Many nursing educational programs have invested a significant amount of time and resources in a manikin-based simulation curriculum. As technology advances, educators are now looking beyond the physical simulation lab as they explore innovative modalities like immersive virtual reality simulation. What does it mean for simulation programs when they adopt immersive virtual reality? Immersive virtual reality is not intended to replace your manikins altogether – in fact they complement each other! Adopting immersive virtual reality allows you to leverage the benefits of this innovative modality while also maximizing your manikin use. Read on to learn more about manikins and immersive virtual reality – and how they can be used together to meet your students’ learning objectives.
According to the Healthcare Simulation Dictionary, the term “manikin” refers to full or partial body simulators that vary in physiologic function and fidelity. Manikin-based simulations are used extensively in nursing education and have been shown to support the development of professional identity, communication, and collaborative nursing skills.
Although high fidelity manikins provide a more realistic experience, this higher degree of fidelity is not always needed for students to meet their learning objectives. Lower fidelity, partial body simulators are excellent for training specific psychomotor skills, like chest compressions. A medium fidelity manikin would be an excellent choice for nursing students practicing physical assessment skills and differentiating between normal and adventitious lung sounds. High fidelity manikins can closely simulate human bodily functions and are often used in robust simulation scenarios that require a range of skills.
This modality involves wearing headsets that immerse students inside a 3D virtual clinical environment. Students experience a high degree of presence and proprioception as they feel their movement and position within the virtual space. The most advanced immersive virtual reality platforms have virtual clinical environments that are highly interactive and hands-on, with students operating equipment, assessing patients, and implementing nursing interventions. Immersive VR increases the realism of the simulation, helping students to suspend disbelief and participate as if they were in a real-life clinical situation. This high degree of realism has been shown to increase student engagement and motivation to learn
.Nursing educators are increasingly adopting immersive virtual reality simulation as a means for providing their students with high quality experiential learning opportunities. The benefits of immersive VR are widespread, offering an authentic learning experience for students while providing flexibility in how educators deliver simulation-based education. Virtual reality simulation does not require a large amount of space, which allows nursing programs to accommodate more students than other traditional simulation activities. Certain virtual reality simulation platforms provide a standardized experience that can be implemented in a peer-to-peer learning model, which uses faculty resources judiciously and scales simulation to a larger number of students. Immersive virtual reality also benefits student learning, having demonstrated non-inferior learning outcomes when compared with traditional methods, and improvements in cognitive, psychomotor, and affective skills.
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So now that we have discussed manikins and immersive virtual reality – how do these two modalities complement each other?
To provide a robust learning experience, educators can use a hybrid approach that leverages the benefits of both immersive virtual reality and manikin-based simulation. While immersive virtual reality can assess certain psychomotor skills, the use of hand controllers may limit the ability for students to perform exacting, fine motor movements. Examples of certain skills that can be difficult to assess in virtual reality include IV insertion or the adequacy of chest compressions. Manikins provide an excellent modality for assessing the psychomotor domain, especially when using simulators designed for specific skills-based learning. In a hybrid model, educators can first engage students in an immersive virtual reality scenario that challenges them to use cognitive and affective skills, execute autonomous decisions, and develop clinical judgment in a realistic environment that fosters the suspension of disbelief. Students can then practice specific skills on manikins that provide the necessary tactile feedback. This approach maximizes the best aspects of both modalities by combining the deep immersion of virtual reality with the psychomotor realism of manikins.
Some student learning objectives are better met in immersive virtual reality and some with manikin-based activities. Adopting both approaches allows you to utilize your resources more effectively by choosing the modality that best fits your needs. Manikin-based simulation can consume a considerable amount of resources, requiring a dedicated staff member to operate the manikin and re-stage the room between scenarios. Manikin-based simulation also requires more space, including a simulated hospital room with physical equipment. This can present challenges in nursing schools with limited space and a growing student enrollment. In contrast, immersive virtual reality simulation requires minimal equipment (just a headset and gaming laptop) and does not need a dedicated staff member to operate the scenario. Only a small amount of space (generally 6.5 ft x 6.5 ft) is needed for students to safely participate in an immersive virtual reality scenario. This allows educators to provide high fidelity simulation-based experiences to a larger number of learners.
By aligning the simulation modality to the student learning objectives, educators can more efficiently use resources and space. For example, students learning how to perform procedures may need a dedicated room with task trainers and stations, while those needing a high fidelity experience could use immersive virtual reality in a smaller area. Having access to both modalities gives educators the flexibility in how to implement simulation-based learning while allocating resources to where they are needed most.
Nursing students participating in an immersive VR scenario. © Laboure College
The COVID-19 pandemic has changed how we do simulation-based education. Simulationists must now consider activities that comply with social distancing and infection control guidelines. With these new measures in place, it can be challenging to provide robust simulation-based experiences while keeping students safe.
Having access to immersive virtual reality enhances your options when providing high-quality simulation experiences in the new normal. When implementing manikin-based simulation, sanitizing the manikin and simulated hospital environment can cause longer turnover times between scenarios. This can lead to downtime during a simulation day, especially in programs with limited staffing and space. To keep students engaged in experiential learning, they can alternate between participating in immersive virtual reality scenarios and manikin-based simulation. This approach will give students the opportunity to benefit from both simulation modalities while also minimizing interruptions in their learning.Providing team-based learning activities can also be a challenge under conditions of social distancing. Manikin-based simulation can be reserved for scenarios requiring a smaller group of learners that can remain appropriately spaced apart in the physical simulation lab. For scenarios that cannot be done under conditions of social distancing, the multiplayer feature of immersive virtual reality allows students to participate together in the same scenario even when not present in the same physical room. In a highly interactive virtual environment, students can hand each other equipment, assess patients together, and develop critical teamwork skills while also complying with social distancing and infection control guidelines.
Watch learners collaborate in a nursing virtual reality simulation
Immersive virtual reality can function as a simulation modality all on its own, or as an effective partner to existing manikin-based simulation programs. No matter the size or sophistication of your current simulation setup, immersive virtual reality provides powerful learning options that will augment your delivery of nursing education.
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