Jon Brouchoud: Welcome to episode 44 of Acadicus Simulation Pulse Live, Friday afternoons at noon central every Friday. So we appreciate you watching and joining us today. And today we have Mitch Luker from NWTC joining us. And we also have Nikki. I’m going to ask your help with your last name. I’ve got a difficult last name, so I don’t, I’m not even going to try.

Riki Szymanski: It’s Rikki and it’s Simanski.

Jon Brouchoud: Szymanski, got it. That’s not as hard as I thought it was going to be. So excellent. Excellent. Well, welcome. Welcome to Simulation Pulse Live. We really appreciate you joining us today. And we’re I’m really curious to learn about what you’ve been doing. And Mitch has shared a couple of videos and some things that you’ve been working on, but would love to hear about your experience and use case and the problem that you were looking to solve. And what were you building?

Mitch Luker: So, yeah, so Ricky and I started off working together on making a virtual reality lecture because being a student myself and having to watch PowerPoints at home on my own and hear the disembodied voice behind them was really painful. I was like, oh my gosh, how am I going to stay awake during this? Because when it’s a 40-minute video and it’s just a PowerPoint on a screen, it’s painful to watch. And I think about our students who are coming to class and they’re trying to study and do all those things. And so I just reached out to faculty. I was like, hey, does anyone want to try doing this with me? Because it was the first time we were doing it. And Ricky said that she would be happy to do it. So we tag teamed and worked together and we actually developed our first virtual reality lecture that so we did it in Acadicus in 3D. And then I took those 3D recordings and put them into 2D. So that way we could upload them into our learning management system so students can see the PowerPoint while Ricky is actually providing care to the patient.

Riki Szymanski: Yeah, I would say exactly what Mitch said, especially for my online students, is for them to sit and watch hours and hours of videos and PowerPoints. And by videos, this is all you see is my face talking. It’s hard to get real animated when you’re trying to record these lectures. And all I have is this limited screen So I was really excited to try this out with Mitch. And it’ll be interesting to see what students will think. I think one challenge I discovered was that the video gets to be pretty lengthy because now I’m not just saying, well, you know, for fluid volume overload, the vital signs will be this and talking about the different signs and symptoms. Instead, now I’m saying them as well as I’m doing the assessment on the patient. So this ends up being more lengthy in time. So I don’t know if that’s going to turn students off when they see the length of the video or if they will be Maybe they’ll still like it and they’ll just kind of fast forward some pieces and then you know slow down on some of the pieces. I’m going to, I think, in the future, be real cognizant of the length and try to really get succinct, just because they do get to be a little lengthy.

Mitch Luker: And while they were in, yeah, it was a little lengthy, but I think the engagement part will help make it not seem as lengthy because I know like I’ve had ones that are an hour that’s just a PowerPoint. right and there’s no animation there’s no movement there’s nothing that’s engaging with it and i mean an hour of watching a powerpoint is really painful so this one ended up being right around like 48 minutes or so um but we were also dealing with three different topics. And so like one thing I am thinking about for the next time we do this is, can we break them up into smaller pieces? So we did acute kidney injury, chronic renal failure, and nephrotic syndrome. And so, and we did it as one. So like my next thought is going to be like, okay, let’s do just acute kidney injury as one and then do chronic renal failure as one and try to make them a little smaller. So that would be like, you know, 15 to 20 minutes each. And so there’d be a little more kind of micro learnings. Right. But like what Ricky said, though, is for the online students, because our students, when they’re online, they don’t ever come to campus. So coming in to do VR is not something they can ever really do unless they’re going to take time. But I mean, they paid for a course to not come to campus on purpose. So this is a way to still use Acadicus for even students who aren’t on our campus, who are just learning remotely. And so they’re still getting the benefit of the work we’re doing with virtual reality.

Riki Szymanski: Well, and I teach in person as well. And for that group, I do a simulation, an actual simulation with one of the mannequins with the group. And I’d recognize that my online learners were missing out on that simulation. So last semester, I did record one of them and posted it. it’s not very good. You know, the camera is way back here and it’s kind of echoey and hard to hear, hard to see. This is seems like, like you’re so much more immersed in, you know, the situation with the VR. I really like it. And I think, I think there’s some entertainment value with it too, to kind of see what the, VR can all do. I really liked how Mitch didn’t keep the 3D camera in one spot all the time. He would do a lot of transitions where it’s moving around and it keeps you more engaged, I felt.

Jon Brouchoud: So just to kind of take a step back and get a little bit more in the technical side of things. So you were using Acadicus to basically, Ricky, put on a VR headset, right? So you’re in the lab and you put on a VR headset and you’ve got the lecture in mind that you want to teach and you’ve already got a scene created in Acadicus that’s aligned with the objectives that you’re after. and you use the 3D recording feature. So you’re in the headset, you hit record, and you perform your presentation, your demonstration, your lecture, and then you hit stop. So you’ve got a three-dimensional, like 3D holographic recording of your instruction in Acadicus. And because the students aren’t coming to the VR lab, like you just said, you’re basically sharing that by capturing a video of that three-dimensional lecture and putting that out instead of a PowerPoint lecture. So it’s the main use case here is, if I’m understanding correctly, it’s really increasing engagement, creating something that’s more interesting, more interactive, more engaging than watching a PowerPoint or just a lecture without any kind of visuals. So that’s kind of the use case, using a virtual reality platform to extract that lecture into a video format so that students can access it from anywhere. Is that right?

Riki Szymanski: Yes. You know, and it really captures application of what they’re learning too. I’ve for a long time recognized that when I’m in clinical, if I find a really interesting patient say that has chest tubes and they’ve never had chest tubes before, I will ask the patient if I can bring the group in and I will basically do a mini lecture right there with the patient there and do an assessment on it and show them how the chest tube works. And the students seem to go, hmm, now that makes sense, you know, that they can really see it. And that’s what VR is just one step below that. I like it.

Jon Brouchoud: Yep, absolutely.

Mitch Luker: So I took her PowerPoint and I captured it as images. So I did I pulled it up and just did screenshots because we need that JPEG or PNG format file to upload into the image viewer. And because the image viewer, you can make it a slideshow. So I just put all of our slides in there. And so then as we went through and I would just change the slide and then we would record the next piece and we broke it up into individual like every slide has its own recording because that was easier. That’s what allowed me to kind of do the different camera angles and move around so that we were able to kind of figure out, you know, again, give that transition and movement. So it was Not just that fixed camera just sitting there staring the whole time and nothing ever really moved. Because, and the reason I did it as individual ones, because like the next time so let’s say that something changes in the practice of how we care for these patients. Ricky can just make one slide, send it to me. I can upload it. We can then let her record that one piece. And then I can capture that through a screen recorder because I use ScreenPal to record my screen when I went back and played it. And then use that to, I can just take out the old slide, put in the new slide, and now we’re ready to go. Which we’ve got to do because I made a boo-boo and accidentally deleted one of her recordings. and duplicated one at the same time. And I was like, Oh wait, yeah, that’s, that’s twice in there. Whoops.

Riki Szymanski: So that’s okay. It wasn’t the whole video. So who cares?

Mitch Luker: But again, it was one, it was one thing. So it should be able to come in for 10 minutes and we’ll be able to go through and fix it really easily. And, uh, you know, make those edits and changes, you know, it’ll take me probably an hour to do the whole thing and get it all finished, touched up and ready to go back out. So,

Riki Szymanski: I think just a minor point is that I had expected when I’d see the video that it would be like a bubble of my face. Um, a picture say that Mitch grabbed from NWTC or what have you, but instead it’s a generic, uh, looking kind of robot with the Oculus on. And I actually prefer that because it looks more realistic. It’s not just a bubble floating around and. And it’s amazing, like as my hands move when I’m talking or approaching the patient or just talking with my hands, you can see a set of hands doing what I’m doing, which I thought was nice too.

Jon Brouchoud: Yeah, absolutely. And you could even potentially, if you’re using, were you using an admin account for the recording?

Mitch Luker: So I had her logged in as a guest account and I logged in as an admin because You know, I don’t ever expect our faculty right now to know how to do all the inner workings of Acadicus. Absolutely. Well, we, we got a new LMS last year, we opened the lab last year, like there’s been a lot of changes, transition in our college. And so what I’m not, I’m not like, oh, by the way, learn a whole new platform as well. Yeah, yeah, yeah. So it is my admin account and went into ghost mode. And so then Ricky was across the lab at one of the stations in guest mode. And so what I did is I was in there but since I was in ghost mode, no one could see me in the recordings. And I just did the recording. And then so she would say, I’d say, OK, recordings on. She would count to three. So that would give me time to chop off me saying recording on. And then when she was done, she would pause for a second and say, OK, next slide. And then that would allow me to slice off that piece. That way, it was a clean, you know, time of her talking without any extra. you know, of us chatting or trying to figure out what to do or, okay, now we’re doing the next thing. So let’s do this. And do you want to move here? And then I could also control the patient. So like, there’s times that when she’s doing interview questions, I make Vincent like nod yes, or shake his head no. And I move him around in the bed for her. So like when she wants to examine his heels, because he has wounds, you know, so we’re able to kind of do some of those other things. And I was there to kind of help facilitate that. So again, the faculty aren’t having to figure it out by themselves. Excellent.

Riki Szymanski: It’s some of the unscripted stuff that that’s kind of cute too. Like Mitch said, he could, I didn’t know he was going to do things like nod the patient’s head. So I’m talking to Vincent telling him he needs to increase calcium in his diet. And I’m giving them some options of things to start eating and drinking. And one of them was sardines and all of a sudden Vincent goes. So, you know, I’m kind of surprised too. And I’m like, Oh, I take it. You don’t care for sardines.

Jon Brouchoud: That’s fantastic. Well, yeah, the only reason I mentioned the admin account is if you do capture a recording as an admin, then you can save the profile photo above your head. You know how like it’s that blue avatar. If you use an admin account, you can click on that icon in the upper right corner when you’re when you’re logging in and upload a profile photo. So then you kind of have like a typical little profile photo. I think it’s totally fine without it. but just kind of a pro tip kind of hack. You can record that in and you can add it later too. It’s like whatever the current image is associated with that account is what will play in all previously recorded 3D recordings. So that’s kind of a, an extra, a little fun. Cause you know, your students like to see that it’s you, you know, and they can already tell because they can hear your voice and see your gestures and it’s pretty easy to kind of connect that. But that little extra, extra profile photo gives you a little more connection that way.

Mitch Luker: Yeah, as we as we do more of these now, I will, that’s something I want to do. But for the first, you know, attempt at it, I’m like, Okay, let’s keep it as simple as possible. Keep it simple.

Jon Brouchoud: Let’s not have too many variables.

Mitch Luker: Because I, you know, as, as, as much as I know, Acadicus can work with it really well. you know, you still want to take things slow and steady because I’m like this, you know, just trying to figure out how to manage everything with it and get everything put together. And, um, you know, that, that was kind of one of those things where I’m like, okay, let, let’s, let’s not have any extra pieces that I have to worry about dealing with in the beginning. Um, because like, we have some generic accounts, um, uh, admin accounts at NWTC. And so in the future, like I’ll probably use those, but like I said, for this first round, I was like, Let’s start simple. Well, we’ll work on tweaking and making things a little cooler each time we do it and having new features put in. And but and Ricky’s already said that she’s ready and she’s excited about doing, you know, the next ones now because she likes it easier. Yeah.

Jon Brouchoud: Well, in terms of, you know, one of this. Yeah. Yeah, absolutely. And what we like to share, you know, in Pulse Live as much as possible is like tips and tricks. And I think what you just said is exactly that is like starting keeping it really simple to begin with. I think a lot of schools miss that and they try to just jump all in and we’re going to do high fidelity simulation and try to do all of this and just start simple, start really simple. And I think that was a great way to a great place to start. And what’s exciting from my perspective is, you know, we built this platform, you know, trying to provide as much flexibility as possible, but we didn’t anticipate some of these use cases. I don’t think any of us when we were first building Acadicus imagined that people would use a 3D recording feature in this way to have an instructor and they’re doing a demonstration that’s captured as a video uploaded to LMS, but what a brilliant use case, you know, and I know, you know, that’s becoming kind of an emergent way that Acadicus is being used by schools and they’re providing, you know, They’re getting a lot of value from that, even though they don’t have, they’re not necessarily bringing all the students into a fully stocked VR lab. You know, it’s a very lightweight, easy, accessible thing. You can do it on your phone from any location with or without high speed internet. You know, there’s a lot of value to that. And like you say, it’s not always possible to do these things in a sim lab or with a live patient. So where that’s not possible, this is a nice kind of backup alternative. So it’s exciting to see that emergent use case and really, yeah, really appreciate the innovation there. So how was it different? In what ways? You’ve already covered some of that, Ricky, but like, in terms of like, if you were giving this lecture live versus you’re in a VR headset, that must have been pretty strange at first. Like, was there a process to get used to that? Were there differences? And like, how was that experience?

Riki Szymanski: Um, it was really awkward at first. And in fact, in fact, Mitch goes, is, is the headset net on tight enough? And I’m like, no, it’s tight enough. And he goes, well, you keep putting your hands up. And I think it was just a nervous thing. Like I was just adjusting it, not used to it being on my head, whatever it was. So I had to like, stop doing that fidget. Um, and. It worked out good. We did it one time, but then we decided we wanted to do some better things. So we just rerecorded the whole thing. And I thought it went much smoother that time. So I think every time I do one, it will get easier. It’s still always just a challenge not to have any people there looking at you, talking to you, asking questions. It’s just you. So that’s just always the challenge.

Jon Brouchoud: Yeah, that’s the thing with 3d recordings. We found that a lot. I know I’ve done a few of them in there and it’s always weird because you don’t know where the person who’s going to be watching you is like you could be especially if they’re coming in and actually going to watch a 3d recording in a scene like you don’t know where they’re going to be. They can be teleporting all they could be behind you for all you know, so We, you know, sometimes we’ll just put like a character, like a human character, just in the scene to give the person recording something to look at, at least knowing that that’s where the person is and they can kind of orient to that. And like you said, too, I think I missed that earlier that, you know, in terms of tips and tricks, it’s like starting simple is the first part of it, but recognizing that you’re going to innovate. or I mean, not innovate, iterate. So you’re gonna be like doing this over again. And every time you do it, you’ll get a little bit better. And maybe next time we’ll try this next time we try that. I think that’s also a really important tip that anybody that’s gonna attempt to do this should think about that. Beginning with the end in mind, the first time you do it, it’s gonna be really awkward. It’s gonna be hard to get used to. There’ll be a process there, but the next time you do it, it’ll be a little easier, a little easier. And you’re creating these resources that are gonna be valuable for potentially years to come, right? I mean, they’re not gonna,

Riki Szymanski: uh be obsolete right away like these are important you know these are integral kind of lessons that you’ll be able to reuse which is really cool yeah yeah i’ve already talked to you know some other faculty it would be nice um because it’s it takes time right to get this prepped and to record it and takes a lot of mitch’s time but um it would be nice if i could get some faculty to team up with me and then we could, you know, split up some of these systems, you know, somebody does endocrine one does renal and, and then we can share all of those.

Jon Brouchoud: That would be amazing.

Mitch Luker: Yeah, divide and conquer and you know, and I’ll say like the process total like we Ricky and I met a couple times to talk about like, Okay, what do you want in the space? What do you, you know, and so like I brought her in and put in her headset once and we went through the tutorial and then I was like, okay, like here’s the kidneys we have, here’s this we have, and we kind of just plotted and planned out all the things that she would want. And then like I made a, I put a table in the room and I kind of put all the supplies that Ricky wanted there. So that way then it would, instead of having to constantly like reload new scenarios or change things up a ton, she could just go over and get the supply she needed. And then when she came in, like, it was funny because I had things on the table. And she came over and she was like, nope, I want this over. And she in her headset, she just went over and grabbed it and moved it. And I’m like, save. And then it just saved it where she wanted it and what was intuitive to her for that time. And so like now that I have that space saved, I don’t have to recreate it again. All I have to do is she wants to do another recording. All I have to do is upload the new image in and we’re ready to go. So I can save so like if she wants a different one for endocrine okay great we’ll go in we’ll design that space we’ll take the one that’s there right now that has Vincent in there I’ll change out a few things if we need to and hit save and save it as a new lecture. recording space and boom, we have another one. And so like, now that we’ve got the first one done, all of the subsequent ones are going to go so much faster because we’re just going to use what we have, make a few tweaks in the moment and then hit save. And we’re ready to go with our next version of the next lecture.

Jon Brouchoud: Yeah, you’ve got a stage set, you’ve got all the props, they’re all saved in the scene. So it’s an instant load. Like the next time you do it, you just load that scene up and everything is exactly as you need it. And like you say, making tweaks and modifications over time to keep improving it, you know, it should be, you know, easier and easier, but you’ve got the stage set and you’ve got all the props in place, you know, and that’s a big part of it. That’s great. We should have probably done this earlier in the episode, but do you mind if I share a clip of the recording? Is that all right with you? Yeah, that sounds good. OK, cool. I’ll play a few seconds of it here. Let me see if I can share with video and sound.

Mitch Luker: And Rick commented, he said, I got to see a clip and was really drawn in by the scene and the interaction.

Jon Brouchoud: Great. I certainly was as well. So let’s see. Oops, I can’t hear. There we go.

Riki Szymanski: It depends on what phase of acute kidney injury he is in. All right. So let’s do an assessment of Mr. Jackson here. Kind of thinking about ABCs, I would, I think a good place to always start is with vital signs. So I would want to get him, let’s get his O2 sat. And we can see up on the screen that he said 89%. All right, well, I guess it’s a good thing we started with oxygenation. Let’s get some oxygen on this gentleman.

Mitch Luker: Like Ricky said, being able to see this happen live in the moment and be able to

Riki Szymanski: you know, understand, you know, and it’s bringing some of that action to leaders and hopefully that gets his oxygen level up into the appropriate range. I’m not too surprised that his oxygen is low because he has all this fluid volume overload. So that fluid is probably spilling out into his lungs, making it difficult to do air exchange. All right, and then breathing. He’s got a respiratory rate of 28. This isn’t too much of a surprise either. His body is compensating, trying to bring in more oxygen since his O2 sat as low. So that’s kind of expected here. And then his heart rate, he’s at 104. Again, not too surprising because his body is compensating. His heart is trying to cycle oxygenated blood as fast as it can to deliver oxygen to the tissues. And then blood pressure, 165 over 92 is high. Again, this would be expected because of all that fluid volume overload. All right. Let’s listen to his lungs.

Mitch Luker: So this is where I was controlling the, so I was able to click off the shirt and kind of just to make things easier for Ricky so she wasn’t having to mess with things while she was trying to teach.

Riki Szymanski: All right, those sound clear.

Riki Szymanski: It wasn’t too easy to hear the breath sounds, but you get the point, right? Because I tell you what I’m hearing.

Riki Szymanski: I was anticipating, because of all that fluid volume overload. Both bases. And of course, if this was a patient in clinical, I would definitely want to listen posteriorly. And in listening to his heart, I can hear an extra S3 sound, which is typical for patients that have fluid volume overload.

Jon Brouchoud: Oxygen’s going up.

Riki Szymanski: All right. So we can see here on his leg that he has, I would say, three to four plus pitting edema. And that’s on both legs. So again, expected for somebody who is in fluid volume overload. He has the shortness of breath. As far as urinary output, I would expect that could be high or low, right? Remember our uremeters over here? It depends on what phase of acute kidney injury he is in.

Jon Brouchoud: So yeah, that’s amazing. Very well done. I mean, and you’ve created this scene and I’m just looking around and, you know, if for anybody that’s joining that hasn’t already, isn’t already familiar, you know, Acadicus is essentially a sandbox. So all of these objects are individual, what we call assets or props that are basically creating, like I said before, like a stage set. And so schools and organizations that are working with Acadicus, some of them will sponsor development of custom content if it doesn’t already exist in the library. And at this point, we’ve got a pretty substantial library. I think there’s over a thousand different prop assets in there. But looking here, I can see that Vincent was a patient that was created, I believe Madison College sponsored development of Vincent and he was a a Gen 2 patient. So Gen 2 patients are basically high-fidelity virtual mannequins that have a lot of capabilities. The anatomy was brought in by Cochise College in Arizona. And I know the vitals monitor was something that Dr. Slayman was looking for at DuPont Children’s Hospital, Nemours DuPont. The oxygen meter was Laurel Technical Institute. The IV pole was Chamberlain School of Nursing. The food, the bananas and the orange juice on the tray there, that was a project for NSU that we created for their geriatric program. And the environment they’re in is actually a pediatric ICU replica of a hospital that we were working with as well. So There’s just a lot of different pieces in here and I’m just kind of like walking through memory lane here thinking about where all these assets came from. But it’s cool that you were able to take all those different assets that were created by all these different resources and pull them in together to create this scene to meet your objectives. I think that’s amazing. And the lecture quality for your very first lecture. That’s fantastic. Great job, Ricky. That’s amazing.

Riki Szymanski: Oh, thank you.

Mitch Luker: Well, and it was one of those things where, you know, because we have a large amount of online students and we do a lot every class we have is all flipped classroom. So, because students are expected to watch their lectures kind of as their pre work and then they come into the classroom to do active learning and what I’ll be excited about to see this semester is. if Ricky sees a difference in how our students do during active learning time in the class. When, you know, if the concepts make more sense because, and I also want to know what kind of questions they’re asking. You know, are they asking deeper questions that are more meaningful versus trying to just, now explain this to me again. It’s like, okay, it was covered in your PowerPoint, but, you know.

Riki Szymanski: But you were sleeping.

Mitch Luker: or they were listening to it as they were doing the dishes because it wasn’t that interactive or fun to watch. So, and while it’s still, you know, material that’s, you know, not necessarily, you know, I won’t say, you know, as entertaining as, you know, like a YouTube video watching, you know, about cats or someone falling off of a ladder or something, but it still is way more entertaining and, engaging than words on a screen that you or even just flat pictures that don’t really move and so and my favorite thing was like being able to listen to those like lung sounds and explain like yes this is what because we say crackles in the lungs but students don’t always get that in their brain when they’re when you’re just saying well we would assess them and we would expect for this this and this But when you can actually see it happening and getting all those different learning styles together at one time, you know, it’s just going to make that information that much more present in their brain.

Jon Brouchoud: Yeah, absolutely. And I just want to double click on one point that you made earlier about studying the efficacy of it. You’re basically measuring to see how students do after they experience this. So before, obviously, you didn’t have this kind of lecture. They were taking an exam, and you have results from that. And now you’re going to compare that to results after they’ve had this opportunity to see the virtual lecture and see how they compare. which I think is amazing. And that’s something you’ve been doing at NWTC since the beginning, since you build your VR lab, is you’ve been, you know, continuously measuring and studying to make sure that, you know, it’s actually making a difference. It’s not just a shiny new thing. Because I think a lot of people look at VR and they’re like, this is just a shiny new toy and you know students love it sure but like it’s just a it’s just a game you know but what you’re doing in terms of measuring the efficacy I think is what’s helped helping to continuously sort of strengthen your program because you can demonstrate that ROI over and over again and say like there is real learning that’s happening here it’s not just something that we’re doing for a marketing soundbite or just because it’s a cool thing you know this is actually making a difference for students so I’ll be excited to see the results as well if you’re able to share that at some point we’re always eager to see how things are going and how we can continuously improve.

Mitch Luker: Well and so far from our blood administration activity we saw a about a 15 percent increase in student grades on their blood administration competencies and We don’t, I mean I can’t say that how much of it is, you know, we are but over the last year we’ve had a 10% increase in pursuit persistence. So, you know, since we’ve integrated VR into our, you know, using Acadicus into our curriculum. So like we are seeing positive results and I mean that’s just in the first year while. you know, still trying to kind of like get our feet underneath us of how do we use this to its best abilities. You know, this is that first pass stuff. So as we keep going with it, I’m expecting those numbers to continue to rise.

Jon Brouchoud: And are you measuring this with surveys? Is that correct?

Mitch Luker: Surveys, but also actually like so the surveys is more about student experience and what they would like us to do to make things better. I’m actually looking like we actually saw a 15% increase in grades on their exam for blood administration or advanced skills class. Because we had 33 out of 39 students pass on the 1st attempt of that competency, and that is unheard of for that skill. Normally that pass rate is about. usually about like 65% on the first attempt. And so, and the ones who didn’t pass were much closer to passing than they would have because they’re required to get an 80 and the lowest score we had was a 75%. So, um, the numbers were way better than we even thought they were going to be.

Jon Brouchoud: It’s amazing. Very, very cool. So what’s your perspective? What’s next? What are the, what are the, what’s the next iteration? You’ve touched on that a little bit, you know, but in terms of, you know, both, you know, just individually Ricky’s next step and then NWTC as a whole, like what, what are, where are you going next with this?

Riki Szymanski: Um, for me, um, I would say renal and endocrine have always been my second semester students, um, toughest points. So, um, I’m going to move on to probably endocrine next, especially some of those Hormone problems, SIADH and DI, I think those we could really show off with a patient if you were actually assessing the patient. Somebody that is, again, fluid volume deficit or overload. Some of those extreme imbalances that I’ve never even seen in practice. like maybe malignant hyperthermia. There’s some things out there that would be great in VR because we just never see them in practice, but they will be tested on NCLEX. And hopefully we’ll remember some of it at some point in practice if they do encounter it.

Jon Brouchoud: So what I’m hearing you say is like you’ve identified difficult things that the students struggle with perpetually, right? So you’re identifying those difficult areas and then mapping these VR experiences to that. Yeah. Okay, cool. That’s amazing.

Riki Szymanski: Like for SIADH and DI, we have the light board. I don’t know if you’ve ever heard of that. And I’ve done like board videos where I’ve drawn like a patient and what’s happening with fluid and everything. The students really like it, but they’re still struggling. So, this could be even better.

Jon Brouchoud: And so, it’s things that the students are struggling with, but like you said, also rare and unusual conditions that they won’t see in clinical practice necessarily. So, that’s another use case for this is really dialing in on things that you can show students that they might not see in their clinical rotations or even in their careers for many years, but at least you’re demonstrating something that will hopefully be memorable in case they encounter that eventually.

Mitch Luker: Correct. Well, like she said, I mean, we don’t know what’s on their NCLEX. And so we have to have them prepared for all this stuff because, you know, they get, I think the maximum number of questions you can have on NCLEX is 265. So, I mean, there’s 265 possible questions out of thousands of topics. And so trying to, you know, make sure that they have a strong enough knowledge base to be able to answer all those questions. And then, and then in practice even be able to use that knowledge again. And so, you know, trying to make something that’s more memorable than a really boring PowerPoint, that is what I say what you’re doing.

Riki Szymanski: And I also feel like in VR, I was able to especially I think we, I think it just about most of the things I lecture on, you could really get concept based, like for renal failure. If you watch the video, I talk a lot about fluid volume overload. I don’t want to talk about acute kidney injury or chronic kidney disease. They just have to remember that the patient is in fluid volume overload. So that should get them through just about any NCLEX question.

Mitch Luker: Yeah, getting those concepts of things and and because yeah, Ricky says fluid volume overload a lot because, but it’s like she keeps talking like, because this pain, you know, because of this issue, the patient’s in fluid volume overload. So we’ve got to deal with the fluid that’s here that’s causing the problem and, you know, being able to keep going back to that concept of fluid volume overload, because fluid volume overload doesn’t affect just kidney, that can appear with congestive heart failure, that can appear with numerous different diagnoses. And so, if they understand that concept of what to do with someone who has too much fluid on board, they’re gonna be able to deal with a plethora of different disease processes, and that knowledge will be there. And being able to, again, see it, kind of live on that in that moment, just makes it that much more applicable, because you can memorize all you want. But if you can’t take it to the bedside and use that knowledge in a meaningful way, then students aren’t going to do well as nurses, they’re going to have they’re going to struggle. And so like, I think being able to see it at the bedside and applying the knowledge to a patient in the VR world is really helpful to help those students who struggle with how do I take this stuff I memorized and do something with it. Yeah. That’s how the NCLEX questions are written. It’s not like Your patient has these symptoms. What’s the disease process. It’s your patient has these symptoms. You’re the nurse at the bedside. What do you do next? And so by being able to see what you do next, instead of just having a list of bullet points, it says for this, you do this for this, you do this and dah, dah, dah, dah, dah, dah. It’s like, oh yeah, here’s the things I do.

Jon Brouchoud: Mm-hmm. That makes a lot of sense. And, you know, I think coming back to this idea of iteration, you know, there’s also platform iteration that we’re working on, you know, to keep making the tools better. And I imagine a world where, you know, even nurses in practice before they’re going in to deal with a patient that has a difficult or a rare condition, you know, maybe they just go over into the simulation bay, put on a, you know, an Apple headset or whatever it is at some point in the future. you know, they’re looking at the, you know, maybe it’s some sort of approximation of the patient they’re reviewing, they’re priming themselves to go in there. And then when they go in and work with that patient, they’ve got deja vu, they just did it in a simulation bay, you know, and maybe there’s a simulation capacity in every floor of every hospital at that point, because they’re lightweight, they’re, you know, less and less costly over time, they’re higher and higher resolution. you know, these things are going to become something you can just fold up and put in your pocket, you know, like a pair of sunglasses. So it’d be great to be able to integrate that to prepare, you know, practicing nurses as well.

Mitch Luker: Absolutely. Yeah. Especially because, you know, patients are so different and not everything always presents the same. And so, you know, having something that can help you with like, oh, OK, what do I do it? Because I think about, you know, we get very specialized because like on in hospitals, you have the cardiac unit, you have the neuro unit, you have the ortho unit. But sometimes those units get full and then you have to overflow a patient that, you know, is a cardiac patient onto the medical unit or to the ortho unit. And the ortho nurses are like, I don’t deal with this. I don’t know what to do. And, you know, that way to kind of refresh themselves, because, I mean, as we thought, hospitals are always busy and full. So there’s not always a space on that specialized unit. And so being able to have a way to because we all have all the knowledge, but you kind of lose it a little bit when you’re not using it. And so having that refresher like, oh, OK, that’s that that process. And here’s what I do. And so having that quick refresher just help make sure that our nurses are competent even when they’re doing something they haven’t done for a while.

Jon Brouchoud: Yeah, that makes a lot of sense. Another great opportunity. Well, I guess I don’t have any other questions for you. I really appreciate you joining today. This has been fantastic. Is there anything left unsaid that you want to share or anything we didn’t cover? I think I’m good. This is fantastic. I really look forward to learning more about the program as it’s evolving and Mitch has been sharing with us, you know, on a lot of these episodes and we’re tracking your progress, you know, with excitement. So thanks again for sharing all this and joining us on the Pulse Live.

Riki Szymanski: Thank you for having me. Thanks.