing simulator and then, oh, wait, now I need one that I can intubate. Oh, now I got to buy that simulator and the life of a simulator three years. you know, maybe you might get four or five out of it, maybe. And then you have a brick, a really big, heavy brick. And so when you take even that five years at $150,000 and you got to have the service contract because it’s going to break. And so you’re going to have, and those are like a hundred grand on top of it almost, if not, you know, 80 to a hundred thousand somewhere in there. So you’re talking about over 200 grand for something that’s going to get you five years. you’re way more expensive than, and then you got to build the room to put it in. Computer system, all that. You come out so much cheaper with the, our set. Yeah. Cause I don’t know what your cost of your lab was bill, but I know we got ours done for about 80,000 and that’s cheaper than a mannequin even with the 20,000 for a catechist. Yeah. And I, that computer will last me five years, pretty guaranteed, maybe even six. And then all I got to do is replace the computers really. But the software is there, the price is there. Like I’m, you know, you’re pretty, you know, you’re much more consistent in what you’re going to get. And a catechist will do more than birthing a baby. It’ll do more than intubation. It’ll do more than, blood administration, it will do all those things in one. So as far as cost savings, it’s a huge savings.

Bill Ballo: Oh, it’s definitely, it’s a massive cost savings.

Jon Brouchoud: Yet it’s so difficult to try to, I’m sorry, Bill.

Bill Ballo: No, there’s no doubt. No, sorry, I’m done. Cost savings, period. There’s no doubt.

Jon Brouchoud: There’s no doubt. And yet we time after time. And, you know, Rick can attest to this, too. It’s like schools are just like we can’t afford VR simulation. And really, if we add this all up and put everything on the table to consider the entire picture of it, you can’t afford not to. Right. I mean, in some ways, it’s like, obviously, you know, I’m drinking a lot of the Kool-Aid here. So like my I’m the vendor, you know, I get it. But I think it’s just really out of an honest appreciation for the value that it provides and wanting to get the word out about it. And I think we all want more people in here working with this because it keeps enriching it for everybody else. But when we hear schools that are like, yeah, unfortunately, we decided we can’t afford to do any VR simulation, that’s what hurts the most. If they’re going to use some other VR platform, I’m okay with that. I get it. There’s a lot of great vendors in the market. There’s a lot of amazing software out there. As long as you’re doing something to explore the virtual frontier, I think that’s a win. But if you just are backing away from it and saying, no, we have all these budget cuts, so we can’t afford it. I think that’s a misstep. I really do. Cause I think you’re missing out on an opportunity. That’s going to put you on a footing. That’s going to remain competitive for years into the future. And it’s only going to continue saving more and more and more money, the more faculty know how to use it, the more students are looking forward to it, the more higher fidelity the headsets are getting. This isn’t going away. So the sooner, if you can already get in there now and start saving money, it’s only going to continue to be that way into the future. Yeah. Just trying to articulate that is, is really tricky. It’s hard to convince people that are watching their budgets get slashed and then say, yeah, you should spend $80,000 and build a VR lab. But it’s like, we can see it when you’re inside, you know, it’s just sometimes you can’t. Yeah. It’s hard to figure out how to tell the market what that, how that works.

Bill Ballo: Yeah. And then add on to that, that, that the students that are now arriving at your doorstep, like they, they don’t want PowerPoint. Or, you know, I mean, some of these things, like an example, we just had, I think I mentioned this earlier in the Sympulse, but I’ll say it again. We had a summer camp. at the XR Center, we just did a summer camp for middle schoolers, that was this past week. And then the week before was high schoolers. So the high schoolers came in and I said, okay, how many of you have been in virtual reality, have done things in virtual reality? And half of them raised their hands. And you go, wow, half of them, like out of the 10 that were there, five of them raised their hands that they had been in VR. Like, wow, the middle schoolers came in And when we asked the same question, how many of you have been in VR, or done games, or learning, or whatever in VR? Only one didn’t raise their hand. Nine out of 10 had been in VR. They’re coming. They’re coming. OK? They’re going to. Like, my son is 13 years old. He’s spent a lot of time in VR. My daughter is 11. A lot of time in VR. They are on the way to your program. They’re coming. And if you think the best time to worry about it is 10 years from now, that’s a bad idea.

Rick Casteel: Bad idea. Picking the can down the road.


Bill Ballo: Absolutely. Getting started with it now and having the knowledge and then growing with it so that you’re ready when my son and my daughter are at your doorstep to learn. And they’re going, really? You’re going to show me what is a glorified overhead? Like, you know, and you’re gonna have to battle this thing, you’re not gonna win. And that’s one of the biggest, biggest things that we talk about right now is student engagement. And I guarantee you, it’s because of this little device right here. We talk about student engagement all the time.

Mitch Luker: this thing is actually gonna be a wearable AR set soon. I mean, Ray-Ban has made one. It’s out there. It’s an augmented reality pair of glasses. Google Glass came out many years ago, just way before its time, but the wearable phone, per se, is coming. And you’re now gonna be competing against a device that you can’t see them Because I always say, I know if you’re on your phone in class because no one looks at their crotch and smiles. Right. And so that’s why I tell them, like, that’s how I know you’re on your phone is because you’re you’re looking down at your crotch all the time. But what happens when it’s right here in front of them and you’re going to be competing against something you can’t see? I can at least see if they’re on Facebook, if they’re on Snapchat or whatever, when it’s right here in front of their eyeball, I can’t see what they’re doing. I don’t know what they’re watching. They could be watching cat videos on TikTok. Absolutely. Instead of listening to my lecture or being it. I’m going to have to have them engaged in some other meaningful way, which is why luckily our school has been able to get grants and stuff to be able to invest in all this to work on and because we realize that we’re going to be competing against because these will be gone in the next probably five years and we’re going to be in wearable glasses that will have everything that’s there for us.

Jon Brouchoud: You can imagine your student when your son is going, you know, if he wants to go into nursing school and he goes around and he goes to the nursing school A and they say, well, here’s how we do our teaching. We use, you know, the PowerPoint presentations and we use the mannequins. And then they go to another school and they’re like, well, we also have PowerPoints and mannequins, but we also have a VR lab. You know, they get it. They know what that is. They know what that means. They understand how it works. They understand how much better they’re going to be able to learn with that. And that’s going to be real hard to not compete in that space in the future. I mean, we’re already at that point. I would imagine, you know, there’s so many nursing schools that now have VR labs. If you’re thinking about going to a school and you go in there and you get to put on a headset and you get to intubate someone or do some scenario like that, you know, that’s going to stick out in your mind versus another school. That’s like, nope, we’re just not, we can’t afford to do that. You know, we’re not adopting VR, you know, that’s, that’s going to be challenging in the future to compete.

Bill Ballo: Yeah, my son’s already telling me which programs. he thinks I need to talk to to get them started in VR because he’s like eyeing programs like this is what I’m thinking I might want to do, but I don’t want to do it unless they’re going to be doing some VR stuff. So dad, you need to be talking to them about doing VR now so that when I get there in five or six years, they’re going to be ready to go because I’m not going to be sitting there, you know, like, you know, like, Sitting in my seat and just watching I want to be doing and it’s the way that they’re doing it in school right now Like my my kids go to go to summer school. It’s a voluntary summer school. They love it every single year They go to it every single year. Why because they do fun stuff They do marble runs and they do you know, like in STEM they’ll build, you know little Robots and stuff like that. They’ll do all of that and they absolutely love it And that’s the kind of stuff that engages them more So than a teacher giving them a thing and saying here go do this group work and then come back and let’s present Yeah, they like that and that’s okay. But at the same time they’re 21st century kids, man Like my kids are my kids are ready to go there. They’re There they want to learn that way and there they learn much better that way

Mitch Luker: Well, and I was reading an article because, um, I was putting together some data for Wisconsin 10 over college systems. Uh, because they were asked, they’re actually seeking money from, you know, the government for funding for simulation. And I was rereading a bunch of articles that I hadn’t read in a while. And I came across one that was talking about that. The, um, the best way of learning was through teaching the material. And that has about an 88% efficacy rate. And then they were talking then about VR, which has about an 85 to 86% efficacy rate. So we’re right there with the strongest teaching method for retention with teaching a material yourself while it’s new. And that’s the thing that hit me when I was reading that, because that article was about three years old. So I would love to go and look back at that and for, you know, repeat that study again, you know, now that things have gotten better, they’ve gotten stronger, they’ve gotten more real. Cause I think back to the beginning of a catechist and I remember John and I joke about this, that there was like four interactables. There was like a heart sound, a lung sound, uh, like there wouldn’t even bow sounds in the And now we have with Gen 2, we have all these other features and all these abilities. And I would love to see what that efficacy rate looks like now. Because now we have new innovators and new people that are coming in and who are educators and creating new ways of using this stuff. And I’d be really interested to see how that would compare now, because I’m going to bet we would be able to overtake the teaching-it-yourself method.

Jon Brouchoud: Yeah, and just imagine if that’s the case, and we’re looking at all this data that’s coming out that has all these promising and sometimes shockingly, you know, effective results. Even if all of it’s half true, there’s definitely an increase in efficacy. We don’t have any doubt there. Anybody that’s used this has seen it firsthand with their own, you know, just watching students in there. If that’s true, wouldn’t we expect that there’s going to be a time when these students graduating and going into the field are getting hired and recruited into these positions where If you’ve been trained using this modality, wouldn’t you be a better provider at that point? Wouldn’t you be a better professional in the real world if the efficacy is there that this is a more effective way and you are actually learning better and you’re going into the field and now you’ve got deja vu because you’ve done this in VR a bunch of times. Eventually, I would like to think that the sites that are recruiting students are going to be selecting for the programs that are allowing for the students to do these VR experiences that are going to make them better providers and professionals in the future.

Mitch Luker: Well, not only that, but you’re graduating more because the national average of students who graduate their nursing program on time is 54%. That means 46% of students are delayed by at least one semester because of failing a course. because of having to withdraw something that means that, you know, if I’m supposed to be in a two-year program, and then when you allow for up to a three-year then, meaning students to graduate with an extra year, that number only goes up to 74%. So you’re still talking about even with two-year programs or a four-year program and giving it an extra for the fifth year, you’re still talking about you’re graduating about 75%, you know, three quarters of those students. What would it mean to the nursing shortage and the healthcare crisis that we’re facing if we could graduate another 10 to 15% of those?

Jon Brouchoud: Yeah, absolutely. And I love what you said about the fact that this is all happening when it’s new. Like, we’re just getting started. We haven’t even you know, and like you say, the studies three years ago, sometimes I, I You know, I brace a little bit when I hear about studies on VR because, you know, you really do here. It’s like if it was three years ago, it’s almost obsolete at this point because it’s come so far since then. If you imagine what we did three years ago or what any of the VR platforms were doing three years ago, it’s almost not even worth looking at at this point. You know, maybe there were some lessons learned, but we’re in a whole different category now and it’s changing every year. It’s becoming entirely different thing and it’s evolving so rapidly. And if we’re already seeing these results now. Like, where does this sit two years, three years, five years, 10 years? You know, this is pretty exciting, you know, ground zero.

Mitch Luker: Well, that’s why literature isn’t supposed to be used past five years old, because things change and evolve so rapidly. So, I mean, you got to think that research is literally nearing its expiration date, technically. Yeah. I mean, two more years and it’s going to be obsolete data anymore, unless it was seminal work. So you’re like, we’re already getting to the point of, yeah, we need to be repeating these types of studies on the regular because that data is going to be just obsolete.

Jon Brouchoud: Absolutely. And some of the state boards of nursing are not allowing VR simulation or narrowing the percentage of what can qualify. So obviously 50% in most cases can count for simulation to get the clinical experience to graduate. But now they’re saying, well, no, only a small percentage of that can be VR simulation. And I have to believe they’re basing that on outdated data. right? Because if they were looking at what’s possible now and they were looking at what students are doing in high fidelity VR simulation and seeing that it’s, you know, the equivalency and the data and the metrics that are coming out of that, why would you not want to? It’s like you’re setting yourself back by doing that. It seems like we can match the efficacy of mannequin-based simulations for certain types of activities. So why wouldn’t you allow for that? You know, I think that’s just confusing and it’s going to change quickly. I mean, they’re quickly going to realize, I think, you know, as we get better and better at articulating and demonstrating the value, but For now, whenever I hear about that, I’m like, that’s just a huge missed opportunity in a world of shortages.

Mitch Luker: Yeah, but you don’t always have to use it just for simulation. I take it into my classrooms for theory classes. I take it into my skills classes. I take it into all different kinds of places. I don’t just use a catechist when it comes to simulation. And Rick and I are playing with doing self-run modules to replace coaching and tutoring. So that way then, oh, you know what? I got an exam coming up on CHF and COPD. I’m going to go in. I’m going to do those self-run modules where I can go in. And I’m calling them learning adventures. That’s my title at NWTC for them. They can go in and they can select the different modules and use that then to tutor themselves and refresh themselves on information that they need. I don’t have to facilitate it then. I don’t have to run it. They just come in, enter that lab in solo mode. Boom. I have now my own non-facilitated VR that students can do. And again, students don’t fail in clinical. Students fail in theory courses. And if I can help him retain in theory courses, that’s money. Cause every rear end, cause in nursing programs, you can’t tell you if a student fails in second semester, you can’t just go and plop any other student in there. It has to be someone who has met all the criteria to be in that course. That means every student you have failed, that’s money lost. And you lose them in the third semester, the fourth semester, you keep losing that money every single semester when you don’t have a butt in that seat. So if I can do something that’s gonna help keep butts in seats, I’m making money for my school now. I am helping them, I’m preventing loss revenue, which that’s a huge key.

Bill Ballo: And Mitch and John both, you talked about money earlier, right? And you know how some places are just, they have a hard time like, oh, I gotta put this amount of money into that kind of stuff. There are so many grants out there for this kind of stuff that it’s like it’s crazy like we had a we had a so this is a little different our school of academic advancement. They had a grant they were already working on for. another item, another thing that they wanted to do. And it was about innovation and all of that. And then when they started to have more trouble with what they wanted to do, and then they came over and saw what we were doing, it was like a light bulb went off and they went, whoa, okay, hold on. We wanna make this quick turn. Now, we got it done in three months, which I actually whispered to a few people, this isn’t gonna happen. Okay. But it absolutely did. And in three months, they took an immediate turn and went to virtual reality and incorporating virtual reality in their programs within three months made that change on that grant. So it can be done. Now that again, they were already starting some of the grant stuff, but when you’re talking about getting a grant for something like that, there are grants out there for doing this type of innovation and companies that are giving out these grants and places that are giving out these grants, they love to hear about this kind of stuff. So, you know, and I know sometimes it can be really tough doing grant writing and all of that, but most of us have some sort of a grant office, some sort of person that even if it’s someone who’s done a grant before, it can just help you fill it out. You know, we have people that can help with those kinds of things, you know, at most of our institutions. So, I mean, most of what we did in, actually, I’d say probably 75% of what we did with a catechist, with the XR Center, with all this stuff that we’ve done, it’s grant funded. It’s grant funded.

Mitch Luker: The grant, my grant’s even paying for my, 75% of my salary. So my school is only paying for.

Bill Ballo: Sorry, Mitch, I cut you off there.

Mitch Luker: I was like, so they’re only paying my school has been paying, hasn’t paid for my role since 2021. Um, and except for 25% for this past year and a half, because we had two different grants that took care of paying for me while I’ve been working in simulation, building up simulation, doing all this stuff. And so. you don’t even have to pay the person that you’re getting to be your champion for it.

Bill Ballo: Not horribly hard to find. Not horribly hard to find. Our botany program, our botany, the stuff that we’ve done in botany, all grant funded. All grant funded. 100% of that. You absolutely can do it. People love to hear about this stuff for grants. you know, because they want innovative stuff. If you’re like, well, you know, I’m going to make this new PowerPoint and I’m going to, I really pick on PowerPoint a lot. I’m sorry, Microsoft. I’m sorry. Please don’t shut me down. It has its role. It has its place. It does. It does. But, you know, if you say I’m going to make this whole new, most places are going to go, eh. But if you’re like, yeah, so I’m going to do some virtual reality and I’m going to bring it into my classroom and I’m going to do that. that they like that kind of stuff.

Rick Casteel: Well, and Bill, one of the things I like to do with PowerPoint now is use that as a foundation for something to bring into my VR experience.

Bill Ballo: You have renewed my hope in PowerPoint. I’m with you.

Rick Casteel: That’s right. Export PNG, pull it into VR, right?

Bill Ballo: That’s it. I can do PowerPoint in VR? OK, maybe I’m in. Maybe you got me now.

Mitch Luker: So I just did that. I haven’t finished recording it yet. But I took my PowerPoint for an instructor. I uploaded it into a hospital room. And she did her lecture in the VR space. Yeah. Yeah. And we’re now I’ve got to go do this. I’ve got a screen record it to get it and I have too many projects going at once to get it done yet, but I’m getting there. But we’re going to have the PowerPoint in VR. So students are watching Ricky actually do the care. They’re going to hear the lung sounds, hear the heart sounds, hear all those things happening. And then now with these learning adventures, like I’m taking PowerPoints, I’m putting them in there, and then students are going to go to kind of stations along the way, and they’ll be like Millie is sitting there chilling out, and they’re gonna have to listen to Millie and hear that S3 heart sound that they’re learning about, CHF. See edema in her ankles while they’re learning about the fluid overload. They’re going to hear wheezing when they’re learning about asthma. And they’re actually going to provide care. And then I’ll have another version of Millie just down the road again. And like, OK, now let’s see when we give the bronchodilator and they’re going to have to take the inhaler and just I’m going to make them just go like at her and, you know, just for the action of it. And then they’ll hear. And oh, now she doesn’t have wheezing anymore. And so but you can make active learning with those PowerPoints in a catechist.

Bill Ballo: Yeah. See, y’all, y’all are going to save PowerPoint for me.

Mitch Luker: You brought Bill back to the table on PowerPoint.

Bill Ballo: So yeah, it was always one of my big things. My students probably would have had a heart attack if I brought out PowerPoint in class. What? Are you sick? What’s wrong with you, Bill? Are you OK? Because I was always doing stuff like bringing in a mannequin or bringing in a heart or bringing in a, you know, I always had all this weird stuff I was doing anyway, you know, or drawing horrible drawings on the board or something like that, you know. So, yeah, you’re going to revive PowerPoint for me. I’m in.

Jon Brouchoud: Well, and if you just full circle going back, if you can’t afford a grant, you can always do a golf fundraiser. There you go. Let me know where it is.

Bill Ballo: I haven’t golfed in a while. I need to get back out on the course.

Jon Brouchoud: It was a pretty great opportunity. It was surreal in a lot of ways, you know, because, you know, the school gave a presentation to the whole group and I don’t know, it was over a hundred people in there, you know, and they were just all, you know, having a barbecue dinner and, you know, talking about the value of RE-R and simulation and check it out. And here’s what we’re planning on doing with it. And here’s the value that we think it’s going to add. And just watching the community sort of like gather around and support this school and say like, yeah, we, you know, I even heard one of the, I think it was the auctioneer that was joking, like, You want to make sure that you’re bidding high enough because eventually you’re going to get sick and you’re going to be in the hospital. And these people, these schools are teaching these students that are going to be caring for you. So, you know, this is the time to be generous. You’d like to think that the schools could just afford to do that out of their own budgets. But if you can’t, you got to be innovative. And I think a Gulf fundraiser was a brilliant idea.

Bill Ballo: I love it. If anybody does golf fundraiser, let me know. I’ll come to your phone.

Mitch Luker: I will start forwarding you. Cause we do one every year and I will forward it to you.

Bill Ballo: Absolutely. Absolutely.

Jon Brouchoud: When we first got the request, I’m like, well, I don’t golf. This isn’t going to work. It’s like, well, they don’t want you to golf, John. They want you to set up VR. Yeah, I can do that. Yeah. We set it up. It was a beautiful country club. It was a great spot. So it was a good time. Well, we’re at the top of the hour. I appreciate you all joining again. This is a great conversation. I really enjoy this every week. You know, we get a chance to talk and, you know, we’ll we’re going to work hard, I think, as we get into the fall semester to get more people in here joining our conversations, because I think there’s a there’s a larger community out there. It’s just hard to get people in summer. You know, they’re busy.

Mitch Luker: Oh, yeah. I do have a non recording question for you. So we’re not recording. I have a question.

Jon Brouchoud: Okay. All right. Sounds good. I’ll stop the recording here. Thanks everybody for watching.

Rick Casteel: Thanks.

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