We asked thought leaders in healthcare and education to share their visions on the future of virtual simulation. Their insightful and visionary responses are shared here in alphabetical order. We thank everyone who shared their thoughts, and invite anyone interested in sharing their vision to contact us.
If you keep doing what you are doing, you will keep getting what you are getting….
Sometimes professions need a stimulus to take them to the next level. That is exactly what Covid has done for healthcare / health care education. Research has directed education that we need to meet our learners at a level that stimulates and solidifies their learning. Reading books, face to face lecture and PowerPoint have remained a mainstay in educational delivery methods with multiple choice testing as our evaluation standard method. Regardless of evidence pointing educators in a different direction, the mainstay methods have continued. Mid-March 2020….the educational world (and life as we know it) is forced to change / use new resources and quickly respond with uninterrupted learning. What we needed: something real, or real like, something interactive, something engaging, something flexible, something easy and something affordable, that would achieve measurable learning outcomes. Traditional brick and mortar, high fidelity-based simulation learning was thought to be the answer. However, traditional simulation is labor and time intensive and not feasible in an environment with limited accessibility when face to face encounters is not feasible. Healthcare education needed a solution to our plethora of issues.
Acadicus provides the answer. It provides a real (like) flexible, safe platform that allows educators and learners to collaborate and apply learned knowledge across any imaginable environment with any type of variable to simulate healthcare challenges.
Additionally, it allows for measurable tracking of learner progress. It provides a replicable, deliberate platform that can easily be supervised by an expert. Furthermore, it has the possibility to transform learning into a gaming environment, with leveling, measurable goal attainment which could lead to safe competition (a fun motivational and hopefully addictive learning environment. This platform takes healthcare learning to the level that educators have been searching for. Educators working together with a technology development expert have the power to reach far and wide across the globe and ultimately positively affect patient outcomes.
The educator’s imagination and synergistic collaboration with technology experts are the only limitation…
Polly Anderson RN, MS
Five years ago I wrote an editorial titled “Games, virtual environments, mobile applications and a futurist’s crystal ball” (Bauman, 2016). This editorial was part of a special edition of the indexed academic journal Clinical Simulation in Nursing. In this editorial I asserted several poignant positions including that the rate of technology development and integration continues to accelerate exponentially. Further, I asserted that clinical teachers, and experts in the area of digital technology must teach learners, whether students or those engaged in faculty or professional development the skills to vet digital technology such as virtual reality solutions for content accuracy and curricular fit. The key to instilling these skills is to promote a sense of digital wisdom (Prensky, 2009). Further, experts, particularly those with expertise in technical development have an obligation to instill and promote best practices, particularly as it relates to user experience and interface. Without attention to this facet, it will be difficult and often challenging to continue to engage a broad swath of stakeholders needed to continue to grow virtual reality solutions throughout the health professions and other professional educational domains. Contemporary and future virtual reality solutions solve problems that I have been writing and talking about with my collaborators and like-minded colleagues for over 10 years (Bauman, 2007). I have been fortunate enough to lead exceptional collaborative teams whose portfolio has foreshadowed the desire and need for cross-platform, mobile solutions.
If you are reading this paper you have first hand experience with the multi-generational augenblick that the COVID 19 pandemic has unleashed not only on the delivery of healthcare, but also health professions’ education, as well as the broader educational paradigm. Never has the concept of anytime-anywhere learning been so salient. Without access to bricks and mortar educational venues, virtual reality provides an elegant solution to various aspects of clinical education. The sage is still relevant, but the stage and theater have changed forever. The stage and theater must now be framed to meet the teachers’ and learners’ environmental demands of circumstance. Teachers, students, and those engaged in continuing professional education still have objectives and expectations that must occur to meet the demands of their chosen professions. The digital ecosystem can meet these objectives and expectations by harnessing virtual reality-based solutions. The best solutions will aspire to the notion of fit (Bauman and Ralston-Berg, 2014; Bauman, Ralston-Berg, and Gilbert, 2021). Fit in terms of educational technology attends to three elements that assist stakeholders in the evaluation of technical or digital solutions to drive curricula. They include: Complexity, cost, and time. Balancing these elements is essential to successfully leverage digital solutions like virtual reality as a solution in the anytime-anywhere teaching and learning paradigm. The most successful solutions very likely are not the most complex or time consuming. In terms of cost, the most expensive solutions will remain out of reach and the cheapest solutions will die with the adage of “you get what you pay for.” The most elegant solutions that balance these elements will be the most sought after solutions.
Bauman, E. (2007). High fidelity simulation in healthcare. Ph.D. dissertation, The University of Wisconsin – Madison, United States. Dissertations & Theses @ CIC Institutions database. (Publication no. AAT 3294196 ISBN: 9780549383109 ProQuest document ID: 1453230861)
Bauman, E. B. (2016). Games, Virtual Environments, Mobile Applications and a Futurist’s Crystal Ball. Clinical Simulation in Nursing, 12(14), 109-114. doi: http://dx.doi.org/10.1016/j.ecns.2016.02.002
Bauman, E. B. and Ralston-Berg, P. (2014). Virtual simulation. In J. Palaganas, J. Maxworthy, C. Epps, and M.E. Mancini (Eds). Defining excellence in simulation. Wolters Kluwer – Lippincott Williams & Wilkins.
Bauman, E. B., Ralston-Berg, P., & Gilbert, G. E. (2021). Virtual simulations and gaming to promote student learning and engagement. In P. Jeffries Clinical Simulations in Nursing Education: From Conceptualization to Evaluation (3rd Ed.). New York: National League for Nursing.
Prensky, M. (2009). H. sapiens digital: From digital immigrants and digital natives to digital wisdom. Innovate: Journal of Online Education, 5(3), 1.
As the Academic Manager of Academic Technology at Madison Area Technical College I must admit I get excited about all new and emerging technologies. I love thinking about how they can help us push the traditional boundaries of how we deliver training and education to our students and community. But when I got back from an amazing weeklong conference a couple of years ago, I couldn’t stop thinking about two presentations I attended that week and they were both Virtual Reality presentations.
One of the sessions I attended was by two researchers at a Florida University who wrote a grant and created an amazing VR experience in the Florida wetlands. One of the many reasons they mentioned for doing this project especially stuck out to me: people with mobility disabilities will never be able to go into this wetland and explore, learn and enjoy its nature and beauty. I hadn’t thought of that aspect/benefit of VR and it got my mind racing – where else can certain populations never be able to visit or experience in real life and how can we create scenarios in VR to replicate that?
Another session I attended was by the two co-founders of a company – one was male, one was female. They told the story about the male going into a virtual environment but the female was logged in, so he was in this virtual world as a woman and realized quickly how differently he was treated and talked to. So, the woman logged in as the man and again was struck by how differently she was treated and talked to when they thought she was a man. What this says about our society is one thing, but what else can we simulate in virtual reality that one could never experience in person – like a man being thought to be a woman and engaging in real-time with others.
The bottom line is I have learned in the last couple of years that there are no boundaries when it comes to Virtual Reality. Botany on Mars in VR? Sure! HVAC gauges in VR? Let’s do it! Customer Service skills in VR? Why not! Virtual Reality is already proving to be a game changer in higher education, and I can’t wait to see what boundary we will push next.
Carly K. Brady, M.S.
Academic Manager – Academic Technology
Center for Excellence in Teaching and Learning
I remember reading Malcom Gladwells 10’000 hour rule. He proposes that, “if you look at any cognitively complex field, from playing chess to being a Neurosurgeon, we see this incredibly consistent pattern that you cannot be good at that unless you practice for 10,000 hours which is roughly 10 years if you think about 4 hours a day.” As I contemplated my time in Nursing school back in the early 1980’s, I certainly received nowhere near that amount of lab time or clinical practicum prior to being degreed and hired as a Nurse. The fact was most of those skills are developed on the job in most professions. Maybe not the best time to be practicing especially in health care. But what is the limitation in improving this training? Well, replicating the jobs setting, the equipment needed, the time of experienced practitioners is hard to come by and expensive. But what if there were a platform that would allow you to simulate the on-the-job scenarios across a variety of settings and situations and repeat them as often as you want, on demand when you needed? Back in my school days that would have been science fiction. Today this can be achieved in most users home for a modest investment. The consumerization of VR (virtual reality) has opened up possibilities for the Training and Education sector that I believe, are revolutionary. Now I can put on a VR headset and place myself in any simulation the developers might be asked to design. Need to perform an EKG, need to get a sterile tray prepped, need to perform proper PPE to enter a Covid unit? There can be a simulation for that. Ask yourself this, whats more effective, reading a procedure and maybe having some graphics to guide you or actually performing the process and being guided by an instructor who has their 10,000 hours in? Many would say the answer is common sense, but even beyond that we have many studies showing the efficacy of VR simulation training. We have just started to tap the potential of Training in VR but I for one am excited about the future of this field and for all those who will be able to leverage it. I imagine many new users experiencing the scene from the Matrix when Neo learns he can have knowledge uploaded into his head on demand and comes out of the simulation startled and says, “I know Kung Fu”. It’s not science fiction anymore.
Virtual reality healthcare simulation allows educators to leverage technology where it is not a standalone singular experience but fully integrated and engaging resulting in a positive learning outcome.
We must continue to explore how we will use this tool to create deep learning experiences as we push the boundaries of standard educational practices.
This kind of simulation will be an influential factor that impacts the quality of patient-centered care and transforms how nurses interact with their patients and colleagues in their professional environments.
Debra L Duncan, BS, MLS
Instructional/Virtual Learning Designer
Covid-19 has forced us to embrace new approaches to educating our students and Virtual Reality (VR) provides the capacity to immerse our students in any healthcare environment, regardless of their own physical location. Virtual reality healthcare simulations enable us to provide unique learning opportunities for our students in a safe environment. Our students are immersed in technology throughout the nursing program and are comfortable with this type of simulation. VR offers us the ability to develop our own unique simulation content that includes critical elements such as family- focused care and communication. Including these elements, allows us to challenge our students to consider the importance of interpersonal elements as they provide care to their patients and families.
Simulation Center Director
Minnesota State University, Mankato
The future of virtual simulation is so bright because it has already started to arrive. Existing technologies already give us the ability to recreate virtual environments, to simulate clinical scenarios, to have remote collaboration and learning, and to teach concepts in both instructor-driven and learner-driven experiences. This allows for continued incremental improvements in both the technology and processing powering the VR as well as in our own teaching methodologies and approaches. The foundation has been laid, and now we will be able build upon it to add ever more realistic and engaging offerings to a wide range of learners. What I hope to see come next is the addition of meaningful haptic feedback and the convergence of PC-based and standalone wireless VR headsets. Haptic feedback, to me, is the cornerstone for teaching procedural competency. Muscle memory is important in mastering a procedural skill.
Learners should be able to learn how to hold an instrument or equipment and feel the weight of it, feel the appropriate force needed to start an IV or do a lumbar puncture or reduce a dislocated shoulder. When virtual simulation can achieve this at a level equivalent to a physical simulation task-trainer, it will supplant and exceed other methods of teaching procedures.
My ultimate vision for virtual simulation is an open-sandbox platform that allows instructors (without knowledge of coding or high-level technical expertise) to create simulation cases and modules for learners which can run either synchronously with the ability to adapt the case on the fly, or asynchronously on-demand with scoring and feedback provided to the learner.
The instructor can then share or exchange cases on the platform to avoid duplication of efforts and allow further dissemination of high-quality cases and teaching modules. A variety of inputs are available such as voice recognition and hand tracking to avoid having to spend time teaching complicated controller schemes to learners. Haptic feedback can be added where needed to simulate procedures and integrate them into simulation cases and provide for just-in-time training and further resources for learners. Improvements in processing or in cloud computing and high speed network connections will allow this to run on a standalone wireless VR headset. I eagerly await the arrival of the holodeck style virtual simulation lab, but until then I look forward to continuing to push the boundaries of what can be achieved with existing technologies in the short and medium term to help train the medical professionals of the future.
Timothy Koboldt, MD, FACEP
Assistant Professor of Clinical Emergency Medicine
Simulation Director for the Department of Emergency Medicine, University of Missouri – Columbia School of Medicine
Our vision for the use of Virtual Reality simulation in nursing education for undergraduate and graduate nursing students, including doctorate nurse anesthesia students, is that it will readily offer an additional learning opportunity to complement the currently offered clinical and lab-based simulation experiences. Our goal in Simulation Based education is to prepare our students to transition to practice easily and seamlessly with the most up-to-date evidence-based knowledge and skills available. Adding Immersive VR simulations is a natural next step to expand and complement our comprehensive simulation experiences.
As educators we need to constantly challenge our students in the development of their critical thinking skills, while providing a variety of patient care scenarios from basic to more advanced. VR Simulation offers us the opportunity to simulate many different patient scenarios and environments that we are unable to replicate in physical spaces. It allows student learners to interact and collaborate with various members of the interdisciplinary healthcare team, while providing them with multiple deliberate practice experiences as they learn to critically think and manage patients in increasingly complex scenarios. VR will also provide a way for us to design multi-patient and disaster type simulations that are labor and resource intensive to create and replicate. We anticipate that the added dimension to simulation education via VR will increase our students’ confidence and readiness to transition to practice.
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
Virtual Reality allows a combination of distance/online learning with the strength of the in-person experience. Real-time person-to-person learning has always been the keystone of education, and now with VR, the opportunity to remove geography and allow people anywhere to join a live classroom is truly advancing educational opportunities.
As a neonatologist, I am committed to partnering with people in our community and globally to work on ways to eliminate healthcare inequities and improve neonatal care. An essential component of providing high quality care to every baby is high quality education and training. To enhance educational and training experiences in neonatology, contemporary approaches are needed to augment traditional teaching strategies in fun, exciting, and realistic ways. With avatar image-based VR, learners can join a 3D distributed virtual environment in the form of real video and as an avatar. This platform allows remote access to “in-person” environments, where learners are immersed in hospital settings that mimic reality. I see future medical training integrating virtual hospitals with virtual patients as the next frontier to optimize learning anywhere and anytime. This creative approach allows for collaboration with experts worldwide, safe training, repetitive learning, dynamic participation, and the ability to review lived virtual experience to promote constructive feedback and process improvement.
Ryan McAdams, MD
Neonatology Division Chief
Division of Global Pediatrics
Department of Pediatrics
University of Wisconsin School of Medicine and Public Health
Just as we unpacked the manikins years ago, conceptualized how to use them with our students, and integrated them into our curriculums, we are now unpacking the realities in relation to education. Virtual Reality (VR) has been used in healthcare for 2 decades and schools throughout higher education are exploring and implementing VR in the education of our future healthcare workforce. The Faculty Administrators Students Technology Strategic Integration Model (FAST SIM) denotes the critical influence and contribution from the triad of faculty, administrators, and students that are integral and essential to achieving successful integration of technology into the curriculum (Gordon & McGonigle, 2018). VR learning episodes can provide opportunity for students to practice clinical and career skills in a safe environment, experience intimate and challenging conversations under the supervision of their faculty. VR can be used to allow the student to become a patient and experience the patient’s reality based upon the patient’s health status (McGonigle & Mastrian, 2021). The patient could have visual impairments, schizophrenia, Alzheimer’s disease or other conditions that become the student’s reality in VR. As the students experience the patient’s realities such as not being able to see, slurring their words or hearing voices, they become immersed in the reality of the patient they will be caring for; it is essential that we research and determine how this impacts the student’s reality when they care for the actual patient. VR can be used to provide students with an immersive experience of interacting as a member of the interprofessional healthcare team caring for patients with rare conditions to prepare them for situations that are seen infrequently in practice. We have realized advances that have enhanced medicine such as using the patient’s own anatomy in VR to practice the surgery and exploring how this impacts the surgeon’s reality when performing the actual operation. The realities of VR impact, influence and have transformative powers in patient care innovations and the healthcare professions. We have VR tools that provide us with different realities that we experience to the extent that we engage with them. Our reality related to healthcare will continue to be shaped by advancing knowledge and technologies. Disruptive forces through the application of knowledge and VR technologies are transforming reality and disrupting the healthcare industry. In education, we must make sense of and meet the challenges of the disruption. As we unpack VR, are informed through its use and expand our knowledge and technology infused practice, we impact our reality and also the reality of the healthcare industry and that of our patients. Of course, we have only scratched the surface of what VR can provide to learning. These innovative disruptions in our healthcare arena are impacting our professional reality, challenging our paradigms and rapidly creating new ways of thinking, working, and learning; they have and will forever change the way we view the world of education, healthcare and especially patient care.
Gordon, R. & McGonigle, D. (2018). Virtual simulation in nursing education. NY: Springer.
McGonigle, D. & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge (5th ed.). Burlington, MA: Jones & Bartlett.
Dee McGonigle PhD, RN, FAAN, ANEF
Director, Virtual Learning Experiences Simulation Excellence (VLESE),
Center for Transformational Education and Learning Innovation, Chamberlain University
Professor, Graduate Program
Chamberlain College of Nursing
Learning for the 21st century students are not satisfied simply hearing about a topic.
They want to see it, touch it and feel it. By bringing the textbook to life with virtual reality creates a level of interest that textbooks or tests struggle to do. Imagine being able to take a virtual field trip inside the human body. Medical care providers have minutes or just seconds to act in order to save a patient’s life and the ability to know “what to do when”, and to “think on one’s feet” can make the difference between life or death. Practice makes perfect VR tools allow providers to simulate situations that rarely occur in order to apply their knowledge gained through theory and keep their lifesaving skills sharp, even if they’re only needed once in a while. Virtual environments provide students with the valuable ability to explore, make mistakes, and learn from them. VR can sharpen key skills including critical thinking, problem solving, communication, collaboration, and creativity. VR can enhance these employability skills that some hiring managers have found lacking in today’s students.
As both a respiratory therapist working on the frontlines and a healthcare educator, I have seen implications during Covid-19 pandemic. I have experienced the challenges it has presented within the economy, healthcare and education, but with every challenge lies opportunity for growth. Acadicus provides the flexibility of both synchronous and asynchronous learning methods. It is a cost-effective tool to enhance hands on skills. Medical equipment does not come cheap, a simulation mannikin alone can cost hundreds of thousands of dollars.
Mary Mittwede BSRC, RRT, RRT-ACCS, RPFT
Director of Allied Health & Program Director, Respiratory Therapy
We see the future of healthcare simulation will be transformed with XR technologies. The current platforms to train physicians and medical students are creating learning opportunities unlike anything that could be scaled today. Virtual Reality has the ability to create high risk and high stress scenarios for physicians and students to practice in many times before performing the procedures or scenarios on real people. I imagine a day in the not too distant future that medical errors are reduced dramatically and training for complex or uncommon procedures will be delivered in near real time. We are excited about the future and how we can help create the next generation of XR designers, developers, and leaders.
Director, XR Initiative
Center for Academic Innovation at the University of Michigan
Virtual reality is extraordinary at showcasing medical devices because it overcomes physical limitations of reality in viewing the technology while in operation but at the same time offers the capabilities to showcase operating characteristics that match reality. At Accuray we produce radiation therapy devices such as the Radixact® System and the CyberKnife® System, which are the size of an entire room and precisely emit focused radiation beams at tumors to kill cancer cells in the patient being treated. Because the systems are so large potential customers typically have to travel to the factory or other hospital locations to see the technology in action. With virtual reality, potential customers can be “transported” to see the equipment right from their desk without the need to spend time or money on travel or endure restrictions associated with COVID-19. Since our devices emit radiation when in operation, potential customers would not be allowed in the room with the system and typically would need to watch a treatment over video camera. Virtual reality allows us to put customers in the room while the system is in operation and allows those customers to walk around and inspect every aspect of the system while it is in operation, an ability not possible in reality. Virtual reality goes even further, we can remove the covers of the system to allow potential customers to see how internal components operate during normal use and we can visualize X-ray beams and radiation beams that are normally invisible to the naked eye, but in virtual reality visually illustrate them to show how the system is working in real life. We took great care to ensure that the system was scaled to life size, the treatment couch moved at real speeds, the gantry rotated at real speeds, and the beams turned on and off to match the real-life performance of the system. This combination of real life performance and the ability to see vantage points and objects not possible in real life is what makes VR the best technology to truly showcase the features and benefits of our products to potential customers.
Product Marketing Manager, TomoTherapy/Radixact
Michael C. Wussow
Senior Director, Content Marketing
As health care workers know, the patients and diagnoses seen in clinical are unpredictable. A student could go through an entire clinical course not taking care of a specific diagnosed patient. The ability to design a case study and integrate the clinical components that need further attention is a true highlight of VR. The overarching goal for students, to reach the highest level of clinical reasoning possible. The opportunity for interdisciplinary health care scenarios in the VR setting is also beneficial to students. The students take away the importance of collaboration with ancillary staff in the health care setting. The students are able to learn who and how to collaborate with health care team, without physically stepping foot in the acute care setting. The ease of remediation of clinical skills along with the opportunity to perform tactile skills of which otherwise would have been incomplete, is another positive of VR. The technology has come a long way and made much more “user friendly.” I am looking forward to the use of VR in the Nursing Program over this spring semester.
Kelly Shafaie RN MSN
Associate Dean of Nursing
Moraine Park Technical College
In the middle of 2012 as the Apple ipad became increasingly popular, medical students in many of the United States medical schools began receiving “free iPads” as part of their admission package. While many were quick to point out the free technology was actually part of the paid tuition, it did show a leap forward in medical education. Shifting from notebooks and pens to instruction on a digital platform was an enormous shift in thinking. In 2018 NYU medical school was the first to offer free tuition to all entering medical students regardless of financial need. This signaled another major shift in the education of future doctors, many of whom took on hundreds of thousands of debt during their four year medical school training and additional debt during their residency training. It allowed for sole focus on learning the craft rather than incessant worry about how to pay back these enormous loans.
The 2020 global pandemic due to COVID-19 has caused its own shift, many say for the worse in medical education. Forced social distancing and reduction in face to face, hands on learning has become the norm. Dependence on technology and distance learning through video conferencing platforms have become the way the next crop of doctors are forced to learn. However, this reliance on technology has opened the door for many to see a way to combine digital learning with more conventional hands on,face to face interactions. The next advance in medical education needs to rely on the use of virtual reality (VR).
Each student entering medical school in 2021 should as part of their entrance be given a VR headset, high powered laptop and a subscription to an online learning world such as Acadicus. There these students can create an avatar or digital representation of themselves. These avatars can interact in real time with other students to attend virtual lectures, create virtual study groups, and upload their own content to help them study and later recall important physiologic and biochemical interactions key for taking care of patients.
However, the greatest advantage of VR is that these same students from very early in their first year can begin interacting with each other in the care of a variety of virtual patients in countless medical settings. Typically, a medical student has very little contact with actual patients in the hospital setting during the first two years of training. Much of that time is spent in lectures, laboratories and small group settings. Using VR, from the very beginning on their own time, students can practice patient interviews, hone their diagnostic skills and most importantly begin team training in mock code scenarios where they care for the sickest patients while each assuming an important role on the team.
Acadicus VR allows for an astounding level of realism and immersion such that students may forget the scenario is a simulation. Countless patients with a spectrum of complaints and diseases can be created and inserted into any medical environment from the operating room to the clinic. The collaborative ability of VR allows multiple students to see, hear and interact as if they were administering care on a live patient together in real time. Any number of medical devices or “assets” such as central lines, ventilators, or medications can be created inVR and used just as they are in real life. The ability to practice with these assets and in these realistic scenarios while putting no actual patient at risk is the center of medical simulation education which has been severely hampered by the COVID-19 pandemic.
The next leap for medical education is already here. It’s time for VR to move into the medical education realm.
Nick Slamon, MD
Fellowship Program Director Pediatric Critical Care
Clinical Professor of Pediatrics and Pediatric Critical Care Medicine Thomas Jefferson University Hospital
Nemours Dupont Hospital for Children
The use of VR technology in healthcare simulation signifies a revolution in the way that we both teach and learn quality patient care. The traditional “plug-and-play” cases of VR software have great learning value and reach a vast number of students. However, as an educator and fierce advocate for immersive learning, I have developed a greater interest in the live learning space within certain VR programs such as Acadicus. Unlike the era in which most of us were subjected to endless PowerPoint and other podium lectures, VR as a live teaching tool allows both the teacher and learners to fully engage as they manage the needs of a complex medical patient. As a software tool, the power of this technology hinges upon the dedication and skill of the instructor and the quality of cases that are presented within this platform. The fidelity of a quality VR software program far exceeds the traditional mannequins that most of us utilized in simulations of the past. It also offers the convenience and safety of remote learning. The live learning interface of VR provides an immersive alternative to the traditional, more passive style of lecturing and learning. As a result, it stands to drastically improve and upend the way that we teach our next generation of healthcare providers.
Emily Tarver, MD
Assistant Professor of Emergency Medicine
2020-2022 Simulation Fellow
University of Mississippi Medical Center
My first experience with immersive virtual reality (iVR) was at a conference exhibit hall. When I donned the headset I found myself in the room with a patient who was sitting on the edge of his bed and appeared distressed. Though he was an animated character, his face appeared ashened, his lips were cyanosed and his chest heaved as he struggled for air. He answered questions in 4-5 word sentences and I felt an immediate urge to reassure him while I grabbed my virtual stethoscope to listen to his chest. I heard wheezing in all lung fields. I did some additional assessments, treated him with the appropriate medication and began to see some improvement in his condition. After the scenario I reflected on my experience and realized that I felt the same twinge of adrenaline I get as a paramedic when I encounter a very patient in need of immediate assessment and care. It also struck me that I had just had an experience that hit on the psychomotor, affective and cognitive domains. This was experiential learning with context. This cannot be replicated in a lab. However, I believe the future of medical simulation will be a blend of the virtual with real world objects to give the learner the visual and auditory context and the tactile experience for psychomotor skills. Students learning at a distance will use stand-alone VR headsets and applications that take advantage of agency for skills acquisition, and artificial intelligence, voice recognition and natural language processing to help healthcare providers to develop their history taking, communication and decision making skills. Analytics will provide the learner with valuable feedback and biometrics will monitor emotions and enable scaffolding of levels of patient acuity to build in stress inoculation. The future of experiential learning looks bright!
Rob Theriault MET, BHSc., CCP(f)
Immersive Technology Lead
I believe medical education has changed and the pandemic has added momentum to the change. Clinical training has always been, and will continue to be, expensive and VR has emerged as an effective simulation model. It is cost effective, it is repeatable, it can be standardized, and there is growing research that it is effective at supporting student success as an instructional tool. I envision VR being embedded, on a more aggressive scale, into all allied health education, and really across all disciplines. I foresee greater advances in technology to include more virtual human interaction that allow for interactive, multiuser simulated clinical experiences. With this and other advancements, my vision is for VR/AR to transform instructional delivery and most remote learning will be done through virtual reality technologies.
Dr. John Walsh
Director of Library Services
As an educator and simulationist, I have seen the impact on how utilizing technology to enhance student learning works. Madison College’s Health Simulation Center offers students a robust level of simulation technologies to enhance learning. However, as technology advances, we educators must be mindful of those technology advancements and how students are learning from them. In 2020, our world has turned from the what we have been doing to what we CAN be doing. Simulation needs to be reinvented. I believe that virtual reality is that next step toward the future of healthcare education.
Imagine you are in a room with your students and you are trying to describe how a mechanical ventilator works. Not a difficult concept to grasp mechanically, but physically how does it affect the patient? Let’s put on the goggles and take a look. We can see the lungs expanding to the terminal alveolar structures but wait, let us take a look at the heart, blood flow and blood pressure. This concept is talked about but how great to actually see it in action. Virtual reality can also be used to help students fully understand, evaluate and treat medical conditions such as a loss of limb, vision impairment, and age related conditions. Avenues for therapeutic communication, response to medical errors, and empathy also can be created in a virtual world.
Combining course work, task training, simulation and virtual reality are key goals for enhancing student success in healthcare education. The future is now. Envisioning virtual reality use from an educational position has many more possibilities to become fully immersed in another realm or “reality.”
Jeffrey Wenzel, MSEd, RRT, CHSE
Program Director, Health Simulation Center
Prof. Jahangir (Jahan) Tavakkoli, a Medical Physics Professor at Ryerson University, Toronto, Canada, who has several years of medical devices industry experience, has conceived the idea of adding a virtual reality (VR) component to courses in their program. His vision is to add an experiential learning component for students to get trained about realistic working scenarios with various medical equipment. The focus is more on capital equipment for which there is limited access to actual physical devices for students training purposes. A few notable examples of such devices are MRI scanners, CT scanners, LINAC radiotherapy systems, X-ray imaging systems, Ultrasound scanners, etc. To this end, and using funding supports from two faculties at the university (faculty of science and faculty of engineering) he approached Arch Virtual Inc., a high-tech company expert in developing novel VR applications in a variety of areas including medical devices and technologies. Through a joint R&D work, Arch Virtual developed the first version of the VR application that was deployed and implemented in one of the courses that Prof. Tavakkoli taught in the fall 2020 term to biomedical engineering students. The VR component added valuable learning outcomes to the course and was very well received by the students. For more info about the VR app, see https://acadicus.com/vr-medical-imaging-treatment/.
As the next step in this pedagogical initiative, Prof. Tavakkoli is planning to further expand the VR app by adding more devices and more functionalities to each device. Tavakkoli states that “Virtual reality (VR) and augmented reality (AR) are very exciting technologies with numerous applications in higher education and training of students. I truly believe that by increasing computational power and developing more real-life applications, the technology will be playing a vital role in the future of higher education industry, among other areas.”
Jahangir (Jahan) Tavakkoli, PhD
Assistant Chair and Undergraduate Program Director, Medical Physics
Professor, Department of Physics
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