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Category Archives: Healthcare simulation

How Can Virtual Simulation Encourage Retention in Healthcare?

Practising clinical skills with virtual simulation
Practising clinical skills with virtual simulation

Since 2016, US hospitals have turned over an average of 90% of their workforce. This essentially means that, on average, just 10% of all staff remain working for the same hospital five years on.

Expenses are spiraling. Annual RN turnover costs US hospitals roughly $4.4m–$6.9m a year, and the loss of a single physician amounts to over $1 million. Our health systems cannot afford to lose staff. 

Ultimately, it’s our patients who suffer. With interrupted patient-provider relationships leading to adverse health outcomes and a reluctance to seek care in the future, continually replacing healthcare professionals can be devastating to patient outcomes. It’s a similar story in the UK, with rising GP turnover rates threatening patients’ quality and continuity of care.

How do we combat this? By embedding consistent, quality education into retention programs, healthcare institutions can build a system of support that empowers staff to deliver outstanding care. It’s time for virtual simulation to prove itself worthy of the task.

Improving staff competency and confidence

Research shows that financial incentives alone rarely help with staff retention. Factors such as a lack of personal growth (in both doctors and nurses), lack of self-confidence, and mismatched expectations in graduates are key contributors to turnover.

Without the chances to develop their skill set, healthcare professionals risk stagnation. This influences more than job satisfaction — it can profoundly affect a practitioner’s confidence in their abilities. Recent research found that poor self-confidence is directly related to increased turnover. It puts patients at a greater risk of harm, too.

To develop confident, competent staff, institutions must invest in learning opportunities for staff that are engaging, convenient, user-friendly, and affordable. Enter virtual reality: a solution that exceeds these requirements.

With VR simulation, users can enjoy on-demand access to immersive, experiential learning. The portable hardware is easy to configure, infinitely scalable, and costs next to nothing compared to traditional sim equipment. Even better, the experience is genuinely enjoyable!

Can virtual reality training increase competence? Absolutely! Studies show it can boost procedural confidence, facilitate technical skill development, and even speed up recognition of needed care escalation. 

VR simulation platforms like OMS offer standardized scenarios which are infinitely repeatable. A scenario’s learning objectives are consistent, meaning every repetition strengthens a user’s understanding and skills. But from a user perspective, it doesn’t feel boring to retry a scenario because dynamic storylines adapt in response to user actions, recreating how a case could unexpectedly unfold in real life. This unparalleled realism trains practitioners — and prepares graduates — to better handle the varied stresses of patient care. 

When OMS’s scenarios were put to the test, researchers found users learned more and felt significantly more confident in key elements of patient care. What’s more, 89% were still applying what they learned in their daily practice three months after the trial! The profound and lasting effects that virtual simulation (such as OMS) has on staff confidence and clinical capabilities will impact the lives of innumerable patients.

Performing an eye exam on a pediatric patient in OMS
Immersive, repeatable virtual simulation scenarios strengthen staff competence and confidence
Doctor in surgery examining little girl
Staff can apply their experience in virtual simulation to real-world clinical situations

Helping to facilitate role flexibility and advancement

A lack of career progression is a key driver in nursing turnover. MedCity News notes that hospitals “need to create a structured approach to career planning that starts with helping nurses determine what kind [of] path appeals to them”.

Healthcare business guidelines suggest continued training and advancement opportunities are excellent ways to encourage retention amongst staff. Enabling your nurses and doctors to build new skills and engage with new roles could give them the fresh perspective needed to remain in your institution.

How can VR facilitate this? Hands-on experiences in virtual simulation give users an authentic interpretation of real-life scenarios for a range of disciplines (such as obstetrics, pediatrics, and ICU), reinforcing the skills and knowledge they need to advance in their field.

Virtual simulation can also support undecided staff to identify where to transfer. Good VR sim platforms have extensive libraries with a variety of disciplines to explore. Through practicing different scenarios, staff can learn where their skills fit and what interests them most—and then managers can work with them to facilitate the change. By giving your team the chance to explore unfamiliar situations, you can help to spark their curiosity and reignite their passion for work.

Regular check-ins between managers and staff are vital to keeping the workforce satisfied. Managers can leverage virtual simulation scenarios to quickly and accurately measure staff performance, helping inform them how they can better support their team’s development. 

Because virtual reality hardware is portable and flexible, you can use it whenever and wherever is most convenient. Instead of finding time on the floor to observe staff performance, managers can schedule a time with staff and watch their skills in action, one-on-one, in an immersive virtual environment. 

Analytics give objective feedback, helping managers notice any key strengths they may have missed during observation. This way, they can also identify suitable candidates to nominate when positions become open—meaning health professionals will feel supported to pursue new opportunities, ultimately keeping them in the industry.

Looking to improve your retention strategy? Book a free demo with one of our experts.

Providing staff support and improving wellbeing

To develop effective retention programs, institutions must include training that fosters a caring, supportive environment for every member of the team.

Healthcare staff frequently cite a lack of support as a reason for burnout and turnover. Mentoring programs, designed to empower and engage staff, are linked to higher satisfaction levels and positive career development in medical staff. 

How can VR contribute to effective mentoring? Virtual simulation platforms that offer enhanced analytics give managers the capacity to identify weaknesses in practitioners and pair them with mentors who perform well in that area. Staff can feel less stressed, knowing that they have someone to turn to when they’re struggling.

Training as a team also helps shift health professionals from a competitive mindset to a more cooperative one. By using virtual reality, interprofessional scenarios can promote collaborative work with practitioners across countries in addition to disciplines. This can give staff a greater openness to different cultures and walks of life. 

A lack of support isn’t the main threat to staff retention. Bullying is one of the main reasons for turnover for doctors and nurses alike. Research attributes nurse-to-nurse bullying as a significant contributing factor to the nursing shortage. What’s more, up to 90% of medical students, foreign medical graduates, resident doctors, and female staff members experience bullying. 

Virtual reality is an ideal medium for promoting empathy among colleagues. Through immersion and presence—the feeling of “being there”—VR delivers a deeply emotive experience that allows users to connect with characters they encounter. 

Virtual simulation platforms (such as OMS) deliver patient-facing scenarios covering a wide range of cases. These can involve handling sensitive topics, including mental health and gender identity. By practicing, debriefing, and discussing these cases, virtual simulation facilitates open and honest communication amongst health professionals—helping them to better understand and handle issues they may not already be familiar with.

Finally, it’s worth considering the psychological benefits of using VR for training compared to more traditional methods. Research shows virtual reality training significantly reduces stress and anxiety. How? It allows staff to repeat scenarios as often as needed, meaning they can become completely comfortable with unfamiliar situations. Virtual simulation empowers clinicians to practice safely and as often as they like, enabling their confidence to soar. Crucially, when healthcare professionals feel more confident and prepared for the challenges they will face, they’re less likely to experience burnout.


Summary

For healthcare systems to keep their valued staff, they must provide a better level of support.

Virtual reality is the ideal medium to deliver this. VR technology is easily scalable and is available on-demand, with negligible costs relative to staff turnover.

With the right software, virtual simulation encourages collaboration with team members, builds empathy, and gives an objective insight into areas of weakness so that staff can get the help they need. 

Happy, collaborative teams help build a positive workplace—and that culture matters for more than just retention. A healthy work culture—one that puts staff retention at its core—leads to successful recruitment as well!

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What is XR, and How is it Transforming Healthcare?

Johns Hopkins Simulation VR team
Johns Hopkins Simulation VR team

Developments in healthcare technology are now more exciting than ever. With increasing pressure on health services, it’s now crucial to use emerging technologies to support staff, reduce human error, and improve patient outcomes.

Enter XR — a group of technologies, first seen in gaming and education, that are now shaking up all aspects of healthcare.

With the global healthcare market for XR estimated to reach $4.6bn in the US alone by 2025, XR is a game-changer for healthcare systems — and there are surprising possibilities for its use in training, recruitment, and beyond!

What is XR?

XR — or Extended Reality — is an umbrella term for all immersive technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR). These all “extend” our reality by blending the real world with computer-generated elements or by creating an entirely immersive virtual experience.


Virtual reality (VR)
is arguably the most well-known of all XR technologies. Using a Head-Mounted Device (HMD), like Oculus or HTC Vive, users receive a virtually immersive experience. This experience can be simple, like a 360° video of a real-life setting, or a completely interactive virtual environment. 

What are the uses of VR in healthcare? There are plenty! On the educational side, platforms such as OMS can deliver virtual clinical experiences to healthcare students and faculty alike. Other virtual reality platforms serve procedural training for specialists, such as surgeons. Beyond that, VR has direct applications to patient care, such as gamifying physical therapy sessions to speed up recovery times, and using immersive, controlled scenarios to improve outcomes in mental health patients.


Augmented reality (AR)
superimposes computer-generated content over what you see in the real world and is used mainly with phone apps and smart glasses. Though it doesn’t offer the total immersion of virtual reality, AR is a valuable tool for overlaying additional information in a real-world environment.

Augmented reality offers some fantastic benefits to healthcare training and patient care. For example, institutions have leveraged AR to improve the success rate of intravenous injection by mapping vein structures onto the surface of a patient’s skin.


Mixed reality (MR)
is similar to augmented reality in that a device projects computer-generated content. The fundamental difference is that mixed reality content is responsive and spatially aware. For example, a ball dropped in MR could bounce when it hits an object in your space, making the experience a lot more interactive.

In healthcare, mixed reality can extend the impact of more limited training equipment. One application uses MR to provide dynamic feedback on low-fidelity manikins, which helps to maximize manikin functionality and significantly improves learning outcomes.

Learners using a high-fidelity manikin in training
XR offers several benefits over resource-intensive manikin simulation
A cardiac exam taking place in virtual reality sim
VR cardiac examination

What Benefits Does XR Offer Over Physical Training?

XR revolutionizes the traditional approach to healthcare training. This is particularly true with virtual reality. 

VR simulation authentically replicates manikin-based simulation scenarios so that trainees and practitioners alike can practice safely, developing their skills and confidence in a lifelike environment, with no compromise to learner outcomes

The most exciting part about XR technologies in healthcare training? They require a smaller number of resources, reach more users, and can provide feedback on improvement over time — helping you prove that you’re getting a return on your investment.

Fewer resources

Hands-on experience with real patients is an invaluable way for healthcare trainees and professionals to develop their skills — but it comes with the added risk of putting patients’ lives in danger. Manikin-based simulation was designed to bridge this gap, allowing students to learn from their mistakes safely.

Sadly, there are still drawbacks to this method of training. To anyone familiar with physical simulation, it should come as no surprise that the setup is expensive and resource-intensive. In fact, recent research suggests that just one physical simulator costs a hefty $62,808 per year! Cost aside, the equipment requires considerable space, ongoing maintenance, and dedicated faculty to run every session. XR platforms differ in that they’re relatively inexpensive, require a fraction of the space, and many require little-to-no external supervision once configured. Virtual reality allows you to create multiple environments using the same platform — such as maternity labs and outpatient clinics — helping you deliver outstanding healthcare education to as many learners as possible.

More scalable

Because of physical simulation’s resource constraints, scaling up operations to meet demand is rarely workable. Institutions don’t always have the time, money, or faculty needed to give learners on-demand access to the training they need. The good news is that these obstacles don’t apply to XR, so you can facilitate truly flexible learning. Cost-savings, portability, and the possibility of unsupervised practice mean that users can train anywhere, at any time, repeating simulations as often as needed to hone their skills.

Better feedback

Even the best technician will find it impossible to operate a scenario exactly the same way consistently, which makes it challenging to measure cohort performance. Additionally, the debriefing process is rarely recorded, and learners can’t effectively benchmark their efforts. On the other hand, standardized XR platforms give the same experience to each user every time without fail. Even better, platforms like OMS use advanced analytics, so users can track their improvement over time and understand how to improve.

Arrange a free demo to find out how VR sim can meet your institution’s needs.

How Can XR Be Used Besides Education?

We’ve explored why XR is an ideal medium to supplement physical simulation and education in healthcare. Still, there are so many other ways that technology is useful in healthcare. This is especially true of virtual reality.

Ongoing training

Learning shouldn’t stop when students graduate. Up to 57% of new RNs leave their roles because of an inability to ensure patient safety, and a lack of ongoing training plays a key role. The portable, scalable nature of XR lends perfectly to solving this dilemma. Users are free to brush up on existing skills — and learn new ones — in a safe context before transferring their learning to actual patients. A vast library of scenarios with VR means a wide range of staff can access tailored learning opportunities. The flexibility of the tech also means that busy doctors and nurses can fit in training around their hectic schedules without too much prior scheduling.

Recruiting the best staff

With up to $250,000 invested in a single physician candidate (and around $82,000 for a nurse), hiring the right person for the job is vital. This makes virtual reality an ideal medium for hiring managers. It can help remove bias, test skills in a standardized environment, and impress top candidates by using innovative tech to show that institutions are willing to invest in staff development.

Encouraging staff retention

The average US hospital has turned over 80% of its RN workforce in the last five years, and annual physician relocation rates sit at around 11–18%. Healthcare institutions need to be investing in their workforce to promote a happier, more engaged culture. Integrating novel technologies (such as XR) into training programs can encourage job satisfaction, and analytics feedback from platforms such as OMS can help faculty identify who needs extra support. Virtual reality is also great at expanding user perspectives, which can be crucial for reducing interprofessional barriers and encouraging collaborative environments.

Improving remediation of healthcare professionals

In healthcare, ensuring patient safety is vital, so staff underperformance is a cause for concern. The problem is this: remediation programs lack uniformity, and there’s little research to suggest whether outcomes are successful. XR can help to change this by providing standardized training that easily integrates into remediation programs. Some platforms even offer detailed analytical feedback to suggest whether staff are genuinely making progress. Even better, tracking performance in this way can help to catch issues early so that institutions can proactively address concerns before patients are exposed to potential harm.


Summary

Extended reality is at the forefront of the new, exciting innovations in healthcare. It’s widely acknowledged as a formidable tool for its educational applications, but there is so much more to what AR, MR, and VR can offer. 

As champions of virtual reality healthcare simulation, we’re particularly excited about the possibilities that VR provides in training competent nurses and physicians, hiring the best candidates, encouraging retention in valued employees, and supporting healthcare professionals to practice safely and elevate their performance.

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Why VR is an Essential Tool for Healthcare Training

Why VR is an Essential Tool for Healthcare Training
Why VR is an Essential Tool for Healthcare Training

Can you imagine a world where to learn, you must put lives at risk?

Though it seems unfathomable now, this was the reality not too long ago. Historically, doctors and nurses used to learn in lectures – then be released onto the wards to practice on patients, learning from their mistakes as they delivered care — mistakes that could put patients’ lives in danger.

Over time, an increasing focus on patient safety spurred the development of physical simulation – the techniques around practicing with manikins and actors. Simulation allowed clinicians to learn from their mistakes safely, and has been widely adopted over time.

Despite this, the healthcare industry faces a problem: medical error is costing patients their lives, being reported as the third leading cause of death in hospitals, behind only cancer and cardiovascular disease.

In the US, despite a nearly $3 billion annual investment from Medicare towards direct graduate medical education, new resident doctors are responsible for 81% of malpractice claims. And error is not confined to doctors. Fifty percent of entry-level nurses are involved in practice errors, and only 23% of nurses graduate feeling prepared for practice.

Essentially, students and healthcare professionals need more opportunities to build confidence and competence allowing them to perform at their best the moment they set foot on the clinical floor.

So how do we create more opportunities to practice in simulation, in a way that’s realistic, repeatable, and available whenever and wherever it’s needed?

Say hello to virtual reality! Here’s why VR is ideal for training well-prepared staff and improving patient care at every step.

Evolution to simulation using manikins
Traditional simulation utilising a CPR manikin
Johns Hopkins Student Nurse
Evolution of simulation to Virtual Reality

1. Immersive, experiential learning

Experiential learning — learning through first-hand experience — plays a key role in creating capable healthcare professionals. Studies highlight it as a key process for developing self-awareness and compassion towards patients. The problem is that it can be hard to practice in traditional curriculums and training programs.

Without frequent, hands-on practice, clinical competence – and healthcare provider’s confidence in their abilities – quickly deteriorates. Training repeatedly, as allowed by VR – can helps to bridge the gap, providing accessible, on-demand experiential learning.

VR technology is perfect for experiential learning. It immerses users, convincing the brain into believing the experience is real. When a user slips on the HMD (head-mounted device), they can treat virtual patients as they would in real life. No matter the stage of a healthcare professional’s career, virtual reality can deliver experiences that ‘feel real’ and become integral to healthcare education and training.

“It makes me feel like I am dealing with real patients. However, I’m not afraid of making mistakes and this has increased my confidence and practical skills.”

— Nursing Student Using OMS

Experiential learning enables users to carry their learning into the real world long after a simulation ends. This means healthcare workers are more equipped and confident to deal with any obstacle they face. In virtual reality, the benefits of experiential learning are remarkable. Research shows VR simulation not only improves performance across medical professions — it also significantly decreases the chance of fatal errors.

At OMS, we authentically replicate real-world clinical experiences, allowing learners to get the most out of their experience. Our AI-driven patients are dynamic and adaptive, deteriorating if they don’t receive appropriate (and timely) treatment. Learners can prepare for the realities of patient care while honing their ability to recognize symptoms.

2. Train anywhere, any time

VR provides true scalability. It’s up to 20 times cheaper than manikin-based training, requires no patient or faculty involvement, and the hardware is easily storable when not in use.

Once it’s up and running, VR simulation software is available to use 24/7. Learners are free to tailor their learning around their schedules, which is a bonus for busy practitioners with limited time to spare.

Standardized VR simulation scenarios provide an infinitely repeatable learning experience. Scenarios unfold differently depending on how a learner engages with a patient, with no risk to the patient no matter what the learner does. This means that learners can make mistakes safely and without anxiety until they are confident in a scenario.

Developing this confidence is crucial to creating independent, capable healthcare staff. A 2020 report highlighted poor clinical decision-making as a factor in 65% of entry-level nurse errors; it also found that just one-third of graduate nurses are confident in their practice. 

The good news is that VR simulation scenarios can significantly improve knowledge retention and self-confidence in learners, which diminishes the likelihood of medical error.

“The ability for our nursing students to practice standardized, realistic clinical scenarios whenever they need is game-changing.”

— Executive Director of Simulation, NYU Rory Meyers College of Nursing

3. Personalized learning for every user

Students, trainees, and experienced professionals all have different requirements and expectations of training. Unfortunately, traditional methods make it difficult to create programs that acknowledge each learner’s individual needs.

Here’s some good news: no matter the career stage or specialization, virtual reality can train healthcare professionals in ways that work best for them.

With its combination of visual, auditory, and kinaesthetic input, VR can accommodate a range of individual learning styles. On-demand access also means learners can choose where and when they prefer to practice, providing even more customized learning.

With VR simulation, users have an extensive library of scenarios at their fingertips. A wide range of scenarios gives learners the choice to focus on specific areas of expertise or refine their general patient care. If learners vary in confidence across topics, that’s not an issue. They can repeat scenarios as little or as often as they need before they put their skills into practice.

Looking to understand the strengths and weaknesses of specific users? Leading VR simulation platforms, such as OMS, offer comprehensive analytics tracking for this reason. It’s ideal for monitoring participant performance and tailoring learning based on concrete results. It also allows learners to monitor their own progress, track improvement and adjust training accordingly. Detailed feedback, tailored to each learner’s performance, helps students and professionals alike to improve and maintain the skills they need for exceptional patient care.

The Bottom Line

Virtual reality can provide exceptional learning experiences. It’s immersive, scalable, and can be tailored to an individual’s needs. It even enables collaboration, with research suggesting that team-based VR training, such as OMS Interprofessional, could reduce patient mortality by up to 15 percent!

Optimizing training is essential to delivering the next generation of healthcare professionals and for keeping our current practitioners clinically competent. With medical errors costing up to $20 billion a year, VR simulation can bridge the gap to hone skills, encourage staff retention, and make a remarkable difference to patient care.

Ready to see what VR simulation can do? Arrange a free live demo with us today.

How We’re Challenging Unconscious Bias to Progress Healthcare for Transgender Patients

Mental Health
Mental Health

It’s time to open up a dialogue with healthcare professionals around gender identity and mental health. 

Though we are becoming acutely aware of the importance of mental health, transgender patients continue to suffer significant barriers to appropriate care, including discrimination and a “lack of cultural competence”. This is especially concerning given the prevalence of mental illness amongst transgender individuals – recent research has found that the community are six times more likely than the general population to have a mood or anxiety disorder. How can we improve the care we provide transgender patients?

At OMS, we’ve created a new mental health scenario to challenge clinicians’ unconscious biases. Here, users encounter an adolescent patient, with the birth name Oscar, who has been admitted to hospital after a suicide attempt. Through a supportive and understanding dialogue, we learn that she is gender transitioning and prefers to go by the name of Ola.

We spoke to Dana Plank, RN – a nurse in New Hampshire – and Dr Bex Thompson – a physician in the UK –  to get a better understanding of its significance. Both are clinical authors at OMS and have been instrumental in the scenario’s development.

A screenshot of the patient from OMS mental health scenario for transitioning youth
Our new scenario features a gender transitioning adolescent who prefers to be called Ola.
A screenshot of the patient from our new scenario, who is gender transitioning and prefers to be called Ola
Ola, whose preferred pronouns are she/her, has been admitted to hospital after a suicide attempt.

We know how important mental health is, and how impactful these scenarios can be. In fact, mental healthcare and health inequalities are areas OMS actively works to improve. But this one resonates with so many people – we’d love to hear how it got started.

Bex: One of our authoring team (Kelly) had a great background in mental healthcare and was very passionate about making scenarios that aren’t just out of a textbook, but really bringing them to life and making them a bit more real-world. Kelly had worked with transgender people before and had first-hand knowledge and recognized how important the topic was. It’s one that’s not talked about enough in healthcare, and we saw an opportunity to change that.

What had been your experience of training on transgender awareness before working on this scenario?

Bex: Certainly when I went through med school (UK) we didn’t receive any formal training about how to approach topics around gender identity.

Dana: It’s the same here (US). LGBTQ issues aren’t something that we’re very good at—we’re not very good at using the right terminology and consistently demonstrating compassion towards these issues. But it’s just because we haven’t had the practice. The idea behind this scenario was to give people the opportunity to learn how to interact compassionately, and to ask the right questions so that you don’t alienate your patient.

You received input from people with first-hand experience of transgender issues to help develop the scenario. How did their expertise influence the finished product?

Dana: We mainly asked for our subject matter expert’s input to ensure we were representing the patient sensitively, and to find out whether we’d overlooked any issues they’d faced in the patient’s care. They have experience with transgender patients and mental health care as an RN, but they also identify as non-binary, which meant that they were able to offer both professional and personal insight. They certainly helped us with some background that we would’ve never thought of. For example, how the parents refer to this gender transitioning adolescent. If you’re calling the parents, it gives you an idea of how they feel. They might either be accepting of the situation that the patient is going through, or they might still refer to them as Oscar.

Bex: I also consulted with a colleague of mine who is training to be a psychiatrist. She helped us to narrow down the scenario and remove any unnecessary elements that could distract users from focusing on the patient’s mental health.

You mentioned taking out unnecessary elements. Can you tell us more about how the scenario developed to focus on the patient’s mental health?

Dana: Originally the patient had ligature marks – they weren’t gruesome, just a minor abrasion or burn. But Bex mentioned that from a doctor’s perspective, any kind of mark like that would suggest a more serious suicide attempt, needing a more serious physical examination. We didn’t want to go down that path – we wanted it to be mental health-focused – and our authoring approach got us there.

Bex: The patient was also originally drinking and using drugs, but we had to pare it back or it would’ve ended up being a child safety issue. It’s difficult because in real life, people do present with lots of things, but we have to be mindful that this is only a 20-minute scenario. At the end of the day, it’s a mental health scenario, so all the objectives are about understanding your patient and what led them to feel the way they do.

Looking to train competent, compassionate healthcare professionals? Discover how OMS can make it happen.

Even after it was stripped back, the scenario still sounds uniquely complex – a juvenile patient who is transitioning and has also attempted suicide. Was that a conscious choice?

Dana: This particular scenario is in an ED setting, so we needed something that would bring a patient there. It might look like a physical problem but in reality, it’s a mental health issue.

Bex: Absolutely. Our first few mental health scenarios were more simplistic, like an anxiety attack. It was a conscious decision, we were focusing on learning outcomes. But people don’t tend to come with just one problem. People are complicated, and this scenario reflects that. A gender transitioning patient is new for our scenarios but we should ideally be asking everyone their preferred pronouns and treating everyone with that consideration.

Why do you think that patient-focused care is so crucial for mental health scenarios like this one?

Bex: With anything you do in medicine, it should be about patient care and compassion, but with mental health in particular it’s so important. If you’re treating somebody’s heart attack and you don’t get on well, they might not like you, but you can still treat the problem quite successfully. That’s not the case with mental health – if you don’t connect with your patient, you’re really going to struggle.

How would you respond to those who would say mental health should only be treated by those within the specialty?

Bex: I think that’s wrong. As we have said, mental health often goes with physical problems and we have to take that holistic approach. Some problems you do need to separate, so you wouldn’t want a surgeon looking at a cardiology problem, but mental health filters into every part of medicine. It’s really important to understand mental health presentations because if someone’s having an anxiety attack and they’re short of breathing and having palpitations, I need to take a good history to make sure they’re not actually having a heart attack. They’re not just ‘patients’, we want to treat them as people.

Dana: We talk about “holism” in treating a patient. People are multifaceted beings, and everything that is affecting them physically, mentally, socially – everything comes into play. This holistic approach is emphasized in nurse training. You would be doing a disservice to a patient to not consider a whole person.

Bex: And even though this scenario is set in the ED, it could just as easily be used for other situations, such as for someone who is on a ward or even the community. The mental health scenarios help users to take the patient’s history and to recognize what’s going on, and that’s an important part of a clinician’s work. Whether you’re on a ward or in an outpatient community, you’re going to come across mental health.

Finally, why do you feel that this scenario is so important to furthering the understanding of transgender patients’ struggles?

Dana: I had an experience a little while back where I was describing this scenario to someone I knew, and saying that we can be better equipped by using the right pronouns, things like that. And he said, “What, just so they can be special?”. But you have to think about it from their perspective. Transgender individuals have been marginalized and treated unfairly their whole life. It’s not giving them special treatment – it’s giving them the same respect that we give everyone else. We are up against that lack of understanding and that’s why this scenario is so important.

Bex: Even if you understand why we need to be aware, a lot of people are uncomfortable because they haven’t come across the situation before. You might never come across it again. There are so many things going on for a clinician and it can be hard to remember things like asking patients’ pronouns, which is why normalizing it in this way is so important. It might feel a bit uncomfortable at first but that’s okay, you’re trying, and that’s key.

Dana: Absolutely. The fact that you’re acknowledging it and trying your best for the patient really speaks volumes.

 

Learn more about mental health simulation from the educational experts at OMS.

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About the Clinical Authors

Dana Plank MS, RN, CHSE 

Dana is a Registered Nurse with a Masters in Nursing Education. Dana is also a Certified Healthcare Simulation Educator. Gaining extensive experience in OR Nursing, homecare, and public health, Dana then transitioned her career to simulation education. Since 2019, she’s been using her expertise to develop immersive sim scenarios as a Clinical Author at OMS.

Dr. Rebecca (Bex) Thompson BSc, MBBS

Bex is a Physician and Simulation Educator with a PGCert in Clinical Education. While working as a hospital physician she began delivering innovative simulation training, and developed specialist knowledge of clinical teaching. Bex continues to practice clinically alongside her work at OMS, and uses this real-world experience to help create engaging scenarios for learners as a specialist clinical author.

Holistic Simulation: Mental and Physical Health in a Pandemic

COVID-19 mental health impact

“If I go to see someone about my eyes, my eyes are what I am, and the rest of me doesn’t matter. It’s the same with mental health. If I go to see someone for a mental health problem, I AM a mental health problem”

Mental health focus group participant  ¹


If you work in healthcare or have ever been a patient with multiple conditions, you may relate to the statement above. You may have been that clinician or that patient.

Why is this? Why do we, as healthcare professionals, tend to see one issue at a time?

Part of it is the time pressures we are under – we need to prioritize and focus on the most urgent issue first. Part of it is about competence – the skills and confidence to work outside our conventional role boundaries. Part of it is about attitudes – there is a tendency to treat physical health ahead of mental health.

And part, unfortunately, is our education. In classes, in clinicals and in simulation, we are taught to think of issues as discrete. A mental health simulation involves a mental health issue, and cardiac scenario is about chest pain, and so on.

Yet we know in the real world people aren’t that simple. We know that mental and physical health are inextricably linked, and it is detrimental to a person’s overall wellbeing to regard these as two separate entities. As such, shouldn’t we be designing simulation to teach just that?

At Oxford Medical Simulation we think so…

Holistic Simulation

We deliver clinical experiences on-demand, helping educators provide fully interactive and immersive simulation on-screen and in virtual reality. Our virtual patients reflect what we see in the real world, taking a holistic approach to managing mental and physical health.

Angry virtual patient

Each scenario of the OMS mental health library has been created to help learners hone their skills in mental health assessment, and – as in real life – contain physical health issues as well.

For example, Maria is an 80-year-old patient presenting with shortness of breath. Though she has a history of heart failure, her most prevalent issue is acute anxiety. The learner must balance these two issues to manage Maria successfully. This involves establishing rapport, elucidating a medical and mental health history, assessing acute anxiety, use of scoring systems, investigating coping mechanisms and sources of support, involving the relevant teams for further assessment, and documenting as needed.

As with all the OMS scenarios, all elements of care are possible: communication, examination, investigations, EMR, charting, and team interaction – just like in the real world. This breadth of possibilities, combined with adaptive scenarios that change depending on learner behaviors, ensures scenarios feel real, whilst scaffolded learning ensures they are appropriate for a wide range of learners.

The virtual patients are designed to look and behave like real patients, from low mood and poor eye contact to confusion and agitation.

After each scenario, detailed feedback, evidence-based blended learning and performance analytics allow the learner to repeat and improve their performance over time, and guided debrief allows them to reflect and document their performance.

Scenarios are objective and standardized and can run with or without faculty input. This allows instructors to focus on debriefing, synchronously or asynchronously, with OMS providing the clinical experience. Running on learners’ own computers, ensuring accessibility, or virtual reality, OMS scenarios are built to deliver simulation at scale for maximal immersion.

The mental health library contains a range of scenarios to cover the mental health syllabus. The growing OMS mental health library consists of scenarios that challenge learners across multiple areas: anxiety, self-harm, bulimia nervosa, alcohol dependence, chronic pain, dementia with difficult behavior, gender transition and suicidal ideation.

There is a lot to learn within each scenario. Our approach reflects the understanding that healthcare professionals don’t need to be experts in mental health to have a huge impact. Getting the basics right is the most important element in mental health care.2 Taking a ‘whole person’ perspective, focusing on communication and consultation skills, ensuring coordination of care, and encouraging self-management and peer support are common across all scenarios.

Mental Health in Context

Physical health problems significantly increase the risk of poor mental health, and vice versa.

Around 30% of all people with a long-term physical health condition also have a mental health problem,3 and mental health problems can seriously exacerbate physical illness, affecting outcomes and the cost of treatment.4

COVID-19 mental health impact

This is compounded as many of those with diagnosable mental health problems receive no formal treatment. As such, a presentation for medical care may be the first presentation with an underlying mental health issue.5

To appreciate just how important and timely these issues are, before COVID-19, one in five U.S. adults lived with a mental health issue.6 In 2020 this skyrocketed. Nine months into the pandemic, 42% of people surveyed by the US Census Bureau reported symptoms of anxiety or depression – an increase from 11% the previous year.

This is not surprising. Fear of contracting the virus, working from home, temporary unemployment, home-schooling, and lack of physical contact contribute. “I don’t think this is going to go back to baseline anytime soon,” says clinical psychologist Luana Marques, at Harvard Medical School in Boston, Massachusetts, who is monitoring the mental-health impacts of the crisis.7

COVID-19 anxiety and depression impact

And amongst the mental health casualties are healthcare workers. It was known from the SARS outbreak that clinicians were at high risk of developing anxiety, depression, stress during outbreaks.8 Sadly, this has been reflected across the healthcare spectrum during COVID-19, with nurses seeming to be most impacted by the consequences of the pandemic.9 Without healthcare workers, there is no healthcare system, so whilst we continue to strive to improve the care we provide our patients, we mustn’t forget about ourselves, and each other.

All this to say that as the urgency of the pandemic begins to recede, the focus will rightly turn to the mental health epidemic. We should be designing scenarios that reflect this. Blending learning objectives across mental health and physical health through simulation is one way to help us deliver the complex care required for our patients, and scenarios such as those we design are part of that picture.

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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
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Virtual EFM obstetric scenarios
Virtual EFM obstetric scenarios
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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.

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Virtual Reality World Tech Magazine: Informed Immersion

Immersive technology is making significant strides in training medical professionals and as a treatment in health and wellness.

There are many ways that virtual reality (VR) can be applied in healthcare – from training medical professionals to aiding surgeons through visualisation or even robotics. But where is immersive tech really excelling right now, and what is it achieving for patients and medical professionals alike?

In the article below, Dr Jack Pottle, Chief Medical Officer at Oxford Medical Simulation, speaks to VR World Tech – discussing the views and often misconceptions that institutions have about immersive tech…

Read the full interview here

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What is VR simulation good for in 2020?

Every year, January brings the largest event in the global simulation calendar: IMSH. This year, we were excited by the ongoing and mounting interest in virtual reality simulation and improved learner outcomes.

 

Shifting perspectives 

At IMSH this year we noticed a marked shift in the awareness and understanding of VR simulation in the wider simulation community. 

Back in 2019, people were asking, “What do you mean exactly when you say ‘VR?’”. This year we were instead asked “VR has been around for a few years… what’s it good for?” and “Is it practical enough to be used meaningfully for sim?”. 

These are excellent questions. 

Here, we look at some of the ways that VR sim can be used to; create efficiencies, optimize data and encourage flexible learning – including some of the crucial concepts to consider when looking to implement a VR platform in your simulation facility.

Doing More with Less

Physical (mannikin-based) simulation involves significant overhead costs. Research has shown that faculty/admin hours, equipment, maintenance, space, and consumables contribute to an average cost of $390 to deliver just one traditional simulation session(13).

In contrast, immersive VR is instantly scalable, allowing institutions to deliver more simulation experiences to their learners at a greatly reduced cost. Because VR simulation is repeatable and can be used without faculty supervision – meaning engaging clinical experiences can be provided using fewer valuable resources.

One recent study showed “no significant differences in quantitative measures of learning or performance” in VR vs. physical sim, but demonstrated that VR sim was more affordable(4). Institutions have capitalized on using VR to deliver sim that is 5 – 50x cheaper than physical sim.

The ultimate goal of using VR for sim is to increase access to this incredibly powerful teaching method and make simulation part of everyday life (not just when learners are in the sim center).

Consideration #1

When seeking to implement VR sim, make sure you consider whether or not you are looking for a faculty-independent platform that will free up the time needed to run simulation sessions, as not all solutions offer this.

Supporting Data-Driven Simulation

Collecting information about a learner’s performance and behavior during physical sim can be time-consuming and often requires subjective input. Using standardized simulations in immersive VR allows educators to deliver more simulation experiences whilst leveraging the data-tracking and analytic power of a technology-based system. 

This push towards data-driven learning experiences makes 2020  one of the most exciting times to be working in simulation and is empowering institutions to further the use of sim in ways previously considered impossible.

The most immediate – and important – use of this data is to support the performance improvement of learners. However, these analytics can further be used to research clinical behavior, supplement assessment techniques, and aid in recruitment processes.

Sim educators have historically struggled to show the economic impact of their efforts. Now, for the first time in history, having simple access to the type of data VR-based systems offer allows instructors to justify sim implementation to key stakeholders who are increasingly asking simulationists to “measure the effectiveness of what we do, how we do it, and why we do it.(5)

Consideration #2 

Platforms that offer standardized and peer-reviewed VR scenarios allow for detailed, personalized, and thorough analytics. Creating custom content in VR is undoubtedly appealing and may be useful in certain cases, however it removes the possibility of having rich, scalable feedback across cohorts. Implementing a broad range of standardized scenarios may provide you with the same variations as building your own, without compromising the levels of feedback you can give to learners.

Meeting Demands of Flexible Learning

Studies are increasingly finding that immersing a learner into a virtual world via a Head-Mounted-Display (HMD) has a greater impact on educational outcomes than screen-based learning(6). However, as simulation becomes a part of everyday life and distance-learning options are increasingly in favor, institutions need a way to deliver these simulations when VR hardware is not available.

Meeting the evolving educational needs of hospitals and universities means using a virtual reality platform that can support immersive VR sim in addition to an identical screen-based experience. 

Consideration #3 

As you consider approaching a hybrid VR-immersion/screen-based implementation, evaluate whether or not your learners will also need to use VR for group-based simulations, individual learning sessions, and multiplayer for interprofessional simulation experiences. 

We’re excited to see how our partners – and the wider sim community – will continue to advance the use of virtual reality in simulation in 2020. For more information about how VR simulation can work for you, contact us here.

References

  1. McIntosh (2006). Simulation: What does it really cost? 
  2. Iglesias-Vázquez (2007). Cost-efficiency assessment of Advanced Life Support (ALS) courses based on the comparison of advanced simulators with conventional manikins. 
  3. Pottle (2019). Virtual Reality Medical Simulation: Economic Evaluation and Return on Investment. Available on request.
  4. Haerling (2018). Cost-Utility Analysis of Virtual and Mannequin-Based Simulation. 
  5. Waxman (2019). SSH March Presidential Message. 
  6. Krokos, Plaisant, and Varshney (2019). Virtual memory palaces: immersion aids recall.

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