One of the primary strengths of the Simulation Learning System (SLS) with virtual reality (VR) solution is the ability to truly “train how you fight,” as the military saying goes. Achieving a high degree of psychosocial immersion is key to encouraging learners to make decisions around patient care, helping to cement both the memory of the experience and the lessons learned. However, inadequate preparation can leave learners unmoved by even the most sympathetic of simulated patients. Similarly, a lack of deliberate and effective performance review, or debrief, can leave learners unable to process the experience and integrate feedback into future patient care experiences. VR simulation brings unique challenges and advantages to the paradigm of experiential learning, and properly understanding these unique aspects of VR simulation can allow instructors to fully realize the learning potential in any given learning scenario. Below are recommended strategies for preparing, using, and debriefing from a VR simulation.
Setting Expectations for Students in the VR Simulation Space
In preparing learners to participate in VR simulation, instructors are best served by clearly communicating the overarching learning objectives of a scenario. Special emphasis on objectives related to communication and interprofessional patient care will sufficiently prepare students to eliminate any systemic barriers to learning. As with other simulation modalities, giving students a general sense of clinical context, including briefing them on the simulated environment (hospital, clinic, etc) and their role within the scenario (nurse, EMS, etc), is crucial to their success in navigating the VR medical simulation.
Once inside a scenario, students must navigate the social and medical complexities of the scenario, including getting additional background/history and responding to the social and physiological changes in the patient. Students should be encouraged to verbalize thought processes as much as possible, especially to other learners present in the VR scenario, but also to the VR patients themselves. This will allow instructors to more easily recognize whether students are achieving learning objectives centered around communication and observation. Similarly, students should be reminded that they have access to the same types of healthcare staff they would in any other clinical context, specifically the attending provider and emergency response teams.
The SimX software platform has a unique functionality that blends the advantages of standardized patients with manikin-based simulation, so learners should be prepared to interact with patients and other virtual characters as they would in real life. This includes speaking with virtual characters freely, using clinical tools to conduct physical exams as they would in real life, and using medical devices as they would in any other clinical setting. The SimX system strives to remove as much artificiality as feasible, so in general, tools such as stethoscopes, oxygen flow meters, and syringes work much as they would in reality, albeit with some shortcuts to enable smooth functioning.
Acclimating to New Technology in the Classroom
Although VR has the unique power to place learners into wholly immersive environments with a diverse range of patient archetypes, it remains a relatively new technology. Due to this fact, the two key systemic barriers to immersion that instructors must address are the lack of familiarity with VR hardware and VR interactions and the novelty of VR simulation. As with any new simulation tool, if students are distracted by the tool itself, they will be unable to emotionally invest in the learning scenario and unable to navigate it as intended. The best way to mitigate this effect is to ensure that learners have access to training materials in advance and allow them to experience the VR environment and hardware outside of the simulation session. To this end, training literature and videos are available for review which introduces students to VR simulation and the hardware used, as well as how tool use and patient interaction is achieved using VR hand controllers. In addition, learners should spend at least ten minutes within the available VR tutorial scenario, if not more. This will enable them to experience immersion within VR, as well as practice navigating within and interacting with the SimX VR environment specifically.
With proper preparation, students should be appropriately aware of the realistic nature of content within the simulation curriculum and the treatment of VR scenarios as a practice run for a true clinical setting. Accordingly, many will not optimally navigate cases. Prior to entering the simulation, students should be reminded that mistakes in simulated care will lead to better care of actual patients, and they should be prepared to review their performance in a safe and judgment-free debriefing session following their VR experience.
Debriefing the VR Classroom
In nursing simulation, the debriefing process is where much of the learning occurs. As the simulation proceeds, the SimX Moderator interface will automatically track many actions students take, including relevant physical exam maneuvers and other direct patient care activities, such as medication administration and wound care. In addition, the Moderator software allows for subjective learning goals to be manually tracked by the instructor observing the case directly. At the conclusion of a scenario, all of these predetermined learning objectives are displayed in a simple and streamlined debriefing summary. Below a header showing scenario information, a breakdown of the learners’ performance in each state of the scenario is shown, indicating which learning objectives, or “critical actions,” were accomplished, and which were missed. At the bottom of the report, all of the events of the simulation session are listed in chronological order. This is especially useful when talking through a case with a learner and reconstructing the events that occurred during the simulation. Using additional software tools, it is also possible to record the entire VR simulation on a computer running the SimX Moderator software. This can allow learners to see exactly what they were doing during the case, and when compared to the debrief summary, what learning objectives they achieved or missed, and when.
In giving learners sufficient preparation for VR simulation, and the SimX system more specifically, the time spent in the VR simulation lab can effectively ready students to tackle complex social and medical patient care experiences. An emphasis on investing in their virtual patients, verbalizing their thoughts and plan of care, and familiarizing themselves with VR hardware and the SimX virtual environment can yield appropriately stressful and meaningful experiences within VR clinical scenarios. Using the debrief summary to review learner performance with respect to clear learning objectives in a safe environment can help build clinical confidence and lead to significant growth in areas of deficiency. SLS with VR (powered by SimX) provides a broad variety of complex and socially challenging clinical scenarios, and if students approach it with the proper mindset, the short time spent in VR may be some of the most memorable and valuable for healthcare professionals in training.
SLS with VR allows you to step into a completely immersive virtual reality environment and experience clinical nursing in a whole new way. Partnering with SimX, an industry-leading virtual reality company, Elsevier’s new nursing solution will change the way students learn, and ensure they are ready for practice. Learn more
