Dr Sally Shiels discusses the value of VR simulation at the OxSTaR simulation centre in the Oxford University Hospital Trust
Dr. Sally Shiels is an anaesthetist at OxSTaR (Oxford Simulation, Teaching and Research), the purpose-built, state-of-the-art medical simulation teaching and research facility in Oxford University Hospital.
Sally discusses virtual reality’s impact on training for medical students and clinicians, how immersive technology is supporting patient safety, and the types of programs the OxSTaR center are developing.
“Providing our students with virtual patients has been an absolute sea change in terms of medical education”
Using OMS has allowed OxSTaR to expand their training capabilities, preparing medical students more fully for clinical practice, in order to improve patient safety.
“We’re taking our students into a virtual world where they can learn safely, and that is really important, because then they feel safe to make mistakes.”
Learn more about the work Oxford University are doing with OMS using the link below, or see PharmaComms TV for the original content.
Immersive technology is making significant strides in training medical professionals and as a treatment in health and wellness.
There are many ways that virtual reality (VR) can be applied in healthcare – from training medical professionals to aiding surgeons through visualisation or even robotics. But where is immersive tech really excelling right now, and what is it achieving for patients and medical professionals alike?
In the article below, Dr Jack Pottle, Chief Medical Officer at Oxford Medical Simulation, speaks to VR World Tech – discussing the views and often misconceptions that institutions have about immersive tech…
Dr. Jack Pottle outlines OMS Interprofessional during the IMSH 2020 conference
Dr. Jack Pottle, Chief Medical Officer of Oxford Medical Simulation, speaks with the team at HealthySimulation about the OMS VR simulation system.
“OMS is taking the traditional way we do simulation and scaling it – saving time, saving space and saving money”
Designed for medical and nursing professionals of all levels, Dr Pottle outlines the development of OMS Interprofessional – the IPE mode that allows clinicians to treat virtual patients together wherever they are in the world.
OMS is helping healthcare system expand and optimize their simulation delivery to improve patient care…
“Allowing hospitals, hospital systems and simulation centers deliver training that is objective, standardized and of seriously high quality. It feels real; it improves performance”
Learn more about the OMS platform here, or discover more about interprofessional simulation below.
This week is Healthcare Simulation week and as part of the celebrations we take a look at five reasons to salute the wonderful practice of simulation…
1. Simulation improves patient care
By far the most compelling benefit of simulation in healthcare is the positive impact that it can have on patients. After all, a drive to improve patient outcomes and the quality of their care is at the basis of healthcare education systems worldwide…
Providing future healthcare workers with the resources to optimize patient care – be that through effective clinical acumen, time management, communication and everything else in between – is the bedrock of a successful healthcare system.
Essentially, simulation sets trainee doctors and nurses up to effectively make people better when they come to practice in real life. In 2012, Benjamin Zendejas (Mayo Medical School, Rochester) set out to prove how far simulation training promotes positive results for patients. The findings were powerful; simulation-based education was shown to be directly linked to patient benefits when compared to both non-simulation-based training and instances where no intervention was given at all.
Linked to this is the propensity for simulation to reduce patient harm. No clinician wants to inadvertently complicate or worsen a patient’s condition but medical error is the third leading cause of death in hospitals worldwide. With simulation, we are able to reproduce patient care sequences with all the clinical complexities of real life scenarios allowing clinicians to cover all the bases when treating real people.
Ultimately, simulation-based training produces more competent healthcare professionals which can only be beneficial in improving the quality and safety of patient care.
2. Simulation inspires confidence
Few on-boarding periods of a new job can be as daunting as starting out as a junior doctor or nurse. Fetching coffees, navigating the intricacies of a Kafkaesque office bureaucracy, whilst remembering not to raid Belinda from Accounts’ personal HobNob stash seem like a walk in the park compared to a 12-hour shift filled with hundreds of patients with complaints ranging from the utterly absurd to the genuinely life-threatening.
To make matters worse, strained resources, overcrowded hospitals and staff shortages mean that most junior healthcare professionals face much of this without the necessary support. With simulation, clinicians are able to practice managing acutely unwell patients without causing real patient harm if it goes wrong. In this way, practicing emergency care during training can take the edge off the intimidating world of real life practice.
This is something we’ve been made directly aware of at Oxford Medical Simulation through the roll-out of our virtual reality simulation platform at Oxford University. There, learners told us that, “it’s really good to get the experience of being put in the driver’s seat, of making the decisions…I think it will give me more confidence to make those decisions [in real life]”.
What is more, simulation-based training as been shown to improve junior clincian’s confidence in pushing for improved patient outcomes within real life treatment. Healthcare training is inherently hierarchical and this can often mean that trainees are afraid to speak up when they think a senior colleague is not administering the right kind of treatment.
In a study carried out by the University of Harvard and Massachusetts General Hospital, simulation was shown to increase the frequency and quality of interventions by Residents in the care suggested by their seniors.
Simulation can therefore be seen to not only improve patient care by bolstering the doctor or nurses confidence in their individual practice, but also promoting appropriate assertion in challenging a treatment plan when they think there might be a better way.
3. Simulation lets us learn from our mistakes
In our personal and professional lives we learn best from the mistakes we make. Cultivating an attitude that embraces mistakes as an inevitable part of life that can be mined for valuable lessons is an effective way to successfully avoid making mistakes in the future. Within the context of healthcare however – where the price of our mistakes can be fatal – this kind of philosophy can be hard to accept.
In practicing simulation a safe-space is created in which healthcare professionals can refine their clinical skills without the risk of harming real patients. When effective debrief is built into simulation, the learnings taken from this form of training are invaluable. With learners identifying strengths and areas for improvement in a supportive atmosphere. This is a powerful combination that mitigates against these mistakes being made in real life.
Further, the emphasis on debrief engenders good habits of self-reflection for trainees to take through their entire professional careers. When clinicians are used to assessing their own practice regularly they are personally assuring the quality of the care they provide.
4. Simulation works across all healthcare disciplines
Simulation works effectively across all healthcare domains including; medicine, nursing, paediatrics, mental health, surgery, emergency care, life-saving and more. What is more, simulation surpasses all other training mechanisms in touching the most comprehensive set of skills ranging from specific procedures to communication and teamwork.
The controlled nature of simulation means that institutions can ensure learners are exposed to as wide a range of clinical presentations as possible to build up depth of knowledge. Stress conditions can be put in place to mirror real life scenarios and test trainees ability to cope under pressure. The debrief that follows these experiences means that learnings are not lost or left open to individual interpretation.
Simulation is also deliverable across multiple platforms. Mannequin-based simulation has long been used to produce life-like conditions in which learners can practice patient management. Similarly, the use of standardized patients in simulation is effective in creating a true-to-life environment where learners are able to interact with a real person. Increasingly, virtual reality is being used to deliver repeatable, immersive simulation at scale.
5. Simulation is widely practiced worldwide
We’ve often heard it said that – if you do not work in healthcare – simulation is probably the biggest industry that you’ve never heard of. When you stop to think about it – it makes sense. You wouldn’t expect pilots to fly planes without practicing in simulators first – so why should we expect the people taking care of our health not to do so as well?
There are hundreds of organisations, institutions and individuals doing wonderful things in simulation across the world. Organisations such as SSH and ASPiH organise renowned international events like the International Meeting on Simulation in Healthcare (IMSH) to encourage knowledge sharing and best practice.
As part of Healthcare Simulation Week, Boston Children’s Hospital hosted a Facebook Live event to give the community insights into how its state-of-the-art paediatric simulation center works. Having run an immeasurably impactful simulation programme for over a decade, BCH has now taken is simulation capabilities on the road. Offering over 50 courses at nine institutions across eastern Massachusetts – its SIM Network initiative shows that simulation best practice can be distributed at scale.
In the UK, the NHS Diabetes Programme is using simulation to directly impact the treatment of people with Type 1 diabetes. Using the OMS virtual reality simulation platform, doctors are able to practice treatment before they see real life patients. Diabetes treatment can be notoriously tricky and for many doctors the first time they have to manage diabetes-related cases is in real life. Using simulation, the NHS is able to train doctors on the specific complexities to look out for, without compromising the quality of patient care.
The healthcare team at St Luke’s University, Pennsylvania, have customised a freight truck to serve as a mobile simulation suite. Offering training opportunities across disciplines, people that live in remote areas that once may have been unable to access a healthcare education are now able to access valuable resources to further their careers. In this way, St Luke’s mobile simulation operation is promoting diversity and social mobility in healthcare and beyond.
These are just a few examples of the ways in which simulation is being leveraged to improve healthcare training and education, and in turn, our healthcare systems and standards of patient care.
For the past few weeks we’ve been avidly testing out the latest Oculus Rift S kit. The new hardware’s inside-out tracking shows the progression of VR technology and can only mean better, more exciting things for the world of healthcare simulation.
So, what’s changed?
The most significant difference between the new Rift S model and its predecessor, the Rift, is that it using inside-out tracking. This means that the sensors now sit inside the headset rather than using a separate desk-mounted sensor as with the original Rift. It has simpler halo-style headband making it easier to put on and the original over ear headphones have been replaced with directional speakers embedded into the headband.
The screen resolution on the Rift S is slightly higher than previous models and they way the user sets up their guardian fields (ie the area in which you can “play” in VR) has changed. Now operated from entirely within VR, you draw a line to mark out your play area to map it out more precisely. New outward facing cameras on the Rift S headset mean you switch to seeing your real-world surroundings if you move outside of the physical space you’re meant to be in. It’s a clever feature that means you no longer have to worry about bumping into anything or anyone whilst your immersed in the virtual space.
What do these changes mean for virtual reality simulation?
In terms of how learners use the OMS simulation platform, the move to the Rift S won’t require you to change anything at all. Whether you’re using a Rift S or and original Rift model, you can still train healthcare professionals using fully immersive VR medical and nursing scenarios as before, and there are some added benefits.
Firstly, freeing the headset from the external sensors means that the setup is even easier and quicker and the Rift S is smaller, making it even easier to store and transport. Particularly if you are looking for simulation suite that can be used across multiple sites then the Rift S is perfect.
The new guardian set up allows users to take full advantage of the six degrees of freedom (how your movement in the real world matches your movement in the virtual world) in a much simpler format. The guardian system allows you to more easily avoid any fixtures and fittings that might otherwise get in the way and interrupt your immersive experience. Because users can now view their surroundings without coming out of VR – health and safety is assured and the capacity for independent learning of VR simulation is further enhanced.
In conclusion, in terms of learning outcomes and visual experience, the Rift S offers much the same experience as the original Rift – ie excellent. The improvements made on the Rift S tend to make the practical experience of setting up and implementing simulation simpler with fewer pieces of hardware and the smaller, more transportable kit. All of this means the Rift S continues to allow VR to provide simulation at scale, to deliver all the benefits of OMS VR simulation.
If you want to try out the OMS VR medical or nursing simulation platform on the Rift S get in touch with one of our Educational Specialists today.
We look at the ways in which virtual reality will impact our daily lives in the future.
At Oxford Medical Simulation we are constantly investigating the impact of virtual reality in healthcare training and simulation. Throughout our discussions with students, clinicians, educators and simulation professionals it’s clear there is a huge appetite for VR to improve clinical training and the delivery of simulation. However, whilst people are enthusiastic about applying VR to specific use cases – such as virtual reality medical simulation – we are yet to see VR truly embedded into everyday life.
However, as VR headsets come down further in price and software becomes even more accessible, this is changing. To that end, we’ve put together a list of six areas that we predict will have been changed by virtual reality by 2025…
1. Training and Education
Healthcare is one of the primary areas benefiting from VR training and education, with immersive technologies being used to simulate surgical procedures and medical emergencies. Learners are able to enter VR and practice managing complex situations with no risk to real lives. Companies such as 3D systems and Digital Surgery focus on the surgical aspects, while those such as OMS cover the medical and nursing aspects. We recently wrote about the collaborative work of OMS and the NHS England Diabetes Programme – training doctors using VR to reduce errors in treating patients with diabetes.
VR training has expanded due to increased understanding that experiential learning is the best way to understand and retain information. Given this rising acceptance of experience over traditional study, it’s no surprise that immersive technologies are being used in other fields of education, too.
At the Natural History Museum in London the ‘Hold the World’ portal allows visitors to be guided through historical artefacts by Sir David Attenborough. Similarly, the Anne Frank House VR experience allows users to travel back in time and experience life as it was in the famous Amsterdam attic. Similarly, archaeologist David R. Hixson of Hood College is using virtual reality to bring the ancient Maya City of Chunchucmil to life for modern day visitors, allowing them to experience what daily life was really like in the ancient world.
VR offers a way for us to embed immersive experiences into learning curriculums in myriad ways, and it won’t be long before we see these experiences leave museums and specialist skills labs and enter the mainstream classroom.
2. Experiences and Entertainment
The way in which VR may transform conventional forms of entertainment are yet to become clear. Notwithstanding gaming – in which VR has well and truly made its mark (Beat Saber famously sold over 100,000 copies in its first month) – the world’s film and television are only just dipping their toes into the water.
However, we are seeing some forays into VR experiences as content akin to traditional TV and film. The Baobab Studios 2018 offering, Crow: The Legend, was a VR animated film that featured Oprah Winfrey and John Legend that received critical praise. This kind of animated content – with a star-studded cast to pack a punch – is a great way to get consumers accustomed to the idea of virtual reality as an entertainment form beyond gaming. Critics are also embracing VR as a new story-telling device. For example, 2018’s Venice Film Festival had a dedicated segment for VR Works. As the technology continues to improve year on year (Oculus just released a new, sensor-free Rift model as a precursor to the wireless Quest model) it’s only a matter of time before we’re donning our VR headsets to enter the virtual world of our favourite films and TV shows, rather than just watching them on screen.
VR is also being used by contemporary artists to produce new immersive offerings. Anish Kapoor and Jeff Koons have both collaborated with Acute Art – an agency that specialises in producing artworks using virtual reality. There will also be a dedicated VR space at this year’s upcoming Frieze festival in New York. With influential events, artists and organisations backing virtual reality art, it won’t be long until we’re consuming this in the same way as we do traditional paintings, sculptures and more.
3. Patient Care
The impact of vr in healthcare goes beyond training and education, and VR is showing huge potential in areas such as pain management and treatment for specific conditions. Companies such as Virtue are leading the way in applying VR to dementia and Alzheimer’s treatment. Using immersive technology to recreate familiar childhood scenarios and trigger memories – Virtue is taking reminiscence therapy to new heights. In an area that traditional healthcare struggled to tackle (Pfizer ended its research into new Alzheimer’s drugs last year) virtual reality may just be the answer.
Similarly, virtual reality technology has been shown to reduce pain during complicated childbirth scenarios. Trials at Monash University in Melbourne, Australia have shown that using immersive VR experiences during external cephalic version procedures (where breech babies are manually turned) can significantly reduce pain.
At Cedars Sinai Medical Centre in Los Angeles significant research and work is going into the impacts of therapeutic VR. It has already been shown to have fantastic results in terms of pain management and recovery. At their Virtual Medicine Conference in March this year, we heard from Former Cedars Sinai patient Harmon Clarke who recalled how meditating and travelling in VR during his hospital stay, instead of relying solely on pain medication, accelerated his recovery from Crohn’s disease.
Skip Rizzo, a psychologist and leading mind in therapeutic VR has conducted award-winning research into the positive effects of virtual reality-based exposure therapy to treat PTSD and continue to analyse the benefits of virtual reality therapy across a range of psychological domains.
How we shop has already transformed beyond recognition over the last decade. Virtual reality technology will open up new possibilities for how we engage with consumer products and ultimately, buy them.
The most obvious application of this is within the home improvements market. VR home design tools will allow consumers to place potential furniture or decorative purchases within a virtual mock up of their real home and interact with these items. This goes beyond current screen-based design tools – in VR consumers will be able to interact with items and get a clear sense of how they’ll live with them once purchased. Macy’s Department Stores in the US is already offering this kind of service to their customers.
The retail world has already explored how VR will affect online shopping. In 2016, Alibaba rolled out a VR shopping experience during Single’s Day – reportedly the biggest annual online shopping event in China. Shoppers from China were able to enter American stores virtually – such as Macy’s – and interact with the products in that environment.
As VR shopping experiences become more commonplace the consumer will gain more agency over their consumption. We’ll be able to make informed decisions over the products we buy online, before we buy them.
5. Social Behaviours
VR has recently shown interesting possibilities for changing problematic social behaviours. This ranges from sexual harassment, unconscious bias in the workplace and racial bias.
Vantage Point has developed a virtual reality based environment for sexual harassment training within the workplace. The solution is based on the premise that the simulated environment provides a safe space in which professionals learn how to respond to and report incidents of harassment in a safe, unintimidating environment. By simulating true to life scenarios, sexual harassment training is transformed from something typically seen as a matter of compliance to one of workplace safety that is taken more seriously. Improving how we educate people about sexual harassment will undoubtedly reduce cases of harassment and make for safer workplaces.
Similarly, programmes that use VR to highlight and remove unconscious biases in the workplace are rising in popularity. New York based consultancies BCT Partners and Red Fern Consulting have partnered to launch the Through My Eyes programme which uses immersive scenarios to help employees recognise – and then change – their unconscious perceptions. The programme allows participants to walk in the shoes of victims of social biases in order to confront their own real-life discriminatory behaviours through empathy. In a world that is finally prioritising diversity in the workplace, VR is offering an innovative way to push this forward.
Mel Slater has run a series of studies at the University of Barcelona that have shown that inherent racial bias is decreased within virtual environments. In one, participants were given implicit association tests before entering a virtual scenario in which they were immersed in a virtual body of a different race. They were given the same test after being inside the VR and participants that were put in a dark virtual body showed a marked decrease in their inherent biases. The impact of these findings could be to trigger a reduction in unconscious prejudices – leading to increased empathy towards others in the real world.
6. Social interaction
Virtual Reality technology also has the potential to transform the way we work, communicate with each other and even socialise. Using virtual reality as a new form of meeting software allows remote workers to enter virtual meeting rooms with colleagues. This will certainly enhance collaborative working by connecting regional offices and distributed workforces. Efficiency will also be boosted with the time and financial costs of commuting greatly reduced.
Similarly, virtual reality has the potential to take communication with our friends and family to the next level. Just as experiences like Skype and Facetime have revolutionised how we interact with distanced loved ones, it’s not hard to imagine keeping in touch with our friends and family within immersive settings. Because VR allows users to feel present together – no matter where they happen to be physically – these interactions will be taken to whole new levels. Couples in long-distance relationships will be able to enjoy fully interactive, involved, dates using the technology. Since shared experiences bind us to those we care about – virtual reality experiences have the potential to keep us connected to our friends and families in entirely new and powerful ways.
To that end, Facebook has dedicated an entire business unit to building immersive experiences for social life. Social VR is dedicated to creating “technologies that help people to create, share meaningful moments, and build communities using the unique qualities of this immersive new medium”. As the precarious world of established social media continues to shift – Facebook has reportedly lost 15 million users in the US since 2017 – it’s no wonder they are looking to virtual reality as the next platform for social interaction.
So there we have it, the six ways in which virtual reality will affect our lives in six years time. At OMS we look forward to continuing to do our bit in applying this technology to improve healthcare training to improve patient care worldwide.
We attended the Virtual Medicine conference at Cedars Sinai Medical Centre in Los Angeles where we joined leaders in the virtual reality healthcare space to discuss the latest developments – and applications – of VR in patient care and medical education.
Oxford Medical Simulation (OMS) was proud to join other leading thinkers excited about the potential of virtual reality in healthcare. The Virtual Medicine conference (vMed) brought together not only healthcare professionals, but also researchers, technical developers, business leaders and patients. This made showcasing our virtual reality scenarios for healthcare training during the event all the more special.
As always, we loved getting VR newbies into the system to demo how intuitive VR can be, and it was even more encouraging to get the endorsement of VR experts who live and breath virtual reality in healthcare.
We were excited that when healthcare professionals entered our scenarios for a quick taste they quickly became so immersed that they were determined to save the patient, or delve into the details to find out more. Surprised at the level of realism in one of our virtual patient’s histories, one user at vMed19 announced; “Whoa! I’m going to ask about his social history! I want to know what kind of recreational drugs he uses.” Only in Los Angeles!
Besides the kind words about our own platform, we received a fascinating update into the other ways in which VR is impacting healthcare for the better. From helping to manage pain associated with Crohn’s Disease, to facilitating reminiscence therapy in people with dementia, the applications of therapeutic VR just keep growing. Dr David Rhew (Chief Medical Officer at Samsung Electronics America) gave a compelling talk on the effects of VR on people with dementia, loneliness and concussion amongst a host of other applications. In the case of concussions, VR is now proving to be as effective as sleep, exercise and education. Former Cedars Sinai patient Harmon Clarke recalled how meditating and travelling in VR during his hospital stay, instead of relying solely on pain medication, accelerated his recovery from Crohn’s disease.
The Patient Panel on Day 2 was another highlight: the moving accounts of four patients who had experienced therapeutic VR really brought home the positive results that this technology can have.
Research on the efficacy and optimal methods of delivering VR therapy remains in its infancy and is a fascinating topic. The groundbreaking work done by Skip Rizzo on the applications of VR to treat PTSD and anxiety in particular and Mel Slater on VR in cognitive neuroscience and body-swapping keep us pushing the boundaries of what VR can do and how it can deeply affect individuals perceptions and abilities to learn.
Despite the excitement of the forefront on the technology, the ongoing message of matching appropriate immersive content and delivery to the individual’s needs remains central to all VR design. At OMS we couldn’t agree more. We often ask ourselves and others considering virtual reality “what are your learning objectives?” and ensure that everything we design meets a specific need.
Cedars Sinai Medical Centre proved to be a compelling setting for the event, too. Set against the backdrop of one of the largest academic health centres in the US, the discussions, revelations and real life stories felt even more relevant. It almost felt like we – as a global VR in healthcare community – were more galvanised, united and inspired by physically locating us within the system we’re seeking to change.
It was this collective feeling of inspiration and celebration that made vMed19 such an impactful conference. The world’s leading thinkers and innovators in VR medicine came together in one place to share new developments and celebrate success stories, and we left with a boosted motivation to continue our work in the space. Brennan Spiegel, Director of Health Research at Cedars Sinai and the driving force behind the vMed conference summed up this feeling best when he offered some uplifting advice in his closing remarks: “VR offers joy. Leverage that like crazy.”