Category Archives: Future of Simulation

Virtual Simulation for Clinical Hours

Virtual simulation for clinical hours
Virtual simulation for clinical hours

Healthcare institutions are no strangers to disruptionOver the past 10 years, they have faced an ever-evolving landscape from introducing new technologies such as electronic medical records, insurance regulatory reforms, the birth of new competitors, and now a global pandemic. To build greater resilience, institutions must become instinctive. 

The most recent challenge facing universities and hospitals is effectively training and maintaining the next wave of healthcare providers, in the face of ever-decreasing opportunities to train students and clinicians through clinical placements. The answer just might be dynamic, high-fidelity, virtual simulation.

The question of how to supplement clinical hours with simulation has been an ongoing debate for some time. With the loss of physical simulation and clinical placements during the pandemic, educators realized simulation was no longer a “nice to have” learning modality but a “need to have” to supplement lost clinical hours and placements. 

Instead of asking if virtual simulation can make up lost clinical hours, educators are asking how virtual simulation can supplement or replace those clinical hours?

Eye examination in virtual reality
Pediatric nurse care in virtual reality

Can Virtual Simulation Replace Clinical Hours?

Can virtual simulation be used to replace clinical hours at all? According to a statement released by Dr. Cynthia Foronda, president of INACSL, and Robert Armstrong, president of SSH, the answer is Yes! Evidence supports the use of virtual simulation to replace clinical hours. 

Ultimately, it comes down to the governing board’s regulatory requirements to determine the scope of virtual replacement. Lawmakers quickly responded to COVID-19, loosening restrictions and allowing flexibility to fulfill clinical hour requirements. Already faced with shortages in medical personnel, the COVID-19 pandemic paved the way to leverage simulation resources and promote healthcare learners to practicing professionals while still providing them with the best educational experience possible. 

For institutions already using high-fidelity simulation for clinical hour replacement, the next question is, does virtual simulation count as high-fidelity simulation? According to the SSH definition, the answer is a clear Yes!

SSH defines high-fidelity simulation as:

Simulation experiences that are extremely realistic and provide a high level of interactivity and realism for the learner

In short, virtual simulation meets the definition perfectly.

Watch our on-demand webinar to learn how you can replace clinical hours with virtual simulation. Webinar hosted by Molly Schleicher MSN, RN, CHSE.

How Much Virtual Simulation Equals Clinical Experience?

Our next question is how many clinical hours can virtual simulation replace. The increased intensity and efficiency of simulation makes it an ideal and efficient replacement for clinical time. Evidence supports using a 1:2 ratio for high-fidelity simulation to clinical hours. As we have established, virtual simulation is high-fidelity simulation, we can argue this same ratio applies. 

Depending on the virtual simulation source and how simulation is supported, learners could replace 1 to 4 hours of clinical time through a single virtual simulation scenario. Resources provided before and after, the simulation structure, and curriculum integration are all considerations to replace clinical hours with virtual simulation adequately.

Designing Virtual Simulation to Replace Clinical Hours

Design begins at the source, learning objectives. Educators must first determine what learning objectives they wish to meet and select an appropriate simulation scenario. 

Just as ‘no man is an island’, no simulation should stand alone. Following the INACSL Standards of Best Practice to support simulated patient experiences pre-briefing, orientation, learning objectives, reflection, and debriefing should be included in simulation design. These practices enhance the learning experience, increase the simulation’s value as a clinical replacement and increase the time defended for clinical experience. 


Pre-briefing a virtual simulation doesn’t look all that different from a physical simulation experience. Learners receive learning objectives, room orientation, equipment orientation, pre-simulation activities, simulation timeline, and the opportunity to ask questions in simulation pre-briefing. Virtual simulation lesson plans can incorporate traditional pre-briefing activities. Educators or former learners can also include a prerecorded shift report for learners to review before entering the virtual scenario. 

The most significant difference between a physical simulation pre-brief and virtual simulation pre-brief is the responsibility and time required to complete it falls more on the learner than the simulation faculty. Providing an expected timeline for this experience will help the learners guide and track their time as part of the simulation. 

Deliberate Practice

Deliberate practice improves critical thinking, clinical judgment, decision-making, and confidence. Virtual simulation provides learners with the opportunity to repeat scenarios as many times as they’d like. This reflective practice offers the personalized and individualized experience of running a scenario repeatedly without adding the time, space, or cost associated with running a physical simulation again and again. 

Virtual simulation is ideal for deliberative practice as the standardization is consistent, regardless of repetition. With the OMS platform, the scenario evolves based on the learner’s clinical decision-making. Individualized feedback post-scenario provides the learner with resources to enhance their experience with each repetition. When building a simulation program to replace clinical hours, consider requiring learners to complete the scenario at least twice. 


A key component of any experiential learning activity is reflection. This can occur mid-scenario as part of a reflective pause (reflection-in-action), or post-scenario (reflection-on-action). Combined with deliberative practice, learners can immediately return to the same scenario, now with the knowledge and insight gained from the first pass through, preparing learners to reflect-in-action in the follow-up experience. 

Within the OMS platform, learners are prompted to self-reflect immediately following each scenario. They receive personalized, objective feedback based on their clinical decision-making. Finally, there is a place provided for learners to complete and document a proper self-debrief or self-reflection. While the research on self-debrief, post-virtual-simulation is ongoing, so far the news is “it works!”


Simulation debriefing is one of the most crucial simulation-based education components and the cornerstone of the learning experience. Each simulation must have a debriefing or feedback method. It should be consistent and is an absolute necessity when using virtual simulation to replace clinical hours. 

With virtual simulation, debriefing techniques – such as PEARLS debriefing tool are built into the platform. These can support and facilitate synchronous or asynchronous debriefing. The effectiveness of the debriefing experience in physical simulation depends on the facilitator’s expertise, time, and tools. 

While debriefing immediately after the experience is ideal, it may not always be possible. The pandemic restrictions made us reconsider how we debrief virtually, at a distance, and occasionally asynchronously.

Depending on scheduling, a group debrief immediately following the simulation experience may be possible.  This could be in-person or virtually via a video conferencing platform. A chatroom-style classroom on a learning management system also allows synchronous or asynchronous group debriefing.

When unable to coordinate group debriefs, learners can complete a self-reflection and conduct a self-debrief using the feedback, guided questions, and supplemental post-simulation activities. If a later group debrief is scheduled, learners can then review and bring their input to this group discussion. 

Although there is some debate on how long debrief sessions should last, research and best practice suggest debriefing approximately twice the scenario’s length. For example, a 20-minute simulation scenario should incorporate about 40-minutes of debriefing.

Post Simulation Activities

Post-simulation activities are another opportunity to extend a learner’s experience and physical practice. 

Learners can practice documenting their virtual experience assessment. On-screen virtual simulation, in particular, lends itself to this nicely to this experience. Learners can take notes as they go and catch missed items in their subsequent runs of the scenario. Practice notes or EHR notes provide learners the opportunity to practice completing documentation. Institutions without an EHR platform can build distance-friendly solutions through Excel or Google Forms, creating a simulated EHR experience that can be tracked and reviewed by faculty.

Another post-simulation activity option is a shift-to-shift report based on the scenario. Learners can record a shift-to-shift report and post the recording to the LMS for peer review and instructor feedback. 

Additional design resources:

Book a demo and connect one-to-one with an Educational Specialist to learn more about replacing clinical hours with simulation.

Virtual Simulation Example

In an OMS Distance nursing simulation scenario participants engage with George, a 28-year-old male presenting with chills and feeling generally unwell. His medical history includes Testicular Cancer and Type 1 Diabetes. Lab results reveal low WBC and high lactic acid levels correlating with vital signs suggestive of sepsis. George needs antibiotics but has a severe penicillin allergy.

Note: This same structure can also be used for the medical scenarios or interprofessional education scenarios, depending on the implementation.


  • Allow learners the opportunity to practice critical thinking and efficient patient care.
  • Provide a post-scenario structure that allows for self-reflection, personalized feedback, and scenario debrief.
  • Create a virtual experience that meets expectations to qualify for clinical hour replacement.

Timeline (mileage may vary per learner):

Component Details/Examples Time
Pre-briefing Present learning objectives

Provide relevant reading 

Assign tutorial scenario

20 minutes
Deliberate Practice Complete virtual simulation

Example: George, SNR101US

20 minutes
Reflection Review scenario feedback

Complete reflective practice (Reflection must be three or more sentences and shared with your clinical lead)

10 minutes
Deliberate Practice Repeat virtual simulation

Example: George, SNR101US

20 minutes
Reflection Review scenario feedback

Complete reflective practice (Compare and contrast your current attempt to your previous)

10 minutes

Post Simulation Activities

Group debrief

Simulation documentation

Individual debriefing worksheet

40 minutes
Total time: 2 hours

In our example, a single virtual reality simulation scenario provided 2 hours of meaningful simulated clinical experience. We are utilizing the 1:2 replacement ratio that equates to 4 hours of clinical time.

Get in touch

Can maternity simulation really be pain-free?

Virtual Reality OBGYN simulation

As a simulation professional, you or your team have likely considered the possibility of adding maternal simulation to your curriculum.

There are many benefits to doing so – providing sought after opportunities to learn ‘hands-on’ techniques, preparing learners for certification and making-up for missed clinical opportunities, just to name a few.

However, many quickly learn that the obstacles can outweigh the opportunities. Maternity manikins are expensive, require specialist knowledge to set-up and are challenging to maintain. From creating artificial blood to properly lubricating the fetus, creating realistic maternity simulation requires unique accessories and takes exponentially longer to set up than traditional simulation scenarios.

Maternity simulation requires multiple technicians to manage the computer, control manikin movements and sometimes vocally role-playing a laboring mother.  Once a simulation is complete, there is the arduous task of cleaning and preparing the manikin for reuse or storage. By the end of the scenario, many techs are cursing the day their maternity simulation lab was born!

So, why would anyone stick it out to create maternity simulation?

Maternal mortality impacts an astonishingly high number of women. In 2017, 295,000 women worldwide died from preventable causes related to pregnancy and childbirth. That is a staggering 810 women per day. In the United States, maternal mortality is 14:100,000; in the United Kingdom, 7:100,000. Shockingly, maternal mortality among black women is more than double that of white women in the United States and five times more likely in the United Kingdom.

Increasing numbers of women with high-risk conditions with inherent risks of complications as well as institutional policies limit opportunities for nursing students to gain hands-on training in maternal care. Yet, all nursing students, including LPN and nurses, trained in a 2-year program must prove MCH competency on NCLEX.

Governing bodies, such as JCAHO, are also seeking to decrease maternal mortality with compliance directives. Hospitals will be required to increase staff education, emphasizing hemorrhage and hypertension and preeclampsia (PPH and PreE). As part of the directive to increase education, annual drills will be standard procedure to help identify and improve quality issues. These will be in addition to any hospital system requirements already in place.

As sobering as these figures are, the most impactful is that an estimated 60% of maternal deaths are preventable.

VR Obstetric Scenarios Oxford Medical Simulation
Virtual EFM obstetric scenarios
Virtual EFM obstetric scenarios

If you could improve maternal outcomes, would you? If the data proved that skilled care before, during and after childbirth saved lives, would you create an opportunity to train more practitioners? That, simply put, is why simulation labs endure the cost, difficulties and agony of maternity simulation. 

Our team saw an opportunity to deliver pain-free simulation – no epidural needed.

At OMS, we strive to improve patient outcomes by helping nursing students and hospitals meet their educational goals through immersive Virtual Reality (VR) simulation. In the first of a new library of Maternal Care scenarios, participants can gain much-needed practice in caring for a high-risk obstetric patient. 

Patricia is the first patient, presenting with preeclampsia. The OMS VR system allows participants to fully assess Patricia through history, examination, vitals and investigations, and provide management efficiently, effectively and sensitively.  The comprehensive scenario hones critical care pathways, including:

  • Caring for the ‘invisible patient’ through fetal monitoring
  • Dynamic EFM for strip review
  • Delivering medication in pregnancy 
  • Exploring risks around preeclampsia (placental abruption, stroke, eclampsia etc.) and markers of deterioration
  • Exploration of potential next steps depending on both maternal and fetal condition

The immersive scenario delivers an incredibly realistic virtual clinical experience, providing a real opportunity for learners to engage in the global initiative to improve maternal health outcomes.

Point-by-point, VR provides the experience learners need to provide care that returns more moms and babies safely home.

For a demo of the software, or to get a free trial of the maternity scenarios in your insitution, please use the link below.



Distance learning during COVID-19

Online distance medical and nursing simulation

Rapidly implementing online simulation during COVID-19

Faced with the  COVID-19 outbreak organizations all across the world  have cancelled all face to face classes. Exams are being postponed and educators are struggling to quickly transition learning resources online. However, perhaps the most difficult of these challenges is the sudden inability to meet clinical requirements.

We appreciate how hard it is to deliver simulation and clinical education at the best of times, let alone during a crisis. As simulation educators, the team at OMS have experienced the chaos caused by last-minute clinical cancellations and the need to rapidly deliver simulation to fill the gap.

This same phenomenon is now happening on a global scale. In response, OMS immediately offered the OMS Distance Simulation platform free across the US, Canada and the UK as of March 16, 2020.

Why? Well, as one of the OMS educational specialists notes:

“We are sim people, educators and folks who ultimately care about patient lives. This is a chance to train nurses and doctors when they need it most… this is exactly why we got into this in the first place!”

The OMS Distance Simulation Program

The OMS virtual simulation platform runs both in immersive virtual reality (using a VR headset) and as a screen-based simulation  using the learner’s own PC or laptop (no VR equipment required). It is, in fact, one platform delivered in two different ways. 

Scenarios are just as interactive and dynamic whether in VR or on screen. This provides immediate scale and accessibility during social distancing and the ability to switch to fully immersive virtual reality as required. 

OMS has hundreds of cases across medicine and nursing, dynamic scenarios,  fully-automated feedback and debriefing tools, embedded blended learning resources and simple methods of integrating with curriculum requirements. All of this is offered for free, with no ongoing commitment, until the situation improves.

Online distance medical and nursing simulation
Online distance medical and nursing simulation

Uptake of OMS Distance during COVID-19

Since May 16, over 50 institutions – with over 17,000 learners between them – have signed up. Many have started utilizing the platform already and many more will start over the coming days. This is being done across all levels of medicine and nursing and for many different use cases:

  • Nursing programs (BSN and NP), unable to deliver clinical placements 
  • Medical programs (DO and MD), fast-tracking their learners for clinical practice 
  • Hospitals, upskilling clinicians moving between departments
  • Health systems, rapidly bringing in new nurses and retraining clinicians returning to practice

Implementing and integrating online simulation

Organizations are using OMS Distance in many different ways. Many are providing it to learners at home. This may be either for just-in-time simulation for those returning to practice, or in schools and colleges by allocating learners to specific scenarios at different times to align with curriculum requirements. Educators can then asynchronously debrief over a video conference, using the automated performance feedback and the learner’s case reflection as a springboard for debriefing.

Others are using OMS Distance for group learning – having learners go through the same scenario at the same time, then group debriefing and case teaching over a video conference. This allows for more team discussion of cases, and the ability to review labs, imaging and EKGs as a class.  

Others are limiting what they expect the learners to do in a scenario – asking them to only perform the history and physical exam from the clinical scenarios, using this as a clinical experience structured with more junior learners  in mind. 

Ultimately, there is no ‘correct’ way of using the OMS system, which makes the platform versatile enough to fit around any program’s goals. 


Here to help

OMS works with institutions to help them solve their problems and fulfil their goals – whatever they may be – by providing clinical experiences on demand. Ultimately, we are here to help.

Our educational specialists and support team are working around the clock to provide educators with all the assistance you need through this time – if you think we may be able to help please get in touch.

The scale of the task for healthcare and healthcare education is enormous, and it is an honor to be able to support clinicians and educators through this time of uncertainty.


If you are in the USA, Canada or the UK and an affected educational institution complete the details below and we will get back to you as soon as possible.

Video: OMS Interprofessional at IMSH 2020

IMSH 2020 VR - OMS

Dr. Jack Pottle outlines OMS Interprofessional during the IMSH 2020 conference

Interprofessional Education (IPE) in VR

Dr. Jack Pottle, Chief Medical Officer of Oxford Medical Simulation, speaks with the team at HealthySimulation about the OMS VR simulation system.

“OMS is taking the traditional way we do simulation and scaling it – saving time, saving space and saving money” 

Designed for medical and nursing professionals of all levels, Dr Pottle outlines the development of OMS Interprofessional – the IPE mode that allows clinicians to treat virtual patients together wherever they are in the world. OMS is helping healthcare system expand and optimize their simulation delivery to improve patient care…

“Allowing hospitals, hospital systems and simulation centers deliver training that is objective, standardized and of seriously high quality. It feels real; it improves performance”

Learn more about the OMS platform here, or discover more about interprofessional simulation below.

See more of OMS Interprofessional LEARN MORE


The Importance of Simulation

Types of simulation

This week is Healthcare Simulation week and as part of the celebrations we take a look at five reasons to salute the wonderful practice of simulation…



1. Simulation improves patient care 

By far the most compelling benefit of simulation in healthcare is the positive impact that it can have on patients. After all, a drive to  improve patient outcomes and the quality of their care is at the basis of healthcare education systems worldwide…

Providing future healthcare workers with the resources to optimize patient care – be that through effective clinical acumen, time management, communication and everything else in between – is the bedrock of a successful healthcare system.

Essentially, simulation sets trainee doctors and nurses up to effectively make people better when they come to practice in real life. In 2012, Benjamin Zendejas (Mayo Medical School, Rochester) set out to prove how far simulation training promotes positive results for patients. The findings were powerful; simulation-based education was shown to be directly linked to patient benefits when compared to both non-simulation-based training and instances where no intervention was given at all. 

Linked to this is the propensity for simulation to reduce patient harm. No clinician wants to inadvertently complicate or worsen a patient’s condition but medical error is the third leading cause of death in hospitals worldwide. With simulation, we are able to reproduce patient care sequences with all the clinical complexities of real life scenarios allowing clinicians to cover all the bases when treating real people. 

Ultimately, simulation-based training produces more competent healthcare professionals which can only be beneficial in improving the quality and safety of patient care. 


2. Simulation inspires confidence

Few on-boarding periods of a new job can be as daunting as starting out as a junior doctor or nurse. Fetching coffees, navigating the intricacies of a Kafkaesque office bureaucracy, whilst remembering not to raid Belinda from Accounts’ personal HobNob stash seem like a walk in the park compared to a 12-hour shift filled with hundreds of patients with complaints ranging from the utterly absurd to the genuinely life-threatening. 

To make matters worse, strained resources, overcrowded hospitals and staff shortages mean that most junior healthcare professionals face much of this without the necessary support.   With simulation, clinicians are able to practice managing acutely unwell patients without causing real patient harm if it goes wrong. In this way, practicing emergency care during training can take the edge off the intimidating world of real life practice.

This is something we’ve been made directly aware of at Oxford Medical Simulation through the roll-out of our virtual reality simulation platform at Oxford University. There, learners told us that, “it’s really good to get the experience of being put in the driver’s seat, of making the decisions…I think it will give me more confidence to make those decisions [in real life]”.


What is more, simulation-based training as been shown to improve junior clincian’s confidence in pushing for improved patient outcomes within real life treatment. Healthcare training is inherently hierarchical and this can often mean that trainees are afraid to speak up when they think a senior colleague is not administering the right kind of treatment. 

In a study carried out by the University of Harvard and Massachusetts General Hospital, simulation was shown to increase the frequency and quality of interventions by Residents in the care suggested by their seniors. 

Simulation can therefore be seen to not only improve patient care by bolstering the doctor or nurses confidence in their individual practice, but also promoting appropriate assertion in challenging a treatment plan when they think there might be a better way. 


3. Simulation lets us learn from our mistakes 

In our personal and professional lives we learn best from the mistakes we make. Cultivating an attitude that embraces mistakes as an inevitable part of life that can be mined for valuable lessons is an effective way to successfully avoid making mistakes in the future. Within the context of healthcare however – where the price of our mistakes can be fatal – this kind of philosophy can be hard to accept. 

In practicing simulation a safe-space is created in which healthcare professionals can refine their clinical skills without the risk of harming real patients. When effective debrief is built into simulation, the learnings taken from this form of training  are invaluable. With learners identifying strengths and areas for improvement in a supportive atmosphere. This is a powerful combination that mitigates against these mistakes being made in real life. 

Further, the emphasis on debrief engenders good habits of self-reflection for trainees to take through their entire professional careers. When clinicians are used to assessing their own practice regularly they are personally assuring the quality of the care they provide. 


4. Simulation works across all healthcare disciplines 

Simulation works effectively across all healthcare domains including; medicine, nursing, paediatrics, mental health, surgery, emergency care, life-saving and more. What is more, simulation surpasses all other training mechanisms in touching the most comprehensive set of skills ranging from specific procedures to communication and teamwork. 

The controlled nature of simulation means that institutions can ensure learners are exposed to as wide a range of clinical presentations as possible to build up depth of knowledge. Stress conditions can be put in place to mirror real life scenarios and test trainees ability to cope under pressure. The debrief that follows these experiences means that learnings are not lost or left open to individual interpretation. 

Simulation is also deliverable across multiple platforms. Mannequin-based simulation has long been used to produce life-like conditions in which learners can practice patient management. Similarly, the use of standardized patients in simulation is effective in creating a true-to-life environment where learners are able to interact with a real person. Increasingly, virtual reality is being used to deliver repeatable, immersive simulation at scale. 


5. Simulation is widely practiced worldwide

We’ve often heard it said that – if you do not work in healthcare – simulation is probably the biggest industry that you’ve never heard of. When you stop to think about it – it makes sense. You wouldn’t expect pilots to fly planes without practicing in simulators first – so why should we expect the people taking care of our health not to do so as well? 

There are hundreds of organisations, institutions and individuals doing wonderful things in simulation across the world.  Organisations such as SSH and ASPiH organise renowned international events like the International Meeting on Simulation in Healthcare (IMSH) to encourage knowledge sharing and best practice. 

As part of Healthcare Simulation Week, Boston Children’s Hospital hosted a Facebook Live event to give the community insights into how its state-of-the-art paediatric simulation center works. Having run an immeasurably impactful simulation programme for over a decade, BCH has now taken is simulation capabilities on the road. Offering over 50 courses at nine institutions across eastern Massachusetts – its SIM Network initiative shows that simulation best practice can be distributed at scale. 

In the UK, the NHS Diabetes Programme is using simulation to directly impact the treatment of people with Type 1 diabetes. Using the OMS virtual reality simulation platform, doctors are able to practice treatment before they see real life patients. Diabetes treatment can be notoriously tricky and for many doctors the first time they have to manage diabetes-related cases is in real life. Using simulation, the NHS is able to train doctors on the specific complexities to look out for, without compromising the quality of patient care. 

The healthcare team at St Luke’s University, Pennsylvania, have customised a freight truck to serve as a mobile simulation suite. Offering training opportunities across disciplines, people that live in remote areas that once may have been unable to access a healthcare education are now able to access valuable resources to further their careers. In this way, St Luke’s mobile simulation operation is promoting diversity and social mobility in healthcare and beyond.

These are just a few examples of the ways in which simulation is being leveraged to improve healthcare training and education, and in turn, our healthcare systems and standards of patient care. 

Happy Healthcare Simulation Week! 


Oxford University Partners with Oxford Medical Simulation to Transform Medical Education

The world’s leading medical schools are embracing state of the art virtual reality software to push student’s learning to new heights.

Oxford University has partnered with Oxford Medical Simulation to train medical students using virtual reality. Students can now practice medical emergencies using true to life virtual scenarios without risking patients’ lives.

The technology, developed by Oxford Medical Simulation (OMS), allows medical students to practice treating acutely unwell patients in a simulated, virtual environment as often as they like. Training in this way improves patient care in real life by allowing repeated practice in simulation to build competence and confidence.

Why VR?

Oxford University decided to employ this innovative technology as a way to get more students through simulation. Simulation – where trainees practice medical emergencies as they would present in real life – is widely regarded as one of the most effective ways of training healthcare professionals. Simulation is traditionally practiced with high fidelity plastic mannequins in mocked up hospital wards. However, this form of simulation is time, space and budget consuming meaning medical students may only get to experience one physical simulation in an academic year. With virtual reality simulation, students are now able to practice simulated scenarios as often as they like.

The system is being used at the OxSTaR centre based at the John Radcliffe Hospital in Oxford – the main teaching hospital for Oxford University Medical School.

Rosemary Warren, Centre Manager at OxSTaR commented,

“As a world-leading institution, it is important for us to remain at the forefront of changes in the types of learning opportunities we offer our students. Embedding virtual reality simulation into what we do has enabled us to give a far greater number of learners access to simulation in a shorter space of time. It’s encouraging to see how quickly our students have adopted the technology. I’m excited to see how they progress clinically as they use it more and more. Simulation is a vital part of medical education and students just don’t get to do it enough. The OMS virtual reality platform allows learners to enter simulation as often as they like to transfer their knowledge to practice.”

The OMS system works by providing students access to libraries of medical emergencies that allows them to simulate the treatment of a range of conditions such as sepsis, diabetes, cardiac failure, pancreatitis and many more. Students enter the interactive virtual scenario using an Oculus headset and are greeted by a virtual nursing assistant and their patient. Learners are able to question, comfort, examine and treat the patient as they would in real life. Every action the learner takes up to – and including – diagnosis and resolution is recorded and fed into the system’s inbuilt feedback engine. Once the scenario is complete, the learner is taken through this feedback to understand what went well and what they need to improve on.

The emphasis is on training effective decision making, critical thinking and clinical reasoning. Healthcare learners have a safe space where they can apply their knowledge and learn from their mistakes.

Dr Jack Pottle, Founder and Chief Medical Officer at OMS said:

“We’re delighted to be working with world leading institutions like Oxford to bring our platform to medical students. We have developed OMS out of a belief that training healthcare professionals in a flexible, zero-risk environment will transform patient care around the world. We learn best when learning from experience and our system allows users to do just that – without putting patient’s lives at risk.”

OMS are currently providing free trial access to the platfrom to healthcare institutions – use the form below to contact the team. 


Is Embracing Human Error the Future of Healthcare?

It’s a good job Frank Sinatra wasn’t a clinician…

Crooning “Regrets, I’ve had a few, but then again… I can never mention them because there’s an inherent denial of error in healthcare,” doesn’t exactly have the same ring to it, does it?

Ol’ Blue Eyes aside, I’ve been thinking a lot about mistakes recently. I’ve been thinking about the mistakes that we make as doctors and nurses and how they have irreversible effects on the lives of our patients. And I’ve been thinking about my own mistakes. How I have missed diagnoses, delayed treatments, discussed plans insufficiently and how this has impacted the lives of the patients who trusted me with their care.

And as well as reflecting on these errors and how they forever change the lives of our patients, I’ve been thinking about how they affect us as clinicians and how best to learn from them. And, paradoxically, how we never speak about them.

Humans make mistakes. Outside hospital we admit these mistakes, own up to them with people we trust and try not to repeat them again. Yet what is taken as normal in everyday life doesn’t work in healthcare.

Why don’t we discuss our mistakes?

Firstly, litigation. There’s an understandable sensitivity around talking about what’s gone wrong as it leaves us open to malpractice cases. Cases like that of Hazida Bawa-Garba – a doctor struck off for missing sepsis – does little to dispel this. There is a feeling that the legal vultures are just waiting to close in after every slip-up.

Then there is shame. There is a deep personal shame in making mistakes. We are taught that only juniors make mistakes and we grow out of them as they become more senior. There is therefore an inherent unwillingness to admit we make mistakes as we become more senior; we should be above this.

And in addition to the personal threat of shame is the societal threat of ridicule. Healthcare is a competitive field where we only show the best side of ourselves to our peers. In opening ourselves up to become ‘the guy who made that mistake’ there is a vulnerability we’re not prepared to accept.

The organisation threat of litigation, the personal threat of shame and the societal threat of ridicule by our peers is a powerful combination. And a combination that coalesces to form a more general fear – if we do admit our mistakes we will be alone.

The fear of ridicule distances us from our peers. We fear the institution we work in will distance itself from us in litigation. And the removal of these two vital supports – colleagues and organisation – leaves us alone and adrift when we are least prepared to deal with it.

Does discussing mistakes matter?

In short, yes. If we don’t discuss our mistakes, it is impossible to learn effectively from them. There is a wealth of evidence that debriefing on mistakes improves future performance. This effect comes not only from learning from our own mistakes, but learning from our colleagues’ errors. In not discussing our mistakes as a group we are depriving our colleagues of the knowledge they could have gleaned from our mistake and the rich vein of potential for broader error reduction has been lost.

This error reduction is not just in relation to other clinicians avoiding specific mistakes. Most errors are not due to a ‘bad clinician’, rather the same or similar medical errors have been made many times before in many different ways by many different clinicians. And errors are rarely due to one clinician happening to make a mistake. They are a combination of a huge number of factors that align to make an error. Therefore in not discussing as a group we are not only depriving our colleagues of knowledge, but we are leaving the system open to ongoing failures by not identifying system-wide faults.

Brian Goldman discusses the culture of mistake denial in medicine in his 2010 TEDX Talk: Doctors Make Mistakes. Can we talk about that? Goldman talks about his own experiences of making mistakes and argues we need to find a way to embrace that in a more constructive way.

Goldman closed his TED Talk with a call to action for the medical community to redefine its attitude to mistakes, to find ways to openly and sympathetically discuss them in order to better learn from them. That was almost ten years ago and I’m not sure we’ve answered his rallying cry yet.

So what can we do?

There is still hope, and it starts in medical and nursing school.

We must teach medical and nursing students that mistakes are inevitable in a high pressure field with exponentially increasing complexity and pressure. Only in doing this from the start, in teaching students to be comfortable with uncertainty and that mistakes are inevitable in an uncertain world, will we begin to change the tide.

Companies such as Oxford Medical Simulation are actively trying to create a safe space in which to consider clinical mistakes that Goldman so rightly encouraged us to cultivate.

OMS builds lifelike but non-judgemental virtual reality scenarios in which students can see and treat patients like in real life. This allows learners to make mistakes in the virtual world rather than in real life, without any sense of reprisal.

Reflection and debrief on performance is built into the system, guiding learners to discuss errors, before providing structured feedback on performance. In this way, learners are in control of building a culture of supportive discussion of error.

While it is key to embed a culture of discussing errors at medical or nursing school, this is not enough. Once clinicians have been taught that making mistakes is normal, that discussing them is vital, and that this can improve patient care, we need to have systems that support reporting of these errors, to disseminate knowledge.

Reporting of mistakes, reporting of near-misses, reporting of anything that might compromise patient care should be the norm. And this should be true from the porters through the clinicians to the CEO.

To do that, we have to extricate the shame loaded into such discussions of error. Though a broad culture change to make error reporting the norm will take time, one simple way to help this is anonymisation. Building simple, anonymised reporting systems into hospital infrastructure – where an error is reported to the patient safety team, a collaborative action plan is formed and reported back to the clinical team without fear of reprisal – is vital. None of this is difficult, and it will surprise many people outside healthcare that this is not the norm in more hospitals, but all will help create a system that helps identify and supports rather than punishes.

Finally, the systems above are worth nothing if not supported by patients. It is imperative that patients and the public support and can contribute to the structure of such systems – what clinicians and hospital managers feel is important can be very different from the patient voice.

Alongside this, patients and the public must begin to accept that in a complex system, doctors will make mistakes. Healthcare is an imperfect science – many of the decisions we make are based on little or no evidence. In a world where new treatments are being invented daily and conflicting evidence is produced at the rate of 1,000 papers per day, clinicians cannot know what the ‘correct’ course of action is in many cases.

Often the ‘correct’ course does not even exist so we make 50:50 calls.

Combine this with a workforce that is understaffed, overworked and burned out and there is no surprise that mistakes are made so frequently. That is not to accept mistakes – it is to accept what we cannot change, identify what we can change, and target this actively.

In summary…

Like the patients we harm, we carry our mistakes with us for the rest of our lives.

Arming our clinicians with the resources to acknowledge, reflect on and learn from their mistakes is crucial to identifying areas for growth and improving patient care.

Dr Jack Pottle is a practicing doctor, member of the Royal College of Physicians and Chief Medical Officer at Oxford Medical Simulation


Six Ways Virtual Reality Will Affect You in Six Years Time

We look at the ways in which virtual reality will impact our daily lives in the future.

At Oxford Medical Simulation we are constantly investigating the impact of virtual reality in healthcare training and simulation. Throughout our discussions with students, clinicians, educators and simulation professionals it’s clear there is a huge appetite for VR to improve clinical training and the delivery of simulation. However, whilst people are enthusiastic about applying VR to specific use cases – such as virtual reality medical simulation – we are yet to see VR truly embedded into everyday life.

However, as VR headsets come down further in price and software becomes even more accessible, this is changing. To that end, we’ve put together a list of six areas that we predict will have been changed by virtual reality by 2025…

1. Training and Education

Healthcare is one of the primary areas benefiting from VR training and education, with immersive technologies being used to simulate surgical procedures and medical emergencies. Learners are able to enter VR and practice managing complex situations with no risk to real lives.
Companies such as 3D systems and Digital Surgery focus on the surgical aspects, while those such as OMS cover the medical and nursing aspects. We recently wrote about the collaborative work of OMS and the NHS England Diabetes Programme – training doctors using VR to reduce errors in treating patients with diabetes.  

VR training has expanded due to increased understanding that experiential learning is the best way to understand and retain information. Given this rising acceptance of experience over traditional study, it’s no surprise that immersive technologies are being used in other fields of education, too.

At the Natural History Museum in London the ‘Hold the World’ portal allows visitors to be guided through historical artefacts by Sir David Attenborough. Similarly, the Anne Frank House VR experience allows users to travel back in time and experience life as it was in the famous Amsterdam attic. Similarly, archaeologist David R. Hixson of Hood College is using virtual reality to bring the ancient Maya City of Chunchucmil to life for modern day visitors, allowing them to experience what daily life was really like in the ancient world.

VR offers a way for us to embed immersive experiences into learning curriculums in myriad ways, and it won’t be long before we see these experiences leave museums and specialist skills labs and enter the mainstream classroom.

Sir David Attenborough with virtual reality education equipment (Natural History Museum)

2. Experiences and Entertainment

The way in which VR may transform conventional forms of entertainment are yet to become clear. Notwithstanding gaming – in which VR has well and truly made its mark (Beat Saber famously sold over 100,000 copies in its first month) – the world’s film and television are only just dipping their toes into the water.

However, we are seeing some forays into VR experiences as content akin to traditional TV and film. The Baobab Studios 2018 offering, Crow: The Legend, was a VR animated film that featured Oprah Winfrey and John Legend that received critical praise. This kind of animated content – with a star-studded cast to pack a punch – is a great way to get consumers accustomed to the idea of virtual reality as an entertainment form beyond gaming. Critics are also embracing VR as a new story-telling device. For example, 2018’s Venice Film Festival had a dedicated segment for VR Works. As the technology continues to improve year on year (Oculus just released a new, sensor-free Rift model as a precursor to the wireless Quest model) it’s only a matter of time before we’re donning our VR headsets to enter the virtual world of our favourite films and TV shows, rather than just watching them on screen.

VR is also being used by contemporary artists to produce new immersive offerings. Anish Kapoor and Jeff Koons have both collaborated with Acute Art – an agency that specialises in producing artworks using virtual reality. There will also be a dedicated VR space at this year’s upcoming Frieze festival in New York. With influential events, artists and organisations backing virtual reality art, it won’t be long until we’re consuming this in the same way as we do traditional paintings, sculptures and more.

3. Patient Care

The impact of vr in healthcare goes beyond training and education, and VR is showing huge potential in areas such as pain management and treatment for specific conditions. Companies such as Virtue are leading the way in applying VR to dementia and Alzheimer’s treatment. Using immersive technology to recreate familiar childhood scenarios and trigger memories – Virtue is taking reminiscence therapy to new heights. In an area that traditional healthcare struggled to tackle (Pfizer ended its research into new Alzheimer’s drugs last year) virtual reality may just be the answer.

Similarly, virtual reality technology has been shown to reduce pain during complicated childbirth scenarios. Trials at Monash University in Melbourne, Australia have shown that using immersive VR experiences during external cephalic version procedures (where breech babies are manually turned) can significantly reduce pain.

At Cedars Sinai Medical Centre in Los Angeles  significant research and work is going into the impacts of therapeutic VR. It has already been shown to have fantastic results in terms of pain management and recovery. At their Virtual Medicine Conference in March this year, we heard from Former Cedars Sinai patient Harmon Clarke who recalled how meditating and travelling in VR during his hospital stay, instead of relying solely on pain medication, accelerated his recovery from Crohn’s disease.

Skip Rizzo, a psychologist and leading mind in therapeutic VR has conducted award-winning research into the positive effects of  virtual reality-based exposure therapy to treat PTSD and continue to analyse the benefits of virtual reality therapy across a range of psychological domains.

Virtual Reality Patient Care (Evidently Cochrane)

4. Shopping

How we shop has already transformed beyond recognition over the last decade. Virtual reality technology will open up new possibilities for how we engage with consumer products and ultimately, buy them.

The most obvious application of this is within the home improvements market. VR home design tools will allow consumers to place potential furniture or decorative purchases within a virtual mock up of their real home and interact with these items. This goes beyond current screen-based design tools – in VR consumers will be able to interact with items and get a clear sense of how they’ll live with them once purchased. Macy’s Department Stores in the US is already offering this kind of service to their customers.

The retail world has already explored how VR will affect online shopping. In 2016, Alibaba rolled out a VR shopping experience during Single’s Day – reportedly the biggest annual online shopping event in China. Shoppers from China were able to enter American stores virtually – such as Macy’s – and interact with the products in that environment.

Alibaba launches virtual reality shopping on Single’s Day (Upload VR)

As VR shopping experiences become more commonplace the consumer will gain more agency over their consumption. We’ll be able to make informed decisions over the products we buy online, before we buy them.

5. Social Behaviours

VR has recently shown interesting possibilities for changing problematic social behaviours. This ranges from sexual harassment, unconscious bias in the workplace and racial bias.

Vantage Point has developed a virtual reality based environment for sexual harassment training within the workplace. The solution is based on the premise that the simulated environment provides a safe space in which professionals learn how to respond to and report incidents of harassment in a safe, unintimidating environment. By simulating true to life scenarios, sexual harassment training is transformed from something typically seen as a matter of compliance to one of workplace safety that is taken more seriously. Improving how we educate people about sexual harassment will undoubtedly reduce cases of harassment and make for safer workplaces.

Similarly, programmes that use VR to highlight and remove unconscious biases in the workplace are rising in popularity. New York based consultancies BCT Partners and Red Fern Consulting have partnered to launch the Through My Eyes programme which uses immersive scenarios to help employees recognise – and then change – their unconscious perceptions. The programme allows participants to walk in the shoes of victims of social biases in order to confront their own real-life discriminatory behaviours through empathy. In a world that is finally prioritising diversity in the workplace, VR is offering an innovative way to push this forward.

Virtual Reality training in the workplace (VR Focus)

Mel Slater has run a series of studies at the University of Barcelona that have shown that inherent racial bias is decreased within virtual environments. In one, participants were given implicit association tests before entering a virtual scenario in which they were immersed in a virtual body of a different race. They were given the same test after being inside the VR and participants that were put in a dark virtual body showed a marked decrease in their inherent biases. The impact of these findings could be to trigger a reduction in unconscious prejudices – leading to increased empathy towards others in the real world.

6. Social interaction

Virtual Reality technology also has the potential to transform the way we work, communicate with each other and even socialise. Using virtual reality as a new form of meeting software allows remote workers to enter virtual meeting rooms with colleagues. This will certainly enhance collaborative working by connecting regional offices and distributed workforces. Efficiency will also be boosted with the time and financial costs of commuting greatly reduced.

Similarly, virtual reality has the potential to take communication with our friends and family to the next level. Just as experiences like Skype and Facetime have revolutionised how we interact with distanced loved ones, it’s not hard to imagine keeping in touch with our friends and family within immersive settings. Because VR allows users to feel present together – no matter where they happen to be physically – these interactions will be taken to whole new levels. Couples in long-distance relationships will be able to enjoy fully interactive, involved, dates using the technology. Since shared experiences bind us to those we care about – virtual reality experiences have the potential to keep us connected to our friends and families in entirely new and powerful ways.

To that end, Facebook has dedicated an entire business unit to building immersive experiences for social life. Social VR is dedicated to creating “technologies that help people to create, share meaningful moments, and build communities using the unique qualities of this immersive new medium”. As the precarious world of established social media continues to shift – Facebook has reportedly lost 15 million users in the US since 2017 – it’s no wonder they are looking to virtual reality as the next platform for social interaction.

Virtual reality meeting (via Virtual Speech)

So there we have it, the six ways in which virtual reality will affect our lives in six years time. At OMS we look forward to continuing to do our bit in applying this technology to improve healthcare training to improve patient care worldwide.