Medical Practitioners Get Real at Immersive Learning Symposium

On a chilly Thursday, in a small room on the second floor of the George Washington University's Innovation Hall, three School of Nursing students prepared to assist a birth. Sophie Frey, Veronica Glimada and Petrina Sweet, all students in the school's accelerated B.S.N. program, gathered around the groaning woman on the hospital bed.

Speaking warmly and calmly, they kept her breathing steady, massaged her palms and elicited her partner's name-Brian-and contact information. (He was stuck in traffic. They hadn't expected the baby to come so soon.) Did they know the child's sex? They did not. "So we'll have a few beautiful surprises today," Sweet joked gently, making her patient laugh.

As the woman's contractions increased in intensity, her OB-GYN entered the room and the team of nurses-in-training attended to their necessary tasks like veterans. As the woman cried, pushed and squeezed the nurses' hands, the child's head began to emerge. In just a few minutes, the baby was out and placed in the exhausted mother's arms. It was a boy. Did they have a name in mind? Yes, the mother said, smiling tiredly. They would call him Jack.

And in a crowded monitoring room behind a two-way mirror, a group of riveted onlookers finally exhaled. For them, this was just one station, albeit a heart-stopping one, on a comprehensive tour of GW Nursing's state-of-the-art technical capabilities.

"Jack's" birth was a simulation-a centerpiece of GW Nursing and Access VR's second annual Immersive Learning Symposium, held Nov. 21 on GW's Virginia Science and Technology Campus in collaboration with the Virginia Innovation Partnership Corporation (VIPC). Partners from across the spectrum of immersive medical education gathered to showcase their technology, learn about new training options and explore the field's evolving landscape.

GW Nursing has already integrated virtual reality with Oculus VR headsets into several courses and is slowly expanding that integration across both the graduate and undergraduate curriculum, GW Nursing Dean Susan Kelly-Weeder said. Though she called herself a "complete novice" to the world of virtual learning technology, Kelly-Weeder said the day gave her insight into ways these powerful tools could be extended into new learning contexts.

"GW Nursing and Access VR have been partnering on immersive learning for about seven years, and this is an amazing collaboration that we have developed-and I'm just starting to get the tip of the iceberg of how important this relationship is," she said. "We have die-hard faculty and staff who are experts in this space, and I'm grateful that they're leading the charge and revolutionizing the way we teach nursing."

A range of initiatives were on display, including VR headset training materials for first responders, developed by a team of fire, emergency and law enforcement personnel supported by VIPC; a virtual lakeside retreat where people struggling with substance use disorder can practice cognitive-behavioral skills to help cope with addiction; an educational initiative that seats players beside the founding fathers as they develop the Electoral College during the Constitutional Convention of 1787; practical tools for the unsung task of sanitizing complex simulation equipment; and much more.

Patient Trish Epperson was outfitted with an Avkin Birthing Simulator, a 40-pound mechanical bodysuit that actually squeezes a realistic mannequin baby through a simulated birth canal, with accompanying fluids.

The simulated birth was part of a tour of GW Nursing's 20,000-square-foot Simulation and Innovation Learning Center, where stops also included demonstrations of GW's high-fidelity mannequins, of the 360-degree video and sound equipment that captures immersive learning scenes and of the Access VR editing software that lets instructors turn raw footage into training material, potentially including branching outcome paths, mid-scene quizzes or explanatory pop-ups.

The woman on the bed was actor Trish Epperson, a standardized patient, or SP, trained to portray a range of medical conditions. She was outfitted with an Avkin Birthing Simulator, a 40-pound mechanical bodysuit that actually squeezes a realistic mannequin baby through a simulated birth canal, with accompanying fluids. (The company's downstairs table showcased more wearable simulators, like a flesh-tone sleeve SPs can wear for painless IV insertion practice and a chest piece that simulates non-standard heart and lung sounds for trainees to pick up on a stethoscope.) The whole process was captured on a 360-degree camera, so a student wearing a VR headset might someday stand in the middle of that birthing room beside Frey, Glimada and Sweet.

For the students themselves, the experience was invaluable. They had seen live birth before in their obstetric clinics, and all three agreed that this simulation felt similar. (They were amazed that Epperson could deliver such a visceral performance without having actually given birth; she drew on her two sisters' deliveries, which she attended.)

"It was amazing-and very realistic," Sweet said. "I did get emotional."

While the students knew intellectually that they weren't delivering a live baby, working with a human patient as compelling as Epperson and a technology as comprehensive as Avkin's made an undeniable difference. They didn't know what to expect and had to rely on their training, working through their emotional and physical reactions in the moment to provide the best possible care. And the presence of a trusted teacher-clinical education instructor Amanda Nicklas, who played the OB-GYN-was also essential.

"Working with our OB instructor was so reassuring, and just seeing how she does it in action is important too," Frey said.

"I think it's a great resource for those who are still in nursing school to see and participate in something you've never had experience with," Glimada said.

Immersive learning also provides a safe space for medical professionals and first responders to make mistakes, said Jennifer Wendel, a trained nurse and dedicated simulation educator at GW.

"Not only are you acquiring clinical decision-making skills in real time, but you feel the confidence afterward that you know more than you think you do, and that creates resiliency," she said. "They have the opportunity to take on difficult situations in a safe container, in a learning environment where we're going to have a discussion and a debriefing about it afterward. That's a great opportunity for them, because it isn't about focusing on your mistakes-it's about learning and growing together."

Wendel had some simulated learning as part of her own nursing education, she said, but the technology has improved by leaps and bounds since then. She said GW's commitment to the cutting edge makes a huge difference for students as they prepare to enter high-stakes, life-and-death situations regularly during their careers.

"The fact that GW has such a strong commitment and focus on incorporating [immersive learning] for our students has been such a great thing, not just for the students, but also for educators," she said. "That fidelity and realism mean students get that 'click' where all of a sudden they understand their training and how to apply it-and I get to see that moment."