EDUCATIONAL TECHNOLOGY, ONE STEP AT A TIME
by Rob Theriault
One of the greatest challenges in paramedic education, or any form of education, is to make the learning engaging, contextual, experiential and as realistic as possible to prepare graduates for the field. All of the work we do is aimed at preparing students for the “real world”. However, when students finally get to experience the real world in their hospital and field placement, their theory and lab classes may, in retrospect, feel like they fell short. Cased based learning in the classroom provides context, increases success (Jenkins, & Dugan, 2013; Neumeyer, 2012; Predmore, 2004) and is clearly superior to content laden lectures that anaesthetise students with abstract information. Simulation and role playing in the lab adds another layer of context and hands-on practice that is invaluable, but doesn’t come close to what students will experience with live patients. These shortcomings should motivate us as educators to continually seek out new ways and new technologies to make learning in the classroom and the lab more “real”.
Virtual reality (VR), while not new, underwent monumental improvements in the head mounted display technologies and software in 2016. VR now stands ready to supplement the classroom and lab experience with yet another layer of realism that’s distinct from what we currently offer in education. Palmer Luckey, founder of Oculus, said that “Watching a movie, reading a book, playing a video game - those are all fun things to do but they don’t actually trick you into thinking that YOU are in this fantasy world”. VR is a 360 degree computer generated simulation that puts you in an entirely different world. The experience, as those readers who have tried VR understand, is completely immersive.
A Personal Story
In the summer of 2017, I spoke the National Association of EMS Educators (NAEMSE) Symposium in Washington DC where I had the opportunity to experience VR patient simulations from a company called Virtual Education Systems - now owned by Ferno. At first I watched a scenario unfold on a large TV screen and saw what another person was seeing while he wore a head mounted display. On the big screen, it looked interesting, but not unlike any other patient simulation I had seen on a PC: A patient in respiratory distress was sitting on the edge of his bed while the participant selected questions, assessments and interventions from a series of drop-down lists. However, while simulation is great, there was no “wow” factor for me. Then I donned the head mounted display and my perception of the simulation was completely different. I felt like I was in the room with a patient, and though animated, it looked so much like a real person it was startling. His face appeared ashened, his lips were cyanosed and the use of his accessory muscles was evident as he struggled for air. While I had to choose from a list of questions, my patient answered in 4-5 word sentences through the prerecorded voice of an actor, and I felt an immediate urge to reassure him while wanting to grab my stethoscope and auscultate his chest. I was immersed! It was experiential in a way that can’t be replicated in the lab, even with high fidelity simulators. I felt the same twinge of adrenaline all paramedics get when you see a real patient and you know you need to assess him and intervene quickly before he deteriorates further.
Virtual Reality Learning Environment
A virtual reality learning environment (VRLE) can be computer based or fully immersive with a head mounted display. The former has shown to be effective in improving learning outcomes (Merchant et al., 2014). The latter has yet to be researched extensively but offers lots of opportunity for educators and researchers to explore both qualitatively and quantitatively its potential. Immersive VRLEs will allow students to experience a variety of patient encounters in a multitude of settings, with the potential to improve their assessment and decision making skills and develop their sense of situational awareness. Other VRLE software applications allow students to share someone else’s sensory reality, and as such, is proving to be a remarkable medium for teaching empathy (Gerry, 2017) and enhancing, as an example, the user's’ knowledge and attitude toward patients with mental illness (Formosa, et al., 2017). This offers educators new ways of teaching in the affective domain, an area most educators would agree is far more challenging than teaching in the cognitive and psychomotor domains. If VR can help students walk a mile in someone else’s shoes and help them develop their soft skills, it will truly be groundbreaking.
Learning Empathy in VR
How virtual reality can create the ultimate empathy machine.
Simulations in Multiple Environments
The potential of VR in paramedic education is exciting. Instead of all scenarios taking place in the same room(s) with the same off-coloured mannequins, VR takes you to the side the highway, a nightclub, a shopping mall, an office building or the patient’s bathroom floor with patients of all ages, ethnicities, illnesses, injuries and people who look genuinely sick. It could be used to supplement either theory classes, labs or both.
VR With Artificial Intelligence
Dawn Of The The Experiential Age
The technology in virtual reality is evolving rapidly and the next iterations will include artificial intelligence, voice recognition and haptic technology that will enable the user to have natural conversations in VR and be able to feel using haptic gloves and other garments. This ability of see, hear and feel will take patient simulation to a new level of realism and be another step, in the words of Kent Bye from the “Voices of VR Podcasts”, toward “transitioning from the information age to the experiential age”.
Formosa, N. J., Morrison, B. W., Hill, G., & Stone, D. (2017). Testing the efficacy of a virtual reality-based simulation in enhancing users’ knowledge, attitudes, and empathy relating to psychosis. Australian Journal of Psychology. doi:10.1111/ajpy.12167
Gohd, C., (2017). Google Created an AI That Can Learn Almost as Fast as a Human. Retrieved from https://futurism.com/google-created-an-ai-that-can-learn-almost-as-fast-as-a-human/
Jenkins, D. M., & Dugan, J. P. (2013). Context Matters. Journal of Leadership Education, 12(3), 15-29. doi:10.12806/v12/i3/tf1
Merchant, Z., Goetz, E. T., Cifuentes, L., Keeney-Kennicutt, W., & Davis, T. J. (2014). Effectiveness of virtual reality-based instruction on students' learning outcomes in K-12 and higher education: A meta-analysis. Computers & Education, 70, 29-40. doi:10.1016/j.compedu.2013.07.033
Neumeyer, X. W. (2012). Embedding Context in Teaching Engineering Design. Retrieved from https://eric.ed.gov/?q=contextual+learning&ff1=dtySince_1998&ff2=eduPostsecondary+Education&ff3=subContext+Effect&pg=6&id=EJ1076103
Predmore, S. R. (2004). Putting it into Context. Retrieved from https://eric.ed.gov/?q=contextual+learning&ff1=dtySince_1998&ff2=eduPostsecondary+Education&ff3=subContext+Effect&pg=2&id=EJ718606