Category Archives: VR Nursing Simulation

‘This will translate to the real world’: Nursing students learn skills through virtual reality

Nursing student being introduced to a scenario at UNE

Nursing students have had few opportunities to learn in hospital settings because of the COVID-19 pandemic. But, as this report from reports the Maine News Center demonstrates, virtual reality simulation from OMS is allowing students at the University of New England’s School of Nursing and Population Health  to learn skills that prepare them for the real world.

During class on UNE’s Portland campus, nursing students use virtual reality scenarios from OMS to assess patients as they would in real life. 

Having opportunities to build confidence and competence in this way is vital, as research shows that only 23% of nurses graduate feeling prepared for practice and 50% of entry-level nurses are involved in practice errors.

The inability to practice has only been made worse over the pandemic. As Dawne-Marie Dunbar, the director of the UNE Simulation Center notes:

“With the challenges of COVID-19, oftentimes are units are closed to our students, so being able to experience in the virtual reality has been a huge benefit”

— Dawne-Marie Dunbar, Director of the UNE Simulation Center

Nursing student being introduced to a scenario at UNE
Nursing student being introduced to a scenario at UNE
Dawne-Marie Dunbar, Director of the UNE Simulation Center

Some scenarios takes place in a hospital maternity ward. Students must first determine the symptoms of a pregnant patient, who was just sent over from her doctor’s office. Students check reflexes, vital signs of both mom and baby. 

As VR immerses completely immerses students in the virtual world, it convinces  the brain into believing the experience is real. Kathleen Humphries, who is a senior in the program, said the scenarios make her feel like she is actually in the room with the patient and allows more practice in emergency cases: 

“It allows us to screen for more critical cases where we need to do interventions and call providers”

— Kathleen Humphries, nursing student

After the students run through a scenario, they get immediate feedback on their mistakes without the stress of “practicing” skills on a real patient.

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

The good news is that VR simulation scenarios such as those used by UNE can significantly improve knowledge retention and self-confidence in learners. Unlike with traditional training, scenarios can also can be repeated as often as needed to improve skills.

“A lot of times we can go back in and redo the scenario and it’s a good opportunity to really learn”

— Katy Hancock, nursing student

Following the ongoing success of the VR program in nursing, the team at UNE are now looking to expand VR to cover PAs and other healthcare professionals. 

Interested in trying VR sim? Arrange a free demo with us today.

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.

VR Simulation at Johns Hopkins University School of Nursing

Johns Hopkins Student Nurse
Johns Hopkins Student Nurse
Johns Hopkins Student Nurse

“It’s amazing. You feel like you’re in a whole other world!”

Melissa Boggan, Nursing Student

Johns Hopkins University (JHU) School of Nursing is one of the world’s leading nursing programs, driving advancements in education, research, and practice.

As their simulation program expanded, the team at JHU were looking to scale delivery of simulation quickly, using the leading technology and software available. They therefore implemented Oxford Medical Simulation (OMS) Virtual Reality scenarios in pre-licensure and advanced practice programs across the nursing school.

The newly implemented VR program is part of their integrated simulation training program, including manikins and live actors, and complements clinical visits with hospital patients.

JHU’s Virtual Reality lab provides fully immersive virtual placements for multiple nursing programs, including the newly launched DNP Nurse Anesthesia and DNP Pediatric Dual Primary/Acute Care Nurse Practitioner programs. The program’s implementation in 2020 helped JHU maintain training momentum during the COVID-19 pandemic.

“We rolled out the [OMS] virtual simulation platform over the summer, during COVID, and were able to train about 400 students in a short time frame,” says Kristen Brown, advanced practice simulation coordinator at the School of Nursing.

Johns Hopkins Simulation VR team

VR simulation, a growing movement in nurse training before the pandemic, took on new meaning when restrictions impacted learning. VR simulation made socially distanced simulation possible. The spread of coronavirus “put steam behind moving the project forward,” says Nancy Sullivan, clinical simulation director at the school. 

Implementating VR in Practice

“Since March and the beginning of restrictions for in-person clinical experiences, traditional clinical and simulation for MSN (Entry Into Nursing) students were conducted virtually to enhance and sometimes replace clinical hours. Virtual or remote simulation also replaced non-direct clinical hours for advanced practice DNP students.” 

Maximizing experiential learning opportunities, JHU learners begin with the scenarios on-screen. Students who score 80% and above can visit the school’s brand-new Virtual Reality Lab, where COVID-19 safety protocols enable them to use the VR headsets for a fully immersive experience.

Whether on-screen or via VR headset, each OMS scenario places the learners in a virtual setting with a nursing assistant, who helps users assess and manage their virtual patients. With adaptive conversation, dynamic physiology, and powered by artificial intelligence, OMS virtual patients enable patient avatars to alter their behavior based on the learner’s interventions. “Depending on when you do something, the physiological response of the patient changes,” Brown explains. “When I put the oxygen on, or how much oxygen I give, changes the scenario. It adjusts to the learner.”

Johns Hopkins Virtual Simulation Lab

“I first used the on-screen version last semester,” recalls Kristin White, a pre-licensure student who graduates from the Entry into Nursing Practice program in May. “It was an asthma patient. We practiced at home and had to score 80% on different tasks. Then we got to do it with the headset on campus, which was great, almost like real life.”

Another nursing student, Melissa Boggan, says, “It’s amazing. You feel like you’re in a whole other world.”

Following Virtual Reality sessions, students gather, at a safe distance, with their instructors to participate in a group debrief session. Together with their instructors, students discuss the case, review their performance, ask questions, learn as a team, and become better prepared for clinical practice. 

Students then repeat scenarios to help improve their performance and reduce the emotional stressors that can derail procedures. “And they don’t run the risk of hurting anyone,” Brown says. “They learn critical thinking skills while being exposed to high-risk situations not seen very often. It’s great preparation.”

Benefits of VR in Nursing Education

Virtual Simulation has numerous benefits for nursing students:

  • Increasing experiential learning opportunities 
  • Improving performance and reducing emotional stressors through repetition
  • Better preparing new nurses to enter the workforce
  • Ultimately protecting patients and improving patient care
Johns Hopkins Simulation Lab

VR simulation, as a tool in the sim toolbox, has extensive benefits for the nursing profession. “It has implications on enrollment and increased delivery of online programs, allowing nurses to remain in the workforce while advancing education,” Brown says. “More education rooted in experiential learning will produce a better-prepared workforce improving patient care.”

Brown and Sullivan are also researching how VR compares with other simulation methods and clinical practice. Early results are positive, with user  ratings being “very high in terms of usability and the scenario debriefing.” 

Vitally, when students compare OMS VR scenarios to traditional simulation and clinical experience, they either rated OMS “‘’similar’ or ‘higher'” illustrating the quality of the VR experience relative to traditional approaches. 

The JHU simulation team is now expanding OMS use in their virtual simulation program, continuing to provide world-leading simulation opportunities to their students. 

Read more from JHU

  1. Amidst Covid-19, Virtual Reality Makes “Social Distancing” Simulation Possible
  2. School Of Nursing Introduces A New, Cost-effective Form Of Training: Virtual Reality
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How to Clean Your VR Headset

Cleaning VR headsets during COVID
Cleaning VR headsets during COVID
Cleaning VR headsets during COVID

Guidance on Cleaning VR Headsets

Disclaimer: This is not medical advice. This guidance should not overrule protocols your institution may already have in place or the need for specialist advice to be taken. Rather, this is guidance collated from various sources that you may find useful.


The SARS-CoV-2 (COVID-19) virus is thought to be able to survive up to 72 hours on plastic. The options are therefore to quarantine your equipment or decontaminate it. The information below covers decontamination as well as general measures to prevent transmitting COVID-19 during VR sessions.  

General measures

  1. Assess learners for potential symptoms or exposure risk before they use the VR headset and record who uses the headsets to facilitate contact tracing. 
  2. As per your departmental protocols, maintain a safe distance between learners, wear masks where practical and ensure regular hand-washing.
  3. Note that if a learner cannot use the VR headset they can always run OMS simulations on-screen using the mouse and keyboard. These should be cleaned using your usual protocols.

Cleaning methods

  • Wash your hands prior to using the VR headset and handling shared equipment. Use nitrile gloves while cleaning and dispose of gloves after each use. Between cleanings, either wash hands thoroughly or use hand-sanitizer. Wash hands thoroughly after each use.
  • Ensure the equipment is cleaned between each use. This should include the interior and exterior of the headset, the controllers and the computer – with special attention to the mouse, track-pad and keyboard. 
  • Let all equipment completely air dry after cleaning before the next use – ideally for at least 10 minutes. 
  • Use a dry microfiber cloth to clean the lenses to avoid smudging.
  • Never use abrasive cleaners on VR headsets or other plastic equipment.

Cleaning products

Alcohol-based cleaning products

Different products have different effects on the survival of COVID-19. Alcohol-based products appear to be most effective against COVID-19. However, many equipment manufacturers specifically advise against alcohol, as in the long term it can dissolve certain plastics, make plastic less flexible or discolor it. Non-alcohol-based products are also available and do appear to be effective, but a concession has to be made between potentially damaging your headset in the long term and achieving theoretical maximum protection for your learners. Note that alcohol-based products should not be applied to the lenses of the headset under any condition. 

Non-alcohol-based cleaning products

Non-alcohol-based products are recommended if you would like to avoid alcohol-based cleaning products to protect your headset. These appear to be highly effective provided they are used correctly. Always follow the manufacturer’s instructions – in particular, ensure the headset’s surface becomes visibly wet and is then fully dried prior to the next learner. Examples: Wexford Cleancide; Lysol wipes.

Face pads

Your current headset face pads may be porous and therefore have the potential to harbor viruses. Cotton coverings and disposable face pads often allow moisture through, so are generally not advised. Instead, removable waterproof face pads may be used to increase the ease of disinfecting the whole headset. Examples: vrcover.com; kiwidesign.shop

UVC light

Headsets can be decontaminated by exposing them to UVC light for a specific amount of time with a specific wavelength. Such lights and light boxes are commercially available, and appear to be effective. However, they can be costly. Examples: Cleanbox; UVBox 

Further References

  1. RoadtoVR – how to clean your headset
  2. Iris VR – Guidelines for cleaning your headset
  3. Upload VR – Cleaning your Oculus
  4. VR Hygiene and Safety on LinkedIn


Using Distance Simulation to Supplement Clinical Hours

Clinical hours replacement with VR simulation
Nursing Virtual Simulation Oxford Medical Simulation
Nursing Virtual Simulation Oxford Medical Simulation

In these uncertain times, universities and hospitals are being forced to reconsider how to train their learners and keep students on track to graduate or promote the next wave of healthcare providers. 

For some, the question of how to supplement clinical hours with simulation has been an ongoing question or debate. Now, simulation is no longer a “nice to have” learning modality for programs but a “need to have”. Furthermore, live simulation is no longer an option for most so the question becomes, how can virtual simulation be used to supplement or replace lost clinical hours?

This is a question on so many minds at the moment and while the research and data to fully support this answer is still coming, there are several existing resources and theories around simulation-based education that can be used to help answer it. 

“Simulation is no longer a ‘nice to have’ learning modality, but a ‘need to have'”

Can I Use Virtual Simulation for Clinical Hour Replacement?

First, there is the initial question of can virtual simulation be used to replace clinical hours at all? According to a statement released by Dr. Foronda (president of INACSL) and Bob Armstrong (president of SSH) the evidence and these organizations support the use of virtual simulation to replace clinical hours. This statement outlines the problem being that students may be blocked from graduating from their programs because of clinical hour requirements.

This ultimately comes down to the state policymakers but many states in the United States have already loosened the reins on these requirements to allow for flexibility. In a time where there are already shortages in medical personnel and now a pandemic on top of that, it is critical to support the training and promotion of these health care students to practicing health care professionals (doing so in a way that still provides them the best educational experience possible). 

The next question for some whose state legislation allows high-fidelity simulation to replace clinical hours is: does virtual reality or virtual simulation count as high-fidelity simulation? The answer to that, based on the SSH definition of high-fidelity simulation is clear: Yes.

According to the SSH Dictionary,  “high-fidelity refers to simulation experiences that are extremely realistic and provide a high level of interactivity and realism for the learner” which includes virtual reality. 

“Does virtual reality or virtual simulation count as high-fidelity simulation? The answer to that, based on the SSH definition of high-fidelity simulation is clear: Yes”

Clinical hours replacement with VR simulation
Clinical hours replacement with VR simulation

How Much Time in Virtual Simulation Equals Clinical Experience?

Now that we’ve established virtual reality and virtual simulation is high-fidelity simulation and there is evidence to support its use in place of live clinical experiences during this pandemic, the primary question has been how many clinical hours can be replaced with virtual simulation. 

The answer to this depends on the source of virtual simulation, the resources provided before and after and the structure in which the simulations are implemented into the curriculum. The following is one example, using an OMS Distance nursing simulation scenario, in which one scenario could replace up to 4 hours of clinical. This same structure can also be used for the medical scenarios or interprofessional education scenarios depending on how they are implemented.

This example is based on using the INACSL Standards of Best Practice: Simulation Design and Debriefing to support prebriefing and debriefing activities before and after simulation. It is also using evidence from the 2019 study supporting 2:1 clinical to simulation hour ratio

The following example was created starting with the simulation itself and working out (adding pre-simulation and post-simulation activities). Again, this is based on personal experience as a simulation educator, what is known about the standards of best practice and specifically using OMS scenarios as an example. These guidelines can be used for any virtual simulation and then can translate back to live simulation or live VR simulation (headset or HMD) when learners are able to return to campus.

To allow learners the opportunity to practice critical thinking and efficient patient care, each scenario is 20 minutes in length. Although the question of how long to debrief an experience has been debated, the research and best practice that I’ve always been taught is to debrief for twice the length of the scenario.

In this case, 40 minutes which can include the provided self-reflection and personalized feedback. In this example, 1 virtual OMS simulation scenario could equate to 1 full hour of simulation or clinical experience; however, there is much more that can and should be built into this simulation experience to increase the value as well as length of time. 

How Do I Use Deliberate Practice in Virtual Simulation?

There are several simulation practices that can enhance the learning experience that can be incorporated into this timeline. First, deliberate practice which improves critical thinking, clinical judgment, decision making and confidence. An advantage of using virtual simulation, whether on screen or in a headset, is the ability to allow students to repeat scenarios as many times as they’d like (deliberate practice). This practice provides the personalized and individualized experience of running a scenario again and again without adding the time, space, or cost associated with running a live simulation again and again. In this example, it’s suggested to have the students run the scenario at least twice. 

Can I Use Reflective Pause / Reflection-in-action?

Another tool that can be helpful in simulation-based learning is the reflective pause or focus on reflection-in-action. In this example, students are encouraged to reflect-on-action by reviewing the feedback and completing their reflection after the initial scenario. However, then by having students immediately return to the same scenario, now with the knowledge and insight gained from the first passthrough, they are better prepared to reflect-in-action during their subsequent experiences. 

As previously mentioned, in this virtual reality simulation platform, students are prompted to do a self-reflection immediately after completing the scenario. Then, they are given personalized yet objective feedback based on their clinical decision making during the scenario. And finally, there is a place provided for students to then complete and document a proper self-debrief or self-reflection. In this example, students can take about 20 minutes to do this after the first session, then extend that time using additional activities and debriefing methods to 40 minutes after the second session. A full timeline breakdown is provided below. 

How Do I Debrief Virtual Simulation?

According to the INACSL Standards of Best Practice: Simulation Design – criterion 8, each simulation should have a debriefing or feedback method and it should be consistent. While the self-reflection and feedback provided with OMS is based on the PEARLS method, there are several methods that can be used to debrief a virtual simulation

In this example, at least 40 minutes should be used in the final debriefing session which gives educators time to allow students to review the objective feedback and then break into additional group debriefing. This group debriefing can be via video conferencing (ideal) or via a chatroom style classroom on a learning management system. 

Additionally, students can be asked to complete a post-simulation activity to extend their learning experience and physical practice. For example, students can practice documenting their assessment from their virtual experience. On-screen virtual simulation (compared to headset/HMD VR) lends itself to this nicely as students can take notes as they go and catch missed items in their subsequent runs of the scenario. Documentation can be done in a note fashion or by using an EHR platform. EHR’s can also be created using Excel or Google Forms. 

Another post-simulation activity option is to have students record themselves doing a shift-to-shift report based on the scenario. This report can then be posted to the LMS for peer review and feedback. 

Depending on the scheduling ease or conflicts, a group debrief immediately following the simulation experience may not be possible (although debriefing immediately after the experience is ideal). In this case, students can complete the self-reflection and conduct a self-debrief using the feedback, guided questions and supplemental post-simulation activities. If a group debrief is scheduled for a later time, students can then review and bring with them their feedback to this group discussion. 

To learn more about debriefing virtual simulations, see Simulation Canada‘s webinar “Virtual simulations: What are my debriefing options?

Should I Prebrief Virtual Simulation?

The last thing missing from this experience is prebriefing (INACSL Standard of Best Practice: Simulation Design, criterion 7) which does not have to look very different from prebriefing a live simulation experience. In live simulation, students may be provided with a room orientation, orientation to equipment, learning objectives, pre-simulation activities, a timeline, and the opportunity to ask questions. Using the LMS, students can be provided with learning objectives, pre-simulation activities or reading assignments, as well as a forum to ask questions and troubleshoot before their virtual simulation. Room and equipment orientation is then provided by OMS via videos to teach or remind students how to navigate the virtual scenarios and review the feedback. Educators or former students could also include a recorded shift report for students to review online prior to entering the OMS scenario. 

The biggest foreseen difference between a live simulation prebrief and virtual simulation prebrief is that the responsibility and time required to complete this falls on the student. In this example, prebriefing time will be considered 20 minutes. To help guide and track students time, part of the prebriefing experience should be providing the students with the expected timeline for this experience. An example of this posted to the LMS may look like this:

Today’s Simulation Experience timeline:

  1. Please complete the pre-simulation activities (20 minutes)
  2. Complete simulation scenario – George, SNR101US (20 minutes)
  3. Review feedback and complete “My reflective practice” (20 minutes) – Reflection must be 3+ sentences and shared to faculty
  4. Repeat simulation scenario – George, SNR101US (20 minutes)
  5. Review feedback, complete “My reflective practice” comparing first attempt to second attempt, complete additional post-simulation assignment (group debrief, documentation assignment, individual debrief using worksheet or tool, etc) (40 minutes)

“In this virtual simulation example, the 2 hour virtual simulation experience (based on a 20 minute scenario run twice with structured prebriefing before and debriefing after) would equal 4 hours of clinical time.”

Final Timeline Review

In review, we’ve now taken a single virtual reality simulation scenario and structured it’s execution to equate to 2 hours of simulation time. 

The final element of this “how much clinical time equals virtual simulation” debate is considering how much live simulation is considered clinical time. In this scenario, we are considering virtual simulation and live simulation time equivalent, although future research and data can hopefully help clear up whether that ratio is appropriate. 

Due to the increased intensity and efficiency of simulation, evidence supports using a 1:2 ratio for simulation to clinical time. What this means is that for every 1 hour of simulation, students are given 2 hours of clinical time. In this virtual simulation example, the 2 hour virtual simulation experience (based on a 20 minute scenario run twice with structured prebriefing before and debriefing after) would equal 4 hours of clinical time. 

This information, as well as a discussion and demonstration of the OMS Distance platform is also provided as a Webinar. To access the webinar or discuss this further with an Educational Specialist, please click below.


Article by Molly Schleicher RN, MSN, CHSE – Educational Specialist at Oxford Medical Simulation


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.


  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.


Supporting Nursing Education at the University of New England

Virtual Reality (VR) simulation allows nursing students at the University of New England to practice caring for acutely ill virtual patients within an immersive, realistic setting.

The University of New England (UNE) is working with Oxford Medical Simulation (OMS) to deliver state-of-the-art virtual reality software to transform nursing education. 

The immersive virtual reality platform supports nursing students at the UNE School of Nursing and Population Health in providing simulated patient care to advance clinical decision making and communication skills with other health care providers. This training allows nursing students to practice in true-to-life virtual scenarios without posing risk or harm to patients and families.

The technology is developed by Oxford Medical Simulation, an award-winning VR simulation company – based in Boston and London – and allows nursing student to practice treating acutely ill patients in a simulated, virtual environment. This optimizes skill development including clinical reasoning, decision making and patient/team communication, resulting in increased competence and confidence in managing complex care. 

UNE’s Interprofessional Simulation and Innovation Center (ISIC) is committed to providing state of the art experiential learning opportunities to health professional students,” said Director of Clinical Simulation Dawne-Marie Dunbar, MSN/Ed., RN, CNE, CHSE. “With the OMS VR platform, we will be able to increase simulation capabilities that offer students access to complex patient care scenarios while optimizing time, space, and resources.” 

This innovative technology allows UNE ISIC to engage students in expanded simulation-based experiences. Simulation refers to the use of simulated patients to practice delivery of acute patient care and is widely regarded as the most effective way of training health care professionals. Simulation is traditionally implemented with actors and/or manikins staged within a mock, realistic setting. However, high-fidelity simulation requires significant time, space, and budget. As a result students may only receive two-to-three simulation experiences per year. With virtual reality simulation, students are now able to practice simulated scenarios as often as needed.

“We’re delighted to be working with the University of New England to take nurse training to new heights. We developed OMS because we believe that training healthcare professionals in a flexible, zero-risk environment will transform patient care around the world. We all learn best from experience and the OMS system allows users at UNE to do just that – without putting patient’s lives at risk,” said Jack Pottle, MD, Chief Medical Officer of OMS.

The OMS system provides students access to libraries of nursing scenarios, supporting practice of care provision and clinical decision-making across a wide range of conditions such as sepsis, pneumonia, heart failure, and meningitis. Students enter the interactive virtual scenario using a VR headset and are greeted by a virtual mentor and their patient/family. Learner interaction with the patient mimics real-life engagement with a patient. Through this pedagogy (or experience), learners can examine the patient, ask questions, initiate treatment, and provide support/reassurance as they would in actual clinical practice. Every action the student takes is recorded and compared to best practice. Once the scenario is complete, the platform produces a comprehensive data analytics report providing the student with detailed feedback. This serves as a debriefing tool to guide reflection as to what went well and what they need to improve on.