Tag Archives: Clinical hours replacement

OMS Partner with The Big 10 on Multi-Patient VR Simulation

University of Minnesota Nurse in VR
University of Minnesota Nurse in VR

At our core, the OMS team is made up of clinicians and healthcare educators. Like all of our colleagues in these fields we’ve become increasingly concerned by systemic issues in healthcare in being able to produce confident, competent, practice-ready healthcare professionals.

Thankfully, our company mission allows us to  be part of the solution. When we were selected to work with the The Big 10 Practice-Ready Nursing Initiative to do just that, we were prepared for the challenge.

Big 10 Practice-Ready Nursing Initiative is a partnership between the University of Minnesota School of Nursing, University of Michigan School of Nursing and Purdue University School of Nursing. The initiative was formed to respond to the issues arising from nurse graduates being unprepared to practice in today’s highly complex and dynamic care environments.

“As a caseload of patients increases, how do students learn how to prioritize care? How do they know what to do first and with which patient?”

– Cindy Bradley, Director of Simulation at UMN School of Nursing

To address these issues, the Big 10 has been exploring the strategies and curriculum integrations that a nursing school can employ to reduce the time their graduates need to onboard into the workplace. Ultimately, the aim is to prevent burnout and turnover in nursing. This initiative is supported by a $1.3 million grant from the American Nurses Foundation.

Enter VR simulation. Using the OMS virtual simulation platform and a VR headset, nursing students will be able to practice caring for multiple patients at once in a safe, risk-free virtual environment. By allowing more time to practice without risking patient safety, the project aims to demonstrate how nursing students’ confidence, competence and readiness for practice can be improved through virtual reality.

Virtual patient and instructor
Nurse at UMN
Nurse at UMN

Establishing a common goal was the easy part. The next phase of the project meant collaborating closely with the Big 10 to develop cutting edge multi-patient VR scenarios – pushing our platform to brand new heights in the process.

Cindy Bradley PhD, RN, CNE, CHSE, Director of Simulation at the University of Minnesota School of Nursing explains why multi-patient scenarios are so important: “As a caseload of patients increases, how do students learn how to prioritize care? How do they know what to do first and with which patient?”

Additionally, we have worked closely with the teams on the ground at the participating universities to ensure that all the necessary logistics are in place: from setting up VR headsets to ensuring onboarding guides are readily available.

Jannie White BSN, RN, CFRN, VP Client Solutions at OMS, describes how the partnership has come together around a shared vision: “A project like our collaboration with the Big 10 has a lot of moving parts. What has been most inspiring has been seeing how colleagues at OMS and The Big 10 have been galvanized towards a common objective. We knew going into this that we were pushing the boundaries of what could be done in VR simulation, and to be able to deliver on that with such success has been truly rewarding.”

“We are pushing the boundaries of what can be done in VR simulation, and to be able to deliver on that with such success has been truly rewarding.”

– Jannie White, VP Client Solutions at OMS

At the time of writing, the first two modules of the project have been completed – allowing students to scale up from managing a single patient to juggling two at a time. By the end of the program participants will have access to scenarios that involve managing up to five patients at once.

Bradley explains: “starting with one or two patients [students will work] their way up to a caseload of five. They’ll have more time to practice in a safe space without risking patient safety, while also gaining confidence and competence. Most importantly, they’ll be able to practice decision-making skills”.

The potential impact of the Big 10 and OMS collaboration reaches far further than the students that will be enrolled in the pilot project. Bradley imagines that, “With a headset and an internet connection, students anywhere can have the same learning experiences as students in our program”.

For OMS this project has proven to be symbiotic with our company mission: to improve patient care through increasing access to simulation.

Dr Jack Pottle, Chief Medical Officer at OMS, notes: “We founded OMS to address the global issues of preparing learners for the realities of working in healthcare today. These issues have only become more apparent in recent years. We’re delighted to be partnering with the Big 10 Initiative to further this mission whilst breaking new ground in VR simulation technology by offering true-to-life multi-patient scenarios.”

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

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
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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.

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

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Distance learning during COVID-19

Online distance medical and nursing simulation

Rapidly implementing online simulation during COVID-19

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

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

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

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

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

The OMS Distance Simulation Program

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

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

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

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

Uptake of OMS Distance during COVID-19

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

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

Implementing and integrating online simulation

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

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

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

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

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Here to help

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

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

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

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