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Due to the COVID-19 pandemic and subsequent stay-at-home orders, educational content delivery at the University of St. Augustine for Health Sciences (USAHS) transitioned from face-to-face learning to a virtual learning model in March 2020. With this new virtual environment, students at USAHS had limited opportunities to collaborate together in real clinical environments. The Center for Innovative Clinical Practice (CICP) made it our goal to create virtual simulation experiences that promoted student clinical readiness for interprofessional collaboration. The CICP shifted face-to face interprofessional learning experiences to immersive virtual encounters using 360-degree technology. We merged this technology and an interactive “choose your own pathway” platform to create personalized experiences for our students. Students interacted with these virtual learning experiences to make team-based clinical decisions about patient care.

These virtual simulations enabled our students to immerse themselves in realistic practice and community sites—such as hospitals, educational settings, homes, and workspaces—so they could engage in home safety evaluations, inpatient skills practice sessions, and workplace ergonomic assessments. The interactive scenarios allowed students to first explore situations by clicking hotspots, and then either answer clinical questions based on the patient information provided or watch short videos that gave them more information about the patient case.

We developed these experiences through a strong collaboration with staff, faculty, and the digital media team. They take about 20 hours of work to develop. The first steps involved identifying a clinical scenario for the virtual learning experience and identifying two to four student learning objectives for the simulation. For example, one of our first simulations focused on the identification of lines and leads in an acute care hospital setting. The specific objectives of this scenario focused on correctly identifying medical devices often seen during critical care practice and on demonstrating safe and competent clinical decision-making in the critical care setting.

Once the concept for a virtual simulation scenario was created, we developed a detailed media plan to ensure our simulation specialists and media team captured images and videos that supported the learning activity. We transformed our simulation room into a critical care ICU room and connected a standardized patient up to a simulated ventilator, IV pole, and various other ICU lines and leads.

Our simulation team then used a 360-degree camera and standard video camera to capture high-quality panoramic views (video and still images) of the environment, the patient, and the interaction between the patient and clinicians. We then used H5P, a software system for adding interactive content to media, to embed hotspots in the images that open additional educational content, such as instructional video, or interactive questions.

Students worked through the simulations in groups from a distance to imitate the collaborative work of care teams in clinical practice. Students first watched a pre-brief video that introduced the experience and the learning objectives and provided information about the patient or case scenario. Faculty and CICP staff created a pre-brief script, filmed in front of a green screen, then embedded images and videos into the media piece.

Then students explored a 360-degree image of our hospital room and patient. They selected hot spots on various pieces of medical equipment and were asked to identify each one (see Figure 1). They watched videos of patient-clinician interactions and were asked clinical decision-making questions about them. For example, the students watched a video in which the clinician transfers the patient to the edge of bed, and a question popped up that asked, “Your patient complains of dizziness and blood pressure has dropped. What is the appropriate clinical decision to make?” The students were given multiple options, and they had to select the best answer to proceed onto the rest of the scenario.

Patient with clickable hot spots.
Student clicking on patient hot spots.

Figure 1. Patient with clickable hot spots

If the student group provided a correct answer, they would receive positive feedback, and the virtual case would progress to the next level. If the team made a clinical decision that was questionable or put the patient at risk, the virtual learning experience would provide constructive feedback and then reroute the learners to the original prompt (see Figure 2). These personalized learning pathways allowed the student team members to consult each other on how they would work as a healthcare team to best treat their patient. The 360-degree technology and simulation gaming features made these interprofessional virtual experiences interactive and team directed.

Question: "How can you improve your understanding of the situation?"

Answers: "Call the nurse." "Pick up the communication board and begin to ask yes/no questions so the patient can express their thought." "Say, 'I'm having difficulty understanding, let us call on a speech therapist to come assist us." "Ask the patient again if they are in pain using a louder voice or use physical/hand gestures."
Virtual nurse standing by bedside vitals monitor.

Figure 2. Clinical decision-making questions with personalized feedback

Our virtual simulation experiences can be run synchronously and asynchronously depending on faculty preference. In other words, it is possible to bring together 100 interprofessional students, separate them into groups, and have them engage in the virtual simulation at the same time. Alternatively, some faculty choose to assign their students to small interprofessional teams and have the students complete the virtual simulation outside of class. We provided these interprofessional experiences with the goal of encouraging interprofessional collaboration after graduation and promoting professional reflection on the importance of interprofessional collaboration.

As we launched these virtual 360-degree experiences across our campuses, we received positive feedback from our students. Here are some examples:

COVID-19 challenged our simulation team to think outside the box, and we were able to adapt our teaching and learning model by creating and implementing virtual simulations. Due to the positive student feedback, collaborative opportunities, and immersive learning experiences, we plan on continuing to support virtual simulation, along with in-person simulation, even after the pandemic.

Elisabeth McGee, PhD, is the director of simulation education and CICP operations; Emily Frank, OTD, is the manager of simulation education and innovation initiatives Mechelle Roy, CHSOS, is the clinical simulation coordinator; Mauricio Viana, Erolle Dennis-Garner, and Derek Dudek are clinical simulation specialists; and Maria Puzziferro is dean of teaching, learning, and innovation at the University of St. Augustine for Health Sciences.