Orienting Faculty & Nurse Learners to UbiSim

Facing a nursing shortage, the University of Manitoba's College of Nursing expanded its undergraduate nursing program. With over 1100 students now enrolled, there are not enough mentoring opportunities available in the health system for practical clinical experiences. Consequently, up to 50% of clinical training hours are conducted through simulation in certain courses. To utilize limited space and resources efficiently, while still offering an immersive experience akin to actual clinical settings, we integrated Virtual Reality (VR) experiences into our simulation curriculum using the UbiSim platform. In the fall of 2022, we initiated an extensive VR program where each student participated in, on average, six hours of VR clinical training each term. Our three VR labs operate four days a week throughout the year. 

A crucial element of our VR program's success was the initial comprehensive orientation for students and faculty on using VR and navigating UbiSim. This reflection shares my experiences in introducing nurse learners to UbiSim, including key lessons and future recommendations.

Orienting Facilitators 

Preliminary Training

Facilitators start with an orientation to VR. The orientation process for  VR in our lab is designed to ensure that facilitators are both comfortable and proficient in navigating the virtual environment, which enhances their ability to facilitate the learning experience. This begins with a preliminary video, created in-house, which facilitators watch to gain an initial understanding of the VR setup and navigation.

Hands-On Training

After viewing the video, the facilitators attend the VR lab, where the hands-on orientation begins. The first step involves guidance on fitting the VR headset and eyepiece. Proper adjustment is essential for comfort and visual clarity, which significantly affects the user's ability to engage with the content. This is followed by a detailed tutorial on navigating within VR, crucial for moving through various scenarios effectively. 

The orientation also covers manipulating the virtual boundaries within the VR environment to ensure safety and prevent disorientation. Another skill taught is teleporting— a method used in UbiSim for moving the user's position instantly, which helps in navigating more complex scenarios smoothly.

The facilitators are instructed on logging into UbiSim, casting to a screen is also demonstrated, allowing the facilitator to view the student’s perspective in real-time, which is particularly useful for instructional purposes.

The final part of the session is dedicated to what we refer to as "playing" in VR as both active learner and driver. This unstructured time allows facilitators to explore the virtual environment independently, applying the skills they've just acquired in a more relaxed and exploratory manner. This phase is crucial for reinforcing the learning and ensuring they feel confident navigating and interacting within VR, so they can assist their students should difficulties arise.

Pedagogy of Facilitating in VR

On their second day, facilitators attend an orientation to the pedagogy of facilitating in VR. First, the roles of all participants the facilitator will be working with are defined. The Active Student engages directly with the virtual environment, making real-time clinical decisions during the UbiSim scenario. Meanwhile, the Driver Student takes on the role of the patient, health care provider, or visitor, selecting predetermined responses to guide the simulation's progression. The Simulation Operator plays a supporting role by managing the technical aspects of the simulation. This includes setting up the VR equipment, troubleshooting any arising issues, and ensuring that all equipment is properly cleaned and stored after use. Each role is vital to the overall effectiveness and efficiency of the simulation training process.

Facilitators are then instructed on the prebrief and debrief frameworks. The prebrief is essential for setting expectations and preparing students for the simulation. It outlines the objectives and procedures, ensuring that each participant understands their role and the simulation’s educational goals. In our program we debrief using the PEARLS method, a structured framework designed to facilitate reflection, learning, and application of the experiences gained during the simulation. This method helps students internalize what they have learned and apply it to their future clinical practice.

Facilitators are equipped with a comprehensive binder that includes step-by-step instructions on all orientation topics. The binder contains detailed outlines of each simulation that they will be facilitating, including learning objectives and the expected flow of scenarios. Additionally, it provides frameworks and sample phrases that facilitators can use to guide effective PEARLS debriefings. This resource ensures that facilitators are well-prepared to deliver a consistent and high-quality educational experience to all participants.

The facilitators then spend time in UbiSim working through the simulations that they will be facilitating. 

Orienting Students 

Preliminary Training

Our orientation for students is structured to ensure understanding and effective utilization of VR technology in a safe and professional environment. To prepare, students are required to watch the same introductory video that the facilitators watched. This video provides an initial overview of the VR setup and navigation, ensuring that both students and facilitators are on the same page from the start.

On the first day of orientation, students are introduced to the specific guidelines that will govern their interactions in the VR lab. This briefing emphasizes that the VR experience is not a competition or a game, and that recording videos or taking photos is strictly prohibited to maintain the integrity and privacy of the experience. Furthermore, the VR environment is presented as a safe space for learning, where making mistakes is not only accepted but is considered an integral part of the learning process. 

Students are encouraged to treat the VR scenarios as real-life situations, engaging seriously and professionally despite knowing the simulated nature of the environment. This approach is intended to foster a deep level of engagement and realism, enhancing the educational value of the simulations.

Hands-On Training

The Facilitator, with the assistance of the Simulation Operator provide a demonstration prior to the students getting into the headsets. The demonstration begins with a basic introduction to the VR controllers, often referred to as joycons. For safety, students are instructed to secure the wrist straps and familiarize themselves with the primary features of the controller, including the Oculus button, which is central to navigating the VR interface. The facilitator demonstrates how to navigate through the VR system using the handgrip buttons and the toggle.

Students learn how to access the casting feature by navigating through the VR menu to select their computer for screen mirroring. They are also shown how to calibrate their virtual height by stepping to the center of a designated mat and interacting with the VR interface to select the appropriate room scale or stationary boundary settings.

Throughout the session, students are reminded that if they encounter any difficulties or if the VR interface does not respond as expected, they should press the Oculus button to return to the main screen. This action also allows them to re-center their view or adjust their position by holding the Oculus button until the orientation resets.

Basics of locating the correct scenario to launch, “driving” and communicating as the patient or other character is also demonstrated.

Following the demonstration the students enter the UbiSim Operating Room Tutorial. Prior to entering the tutorial, learners receive a comprehensive checklist of tasks they need to complete, which aids in guiding their training and ensuring competency in various skills. This checklist includes twenty practical tasks such as picking up and setting down items, donning and removing a patient gown, and using the teleportation feature. It also covers how to maneuver a vital signs machine, conduct patient assessments such as checking skin integrity and pulse, and adjust patient positioning by helping them sit up or lie down. Additionally, the checklist involves interactive tasks with the electronic patient health record system, including reviewing and signing off on the medication administration record. To facilitate tracking of completed tasks, the checklist is designed with checkboxes next to each item. Some tasks, like teleporting, are meant to be repeated and thus have multiple boxes to ensure learners practice them more than once.

What I Learned

In the fall of 2022, we devoted substantial effort to the orientation of facilitators, operators, and students. Without a structured orientation for both facilitators and students, our learners would likely face numerous challenges as they try to navigate the system, which could detract from their learning.

This investment is now yielding benefits, as we currently only need to orient new students or staff to the program. Our students attend classes year-round, there is no summer break, which helps maintain their familiarity with navigating the VR systems. experience.

Recommendations

Providing the Facilitators and Students with in-house made videos prior to their attendance, provided the opportunity for them to get comfortable with language and expectations before physically doing it. This made better use of their orientation sessions.

By providing facilitators with printed and electronic materials that they could review outside of the VR lab, they are able to understand the scenarios and the learning outcomes.

Regular updates and training sessions for facilitators on the latest VR technology and educational methodologies should be implemented to keep the learning environment dynamic and effective.

Continuous feedback from both learners and educators should be used to refine the simulations, making them as close to real-life scenarios as possible to prepare students better for actual clinical environments.

One thing that both students and facilitators have asked for are open lab times or the ability to sign out headsets to practice with them.  We are currently exploring the logistics, as this could prove to be very beneficial. 

Conclusion

Our thorough orientation plan has led to a positive experience in introducing both facilitators and nursing students to UbiSim. With a solid foundation in place, there is minimal frustration and fewer issues with navigating the headset or application. While seeing the students' engagement and their expressions of amazement upon interacting with their first virtual patient is enjoyable, it is particularly rewarding to witness their "aha" moments when theoretical knowledge from the classroom connects with practical application.