The Untapped Potential of Simulation

VR blood transfusion and AR pharmacy training are just two ways facilities can incorporate cutting-edge tech into provider education.

For the last six years, I’ve had the privilege of working at Immersive Design Systems (IDS) at Boston Children’s Hospital. We provide operations analysis and simulation-based training for clinical staff. While training, instructors emphasize the clinician’s emotional state during simulation as well as when they are providing care. Healing is an art as much as a science, and teams can only function well if everyone is able to focus on the work.

Perioperative work requires safe, effective, respectful communication under very difficult circumstances — and simulation training can do wonders to adequately prepare OR teams.

Breaking it down

REAL FEEL AR Pharmacy Training at Boston Children’s includes software that guides the trainee step-by-step through the process of preparing syringes and practicing sterile procedures.

My specialty is Extended Reality (XR) for active learning. XR is a general umbrella term that encompasses virtual reality (VR), augmented reality (AR), mixed reality (MR) and anything similar. VR takes you somewhere else; wearing a VR headset immerses you in a virtual world in whatever direction you look. MR allows you to interact with digital objects in your physical space. AR enriches your real world with digital information. Our growing XR service line helps everyone, especially nurse educators, who can leverage these technologies to produce new and effective training experiences that become part of nurse orientation and ongoing training.

The most interesting part of creating XR training simulations is “knowledge capture ”— learning from our instructors what they want their trainees to know. This requires multiple interviews, filming, observations, building a prototype or two, and many iterations of the design. Next comes trialing XR-based training with the trainees, who will provide helpful critiques if asked. Because this is digital technology, we can easily make updates even after the experience matures. Best of all, the software can provide valuable feedback to improve the experience and, in turn, help the trainee improve their skills and knowledge.

Although IDS works with clinical educators to create VR and AR training simulations for nurse trainees in many departments, they are most often used in new nurse orientation. They are also useful for training refresh among more experienced staff. Some simulations are automated and solitary learning tools that trainees can practice on their own schedule. Others are designed for group learning experiences supervised by a clinical educator who leads the debrief. Topics for these include blood transfusions, sepsis, code med prep, and patient evaluation and support.

VR training simulations are low-cost, repeatable, standardized and focused. They should feel safe to the user (because they’re not real life) but provide a realistic level of stress. They are great for learning facts and concepts, processes and procedures, emotional regulation, communication and teamwork. Like other digital media, they provide managers and leaders with a wealth of data on training performance, problems and compliance.

VR isn’t great for developing hand skills, however, because you can’t really touch anything and are limited to using controllers. We recommend VR as part of a mixed curriculum, not a replacement. Simulations that employ MR or AR can provide the best of both worlds, but have their own inherent limitations.

Partnership in practice

Here are two examples of simulations we have developed in partnership with our nurse educators:

• VR Blood Transfusion. We created two blood transfusion simulations, one involving an infant patient and one involving an eight-year-old patient. Two nurse trainees each don a VR headset and find themselves in a virtual ICU bay with the patient, supplies, equipment and the patient’s charts. The doctor’s orders require a transfusion, so they must assess and support the patient, start the transfusion, then respond appropriately if the patient has an adverse reaction. Throughout, a nurse educator observes their progress, coaches them and plays the role of the doctor on the virtual phone. Both scenarios are part of our regular new nurse orientation in the medical surgical ICU and the emergency department. Trainee feedback has been overwhelmingly positive.

• AR Pharmacy Training. Produced in conjunction with our pharmacy department, AR software guides the trainee step-by-step through the process of preparing syringes of saline to practice sterile procedures. Twice a year, pharmacists must recertify by preparing six syringes that are then cultured in the lab. If anything grows in the syringes, they fail. For remedial training, this 40-minute AR experience replaces an eight-hour day of being with the new orientees. The best part? Their subsequent pass rate is 90%.

Surgical scrub training

TRIED AND TRUE The trainees’ responses to the simulation training (pictured above) offer compelling evidence that extended reality education was effective.

In the cardiovascular OR at Boston Children’s, we wanted to expand capacity for training surgical scrub personnel without burdening our already overtaxed clinical instructors. The high-pressure role of a scrub tech requires speed and precision, which requires practice. Simulation can provide part of that practice. The VR solution we developed and added to their curriculum provides reinforcement, practice and another way to understand the material.

The VR surgical scrub training modules involve several cardiac surgeries. The training first memorizes the instruments and the sequencing for the surgery on an iPad. Optionally, scrubs can graduate to a VR headset and do the module in a simulated operating room. In the VR, they see the surgical field and all the instruments needed, then pass the instruments to the virtual doctor during a simulated surgery. Modules include the On/Off Bypass procedure, where each of the major arteries and veins going into and out of the heart are hooked up to a heart/lung machine to pump and oxygenate the blood. This allows surgeons to shut off the heart with a local sedative, perform the operation, then reconnect and restart it. The bypass VR modules cover this process, while other modules address several of the surgeries themselves.

Effective, efficient training for providers who need it most

Trainee responses have been remarkably similar across all VR and AR projects, and across time. This highlights the potential of simulation training for our nurses — providers who play such a critical role in health care.

Nurses are my heroes. They make life-and-death decisions, work long hours and bring their humanity to some of the most difficult times our patients and their families have ever faced. Like martial artists, they operate with remarkable precision and speed. That is why technology-based training for them can be a challenge: the training must work well, and it must work quickly. Nurses don’t have time to spend hours working through technical problems. OSM