Success Stories in VR Simulation

Amarillo College

Associates Degree Nursing

Implementation and Use of Acadicus VR Systems in Clinical Courses

1. Original Problem:

COVID-19 caused clinical space to become a premium for students with the closing of hospital, clinic, and rehabilitation clinical sites at the beginning of March 2020. As a result, dependency on high-fidelity simulation, and remote teaching modalities increased dramatically Spring 2020, bringing with the closures the realization of further technological support needs, including the need to create “real” practice environments for students to learn in via remote locations. The AC ADN program began looking into Virtual Reality (VR) and Augmented Reality (AR) systems to supplement simulation in a way that would be a safe, relevant, and content-rich addition to remote teaching tools.

Additionally, due to COVID-19, the nursing resource center (NRC) space was limited. The NRC houses 4 practice lab rooms, high-fidelity simulation rooms, and our debriefing rooms. This space was closed or is currently limited to 10 people per lab space, a limitation which does not allow for full clinical courses to utilize equipment needed to prepare students for entering the hospitals and taking patients face to face. The spaces at SIMCentral became non-existent as well due to occupational limitations. Sim Central is currently at 25% capacity, and unable to accommodate larger clinical student groups. Clinical space within any healthcare facility in Potter or Randall counties was not available, but will be opened in limited capacity for students beginning Fall 2020. Facilities at remote campuses in Dumas and Hereford, Texas could not be utilized.

(a) Description of Project Focus

a.  Professional development plans for simulation instruction: Due to delays in equipment shipments and on-campus network update issues, Professional development and faculty training session have been scheduled for March 2022. March sessions will include orientation and use of the VR system, how to manage the VR sim environments in non-VR and VR modes, how to facilitate VR simulations with students, and how to adapt the VR system and environments into the course effectively to meet clinical course outcomes.

Dr. Hall and K. Young have had several Zoom meetings for user training with the Acadicus development company creating our Virtual Reality environments and VR sims library. These 5 meetings occurred between 3/2021 to 1/2022. We have 1 more planned for March 2022; date and time to be determined.

b. Curricular modification, lesson design, and scenario development to allow alternative strategies, including through distance education, to help students meet specific clinical objectives:

A review of the clinical courses and course objectives was done by K. Young between January 2021 to May 2021. The Acadicus library available for immediate use was reviewed and specific simulations assigned to each clinical course based on their objectives and clinical student learning needs.

The first group of students to use the VR system included the Transitional LVN to RN (RNSG 1261) students enrolled in the Spring 2021 and Fall 2021 classes. The Level 4 RNSG 2263: Clinical-Professional Nursing Leadership students began use of the VR system in Fall 2021 with the initial Mass Casualty event simulation created specifically for the AC Nursing program.

RNSG 1105: Nursing Skills I students will use the VR systems at the end of March 2022 to practice their final Skills safety room and Infection Control PPE scenario. RNSG 1362: Clinical-Principles of Clinical Decision-making student will utilize the safety room and the patient ward simulation settings to prepare for their first clinical rotations in the hospitals. They will also be using the simulation to practice the transfer and safe positioning of patients between beds, wheelchairs, and other equipment pieces once their simulation development is complete.

c.  Facilitation of faculty’s debriefing with students, including through online formats, for clinical learning experiences

Student debriefing takes place post simulation in person or via the Acadicus system while students are in the VR environment. All debriefing can be completed in the VR system where students and faculty can interact with the virtual patients and settings in order to see real-time issues that could happen in clinical settings.

d.  Simulated clinical learning experiences with high fidelity level that include realistic or interactive patient scenarios.

Students in the VR environment are immersed in their “clinical” sites. The students in the mass casualty event experience the sites, sounds, and stimuli of a basic mass casualty bombing site where there are explosions, sirens, and victims that can be triaged post assessment by students.

The Transition students experienced interacting with a patient who was confused, had 12 safety issues in the room that required intervention, and could administer medications should the patient require them. Due to the real time interactions between students and faculty, the students could also speak with the patient during the assessment phase of their interactions. Each of these scenarios in the Acadicus VR Simulation library are interactive however high-fidelity manikins or other equipment have not been added to this system. The use of these items is not possible, but students can pick up objects or manipulate equipment virtually.

e.  Synchronous or asynchronous demonstration and evaluation of skills and competencies

Students and faculty are at the beginning of using this system and have not implemented demonstration of skills and competencies for graded assignments in their respective clinical courses. This process is expected to begin in Fall 2022 once all faculty and student groups have had the opportunity to use the VR system without the pressure of grades or competencies being evaluated.

f.  On-campus hands-on practice and demonstration upon resumed access to campus.

The Acadicus VR system was completed by the time students and faculty returned fully to the on-campus schedule. However, due to COVID restrictions, the system does allow faculty and students to engage in a full clinical experience from distances and in the online/virtual environment. This feature will be used as needed during the changes in COVID numbers and available clinical spaces. All clinical students have access to the VR system for clinical experience make ups as well, however, they are being kept within the context of their course outcomes and the Performance Measure and Outcomes of the NIGP Grant requirements.

Chippewa Valley Technical College

CVTC piloted several virtual reality experiences with students and nursing faculty in Fall 2021, including Acadicus heart scene and Open RN scenarios on “Administering Cardiac Medications to a Patient with Dementia” and “Identifying Safety Hazards.”

After experiencing the VR experience, one of the nursing students said,

“It’s definitely exciting to get this new virtual reality system, and kind of have a different perspective on how to work with the patients. I was actually on a simulation with another one of my peers, so we were bouncing ideas off of how the heart actually works. We were able to put our head inside and look through the valves and everything, grab out and touch the heart, turn around and look through everything. It was really, really cool.”

In celebration of National Simulation Week September 13-17, 2021, CVTC offered VR tours to faculty. Local reporters were invited to visit CVTC’s VR center and published CVTC unveils reality simulator for health care students (wqow.com) and a Leader-Telegram article that can be read on Yahoo News.

NWTC also set up their VR center was featured in their local news in August on Action 2 News and WFRV Local 5.  

There are currently several Open RN VR scenarios in the development and testing phase: Pediatric Pain,Heart Failure, Nitroglycerin administration, Caring for a Hospice Patient, OB Labor and Delivery, and a “Universal Patient” that can be used across multiple scenes and scenarios. We look forward to piloting these VR scenario in 2022!

Kim Ernstmeyer, MSN, RN, CNE, CHSE, APNP-BC

Open RN Project Director

Cochise College

The Fantastic Voyage through the InnerSpace of our Human Immune System

Using Acadicus, I, Frank Emanuele, a Biology instructor at Cochise College, will be traveling with my students to the depths of our innerspace this Spring. 

The human immune system is a difficult system for first year Anatomy and Physiology students typically, and with this scenario students will be placed into the common areas where infections take place. Students will travel through our innerspace,and stand within these areas to watch how the immune system fights off viral and bacterial infections with the various immune cells involved in our bodies. With this Acadicus scenario, the abstract becomes a physical tangible world where my students and I can meet in this space and watch the immune system destroy viruses and bacteria with the different types of immunity. Cell-mediated immunity is shown with T cells destroying infected cells. Antibody immunity is shown with the plasma cells producing antibodies, and the large numbers of antibodies engulfing a pathogen.

I hope to share how this experience goes with the Acadicus community after this is done in my classes this March.

Frank Emanuele

Biology Instructor

Lanier Technical College

First and foremost, we just want to state that our experience with the VR and Acadicus program has been amazing. Acadicus has been such an innovative program that has created a totally new learning environment for our students here at Lanier. 

The first time we used the program with our students, some were hesitant to try it out, but once they put the headset on for themselves, they were truly intrigued with the capabilities of the program. Having the ability to virtually take out all the organs of the human body and hold it in their own hand is something that they wouldn’t be able to experience if it wasn’t for Acadicus. It was so rewarding to see the fun and excitement students had going through these simulations. 

We mainly used the program with our LPN students last semester and incorporated a VR skills station every week they came in for simulations. Some simulations we used last semester included respiratory therapy training, ACLS training, bone and organ anatomy models, and heart rhythm identifying simulations. These simulations immersed our students into a complete virtual environment that allowed them to practice and hone their skills in the safety of our lab. 

Students truly loved the VR stations and looked forward to it every time they came in for simulations. Moving forward, our goal for this year is to use the program with more of the students that we have at Lanier, such as the paramedics and EMTs. 

We are so thankful to have this program at our hands and we are excited to continue using the program and seeing what Academics has planned for this year.

Lanier Technical College Simulation Staff

Madison College

This past year at Madison College we have really focused our VR efforts on building for the future.  Working alongside Arch Virtual developers, we are collaborating with other medical professionals and educators to create a birthing simulator for our Nursing and Paramedic students.  This will allow us to ensure our students can experience childbirth and all of the possible complications as well as post-partum care for mom and baby. 

We are also working on creating a Dynamic Cardiology Asynchronous Simulation for students to engage in and complete the simulation without a live instructor or standardized patient.  One of the hurdles we have found when working with faculty related to VR is how much time it takes them to go through a simulation with students live in Acadicus.  Our goal with the asynchronous simulation is increasing access for students while not putting an additional “burden” on our faculty. 

Finally, we are building a Madison College Headquarters (HQ) in Acadicus that resembles our iconic Truax campus, that will serve as the “front door” for all students and faculty entering Acadicus at Madison College.  Our different simulations and resources will be in different “rooms” accessible through the HQ, allowing students to go in on their own and check out different environments and simulations based on their interests.  The  launch of our virtual HQ will also align with the launch of our physical Extended Reality (XR) Center that we have been planning with consultation from Arch Virtual and hope to unveil next fall.

Carly Brady

Manager of Academic Technology, Center for Excellence in Teaching and Learning

Madison College

Nemours Dupont Hospital for Children

2021 has been a great year for VR medical simulation.  Our group of attendings and fellows at Nemours were able to partner with Acadicus to make some really impressive strides in mock code simulation in virtual reality and it came just in time!  COVID-19 closed the use of in person mannikin simulation throughout most of the country but thanks to our partnership with Acadicus our VR simulator was ready to go.  

Due to the lack of headsets for everyone in our target audience of fellows and residents, we had a great suggestion from the Acadicus team to use Zoom as a streaming platform to allow our subjects to enter the VR scenarios from a distance.  Being able to use multiple laptops with one as our Code leader foot of the bed view and the others to support in the scenario VR avatar assistants, we were able to create complex realistic 3D VR simulations for our learners.  

So far we have enrolled 22 different pediatric and emergency medicine residents in our mock code simulations.  We have created scenarios that simulate shock/sepsis, status asthmaticus, acute respiratory failure due to bronchiolitis, traumatic brain injury and elevated intracranial pressure, ventriculo peritoneal shunt failure, status epilepticus, and a whole host of Pediatric Advance Life Support style rhythm disturbances including asystole, bradycardia, ventricular tachycardia and fibrillation and supraventricular tachycardia, all with fully moveable waveforms that can be seamlessly changed from one to the next using the simulation manager panel.  

We have been able to incorporate scenarios with two of the newest diseases on the planet, COVID-19 associated pneumonia and MIS-c (Multisystem inflammatory syndrome due to COVID-19).  In addition to well developed scenarios, Acadicus has supported our quest for realism by creating the most realistic equipment and various hospital based scenes (including a 4 bed ICU, emergency department bay, operating room, Catheterization lab, Interventional radiology suite and even an MRI scanner where one of our patients is seizing.  Our simulated patients can be bag mask ventilated, placed on high flow nasal cannula, placed on Bipap, be fully intubated, have a chest tube placed, have a central or peripheral intravenous line placed, the works.  They can even be defibrillated or undergo chest compressions.  While our ultimate goal is for everyone to experience the VR experience from their own headset and gaming laptop, the exposure they have had to simulation training in the past year has been phenomenal and invaluable to ongoing patient care.  Remember practice makes perfect!

Nick Slamon, MD

Pediatric Intensivist

Fellowship Program Director Pediatric Critical Care

Clinical Professor of Pediatrics and Pediatric Critical Care Medicine Thomas Jefferson University Hospital

University of Wisconsin School of Medicine and Public Health

Simulation training is a key component of maintaining skills related to neonatology and promoting education on newborn resuscitation. We have developed a virtual reality simulation module mimicking the obstetrical operating room and newborn resuscitation bay. We have created a realistic appearing ~30 weeks’ gestational age newborn who is lying on a radiant warmer in respiratory distress. Through VR, participants can experience realistic visual and audio experiences as they attempt corrective steps to improve the newborn’s respiratory status using Neonatal Resuscitation Program guidelines from the American Academy of Pediatrics.  We are now in the process of implementing training sessions using our VR neonatal resuscitation module.  We hope to study the experiences of participants to understand how virtual reality can potentially enhance training and education related to newborn care.

Ryan McAdams, MD

Neonatology Division Chief 

Division of Global Pediatrics 

Department of Pediatrics

Villanova University

At Villanova University, over this past year the graduate nurse anesthesia program has added additional VR hardware, including new gaming laptops and HP Reverb G2 headsets to provide VR experiences for nurse anesthesia students. One of the curriculum goals for VR is to include content and experiences that will meet new educational requirements set forth by the Council on Accreditation for Nurse Anesthesia Programs. To assist with the implementation of these curriculum goals, two nurse anesthesia students are planning to develop a VR experience for their classmates as their Doctor of Nursing Practice (DNP) project. In addition, another goal is to incorporate VR into the crisis simulation curriculum utilizing some of the scenarios already available.

In the undergraduate nursing program, adding Immersive VR simulations is a natural next step to expand and complement our comprehensive simulation experiences. A new scenario is currently being designed for students as an additional simulation in the advanced medical-surgical rotation. We also plan on using scenarios in the Acadicus Library (OpenRN) for communication and safe medication administration for sophomore level students as a capstone experience. As we move forward with VR, all newly designed scenarios will benefit both the undergraduate and graduate nursing students to provide rich, immersive VR learning experiences.

Carlene McLaughlin PhD, CRNA, CHSE

DNP Project Manager, Simulation Director

Nurse Anesthesia Program

Crozer-Chester Medical Center/Villanova University

Patricia B. Prieto, MBA, RN, CHSE

Assistant Director, Simulation & Learning Resource Center

Louise Fitzpatrick College of Nursing

Villanova University

VSL (Virtual Simulation Lab)

Acadicus has been a great blank canvas to create scenarios for our faculty to meet future course needs. We have been able to develop innovative scenarios using/modifying the assets available to us in Acadicus. Acadicus has even chosen to do further development based on our rough draft creations if you will. We are in the planning and development stages for many innovative projects including curb-side communities, single and multi-focused exam rooms, ghost mode, multi-use holocrons, and fully socketed avatars.  

Our accomplishments in Acadicus include: 

• Developing a multi-patient scenario to challenge students in a variety of disciplines 
• Utilizing the beta physics features to educate students on dropping items and re-sanitization 
• Imagining an escape area instead of a traditional escape room and developed several different difficulty levels 
• Modifying assets in new and innovative ways to accomplish our educational goals 
• Development is underway for two scenarios focused on social determinants of health (SDOH) for undergraduate and graduate nursing students 
• Orienting new users to the VSL using scavenger hunts 
• Enabling asset rich exam rooms without typical issues of asset rich scenes by making them their own separate scene tied to an also asset rich hallway 
• Presenting to 9th and 10th grade students using a condensed version of all our scenes to give a comprehensive idea of all the possibilities in Acadicus 

In conclusion, we are extremely proud for the opportunity to work with Acadicus as a vendor/partner. They have worked with us to accomplish common goals and have been accommodating to all our requests. Their tech support is also top notch. 

VSL (Virtual Simulation Lab) Team – Craig McGonigle, Joe Bengry, Julie Tyson, Dee McGonigle