For medical students and junior doctors, training can be hit and miss. Sometimes you sit down with an actor who plays the part of a patient and rehearse giving a difficult diagnosis, sometimes there's a dummy that you examine, with a colleague shouting out imaginary symptoms along the lines of "His blood pressure's gone through the floor!" or "She looks sweaty and confused now!"
In most cases, your imagination has to do the legwork, converting the unmoving peach-coloured rubber torso into a patient urgently in need of assistance or the actor into someone who's about to get bad news. If you're lucky, you get to practice this way a few times a year.
If you're in a pandemic, you might not even get that. With training oftentimes taking place in hospitals, students and trainers now can't go to these facilities in order to reduce the risk of transmitting COVID. So now a number of universities and medical institutions are turning to virtual reality to bridge the training gap.
"Using mannequins and actors in hospitals is a very common way of training people nowadays, and it works: we can see that that reduces errors, we can see it improves care. But it is not a scalable way of delivering that training, it's very expensive, low throughput, you need lots of space to be able to do it," says Dr Jack Pottle, founder of VR medical simulation training company Oxford Medical Simulation (OMS). The company's software is now used in 200 institutions.
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By putting on the VR headset, students can see virtual patients, look at their symptoms, and ask questions (and get replies). The scenarios the students play through adapt to the decisions they take, with the patient getting better or worse accordingly. It's not the same as in-person training, but it gives learners a flavour of managing patients on the wards.
"There's all of that conversation, which is adaptive and dynamic, but also the patients have rashes, they sweat, they look genuinely unwell. It's those elements, for me, that build that emotional fidelity. It's trying to give doctors and nurses a sense that when you put on these headsets, you can feel like you're there, and it gets your heart rate up, you care about these virtual characters, and therefore, people try to perform like they would do in the real world," Pottle said.
While using VR to deliver medical education isn't necessarily new, like Zoom meeting and telehealth, it's something that's inevitably grown as a result of COVID-19. The pandemic means that doctors are only able to go into hospitals when strictly necessary, limiting the opportunities for training.
It's a similar story for medical students, with many being discouraged from coming on to campus for their learning. VR does offer a way for students to continue learning, but without having to expose themselves and others to the risk of coronavirus by travelling to university.
For students in the University of Texas Medical Branch, it was a situation compounded by the area's recent wild weather.
"They just had a massive blizzard, power and everything's been shut down, and they haven't been able to get into the physical university space. So, they've been creating their own virtual patients, where the educators write these scripts for them," said Alex Young, CEO of VR medical education company Virti, whose technology is being used by the university.
As part of the assessments for their degree, the students can play through a scenario of a patient who comes to hospital because of chest pain. The learners then have to take his medical history from and come to a diagnosis.
While COVID is driving clinical learning to VR, the teaching of human anatomy -- which typically takes place in the early years of a medical degree -- has already shifted to virtual reality in some universities. Case Western Reserve University's medical school, for example, had been teaching anatomy on campus through content on Microsoft Hololens, rather than by dissecting cadavers as many universities do. Now, with students unable to come onto campus, the university has shipped headsets to students at home so they can continue learning at home.
As well as helping students learn in spite of COVID-19, the medical education platforms have been helping hospital staff learn what they need to know to fight it.
At the start of the pandemic, LA's Cedars Sinai Medical Center hospital found itself needing to training its 14,000 clinical staff in COVID-19-related procedures, from reinforcing hand hygiene to putting on personal protective equipment (PPE).
"We were able to deploy [training] to a large number of learners at Cedars Sinai, where otherwise they would have had to bring in groups of, say, 20 people at a time into a physical space, get them putting on protective equipment, get them signed off to say that they're safe to do it," Young said.
VR medical education also means learners can learn from home -- or in the doctor's mess or hospital library, post-pandemic -- if they have the right kit. Some hospitals will purchase the devices themselves and loan them out to students. Many students are unlikely to be able to bear the cost of buying their own devices for when the university-provided ones aren't available. In the meantime, the medical education companies make phone and PC friendly versions of the same content.
By putting on a virtual reality headset, learners can be immersed in the situations that they'll face in their careers, either on their own or with fellow students and doctors.
OMS's scenarios include a not-uncommon situation called anaphylaxis: a patient who's been given a new medication and has a severe, life-threatening reaction. The patient becomes sweaty and pale and, develops a rash. The learners in the scenario have to investigate the patient -- virtually organising blood tests and monitoring their vital signs -- and give the right medication to improve the virtual patient's condition. Get it right, and the patient will recover; get it wrong and the patient will start to deteriorate.
It's a condition that students and junior doctors will be familiar with, but not have seen themselves before. And, given it could be fatal, practicing in virtual reality offers an opportunity to learn how to manage anaphylaxis in a safe way with virtual patients.
"I've seen people not manage to treat anaphylaxis correctly and working as a team is incredibly stressful, and you can see people really stressed in these scenarios. I like getting people to a level of stress where you can see that, when they get to that scenario in real life, they will not make the same mistakes again," OMS' Pottle said.