Translating Healthcare Simulation to Augmented Reality Mobile Learning
Basic competency in patient safety has been a goal of nearly all healthcare systems and healthcare education leaders since the turn of the century. An app-based approach can create a viable piece of curriculum for easy distribution that can be shared independently or within a broader patient safety curriculum. As such, the Patient Safety AR app was designed to emulate a live simulation-based experience focused on environmental awareness of patient safety threats.
Scheduling constraints for live events and the frequent and high volume need to orient novice learners to patient safety drove the request for app creation. Further, the live simulation had a well-established curriculum, designed to run for both healthcare system nursing education and medical learners of the regional medical campus.
The curriculum was ideally suited for adapting to an asynchronous modality and could be performed one learner at a time. The curriculum focused on visual evaluation of an environment, and the experience was pre-defined with no content changes during the clinical simulation. When executed through live simulation the experience also included a facilitator that performed a handful of tasks. However, with the exception of verbal debriefing, the bulk of the tasks performed by a facilitator could be transposed to a programmed environment.
Patient Safety AR has the following learning objectives derived from the curricular objectives:
• The learner will be able to perform an environmental hazards sweep to determine the errors that can occur within a hospital in-patient environment.
• The learner will be able to identify the rationale for relevant safety protocols or the proper response after witnessing safety hazards.
The Patient Safety AR mobile app uses augmented reality (AR) to render a 3D miniaturized patient room environment, which a learner can virtually place on a tabletop surface. After itemizing the features of the simulation, the Patient Safety AR mobile app design team identified an equivalent digital experience approach for each feature, with examples shown in the video demonstration above. The environment allows the user to move around the room, zoom in on potential hazards, and tap items to select them as answers.
The original simulation version of this curriculum asks learners to use primarily just one sense: their eyes. Walking into a simulated patient room where dozens of embedded errors exist is instantly intuitive. The goal of representing the same curriculum digitally was to make it easy to operate. As we built early prototypes of an AR-based product, we wrestled with three aspects:
- What physical scale should be used for this miniaturized environment?
- What is the simplest form of user input achievable?
- How can we orient users quickly and effectively?
The app uses the same concept as live simulation; learners have to visually analyze a patient room environment with safety hazards and other errors intentionally embedded in order to identify as many as possible. The live simulation used either one or two simulated patient rooms, where hazards were pre-composed before the learner would enter.
The learner would write down their observations on a clipboard, and then when they believed they had identified all hazards they would discuss their results with the facilitator. All of this appeared easy to replicate in a digital modality.
However, as the app development team observed live simulations in action, the debriefing conversation with the facilitator was clearly a source of additional knowledge potentially just as important as the hazard recognition itself. The facilitator asked challenging follow-up questions or share anecdotes. Recreating the knowledge acquired from the debrief conversations would prove to be one of our bigger challenges in translating this curriculum into a digital modality.
Building an experience that targeted the environmental scan was simple and straightforward. App users enter into a series of five different patient rooms, each with five randomly selected embedded hazards or errors. Randomization of hazards encourages replay, and when the user identifies one of the hazards/errors through visual inspection, they tap the relevant object.
For example, if the suction machine does not have a canister attached, the user would tap on the suction machine itself to indicate something is not correct. To detract from users simply tapping randomly anywhere and everywhere to find the errors without due diligence of visual inspection, developers count every tap input in order to calculate the accuracy that is then depicted on the results panel.
The Patient Safety AR mobile app team’s strategy to support the learners’ understanding of the rationale behind safety interventions was largely informed by witnessing the clinical simulation debriefing conversations. Within the context of the live simulation, the debriefing occurred after the learner completed their environmental sweep. The approach within the mobile app was to ask a follow-up question after each time the user would tap and successfully identify a hazard or error.
The team opted to do so immediately after the hazard tap to ensure clarity and reinforce learning, as some of the debrief questions had a looser connection to the physical hazard itself. The development of the follow-up app questions was collaborative between the product team and the subject matter expert. The product team first created a rubric and several sample questions, and the subject matter expert developed “true or false” multiple-choice questions to assess the learners.
To date, the app has been downloaded 1,189 times in 11 countries, with 1,044 U.S. downloads, 1,581 attempts to play, 666 players finishing the app at least once, and 784 total completions. This suggests that some players are choosing to play again.
The average time to complete the exercise is 12 minutes and 48 seconds. Among the 784 total completions, 661 players used at least one hint, and for the 25 patient safety quiz items, the mean hint use rate was 27%. The average final score on the items was 87%.
Thus, the Patient Safety AR mobile app team has been encouraged by the aforementioned uptake and use of the app, which is freely available for download. Their future plans include built-in learner experience surveys to better capture feedback. Up to now, informal feedback has been excellent, and the application was accepted as a SimVentors presentation at the International Meeting for Simulation in Healthcare 2022.
Acknowledgments: The Patient Safety AR mobile app team would like to thank subject matter experts Tamera Sanchez Sedekum, Anthony Dwyer, and Megan Springer.
Today’s article was guest authored by Kyle Formella, Director of Medical Visualization at Jump Simulation, OSF HealthCare.