Tag Archives: Nursing Education

Choosing Your VR Partner: A Guide

Oculus On Table
Oculus On Table

Ready to step into the wide world of virtual reality simulation but need help kicking off your search? It can feel daunting to start the process of updating or progressing an educational or training program, but with the right partner, it can feel like you’ve got a knowledgeable guide helping you to find the right solution for you.

If you know you’re in search of a VR vendor for healthcare education or training, you likely already have some knowledge of how VR simulation can positively impact patients and reduce costs.

Even so, there’s a significant amount of information out there, and you may not be sure what the criteria are that will make a difference to your decision-making process. 

That’s why we’ve created this guide – to give you a sense of what to look for and how to select the right VR partner for you!

1. Flexibility

Can learners engage solo and with supervision?

Do you want your learners to use VR only when a colleague or faculty member is present? Or do you want them to be able to remotely access simulations anytime and any place, with or without a supervisor?

If you’re looking to deliver VR simulation to a large number of learners, or to use VR simulation remotely, finding a solution that delivers automated scenarios and feedback is vital. 

In addition to removing scheduling barriers, automated scenarios provide unlimited repeatability, allowing your learners to grow their skills through as much self-directed practice as they need. 

It also allows them to practice alone before leading cases in front of their peers, ensuring psychological safety – so it’s worth considering how important this is to you early on in the process.

Does it work on screen and in VR?

Consider where and when your learners will be able to access these scenarios. If you’re looking for more flexibility, you may want to consider a partner that caters to both virtual reality simulations and on-screen simulations.

Due to a number of factors, some people may not be able to use VR. Providing on-screen simulations in addition to VR can serve as an alternative solution for these learners, opening accessibility for those who otherwise would not be able to participate – as well as ensuring ADA compliance

The flexibility of both VR and on-screen scenarios also grants learners access to simulations at home – even if they don’t have a VR headset – to further increase your ability to scale simulation remotely

With options to run scenarios both in VR and on-screen, with or without faculty, the OMS platform ensures you have all the flexibility you need. 

How flexible is the team? 

Flexibility isn’t just about the product, it’s also about the team. A flexible team can accommodate your time, get creative with solutions, advise on the best ways to implement, and remain available for any questions. 

Consider what support you might need throughout the decision-making and implementation process. Do you need curriculum or implementation advice? Do you want to hear who the company has partnered with before? Do you need a demo to ensure you’re happy with the product?

Asking yourself questions like these will give you a sense of the kind of experience you’re looking for, what impact you’re looking to create, and how flexible your VR partner should be. 

2. Quality

Likely one of the key features you’ll be interested to know about your potential VR partner involves the quality of their scenarios. 

How realistic is it?

First things first, VR simulations should feel real – they should be dynamic, feature realistic characters, and have robust narratives. 

Some virtual platforms have linear or branching scenarios – similar to a choose-your-own adventure – but this simplicity isn’t how clinicians and patients operate in the real world, so always ask a potential VR partner about how their scenarios function. 

  • Are there multiple paths through a scenario? 
  • Can you make mistakes? 
  • Can you multitask? 
  • Can you see the effects of illness in a patient simply through observation? 
  • Is the patient’s conversation, behavior, and physiology adaptive?

All of these factors increase the realism of the experience, and at OMS, the answer to all of the above is ‘yes’.

OMS uses AI-controlled patients who respond differently depending on what’s been said or done already, allowing each learner to have a unique experience. 

An unwellness system provides the opportunity for learners to detect non-verbal signs or cues that they will inevitably encounter in the clinic, such as sudden-onset pallor or clamminess. Patients’ signs and symptoms can also change throughout the scenario – from their vital signs to lung sounds to skin integrity – all driven by a dynamic physiology engine.

In game shot of George feeling unwell

This delivery of functional fidelity and narrative depth is what allows OMS scenarios to feel real and remain non-linear, ensuring that experiences can play out in many ways. It’s all up to your learner to direct the situation and act accordingly! 

What’s the evidence base?

It’s essential that scenarios be grounded in current evidence and best practices to simulate comprehensive, realistic clinical situations. Beyond the scenarios themselves, feedback that is peer-reviewed can provide a meaningful basis for tracking progress and competency. 

OMS utilizes our expert in-house authoring team – composed of leading simulationists and educators – to write scenarios rooted in the latest evidence. Scenarios then undergo a rigorous peer-review process to provide reliable and accurate simulations for your learners. 

Having fidelity in simulation isn’t necessarily enough, so make sure your VR partner explains how they create scenarios and if those scenarios are based on the latest evidence.

Can I do individual and team training?

Think about how important it is for your learners to go into scenarios alone and with others. 

Just like you would expect in the clinic, OMS Individual uses single-player scenarios that place your learner in the position to direct patient care – working on their own with a focus on clinical reasoning, critical thinking, and decision making via deliberate practice. 

If you’d also like your learners to be able to work together in simulations, consider whether your VR partner offers multiplayer scenarios. 

OMS Interprofessional allows learners to work in-tandem or in teams, wherever they are in the world, to coordinate and deliver care. From determining roles to discussing the case to prioritizing interventions, these scenarios maintain a focus on interdisciplinary teamwork, collaboration, clinical reasoning, and communication skills. 

Can I see multiple patients at once?

Clinicians rarely care for one patient at a time, so consider if your VR partner provides multi-patient scenarios to help your learners prepare for practice more effectively. 

OMS Multipatient scenarios require learners to prioritize care in evolving situations with various patients at the same time, just as healthcare professionals do regularly in the clinic.

As learners handle these dynamic simulations, they’ll have the chance to work on care prioritization and reprioritization, multitasking, delegating, and patient and interprofessional communication in order to effectively manage the complex nature of healthcare practice.  

Can I teach procedures and communication skills?

Ask your potential VR partner if they build out other types of scenarios, as well. Not just single-player vs multiplayer, or single-patient vs multi-patient, but also scenarios with hand control and voice control. 

With OMS, you have the freedom to practice however you like to meet a particular goal or competency. 

For instance, procedural scenarios use hand control to allow for repeated practice in technical skills. They give the learner the chance to develop much-needed muscle memory for a particular skill or procedure, with vibrotactile haptic feedback to simulate any level of interaction. 

Scenarios using voice control require learners to actually speak with a patient and the team to gather information, convey empathy, educate, or de-escalate as needed. 

As the use of voice and hand control adds layers of complexity and cognitive load to scenarios, the possibilities are seemingly endless (and maybe even a bit overwhelming)! Your VR partner should help you understand the options available to you, so you can make an informed decision about what types of scenarios will best serve your learners. 

3. Breadth of content

What specialties are covered?

You may need your learners to gain experience or increase their practice in different settings or conditions – perhaps your learners plan to work in the inpatient or outpatient setting, or maybe you need them to have experiences in both maternity and pediatric care.

Elderly patient in virtual reality
Patient in VR communication scenario

OMS has an array of scenarios, across 30 different libraries, with topics ranging from diabetes management to mental health to acute illness and advanced life support. The variation in scenarios gives you the ability to accommodate for different learning levels, and the ability to select specific cases can help you match the needs of your curriculum. 

Let your potential VR partner know about the types of content you’re looking for – they may just be able to partner with you to create a custom plan with bespoke content that fits exactly your needs. 

4. Feedback & analytics 

Providing meaningful feedback is an essential part of any simulation. You may be looking for a VR partner who can provide instant feedback to learners and deliver performance data in a way that is objective and standardized.

What feedback do learners get?

Ask yourself if you want the feedback your learners receive to provide evidence-based, unbiased advice to help them improve after every scenario.

What about the ability to use your VR platform to benchmark performance or even to be used for formative and summative assessment? 

OMS has focused on exactly this, providing instant, standardized feedback on what learners have done well or what they’ve missed – broken down by the critical, the important, and the additional.   

Feedback also comments on the timing, prioritization, and frequency of actions. It touches on how well learners collaborated with their team, guiding them on exactly where to improve for next time. 

To bolster learning even more, there is best-practice evidence to dive into with each comment, so learners not only see whether they hit the criteria, but they also see the rationale for each step along the way. 

What analytics are provided?

Another critical feature to discuss with your future VR partner is what types of insights you can expect to gain from partnering with them. 

If you want to tease it out in more detail, ask:

  • Do they have an objective scoring system? 
  • Can analytics be used for formative and summative assessment
  • Can you track learner improvements over time? 
  • Can analytics be linked with learning management systems? 

Depending on the partner you choose, you may have access to all sorts of information and insights. Your VR partner should be able to discuss with you the data you can expect to see, who can view it, and how it can be used most effectively to bolster your learners’ knowledge and track their progress over time.

Do scenarios link with competency frameworks?

It’s vital that your scenarios be evidence-based, and while simulation itself can be a promising tool for promoting competencies, it can be a challenge to implement virtual reality simulations that track progress in a way that aligns with current competency frameworks. 

Simply put, it’s important that you’re able to measure progress towards competency in a meaningful and objective way.

Debrief after an OMS scenario

OMS supercharges insights and analytics with competency mapping and tracking. You can select the competency framework you’d like to use, enabling you to see how your learners’ performance aligns with that particular competency. 

For example, if you wanted to see how your learners are progressing towards their preparation for the NCLEX, you would be able to see data about how often your learners are taking actions within a scenario that aligns with each core competency. 

Health promotion and maintenance, physiological integrity, psychosocial integrity, and safe and effective care each have their own insights, meaning you can easily view where your learners are performing well and where there’s room for improvement. 

The ability to use immersive scenarios and have access to meaningful feedback can be immensely valuable in ensuring your learners are on the right track, and your VR partner should be able to explain that data and how it can benefit your program. 

5. Customization

What can I do with your authoring platform?

Is it important for you to be able to customize scenarios to meet specific needs? If so, you may want a VR partner that provides an authoring platform. 

Think about the level of control you’d like to have when you author. Are you just looking to tweak existing scenarios by changing vital signs, lab results, or patient conversation? Or are you looking to build new scenarios from scratch? 

With OMS Create – OMS’s authoring platform – you can address the entire continuum. From busy educators who need to quickly adjust medication options, all the way to technologists who need to build multiple complex scenarios for new groups of learners – OMS Create has you covered. 

VR authoring platform - OMS Create

Ask your potential VR partner what abilities you’ll have to make changes to enhance your learners’ clinical experiences. 

Do you offer bespoke partnerships?

In working with your VR partner, could you truly partner with them? 

In addition to authoring platforms, if you’re looking to grow your extended reality (XR) capabilities as an institution, it’s worth asking if there’s the opportunity to engage with your partner on custom content, quite literally designed to fit your needs. 

Ask whether they’ve done this before, what the results were, and how the process works. You can even ask to be introduced to existing clients and partners for reference checks – you need to make sure they’re right for you! 

6. Budget

How does pricing work?

As with any new venture, cost is always a factor, and you’ll likely be considering your budget as a factor in your selection of a VR partner. 

It may be helpful to have a range that you’re comfortable with – this can help as you shop around to determine what kind of solution will ultimately give you the most for your money spent. 

Conversations with a potential vendor should feel like talking to a trusted confidante about your challenges and how you can work together to address them. The right VR partner should work with you to develop the right plan to fit your needs while keeping in mind your budget. 

Take stock of how you feel in these initial conversations. Does their expert understand your specific needs and goals? Are they answering questions you didn’t even know you had? Is ongoing support included in your package? 

A VR partner should bring knowledge to the table and put your mind at ease by explaining all the steps you can expect to take throughout the process. 

Finding your VR partner

All things considered, you’re probably looking for a VR partner that can:

  1. Inform you about VR – in general, and how it relates to your curriculum
  2. Provide flexibility in pricing or structuring
  3. Produce quality content and meaningful data
  4. Maintain open communication and support throughout the process

Coming from the world of healthcare, you likely want to work with a VR partner that has a team of people who understand the world of healthcare and VR simulation. Look at who makes up the team – are there clinicians and simulationists? It may be necessary for you to have people who can understand both! 

Flexibility is an absolute requirement in today’s world. A VR partner should be able to provide you with flexibility and work to tailor a solution right for you. 

Ensure that the scenarios meet your requirements and expectations. Consider the VR vendor’s current list of simulations, if they’re evidence-based, what their future scenarios look like, and if they can create custom content that meets your needs. Ask if you’ll be able to take advantage of any upcoming developments.

In speaking with a VR partner, you should walk away with an understanding of the data you can expect to see and how you’ll be able to use it to assess learners’ progress and promote competency. 

A true partner walks the path with you, and communication is key to maintaining a good partnership. Your VR partner should be responsive and help you troubleshoot any issues along the way, virtually or onsite. Success and support teams should be ready to help you whenever you need it – not just when you’re getting started but throughout your entire experience. 

OMS aims to optimize practitioner readiness and competence to improve patient care. It’s about the people who will use OMS – in the clinic, at home, or in the classroom – and the patients and families who will ultimately be impacted by that care. 

The patient-minded staff at OMS have worked to develop a platform that can provide a safe space to practice and prepare your learners for the situations they may face in the clinic. 

From scenarios to technical support to success teams, OMS works to understand and align with your needs, build your learners’ confidence and competence, and guide you along each step of the way. 

To get a sense of what you can expect when partnering with OMS, send us your questions or set up a time to chat here.

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

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 catheterisation
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.

‘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.

Distance and Virtual Simulation Resources

It’s been over two months since many institutions across the world have had to cancel face-to-face education. Let’s take a minute to celebrate the immense amount of work, adaptation and change educators and students alike have had to do in order to continue delivering quality education at a distance!

One of our values here at OMS is collaboration. As we all continue to adapt to the new normal and consider the Fall semester, we’d like to partner, assist and collaborate with faculty in the process of implementing distance and virtual simulation. 

We do this in our everyday work as we chat with you about your needs and learning objectives. We’re also helping by continuing to offer our 60-day free Implementation trial to support distance learning. And we’ve now created a suite of guides, activities and templates to help you implement OMS in the distance learning classroom. 

We’ve been able to create many of these resources thanks to the quick work of the  #FOAMsim community, who have banded together to share their knowledge about the implementation of virtual simulation. Expert authors and communities of practice such as the International Nursing Association of Clinical Simulation and Learning (INACSL), Simulation Canada, Margaret Verkyl, Cynthia Foronda, Jocelyn Ludlow, and more have released a wealth of information related to virtual simulation. A few of our favorites are:

INACSL Micro Webinars 

  • Evidence to Support Virtual Simulation as an Effective Pedagogy During the Pandemic: Research and Policy Implications
  • Prebriefing Guide for Online, Remote and Virtual Simulations
  • Debriefing Virtual Simulation: The Evidence and Recommendations

Simulation Canada Webinars

OMS Blog and Webinar

While we’re all for staying as up-to-date and informed as possible and reviewing primary sources of information, we also recognize that time is a precious resource, so save you time and energy we’ve watched all the webinars and read the relevant research!

With any OMS trial we therefore provide free consultation on best-practice for virtual and distance simulation implementation, blended learning tools and access to our latest evidence-based resources for faculty.

These cover topics such as:

  • Considerations for implementing distance and virtual simulation, including setting expectations, grading (or not), preparatory work, debriefs, and post-scenario activities
  • Walkthrough guides for synchronous and asynchronous distance and virtual simulation activities
  • Self-reflection activities for students
  • …with more to come!

In the meantime, in the spirit of #FOAMsim you can now download one of these resouces “OMS Distance Faculty Resource: Setting Expectations for Learners” below. We’d love to hear your feedback on it!

Download: Setting expectations for learners

For access to all the resources above, please get in contact with us. For updated information please also consider signing up for our monthly newsletter which includes up-to-date research and news from the virtual simulation community. 

Thanks for your time, onwards and upwards! 

Post by Christina Choung, RN, BScN, CHSE – Educational Specialist at Oxford Medical Simulation


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