Category Archives: VR simulation

Virtual Reality for Nontechnical Skills

multiple people in VR hospital room
multiple people in VR hospital room

Across industries, like healthcare and aviation, virtual, augmented, and mixed reality have been used to assess and  progress technical and procedural skills from emergency medicine to pilot training

As a result of VR’s growing use cases, research has expanded to include the use of these new technologies on the development of nontechnical skills, with a focus on skills like: 

  • Communication
  • Critical thinking
  • Teamwork
  • De-escalation
  • Empathy
  • Situational awareness

According to a systematic review of virtual reality and healthcare professionals’ nontechnical skills training – teamwork, communication, and situational awareness were the most frequently studied nontechnical skills, which are often skills necessary for interprofessional teamwork. 

These nontechnical skills, sometimes referred to as ‘soft skills’, are imperative not only for compassionate patient care, but also for the situational awareness and clinical decision making that comes along with the daily requirements of interacting with patients and making swift, sound clinical decisions at a moment’s notice.

Why use VR for nontechnical skills?

There are several emerging factors that indicate the use of VR as a valuable adjunct to healthcare education and training. VR can be a cost-effective way to promote reeducation or facilitate development of new skills, and it offers an added benefit of portability and requires minimal space to set up. 

Another key feature of virtual reality simulation is the individualized practice that learners go through compared to other methods of simulation that often occur in groups. 

Educators, trainers, or simulation technologists may gravitate toward virtual reality, particularly for difficult to simulate situations, like large-scale emergencies, or for conditions and situations that are not often seen in daily clinical practice.

As virtual reality can be engaged with remotely, it opens the door for members of interdisciplinary teams across departments to work together wherever they are, eliminating some of the administrative work of coordinating schedules or reserving a conference room. 

A systematic review looking into the design of virtual patients in medical communication skills noted the strengths and areas of improvement for virtual reality simulation in medical education, and reported that VR remained an area of interest and promise, in part, due to the repeatability and immediate feedback provided by VR. 

Specific nontechnical skills training in VR

Patient Interactions

With AI becoming ever-more advanced, the use of AI-driven virtual patients allows learners to have conversations with patients in the VR world just like they would in real life. This use of voice control, combined with the rich backstories of virtual patients, brings an additional layer of complexity to virtual scenarios and allows learners to stretch their nontechnical abilities. 

Particularly in scenarios focusing on complex communication, such as de-escalation, breaking bad news and motivational interviewing, skills such as communicating in an empathetic and holistic manner are vital – and VR allows this training at scale.

Interprofessional Teamwork 

In many team-based scenarios, learners from multiple disciplines must work together to collect relevant information, form hypotheses, devise and conduct an intervention plan, and monitor the patient to determine the success of treatment or the need to make adjustments. 

Learners can speak directly with one another during the scenario to facilitate timely team decision making and a collaborative interdisciplinary environment.

Additionally, interprofessional scenarios allow multiple disciplines to learn from one another, providing insights into the roles of other professionals, and with team-based feedback, learners can gain a deeper understanding of how their actions, and the team’s actions as a whole, impact patient care.

VR simulation with defib

Clinical decision-making

Independent of the type of scenario, learners can engage in critical thinking and situational awareness, informing their clinical reasoning and decision making skills.

By engaging in observational skills, learners can monitor patient status changes or fluctuations, like an onset of pallor or clamminess. Performing assessments, like vital signs or auscultation, can provide learners with pieces of information that help them put together a holistic picture of the patient’s status.

In taking on a lead role, learners become responsible for the collation of data provided by the patient and medical chart that, together, help to inform a clinical diagnosis. As this diagnosis becomes clearer to the learner, actions must be taken in order to address the underlying problem, meaning learners must know how to collect relevant information, interpret it, and how to intervene in the best interest of the patient. 

The development of nontechnical skills is essential for both future and current healthcare professionals, which give clinicians a foundation from which to make appropriate decisions and communicate effectively, both interprofessionally and with patients. 

The use of virtual reality for training nontechnical skills is a growing and exciting area of healthcare, demonstrating yet another possibility for using VR to supplement and innovate healthcare education and training.  

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

Clinician Decision Making in Virtual Simulation

Oxygen placement virtual simulation
Oxygen placement virtual simulation

Healthcare professionals, like nurses, doctors, or occupational therapists, make an incredible number of decisions per day. In fact, nurses working in critical care actually make decisions almost every 30 seconds, adding up to about 960 decisions made in a single shift of work. 

This inordinate amount of decision-making directly impacts patient care, so it’s vital that clinicians are not only making and acting on these decisions, but also that they’re taking into account a multitude of factors given the context of the case to make the best possible decision for their patients. 

In order to build a skill, even complex and nuanced ones, repetition is a key component of success. Healthcare professionals and students alike need to continually leverage the knowledge they have to apply their skills and put it all together to make sound clinical decisions, and the use of new digital tools is one way to allow for consistent and flexible repetition to maintain or build skills. 

Clinical decision making

There are lots of terms used to describe a part of the whole process of making a clinical decision, and while they are all a piece of the puzzle, they’re not necessarily interchangeable. 

The term ‘clinical reasoning’, for example, was studied in a scoping review which found that across several hundred papers across health professions, 110 different terms were used to describe or to reference the concept of clinical reasoning. 

Within the context of physical or occupational therapies, there are explicit definitions in clear frameworks that use this term to describe the process of clinical reasoning, however, not all disciplines use the same definition or frameworks. 

‘Clinical judgment’ is a term becoming more quantifiable thanks to the National Council of State Boards of Nursing (NCSBN) who created a working model to measure clinical judgment in the Next Generation NCLEX. 

There are several models or frameworks used to describe the process of clinical decision making in nursing, and there are multiple factors that can influence the decision-maker, both intrinsic to the decision-maker, e.g. experience level, and extrinsic, i.e. environmental factors. 

virtual patient headache

Clinical decision making is context-dependent and often time-sensitive, meaning all of the factors that go into a decision and action require high-level cognitive skill to efficiently assess and analyze the entirety of the situation, then form a judgment, make a decision, and act. 

Methods like simulation-based education have been used to bolster the connection between theoretical knowledge and practice, and as virtual reality has been adopted into the healthcare industry, it’s gaining more traction in its use for the development and assessment of harder-to-test concepts like critical thinking, clinical reasoning, and clinical decision making. 

Virtual simulation supporting clinical decision making

Virtual simulation, often used as an umbrella term to include in-headset & immersive virtual reality (VR) and virtual screen-based simulation (VS) has become an accessible and flexible way to have learners work on skills and knowledge transfer in and outside of the classroom or clinical setting.

A systematic review spanning 1996-2018 found that 86% of included studies reported that virtual simulation had a positive effect on students’ learning outcomes, which included critical thinking and decision making, as well as knowledge and skill performance, among others.

For undergraduate nursing students, in particular, virtual simulation has been used to bolster the development of clinical decision making skills, and while more extensive research is needed in this rapidly-evolving field, virtual simulation appears to be promising for cognitive skill-building in future healthcare professionals.  

Virtual simulation offers a means by which learners can engage in simulation-based education at any time, anywhere, with unlimited opportunity to repeat and practice skills at their own pace.

virtual patient hand tremor

As virtual simulations are standardized, they’re able to be used to both practice conceptually-driven skills like clinical reasoning and for procedural skills like catheterization. 

By placing learners in a lead role, it’s easy to see how virtual simulation can encourage and challenge cognitive skills like clinical reasoning and judgment. 

In these scenarios, learners can assess the situation and gather relevant information through a variety of methods and use context-dependent reasoning and observational skills to inform hypotheses and implement interventions, without ever placing patient safety at risk. 

Learners are able to practice making decisions in a timely manner in a safe environment where mistakes are encouraged and used as a learning opportunity. 

Automated feedback can reinforce well-understood concepts and skills while providing evidence-based rationale to bolster acquired knowledge and bridge the gap for skills or concepts that prove difficult to transition to practice. 

In addition, virtual simulations can be used to assess these types of skills – University College Birmingham has utilized VR in this way with plans to expand its use in their programs, and Stamford Health has used VR to assist their entry-level nurses in the transition to practice. 

Virtual simulations continue to show promise for their use in the development of skills like clinical reasoning and decision making. To learn more about implementing VR into a curriculum or training program, set up a time to discuss in more detail here.

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

The Beginner’s Guide to Virtual Reality Simulation in Healthcare

VR simulation with defib
VR simulation with defib

Healthcare is a fast-paced, patient-centered industry. To keep pace with advancements and increasing amounts of knowledge requires continuous learning, developing new skills, and maintaining foundational skills. 

The advancement of technology has made waves in the healthcare sector, and as tech continues to improve rapidly, its uses and functions evolve, as well. 

The Issues Facing Nursing Today

In the United States, for nursing, in particular, there is serious concern about the rising rates of turnover. This costs employers around $52,000 on average for each turnover, and it may also place an additional workload on remaining employees while the employer recruits and hires a new RN, which can often take about two to four months. 

Many nurses are making their voices heard and their concerns known. Hear Us Out, a campaign launched by the American Association of Critical-Care Nurses, reports that 66% of acute care nurses surveyed stated that they considered leaving the profession following their experiences during COVID-19. 

These circumstances are likely exacerbated by the projected nursing shortage, which is expected to impact at least 30 states by 2030. This impact is already becoming observable – in 2021, the total number of RNs experienced its most significant decline in over 40 years, with over 100,000 nurses lost, many under 35.

Younger nurses are demonstrating greater feelings of anxiousness and lesser feelings of emotional well-being compared to their counterparts over 55, according to the Two-Year Impact Assessment conducted by the American Nurses Foundation. 

Impacted by workforce shortages and declining well-being, about 52% of all nurses surveyed reported that they have considered leaving or intend to leave the profession entirely. Of those who may leave, 63% were under 35. 

With approximately 800,000 nurses planning to leave by 2027, it’s clear that left unaddressed, this could quickly become a crisis. 

Alarmingly, a large majority of new nurses are viewed as underprepared for practice as reported by their employers.

In fact, about 91% of new nurses assessed in terms of their readiness to practice fell outside of the acceptable range for competency. 

These rising expectations are so well-known that the NCSBN generated an entirely new generation of the NCLEX in order to accommodate and reliably assess the concept of clinical judgment for entry-level nurses.

And while the well-being of hospital employees is imperative for a healthy work environment, patients are also likely to suffer in the wake of this looming healthcare crisis. 

Nurses entering the profession need to be adequately prepared to practice, and they need to be supported by their employers.

Advancing technology, like virtual reality simulation, is one component of a much larger plan needed to address the issues above and positively change the state of the nursing industry. 

Virtual Reality in Healthcare: An Overview

Virtual reality simulation is used by many disciplines across the healthcare spectrum, and there are three main areas where VR is often seen – therapeutic, clinical, and education & training. 

For therapeutic purposes, practitioners are often using virtual reality simulations with patients at the helm of the scenario. This is seen in physical therapy treatment during stroke rehabilitation, and in other areas of healthcare such as the management of chronic low back pain.

Clinically, VR is often seen being used to facilitate skill development and procedural processes, such as laparoscopic skills

Educational institutions are embracing this new wave, as well, and are embedding virtual reality into curricula, developing a foundation of virtual reality simulation for their students, and they are often finding positive feedback and engagement from their students. 

For example, medical students have been using VR as a means to develop empathy for their soon-to-be patients. 

From the beginnings of developing a new skill through the transition to practice and into continuing education and training, virtual reality is being used to bolster learning and prepare students and clinicians for practice. 

Beyond education and into practice, VR has been used in areas including: 

  • Assessment
  • Transition to practice
  • Onboarding
  • Training


Often, assessment involves completing a written multiple-choice exam or standing up in front of a room to give a presentation. 

You’re probably pretty familiar with exams like the Next Generation NCLEX which utilizes a written format to test concepts like clinical judgment and make determinations about a test-taker’s readiness to practice. 

In other ways, having an assessor observe and grade a learner in a physical simulation is a means for testing, as well. 

Perhaps you’ve utilized or interacted with live patient actors as a way to grade technical or communication skills, but have you ever thought about using virtual reality to achieve the same goal? 

At Oxford Medical Simulation, a team of in-house Clinical Authors use their professional experiences to inform, ideate, and create holistic, true-to-practice scenarios based on current evidence and best practices.

Because these scenarios are standardized, you can utilize them to determine a benchmark that signals a learner has met the criteria for demonstrating a given skill or set of skills. 

University College Birmingham, for example, has increased their use of VR simulation for both educational and, now, assessment purposes

The faculty at the university collaborated with one another to determine which scenario was most appropriate for their learners, and they collectively decided on a particular score that would serve as a marker showing learners had passed the assessment. 

As OMS scenarios provide automated feedback and rationale, learners have quick access to resources that give them greater context into how they led the situation, what could have gone better, and why certain skills or timestamps are particularly important. 

Feedback with rationale - what went well and what to improve on

Using VR for assessment isn’t limited to healthcare students – licensed healthcare professionals can also participate in testing this way. 

Virtual reality clinical simulations have already been used to assess procedural or technical skills, like surgical endoscopy skills. From medical students to experienced clinicians, this study demonstrated a means by which skills could be measured across a range of experience levels, meaning students and practitioners, alike, can use VR as a tool to assess their skills.  

Even more difficult-to-test concepts like clinical judgment or competence have been tested using virtual simulations, giving more weight to the notion that virtual reality simulations can offer a way to conduct formative assessments in practice. 

Assessing readiness is one way to help learners prepare for the transition to practice, whether they’re taking on an entry-level role or if they’re returning to the clinic in a new or advanced position. The transition to practice is an essential time to provide support and resources to learners. 

Transition to Practice

Virtual reality clinical simulations offer a unique opportunity for learners to take on a lead role in the clinical setting, providing a safe space for learners to immerse themselves in their respective positions, and for learners who are newer to their roles, it’s a chance to explore and more deeply understand the requirements and daily responsibilities of their new position. 

Learners get a first-person perspective on providing patient care while managing their other responsibilities, particularly within the context of low-frequency, high-stress situations that aren’t often seen in the clinical setting or that are difficult to simulate traditionally. 

Taking on the lead role of the nurse or physician, for example, places learners in a position to direct the outcome of the simulation. A given scenario can result in a range of different outcomes, meaning the learner’s decisions and actions directly influence the results of the scenario. 

Learners are able to see the consequences of errors play out in real time, without ever placing patient safety at risk. 

As competency builds and complexity increases, more intensive VR scenarios can be used that reflect building and managing a caseload of multiple patients

This set of scaffolding scenarios builds upon itself, with a beginning caseload of a single patient and ending with a caseload of five patients. 

In these types of situations, learners will have to utilize the skills they’ve already learned to manage a caseload with increasing complexity; learners will need to delegate tasks, prioritize and adapt to new information, and they will need to do all of this while managing their time, as well.

patient with pallor and nurse drawing blood

VR clinical simulations can be used to grow with learners, supporting them as they build their knowledge base and skill set, from entry level to graduate or doctorate level – VR is already being used to help learners beyond the classroom and in the clinical setting. 


Virtual reality can be used to support new trainees as they onboard and get familiar with their new work environment. 

Stamford Health, a hospital system in Connecticut, is utilizing VR to help entry level nurses in their transition to practice. 

As a part of their GEMS program, Stamford uses virtual reality simulations to prepare and assess new nurses’ readiness for practice as they go through a comprehensive onboarding program designed to guide them as they become practicing nurses. 

Some facilities may choose to customize VR simulations for an even more realistic reflection of the actual hospital setting, so that newly hired personnel can become quickly familiarized with their new work environment.

VR can be used to identify and remediate knowledge gaps amongst new and more experienced staff. 

To begin the process of bringing teams together, VR simulations can be used to help with team building, demonstrating dynamics which may be different from facility to facility, and giving newly hired personnel a chance to practice working with their colleagues. 

This also gives experienced employees a chance to get to know other members of the healthcare team, and it can be used to encourage cross-disciplinary collaboration with interprofessional scenarios


From the big to the small events, virtual reality simulations can be made to reflect almost any environment. 

Facilities may choose to use virtual reality as a means to identify and remediate knowledge gaps amongst staff, run interprofessional scenarios involving multiple disciplines, or they may use scenarios to further continuing education for their providers. 

ACLS virtual simulation

Cases can be tailored to fit the typical cases seen in a given environment. For instance, a women’s health clinic may use a scenario involving preeclampsia whereas an emergency department may use an ACLS simulation. 

Virtual reality is already being used to support training for particular cases like those involving diabetic emergencies

VR simulations have also been used to keep staff fresh on specific, low-frequency, high-stress situations, such as in the case of cardiopulmonary resuscitation following a cardiac surgery. 

While many virtual reality simulations focus on procedural and technical skills, there are many non-technical skills that can be practiced in-scenario. 

For instance, the use of voice control allows a learner to speak directly with a virtual patient, providing a safe place to practice communication skills, motivational interviewing, or engaging in crucial conversations. 

From students to newly-licensed practitioners to advanced providers, virtual reality simulations can be a valuable tool for any level of learner, whether your goal is to keep a general skill well-practiced or to recognize signs of an emergent, uncommon condition, virtual reality provides numerous benefits across the spectrum of healthcare. 


For many of those in training or continuing their education, practice is an essential part of the process. 

VR simulations offer unlimited repeatability of scenarios, granting learners the chance to work on skills until they feel comfortable or until they demonstrate competence as determined by the faculty or facility trainers. 

The flexibility of a headset or a computer-based simulation means less emphasis on scheduling and coordination of schedules and more focus on skill-building and refresher training. 

VR sim in headset and on screen

Training can be conducted anywhere, from a large, high-tech simulation lab to a small room with one outlet – you can take VR anywhere. VR can bring about more convenience, less setup and breakdown time, and fewer administrative tasks to juggle. 

Setting up VR simulations can often result in cost savings, whether that be in setup and implementation or in maintenance costs. Quick, reliable, easy-to-use VR headsets can mean more time saved by faculty and staff, and fewer resources needed for simulation training. 

Creating a safe space for learners to practice is also essential, and VR use offers learners the ability to make mistakes in a psychologically safe environment, opening up dialogue and allowing for reflective thinking to improve future performance. 

The ability to stay up-to-date on relevant materials and skills, practice low-frequency situations, and work with colleagues in scenarios may have a positive impact on the state of the nursing industry, as well. 

What’s Next for VR in Healthcare? 

As VR is already in use for a wide range of outcome measures, like clinical decision making, procedural skills, communication skills, and teamwork, with the continuing rapid development of this technology, the possibilities are endless. 

Haptics and hand control allow for tactile feedback, adding another layer of immersion to the realism of VR, along with voice control, which allows for learners to speak throughout the scenario.

With authoring platforms, the possibilities widen even further, allowing for facilities to create their own bespoke content, complete with their own case summaries and learning objectives. Scenarios can be made less or more complex, depending on the learner level and desired outcomes. 

There are so many ways in which virtual reality is already being used in healthcare education and training, and as VR continues to be embedded into curricula and training programs, there will continue to be more avenues for its use as a tool from education and into practice.

For more information or to speak with someone about how virtual simulation can fit your specific needs, schedule a time to discuss with us here.

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