Learning in virtual reality (VR) provides learners an immersive experience that cannot be achieved in traditional manikin-based simulation education. Faculty play a critical role in VR learning experiences by setting expectations for the simulation, establishing a safe learning environment, and facilitating a debrief to support reflection throughout the scenario. Moderating and teaching in a virtual environment gives faculty control of additional tools that will help them monitor learners’ progress and build their clinical judgement. This article provides strategies for faculty to guide students through cases and enhance the VR learning experience before, during, and after the simulation session.
Preparation and Orientation to a VR Simulation Session
Adequate preparation prior to the learning session is one of the most important phases when planning to teach students in VR. Prior to instruction, all teaching faculty should participate in simulation instructor and debriefing training along with an orientation to the VR hardware and SimX moderating software. Next, to plan the simulation session, instructions should begin by selecting the desired clinical scenario(s) and learning objectives. When a case is created, the critical actions, requirements for state change, patient vital signs, and interventions are defined by the case author for each step. Especially those who are new to teaching and moderating in VR, the faculty member should rehearse the case prior to the learning session from both the perspective of the moderator and the learner to familiarize themselves with each element that will affect the flow of the case. Once the moderator is comfortable with the case and how the learning objectives are to be executed in the VR case, you are ready for your simulation session.
Performing an adequate orientation and pre-brief to the VR simulation session is important in cultivating a safe learning environment and setting expectations for the learners. To begin, make sure the learners have been oriented to the VR headset and the VR training environment. Typically, a learner will participate in a case from its onset through completion in one setting. Inform learners how much time is planned for the case and debrief session. Many of the VR cases will allow for multiple learners to participate in VR as a team. If more than one learner is going to participate in a case, it is helpful to identify which learner will take primary responsibility as the “team lead” and which learner(s) will be assistant(s).
Moderating a VR Simulation Case
One of the challenging tasks for the moderator is to ensure that the learners have a fully immersive experience. Encouraging the learners to treat patients and non-playable characters in VR as they would interact with them in real life will allow learners to be fully engaged in the learning environment. Some of the most common ways to interrupt immersion is delayed response to learner questions and not activating animations at the appropriate times. Keeping the “Dialogue” tab open during most of the case will allow for quick responses to questions that are asked by the learners. Furthermore, in most cases, it is best to keep the VR pane in the third person view, to ensure the moderator can see the actions of all participants, switching to a first-person view only to troubleshoot.
Sustaining an immersive experience can be challenging when learners get stuck. Knowing the case well will allow for adapting the case in the moment to the learner’s needs. If a learner is challenged by a particular portion of a case, there are several ways to proceed. For example, some moderators will introduce a “helper” into the case, a “nurse” or “consultant” who will suddenly call into the case to provide a crucial hint or additional information. If the critical action they are missing is trivial, the moderator may consider manually advancing the case using tools in the program like the “Jump to State” button, then plan to discuss the missed order or action during debriefing.
If time allows for the same learner to attempt a case multiple times, the moderator can allow the learner to fail a critical action and the patient to deteriorate. While not all cases are designed with this option, many will transition to a “deterioration” state if they do not perform required actions within a certain period of time. After a short debrief of the failed scenario, you can have the learner repeat the case and correct their mistakes. Notably, there is no option to modify a patient’s vitals manually in the SimX moderator client. This is done intentionally to encourage careful case design and to discourage drastic deviation from the learning points within a case. This also allows the moderator to focus less on manually adjusting patient vitals, and more on observation of the learner in the case to maximize learning.
Reinforcing Clinical Judgment to Simulation Sessions
Following the completion of the case, assist the learner(s) with the transition safely out of the VR headset and give them time to complete any documentation exercises or reflections outside of VR. Using a structured, pre-planned debriefing tool will help structure the conversation to solidify learning objectives. The 3D model of debriefing (diffusing, deepening, discovery) or the PEARLS healthcare debriefing tool are just two examples of debriefing methods that can help guide and facilitate an effective debriefing session. Teaching in VR allows for learners to have a truly immersive learning experience. Optimizing the effectiveness of this platform requires some modifications unique to VR simulation but is ultimately rooted in the foundations of medical simulation.
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