More than ever, there is a need to quickly, remotely, and effectively upskill a large number of people, in the absence of face-to-face training.
After the aviation industry, healthcare education was one of the early adopters of virtual (VR) and augmented reality (AR) technologies to promote learning. To prepare clinicians for the complex nature of healthcare, it was important for them to go beyond knowledge retention, and demonstrate problem-solving, knowledge adaptation, application and transfer. Provisions of the VR/AR environment such as the ability to ‘learn-by-doing’ in a safe environment that mimics real-life but keeps the cost-of-error low was conducive to the system change being sought.
COVID-19 has been an inflection point for the healthcare system. High volume of patients requiring intensive care led to an acute need for a larger healthcare force trained in critical care skills. Many practitioners have been reassigned to areas outside of their expertise; and retired professionals, volunteers, fast-tracked students and residents were brought on to the frontlines. More than ever, there is a need to quickly, remotely, and effectively upskill a large number of people, in the absence of face-to-face training.
As a prime example, critical COVID patients need mechanical ventilation to manage respiratory insufficiency; making endotracheal intubation (ETI) a fundamental skill. ETI is a complex medical procedure to open airways in patients who cannot breathe on their own. This life-saving procedure requires bimanual, near-perfect manipulation of tools in high-pressure situations with little time or scope for error. If performed incorrectly, there could be life-threatening injury to surrounding structures like trachea, esophagus, or the lungs.
For procedural competency it is recommended that a trainees perform as many as 200 intubations. Traditionally ETI training has relied on the “see-one, do one” method, but the time-sensitive nature of the procedure, and the patient’s delicate condition is not conducive to train residents, more so during COVID-19 pandemic. Cadavers and mannequins are expensive, lack realism as they do not provide variability in anatomy or difficulty levels, and do not mimic the stressors and distractors inherent to the clinical environment.
Using VR/AR, high-fidelity, immersive environments can be created to simulate the feeling of being in an emergency room – with patients, medical teams, monitoring systems, and other sights and sounds. Using headsets, speech recognition, or joysticks users can interact with objects and actors in the scene, while receiving real-time feedback. Advanced systems can incorporate haptic interfaces, motion-tracking, or multiple-angle cameras whereby the user’s hand or entire body becomes an actor within the scenario. To train ETI, for example, rigid objects mimicking tools for intubation (laryngoscope and intubation tube), and human-patient-simulators can be incorporated into the VR scene so the trainee will experience the sensorimotor motions of the procedure.
Researchers are also envisioning an interactive VR where complex anatomical structures are modeled into the scene, so when a trainee performs ETI they would receive in real-time, haptic feedback regarding soft-tissue deformation, or collision with an anatomical structure. Learning such complex psychomotor skills likes ETI, laparoscopic, or gynecological procedures requires tremendous practice, making and understanding the impact of error, and feedback – properties inherent to AR/VR-based learning tools.
The effectiveness of use of VR/AR to train medical and surgical skills is well established, and its advantages are numerous. Medical and surgical skills, as well as interpersonal skills such as empathy building, de-escalation, obtaining consent can be trained and evaluated. Scenarios can be personalized, and users can choose to practice identical scenarios or progressively challenging ones (deliberate practice) countless times, without risk to a human life, or themselves.
Compared to traditional methods of training medical skills such as insertion of IV or catheter, wound care, CPR and, intubation, immersion and gamification experienced in VR heighten engagement and knowledge retention by as much as 200%. VR simulations can demonstrate otherwise hard-to-imagine events like aerosol generation during ETIs - to educate workers about the risk of COVID transmission and teach effective donning-doffing techniques. The ability to remotely train and monitor performance improves accessibility and provides a cost-effective way to keep up with the ever-rising volume of new knowledge created in healthcare.
Recognizing that virtual simulation will continue to establish itself as a key pillar of healthcare training, the American College of Chest Physicians (CHEST) have partnered with Dark Slope to develop a remotely accessible, immersive learning program to train pulmonary and critical care workers in current best practices surrounding ETI procedures. The training, based on CHEST’s curriculum, will be delivered through Dark Slope’s innovative immersive learning platform, Involve XR. Using only headsets, pulmonary and critical care workers will have the opportunity to learn intubation skills in a fully immersive and interactive, realistic ICU environment.
Travel restrictions and physical distancing have changed how education is delivered. This has impacted the virtual reality market in the education sector; which is set to grow at a CAGR of 59% in the next four years. VR technologies are promising to make education more effective, more stimulating, and more accessible to all.