The Potential of Virtual Reality in Simulation

May 13, 2016

Just as the healthcare industry continues to evolve, so too does the training of novice and experienced physicians and other clinicians. Jump is a leader in offering hands-on experiences in a variety of simulated environments: beginner and more seasoned surgeons can practice life-saving procedures they rarely encounter on a cadaver perfusion model, fledgling nurses and residents can rehearse working as a team for the first time to save a patient's life, and advanced care planners can practice discussing end-of-life care decisions using standardized participants.

In-person simulation has become a right-of-passage for medical and nursing students around the world, allowing them to practice life-saving procedures before contact with real patients. To some extent, that will always be the case. But in the future more simulation scenarios will occur in the immersive virtual reality space.

The fact is, physical simulation and physically reproduced environments are expensive and require people to travel. This makes frequent or repetitive practice difficult. Offering virtual reality simulations opens up participation for medical professionals who are too far away to utilize a simulation center. It provides the opportunity to create interprofessional teams with staff members who have never worked together before. Virtual reality simulation will allow participants to prepare for in-person simulations and do follow-up repeat practice after they've completed hands-on learning opportunities.

There is much as yet untapped potential with virtual reality. I was recently part of a team, consisting of educators from Lehigh Valley Health Network (LVHN), that published an online paper demonstrating that it was possible to create an outpatient virtual reality simulation in a first-person-perspective environment. The pilot revealed it's an opportunity we, as simulation centers, should continue to explore.

Utilizing Virtual Reality Technology for Medical Simulation

Virtual and augmented reality technology is exploding today with products like the Oculus Rift and the Microsoft HoloLens becoming part of mainstream culture. But virtual reality has been utilized in the medical industry, to some extent, for years. It just hasn't evolved enough to provide real immersive experiences for clinicians in different healthcare environments.

Our research worked to design a user-friendly interface for interprofessional teams to practice outpatient-based emergency scenarios. We used AvayaLive Engage to create a computer-generated replica of an LVHN outpatient facility, and built three simulation cases centered on common office-based emergencies: chest pain, respiratory distress/allergic reaction, and suicidal risk. We chose to focus on office-based emergencies because there aren't a lot of simulation opportunities for this environment, and outpatient care is expanding to include more complex cases.

18 individuals representative of an outpatient interprofessional care team participated in the study. Up to five clinicians performed simulation exercises at a time as if they were playing a video game. They controlled their own avatars and utilized Voice over IP to communicate with each other. Some were also in the same room, so they could talk to each other as they went through the scenarios. Actors played the patients within the virtual clinic room and controlled their own avatars and voice controls. Orientation was provided to all subjects before the simulations took place.

Using a design-based research approach, we were able to continually improve the simulation process, virtual environment, and scenarios based on feedback from participants during debrief. Learners provided reactions to everything from whether the sounds in the outpatient room were realistic to whether the virtual environment was easy to navigate.

A post-activity survey revealed participants were accepting of the learning method and environment. A majority also felt they met the learning objectives of office-based emergencies using virtual reality simulation. The next step will be to test this method out on a larger scale.

The Future of Simulation

A major advantage of using a virtual world for medical simulation is that the cost of distributing content to a wide audience is very low. However, there are upfront costs associated with creating the curriculum and medical environment. In many cases, educators would likely prefer a pre-made virtual environment they could write cases for. There aren't many faculty members with the time or resources to build an interface from the ground up as our research team did.

However, there are an increasing number of technology companies developing more opportunities for virtual reality-based simulation. I envision that students in healthcare will eventually be able to wear a 3D viewing apparatus to fully immerse themselves in a virtual space that allows them to practice procedures or interact with patients.

At this point, I think we are still at an early stage. I imagine the things we are unable to simulate today, we'll be able to simulate easily in the next five to ten years.

William Bond, MD is the Director of Simulation Research at Jump and is instrumental in shaping the research agenda. Dr. Bond is committed to many areas of patient safety, improving health care for professionals and supporting the structure of the work surrounding simulation at Jump.