A local course has been delivered since 2018 to provide training in rare, time-critical, life-saving procedures that emergency medicine trainees may need to perform, including emergency lateral thoracotomy. Previously pig thoraxes have been used to provide thoracotomy training in this course. In 2022 a part-task model was purchased for thoracotomy training to replace this. We compare the use of this to animal models in our provision of simulation teaching of this skill.

Activity:

Animal models are useful due to availability, low cost, and provision of hands-on experience for learners. However, there are associated ethical, religious, psychological limitations with using animals for educational purposes. They may less accurately represent human anatomy and pathology. Their timely acquisition can pose a challenge with defrosting requirements and variable condition which can impact on the quality of training. There are infection risks due to fluid leakage, associated unpleasant odour and animal products require incineration for disposal.

The high-fidelity part-task mannequin can anatomically and physiologically replicate the thoracotomy experience to provide realistic simulation training. The mannequin is equipped with realistic external human features and internal organ anatomy, including a beating heat and blood, to provide an immersive training experience. It is reusable with repair, which could be cost-effective long term and more environmentally-friendly. This model enables thoracotomy skill practice in a safe, controlled environment without infection risk. Another advantage is the ability to provide standardized training, better allowing for objective evaluation of performance which can be challenging with animal models.

Findings:

This model (Figure 1-A108) has been a source of highly stimulating learning for both faculty and participants taking part in the course. The accurate anatomy has given an enhanced learning of real time simulated emergency requiring lateral thoracotomy and this has been reflected in participant feedback. There was a significant upfront cost which will depend on the continuation of the course, committed faculty and upkeep of the model to prove it cost-effective in the long run. The education team attended a course on the repair and maintenance of the model and it takes approximately 4-6hours to clean and repair the model after each use. The model requires a large heavy box for safe storage posing a relative burden given its infrequent use.

Figure 1-A108:

The immersive lateral thoracotomy model we are using, which is fully repairable to be used multiple times for authentic learner experience

Conclusion:

There are disadvantages to use of this model for the department, but the overall learning experience and sustainability is felt to be superior to animal models for training in emergency thoracotomy.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Within health care provision many case history assessments are now performed online [1], with students expected to utilize a variety of virtual platforms in a safe, effective and professional manner.

Aim: To approximate a real environment for students to practice virtual skills of case history assessment with service users.

Objectives: Student development of: 1. Virtual communication skills (verbal, non-verbal, active listening, respect), 2. Clinical reasoning and interpretation, and 3. Reflective skills facilitated by debrief.

Activity:

Simulation preparation including revision of musculoskeletal assessment and familiarization with virtual ground rules linked to HCPC Guidance on Conduct and Ethics [2].

42 students participated, split into groups of 14 for each virtual simulation session with a total of 5 service users briefed beforehand. Initial warm-up activities in breakout rooms were used to familiarize students with use of the online platform and to facilitate virtual communication skills. Groups of 4 students planned and undertook a virtual musculoskeletal case history with a service user.

The Diamond structure for simulation debrief [3] was facilitated by Faculty staff involving the service users and peers; enabling further development of the students’ clinical reasoning and interpretation. Students reflected on their own performance using a simulation checklist as a resource, closing the loop by creating an action plan prior to their first practice placement.

Findings:

25 students voluntarily completed an anonymous questionnaire linked to their virtual experiential learning activity. 75% strongly agreed and 21% agreed that the simulation was helpful in their development for placements (see Figure 1-A122).

Figure 1-A104:

Graph to show student response that virtual musculoskeletal simulation with service users was helpful in their development for placements

Thematic analysis of good aspects of the activity identified 4 main themes: 1.

Benefits and realism of service user involvement compared to actors or peers

Development of virtual communication and assessment skills

Richness of involvement of service users in the debrief

Usefulness of warm up activities using virtual technology

Suggestions for improvement showed 2 main themes around increasing planning time and more opportunities for simulation with service users.

Findings demonstrated the simulation aims and objectives were met with students positively reporting that the activity was helpful in their learning ahead of practice placements - enabling development of virtual communication, clinical reasoning/ interpretation and reflection through debrief.

Conclusion:

Approximation of a real environment for students to practice virtual case history assessment incorporating service users offers a rich educational example that aligns well with practice and sustainability in the current healthcare environment and is highly valued by students.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Electronic patient record (EPR) systems are increasingly prevalent in clinical settings, yet UK medical simulation training continues to use outdated paper-based methods for training healthcare staff. While published literature has highlighted the training benefits of incorporating EPRs into medical simulation training [1, 2], the transition has previously been hampered by a lack of bespoke software. To address this, a novel educational EPR (named SimEPR) was created, a bespoke training software designed to be used on a computer at the manikin’s bedside, which features customizable clinical scenarios (Figure 1-A102).

Figure 1-A102:

A preview of SimEPR, a novel educational electronic patient record system designed for UK medical simulation training

Aim:

This project aimed to incorporate SimEPR into routine medical simulation training in the South East of England, and report trainee experience using the software.

Activity:

Feedback data was collected from trainees who used SimEPR as part of their simulation training using an electronic feedback form. SimEPR was initially deployed in a medical school and two NHS trusts from 11th February 2021, before the project was scaled up to six additional educational centres (one university and five NHS trusts) from 3rd January 2023.

Findings:

Data from 209 trainees was collected, of which 16% were medical students, 82% were foundation doctors and 2% were post-foundation doctors. Out of these, 86% reported that, compared to using paper notes, the educational EPR created a more realistic training experience. Meanwhile, 83% reported that the use of SimEPR helped improve their clinical learning. Last, 87% reported that they would recommend the simulation department to continue using SimEPR.

Conclusion:

SimEPR is the first software of its kind designed specifically for UK medical education, and is the product of collaboration with a number of simulation leads and NHS-affiliated organizations. As well as data supporting a higher fidelity training experience, SimEPR incorporates digital skills into practical training, thus supporting the development of a digitally-ready workforce. In addition, by eliminating the use of paper, SimEPR contributes to the sustainable delivery of simulation-based education. Further evaluation work as part of this pioneering regional project aims to collect pre- and post-training feedback, feedback from medical educators and feedback from other healthcare disciplines.

In the longer term, SimEPR offers to transform the delivery of simulation training for the NHS workforce. The software’s ‘scenario-sharing’ function allows sharing of simulated patient records between institutions, supporting the standardization of training while saving staff time in building training scenarios. Furthermore, features such as performance analytics for trainee feedback, and AI technology to generate interactive scenarios, are being explored.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Transfer medicine is evolving into a more visible, necessary sub-specialty, particularly since the COVID-19 pandemic, during which the need for proficiency in critical care transfers became apparent. As such, there exists a requirement for the provision of good training in this domain, especially for effective simulation-based learning given the dynamic nature of critical transfers, in tandem with the relative scarcity of experience of the average non-specialist practitioner.

The creation of meaningful simulation training is already well recognized as posing numerous challenges [1], often in balancing fidelity with practicality, for achieving engagement of learners and transfer of learning to practice [2]. When adding the dynamism involved in a transfer - such that simulation requires movement of a critically monitored patient from one point to another - this task becomes more complex. Importantly, the integrity of the exercise is lost when provided in a stationary environment, as with much simulation traditionally. This was the focus when designing the Adult Critical Transfer Simulation (ACTS) course - a multi-disciplinary team-based day with pre-course e-learning, focused around assorted simulated scenarios performed in motion across an education suite. Additionally, it incorporates reflexive debriefing, interactive workshops and group discussion sessions to support learning.

Activity:

The greatest technical challenge of ACTS - modified repeatedly now over two years - was the delivery of mobile, multi-environment scenarios that provide an equivocal experience to that of traditional, stationary lab-based simulation. This was addressed utilizing wireless, remotely controlled patient models and monitoring alongside a network of strategically placed cameras and microphones to provide immersive simulation for both active and observing participants. In addition, considerable attention was given to audio-visual cues at all points of transition for creating the ambience of a moving transfer, the efficacy of which is reflected in positive course feedback.

Results:

Feedback on ACTS was collated from all participants, with significantly favourable responses in every domain and 100% overall score of 5/5 for both enjoyment and recommendation, and 93.8% score of 5/5 for relevance to professional needs (Figure 1-A101). Positive comments were most numerous regarding realism and engagement of the experience, and faculty expertise, with additional commentary strongly supporting recommendation to other professionals and anticipation for continued provision.

Figure 1-A101:

Feedback from participants of the 2023 Winter run

Conclusion:

Although there is no substitute for real-life experience, ACTS has demonstrated multi-disciplinary need for critical transfer proficiency can be met successfully through the provision of dynamic simulation when facilitated by technology, with great scope for future development given the rapidly advancing nature of technological resources.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

It is well established that familiarization with the simulation environment is integral to the pre-brief [1]. This fosters psychological safety and creates optimal learning conditions for participants and faculty. We sought to enrich our visitors’ psychological safety by providing a digital preview of our simulated environment, prior to the face-to-face familiarization they receive when attending a course.

Activity:

Combining 360 and 2D video production techniques we have produced an online experience hosted on the CenarioVR platform. This gives visitors an opportunity to explore the simulated environment, patient and equipment, in their own time, while introducing aspects of the fiction contract. We believe accessibility is key to the utilization of this resource. So we have ensured it can be used on a range of devices including:

Virtual Reality Headsets (HTC/Meta)

Desktops/ Laptops

Mobiles/ Tablets (enhanced with accelerometer controls)

The content is cloud-based and accessed via an internet browser across all platforms, requiring no additional app. One limitation is that the experience requires a stable internet connection.

Findings:

A link to the tour was embedded in our pre-simulation communication to participants and faculty, and its usage and impact was evaluated over a period of 2 months using additional questions in our post-course questionnaire. 50 feedback responses to CenarioVR were received. 24 delegates viewed it 26 did not. Of the 24 that viewed 58.3% agreed virtual tour strengthened their experience, 12.5% strongly agreed, 20.8% neutral, 4.2% disagreed and 4.2% strongly disagreed.

Conclusion:

From our data we concluded that over 70% of delegates that viewed the virtual familiarization found it to be beneficial to their simulation experience. With simulation being used more in education it is imperative that those with less experience in this setting are provided with resources they need to feel psychologically safe.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The COVID-19 pandemic has undoubtedly served as a catalyst for adaptation of effective delivery of medical education, paving the way for the adoption of novel teaching methods [1]. Simulation based education (SBE) has been no exception, with increased delivery of SBE through immersive, virtual mediums such as head mounted displays (HMD) to create a three-dimensional (3D) environment.

Simulation is a vital part of the mandatory foundation programme (FP) learning requirement [2]. Our team incorporated synchronous in-person and online virtual reality simulation (VRS) sessions into the foundation doctor (FD) teaching programme at a single trust and supplemented this with additional, facilitated in-person small group 3D VRS sessions.

Methods:

Mixed quantitative and qualitative feedback was obtained from FD through online surveys, which included aspects of the SET-M tool [3]. Semi-structured interviews were then conducted with a purposeful group of FD attending facilitated small group VRS sessions. Interviews were conducted over a sixteen-week period at eight-weekly intervals, with a baseline interview conducted at week zero. Qualitative data obtained were analysed by thematic analysis.

Results:

Learners expressed that VRS sessions improved their confidence in clinical assessment, decision-making, and management of similar real-life scenarios as well as in the provision of interventions which foster patient safety. Moreover, feedback highlighted that the VRS modality fits well into their current teaching programme, is a format that they wanted more regularly incorporated into their learning and one which they would prioritize attendance at. Feedback also outlined some challenges with this modality; namely accessibility and technological troubleshooting.

Conclusion:

Our work highlights the value and associated challenges of using VRS in FP education. There is a strongly positive reception amongst learners in our cohort, a call for more exposure and, vitally, a transferability of learning into real-life practice.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The role of the paramedic is diversifying, and universities need to respond by developing curriculums that support paramedic graduates to meet future workforce needs. Placements are key to our students developing the necessary competencies to become qualified paramedics and the pressure is on universities to offer a wide range of placements to reflect professional diversification. In addition, Health and Care Professions Council’s new standards of proficiency acknowledge that paramedics of the future are likely to consult patients in the virtual world [1].

As universities strive to meet this demand, they are often faced with placement capacity issues. Rising student numbers, staff retention issues and competition for placements from other healthcare students can make it extremely challenging to secure placements, especially in desirable areas such as primary care.

Activity:

The author, with the support from colleagues, was successful in obtaining funding from Health Education England to pilot a series of live virtual placement experiences, the first of which was successfully delivered on 20th April. On this date, 30 learners from our paramedic degree apprenticeship programme, in a classroom on our Lancaster campus, virtually attended a live clinic in a primary care setting in the south of England. The clinic was rigged with various cameras and microphones, with real patients consenting to being filmed.

The experience comprised of 5 patients, with the lead clinician providing a brief to the learners before each patient arrived for their consultation. Afterwards, the clinician would complete their clinical documentation before engaging in a two-way conversation with our learners and academic staff via Microsoft teams. Following the clinic, our apprentices had the opportunity to consolidate their learning via case study driven seminars which linked to the mornings experience.

Findings:

Overall, student feedback was supportive, with the majority stating they found the experience enjoyable and engaging. The video stream of the placement was recorded for reuse in the programme’s curriculum, and we hope that future live virtual placements will see other professions, such as physiotherapy and nursing, take part. Eventually, we want to develop the model for other disciplines and placement settings

Conclusion:

The academic team are looking forward to the second of three experiences, in May, with the view to contributing to the growing evidence base in this area, to reflect the value that we believe ‘Live Virtual Placement’ experiences have in the development of our future workforce.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulation is integral to the recovery of surgical training in the UK after the COVID pandemic. Physical constraints on traditional simulation training can affect access. We sought to understand if cardiac and thoracic simulation training remotely is feasible and effective. It has been demonstrated in other settings and has potential in the surgical setting [1].

Methods:

We completed simulation training sessions using the Teams and Zoom online platforms with single one on one and group simulation training sessions covering Video-assisted-thoracoscopic-surgery wedge resections and lobectomy as well as coronary anastomosis.

Results:

We had 15 participants in the thoracic arm and 5 participants over 4 sessions in the cardiac arm. All participants found the remote simulation training useful and improved their confidence in surgical skill. We did not have any technical connection difficulties during sessions but challenges for simulation in this format included standardizing the equipment and setup pre-sessions. Participants found in 89% of cases that feedback on performance was superior to face to face simulation and/or surgical theatre experience.

Conclusion:

Remote simulation is feasible and effective in cardiothoracic surgery in our pilot study. Further studies are needed to better clarify who this resource should be targeted at included experience of trainees and level of competence.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

High-consequence infectious diseases (HCID) are pathogens which spread easily between people, have high mortality rates, and lack effective treatment [1]. Examples include Ebola and Lassa fever. Most emerging pandemics, including COVID-19, are initially classified as HCID.

Assessment of patients with suspected HCID infection is an advanced procedural skill requiring application of enhanced infection control measures including patient isolation, personal protective equipment, and decontamination. There is a risk of healthcare worker infection if procedures are not followed [2]. HCID often present in non-specialist centres; there is a need for an accessible, educationally effective HCID course for NHS staff.

Activity:

We developed a course for clinicians in infectious disease and emergency medicine, in collaboration with the Health & Safety Executive and clinicians in the UK-HCID network. The course uses a blended approach; theoretical components are taught with online learning. Practical components are taught with high-fidelity, multidisciplinary simulation using VIOLET, a mannequin which coughs, vomits and sweats ultraviolet markers (Figure 1-A51) [3]. This simulates airborne, contact and fomite transmission, allowing visualization and debrief of contamination before and after PPE removal. Training culminates in summative assessment. Educational effectiveness was evaluated through curriculum-linked pre- and post-course tests, and self-rated confidence using Likert scales.

Figure 1-A51:

Ultraviolet tracers are used to replicate contact and airborne transmission of infectious pathogens in simulation scenarios

Findings:

Between 01/12/22 and 01/04/23, 57 specialized clinicians participated. All participants passed post-course competency-based practical assessments. Participants demonstrated significant gains in knowledge between pre- and post-course tests (mean score 61% vs. 83%, p = <0.0001). Pre-course, 36% (19/53) of learners reported feeling confident or very confident at PPE donning and doffing, rising to 97% (32/33) post-course. All participants rated their learning experience as high or very high quality.

Conclusion:

This is the first HCID simulation course internationally using ultraviolet markers to allow visualization of contamination. The course appears to be an effective educational intervention and improves learner confidence in PPE use.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Severe disruptions have plagued Myanmar’s undergraduate and postgraduate medical education – firstly with the Covid-19 pandemic and later with a military coup d’état in February 2021. In the wake of the current humanitarian and political crisis, many medical students partaking in civil disobedience have been driven underground for fear of retribution. Foregoing bedside teaching and crucial clinical learning opportunities in hospitals – for online education through teleconferencing and live broadcast via social media. To scale up these efforts the Global Health Education Group’s (GHEG) novel XR platform was piloted to provide remote clinical experiences streamed to Myanmar students with the help of diaspora doctors and virtual patients in the UK [1].

Methods:

The pilot held over a 4-day period in February comprised 4 Virtual Clinical Experience (VCE) sessions each covering two simulated patient scenarios related to the following disciplines: Medicine, Surgery, Obstetrics and Gynaecology, and Paediatrics. Each session had an introductory, consultation, and debrief phase that ran for 1.5 – 2 hours altogether. This was held on GHEG’s newly developed Virtual CP platform [2], which enabled the students to view a live stream of the consultation with the patient-actor through the clinician’s smart glasses and provided the opportunity for real-time interaction.

Results:

The sessions were successfully delivered to 400 students from across 5 Myanmar Universities. The student’s satisfaction was assessed using an anonymous feedback form that was disseminated; a total of 38 responses was obtained which was overwhelmingly positive. 76.3% of the respondents rated the session to be ‘helpful’ or ‘extremely helpful’ and 68.4% rated the session to be representative of a real clinical experience. On a scale out of 10, 57.8% of respondents rated the VCE platform a 6 and above on ease of use. Technical difficulties did arise affecting 68.4% of respondents, although free text feedback purported they were promptly addressed in subsequent sessions.

Conclusion:

Synchronous remote learning through virtual clinical experiences can be used to address the dearth of clinical opportunities afforded to medical students in Myanmar.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Nottinghamshire Healthcare Medical Education delivers simulation-based learning to over 500 medical students and junior doctors each year. The scenarios for these sessions are co-produced and delivered with a simulated patient actor. In January 2023, we introduced a new type of simulation allowing participants to interact with a digital patient. The AVATr digital patient received good feedback delivered remotely [1], but we intended to use it face to face. Our aim was to find out whether participants found the digital patient more or less useful than the patient actor. A secondary aim was to explore if the digital patient was helpful in preparing for simulation with a patient actor.

Methods:

The digital patient simulation was delivered in the morning of a full-day session to a cohort of F2 doctors. Participants sat on a chair in front of a green screen with a go-pro filming them. Participants were able to see themselves in a third-person perspective on a TV screen and interact with a digital patient. The digital patient was controlled by a facilitator who chose responses from a grid depending on what had been asked and how it had been asked. The participants experienced two scenarios – one around assessing psychosis and one on adult self-harm. The participants also had a simulation later that day with a patient actor. We collected qualitative and quantitative feedback via digital forms and analysed the results.

Results:

Ninety-two participants attended the sessions between January 2023 and March 2023. 70% of participants Agreed or Strongly agreed that the virtual patient was useful, compared to 100% for the patient actor. If facilitator familiarity with technology was adjusted for 68% of participants, Agreed or Strongly agreed the digital patient was useful. Eighty-six per cent of participants believed that digital patient simulation helped them prepare for the patient actor simulation. Total numbers in Figure 1-A17. Reasons participants gave for not finding the digital patient useful fell into four main themes: the limited nature of the responses the patient could give, the artificiality of the arrangement, the awkwardness of the technology and the relevance of being able to see yourself in the third person.

Figure 1-A17:

Clustered bar graph comparing Likert-scale responses to the statements The Virtual Patient was useful and The Patient Actor was useful

Conclusion:

We found that whilst participants overwhelming preferred simulation with a patient actor to simulation with a digital patient, the digital patient played a role in helping prepare participants for simulation with a patient actor.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In the aftermath of the COVID-19 pandemic, where access to traditional simulation environments and experiences was necessarily restricted, increasing focus has been placed on the use of technology in simulation. The use of virtual patient simulations has been shown in literature to increase interest as well as provide opportunities to practice clinical reasoning [1]. Opportunities to develop clinical reasoning are of notable importance in undergraduate pharmacy education currently owing to ongoing changes in pharmacy education, where newly qualified pharmacists will be annotated as independent prescribers from 2026 [2]. Evidence on the extent to which views on the perceived uses and benefits of virtual simulation align between different user groups is limited. In a UK university, a programme of virtual simulation has been utilized since 2020 as a part of the undergraduate pharmacy curriculum. A mixed-methods study was run which aimed to evaluate the alignment of views of students, faculty and stakeholders (who were individuals involved in the design or implementation of virtual simulation products) on the potential uses, intended learning outcomes, and perceived benefits and weaknesses of virtual simulation.

Methods:

Following approval by the school research ethics committee, an electronic questionnaire was sent to final-year undergraduate pharmacy students who had experienced a programme of virtual simulation including a mixture of qualitative and quantitative questions relating to student perceptions of the use of virtual simulation in the curriculum. Semi-structured interviews were conducted with faculty members and stakeholders exploring their views on virtual simulation. Quantitative data were analysed by simple descriptive statistics, and a critical review of free-text responses was performed through grounded theory to identify emergent key themes.

Results:

A total of 25 responses to student questionnaires were received. A total of seven interviews were performed, including three members of academic staff familiar with virtual simulation and four stakeholders responsible for the design or implementation of virtual simulation products. Students most commonly believed that virtual simulation could benefit their development of consultation skills, clinical history taking and physical assessment. Significant alignment between the perceptions of stakeholders and students on the uses and benefits of virtual simulation was demonstrated, but faculty members articulated a more limited list of perceived uses and benefits.

Conclusion:

The views of final-year undergraduate pharmacy students aligned strongly with stakeholders involved in the design or implementation of virtual simulation. The more limited views of faculty may represent a barrier to the full implementation of virtual simulation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In part due motivated by a lack of in-person placement opportunities for undergraduate pharmacy students during the COVID-19 pandemic, a UK university teaching team developed a programme of virtual simulated placement-style events to support undergraduate pharmacy students in developing skills and experience to support them in engaging with their foundation training. These experiences were developed at a time of significant change for undergraduate pharmacy training, as all new pharmacists being annotated as independent prescribers at the point of registration from 2026 onwards [1]. It has been reported that in medical students, the use of virtual patient simulation could improve clinical reasoning skills [2] but evidence of student views on the acceptability and implementation of virtual simulation in the target audience is limited and frequently not reflective of the style of self-directed simulation being utilized. This work aimed to evaluate final-year undergraduate pharmacy student views of the impact of the introduction of a programme of student-led virtual simulation on their education.

Methods:

In academic years 2020–2021 and 2021–2022, an electronic questionnaire was distributed to final-year students who had recently been introduced to and given access to a range of student-led virtual placement experiences in academic years. Prior to administering questionnaires to students, the study was approved by the relevant school research ethics committee. Questionnaires were formed of a mixture of qualitative and quantitative questions, and asked students about their experiences of engagement with virtual simulation and views on the potential applications of virtual simulation in the curriculum. Quantitative data were analysed by simple descriptive statistics, and a critical review of free-text responses was performed through grounded theory to identify emergent key themes.

Results:

A total of 43 student questionnaires were collected, with 18 responses (41.9%) being received in the academic year 2020–2021 and 25 responses (58.1%) received in the academic year 2022. 88.4% of respondents agreed that the introduction of virtual simulation would enhance their educational experience. Four key themes emerged from qualitative data analysis: individuality and autonomy, convenience, immediacy, and control. Students most commonly believed that the second year of the 4-year Master of Pharmacy programme is the optimal time for the introduction of placement-style virtually simulated experiences.

Conclusion:

Final-year undergraduate pharmacy students believed that the introduction of a programme of student-led virtual simulation would enhance their educational experience. Students were found to value the convenience, control and autonomy of the introduction of student-led virtual simulation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulation is a vital part of medical education [1]. It requires many resources to run successfully [2]. Recently, following the COVID-19 pandemic, Virtual Reality (VR) simulation use has increased. There are advantages to using VR now that costs are more reasonable, saving floorspace and facilitators’ time. However, there are concerns about how useful the software is for Physician Associates (PA), the adverse effects of the headset and whether self-directed debriefing is valuable [3]. This study aims to pilot the questionnaire using VR simulation.

Methods:

As part of teaching during September 2022 and January 2023, VR simulation was incorporated into appropriate seminars. At the end of the session, Year 1 PA students were invited to complete an online questionnaire based on the Simulation Effectiveness Tool, which was modified for VR. Before the session, all students were on-boarded to use the Oculus Quest 2 and Oxford Medical Simulation software.

Results:

Twenty-one out of 25 students completed the questionnaire. 71.4% strongly agreed that VR simulation helped prepare them to respond to a change in the patient’s condition and felt empowered to make clinical decisions. 85.7% felt more confident in providing interventions that foster patient safety. 66.7% felt more confident using evidence-based practice to provide care. When focusing on the self-directed debriefing, 66.7% strongly agreed that it contributed to their learning, and 71.4% strongly agreed that it provided opportunities for self-reflection on their performance. Concerning the headset and software use, 28.6% found it was not easy to log into the headset, but 65% found it easy to load the scenario. 57.1% were confident in navigating the virtual environment. This was after a briefing stage to orientate students to the environment. 70.6% felt safe in the virtual world, and 11.1% felt nauseous while in the scenario. The scenarios were also run via a desktop computer. 85.7% found it easier to navigate the virtual world, with 81% strongly agreeing that they felt immersed in the environment. Surprisingly, 52% of students preferred the desktop version, while 14% favoured it via the Oculus.

Conclusion:

VR simulation is an impactful method of providing simulation-based medical education without needing a simulation suite or facilitators. Interestingly, the desktop version can provide an experience that students prefer, but this requires further investigation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A scoping review identified a significant growth in research with immersive technology in healthcare education. However, there are few validated measures that capture the user experience of participants [1]. This study aims to investigate the use of an immersive virtual reality (VR) simulation on sepsis management and measure user experience using a validated tool, the Immersive Technology Evaluation Measure (ITEM) [2]. ITEM was formulated on a learning theory called Model for Immersive Technology in Healthcare Education (MITHE), which borrows cognitive and behavioural theories to help explain our level of immersion and enjoyment that can be facilitated by technology (see Figure 1-A9).

Figure 1-A9:

Model of immersive technology in healthcare education (MITHE)

Methods:

This single-study quasi-experimental investigation was conducted at a single site. Nine participants were recruited, consisting of medical students and healthcare professionals. Participants were trained on varied immersive devices: sepsis management using an immersive VR simulation developed by Gogglemind, and augmented reality (AR) holographic patient with respiratory distress, which included realistic patient scenarios and interactive decision-making. User experience was measured using the ITEM, which assesses user; immersion, cognitive load, intrinsic motivation, debrief and technology usability.

Results:

Nine participants had high levels of immersion (mean 39.6, total 50), high levels of intrinsic motivation (mean 39.6, total 50), high technology score (mean 79.4, total 100), optimum cognitive load (average 59.5, optimum 39–61) and moderate score on debrief (mean 18.1, total 25). ITEM subscores indicated an enjoyable and immersive experience with good technology interface on usability scores. Self-directed debrief in VR had lower scores with emotional considerations and identifying domains of performance and learning.

Conclusion:

The use of the ITEM provided valuable insights into the user experience of the VR simulation, which can be used to improve the design and implementation of future simulations. This contributes to an ongoing ITEM validation process. This study highlights the importance of training in healthcare and the potential benefits of using immersive technologies such as VR and AR simulations.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.