IntroVirtual Incredible.Once you’ve finished the procedure, the

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IntroVirtual reality is mostly known for its applications in gaming and entertainment. However, VR companies in search of a more meaningful purpose might find one in the field of nursing education. Nurses have to learn a myriad of procedural skills and the benefits of practicing in simulated environments, without putting patients at risk, might make VR the perfect educational tool for this particular field. But, VR is still relatively expensive and would only be adopted by nursing schools if it brings unique benefits. Is VR training really better than other, cheaper training approaches? Read on to learn more about how VR could transform nursing education and what this means for the healthcare sector.

UbiSim reviewVR for nursing is already here and one of the leaders in this field is UbiSim, a Shanghai based company with a mission to revolutionize nursing education. UbiSim is a platform that offers skill training in a virtual environment. Recently, I met up with the founders and got the chance to try out a demo of their first scenario: blood transfusion. As a former medical student, I was extremely excited to see what the future of medical training looks like and from the moment I put the headset on, I was impressed. Suddenly, I found myself in a hospital ward and it felt very real: the surrounding, high-fidelity graphics create the perception of being physically present in a treatment room. The scenario took me through every phase of the procedure, starting with the collection of materials, taking care of hand hygiene and even putting on virtual gloves. The app allows you to move through the room, pick up any equipment, and put it on a trolley to take to the patient. Once you’re done collecting the supplies, you proceed to the treatment room where the patient is lying in a hospital bed.

The level of detail amazed me; the patient looks very real, his chest moves up and down and I can even make him sit up to listen to his lungs. And yes, I could hear actual breathing sounds when I placed my virtual stethoscope on the patient’s chest. Incredible.Once you’ve finished the procedure, the training ends and you get to see a report of your performance. The feedback shows you which steps were performed correctly and which steps you missed. After the debriefing phase, you get to try again from the beginning until you’ve completely mastered the procedure.

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For me though, one try was enough to realize the potential this medium has; the possibilities for medical training seem endless. But is it just because of the novelty of the new technology or does this truly have the potential to revolutionize nursing education? In order to understand the bigger picture, let’s dive a bit deeper into the current state of nursing education and examine how VR could make it better.VR makes nursing education scalableOne of the biggest challenges the healthcare industry is currently facing is the nursing shortage. The WHO estimates the global shortage to be about 9 million nurses and midwives today and this issue affects many countries, including the US, China and several parts of Europe. Furthermore, the gap is expected to grow if current trends continue; aging populations, evolving health care systems and a shift in responsibilities from doctors to nurses are causing the demand for nurses to increase but the supply of qualified candidates is not keeping up. However, this isn’t caused by a lack of applications for nursing degrees. In fact, many nursing schools have to turn away a large proportion of applicants each year simply because they have reached the admission limit.

So why are they not expanding? The problem here are the methods that are currently used for practical training: they’re not scalable. Traditionally, nursing students gain experience during clinical placements. In order to get enough practical training, each student needs to complete a certain amount of clinical hours. But the training sites are scarce: in order to provide enough supervision and ensure patient safety, hospitals only have a limited number of places available for interns.One solution for these issues is simulation training. Medical simulations can take the form of persons or devices that try to mimic the clinical setting as realistically as possible without the use of actual patients.

This allows students to already gain a certain level of proficiency before they enter the real clinical setting, thereby reducing the necessary length of their placements. Simulation training is highly valued by students and studies show that it works: a large randomized controlled trial conducted in the U.S. showed that high fidelity simulation could replace up to 50% of traditional clinical hours, without a decrease in learning outcomes. This means that simulation is an effective educational tool, acquired skills are transferred to the real environment and it can thus safely be used as an alternative for (at least part of) clinical placements.

But despite these positive findings, nursing schools haven’t widely adopted this type of training yet. Unfortunately, the current simulation methods are far from ideal: the costs of mannequins are high and schools would need a lot of them to give every student the amount of practice they need. On top of that, the simulations need to be guided by instructors which requires schools to hire extra personnel. As an alternative, schools can partner with private simulation centres but this poses other restrictions: these places often need to be booked way ahead and it limits the accessibility for students. In short, current methods for clinical education are causing a bottleneck in the supply of nurses. This is where VR can make a significant difference: virtual skill training drastically reduces the amount of equipment and organization needed to provide students with high quality practical training.

Mannequins, simulation centres and instructors would be replaced by a headset and a computer. As the software provides instructions and feedback, VR would allow students to train by themselves, at their own pace, and potentially even in their own homes. VR allows practice until masteryCurrently, clinical placements form the backbone of nursing education.

However, their effectiveness is being questioned as studies have shown that many newly graduated nurses aren’t well prepared for the real work. They often lack the practical skills necessary to independently care for patients in a safe and efficient manner. Moreover, students themselves often report feeling unprepared and are unsatisfied with their clinical education. What’s going on here? Findings from qualitative studies on the nature of clinical experiences shed a light on the limitations of these practices. Their value is based on the assumption that students get to apply their theoretical knowledge and improve their clinical practice, but the amount that students actually get to practice is often disappointing. Students report that their tasks mainly consist of very basic stuff, that they don’t receive enough feedback from their supervisor and don’t feel like they got enough practice by the end of their studies. Many also experience a big gap between theory and practice, causing a lot of anxiety for students which reduces their ability to learn and makes them more prone to mistakes. These findings can be explained by the fact that the educational effectiveness of clinical placements is very dependent on variable circumstances like the availability of patients to practice on and senior staff to supervise students.

This makes it very hard for educators to control what and how much each student gets to practice; learning opportunities have essentially become random.  It seems like the clinical setting is not a place where the learners’ needs can be met. Nursing students shouldn’t have to rely on random experiences for the most important part of their education and in order to improve the effectiveness, clinical education needs to be standardized. This is something VR could provide: by creating an environment in which students can get unlimited practice with any procedure, without the pressure of performance or putting patients at risk, educators can make sure every student reaches the same skill level and experience the same situations. In addition, it allows student to develop confidence in their abilities, master the procedural steps even before setting foot in a hospital and use their time during internships much more efficiently. In other words, nursing schools can use VR to build a better bridge between the classroom and real clinical practice.  VR facilitates the practice of a wider range of skillsIn healthcare education, there’s always a tension between providing students with sufficient practical training and ensuring the patients’ safety.

This tension increases when the stakes get higher, for example in emergency situations: hospitals have a duty to provide the best quality care but the less experienced trainees also need to get a chance to learn. Recreating these situations with traditional simulation methods is hard: it would require very advanced mannequins and a lot of actors to reenact the pressures and stress of the real situation in which a large team of nurses and doctors work closely together in a race against the clock. The same is true for situations in which a procedure goes wrong: how do you train someone to respond adequately to a medical error or an unexpected side effect, without having to wait until it actually happens in real life or putting a patient at risk? As a result of these limitations, students often miss out on the chance to practice certain skills and this could affect the quality of care: data from the WHO on European hospitals shows that medical errors occur in 8 to 12% of hospitalizations and a recent study published in the BMJ states that medical errors could be the third leading cause of death in the U.S.

This shows that, despite a lot of initiatives to improve patient safety, medical errors are still a major concern. Allowing students to practice with a wider range of skills and situations could potentially improve these numbers. This is not only important for students, but also in continuing education for professionals. Many procedures are not performed on a daily basis and are therefore practiced unfrequently or not at all because it’s too complex to recreate them in a simulation. The static nature of mannequins makes them unsuitable for recreating the often diverse and complex medical scenarios. Furthermore, the nursing role is continuously expanding: they’re being granted more and more responsibilities and are expected to take on a wider range of tasks. For example, in some countries nurses are now allowed to prescribe medication. These new skills naturally require more training.

With the unique possibilities of VR, almost any kind of scenario can be recreated, allowing nursing schools to go beyond the limitations of current methods and widen the scope of their training. Nursing students would not only be able to master the simple, uncomplicated procedures, but also practice with adverse events, unexpected side effects and emergency situations. Then when it’s eventually time to treat their first real patient, they can be sure they come prepared.

ConclusionThe field of nursing education seems ready for innovation; current challenges like the nursing shortage, the expanding scope of nurses’ tasks and the scarcity of clinical placements are forcing nursing schools to rethink traditional teaching methods. The solution lies in making practical training more accessible, flexible and scalable. VR ticks all of these boxes and could be the gamechanger the nursing field has been waiting for. By making clinical education independent of patients and mannequins, VR offers the opportunity to provide students with the kind of hands-on training that wasn’t possible before. Of course, VR development is still a big investment, but the big advantage is that it’s a lot more dynamic: once a basic scenario is created, it’s much easier to create a range of variations with VR than with physical simulation equipment. Therefore, in comparison with a traditional mannequin, the educational value of a VR headset is significantly greater.

In my opinion, VR will inevitably be the future for procedural training in medical education: it will be hard to justify letting students practice on patients, when they can get similar (or even better) training in a virtual world. For now though, VR for nursing education is still in its early stages and it definitely won’t completely replace traditional educational tools (yet) but companies like UbiSim are working hard to make this a reality.

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