One hundred forty-six. That’s how many medical residents needed to undergo orientation training upon joining Cedars-Sinai Medical Center this spring.
Usually, that would mean 146 new doctors gathering for a one-day in-person orientation on how to use equipment, perform resuscitations, and have challenging conversations with patients. But amid the COVID-19 pandemic, leaders at the Los Angeles hospital opted to move roughly half of that training to a two-week remote learning program.
That not only included standard remote education practices like offering recorded lectures to watch online, but also developing new training modules that use virtual reality.
With VR, residents can essentially “jump into a virtual ICU or into a virtual operating room from anywhere,” said Russell Metcalfe-Smith, director of simulation at Cedars-Sinai.
Cedars-Sinai has been using simulation technologies for years to help clinicians practice surgeries. Last year it started working with Virti, a U.K. software startup that builds VR and augmented reality modules for corporate training, to add to its orientations.
Virti was one of 11 health tech startups included in the 2019 Cedars-Sinai Accelerator program, which meant it received a $100,000 investment from the hospital. And the Women’s Guild, a volunteer group at Cedars-Sinai, donated another $100,000 to the Cedars-Sinai simulation center to fund its Virti program.
In light of the pandemic, staff quickly filmed new training videos using Virti’s VR tools, so residents could go through some training at home.
That required shifting some training sessions that would typically be completed in-person to a VR experience, as well as adding modules on how to manage COVID-19 patients and new guidelines for use of personal protective equipment.
Residents access the interactive videos through an app, which they watch on their smartphone using a VR headset provided by Cedars-Sinai. Questions on next steps pop up throughout the 360-degree videos, prompting residents to select a correct answer before the module continues.
In a scenario about doffing PPE, the training module asks a resident whether, when they’re done seeing a patient, they should first exit the patient’s room, remove various articles of PPE or perform hand hygiene. The correct answer: remove gown and gloves, followed by hand hygiene. Then clinicians are ready to leave the patient’s room.
“The platform allows us to train and assess the ability of people to do certain things without physically having to bring them into a location,” Metcalfe-Smith said. “We’re able to collect information on their performance by questioning them (and) by looking at how long it takes them to do something.”
Cedars-Sinai hasn’t decided whether it will continue using VR in its orientations after the pandemic subsides. The outcomes from this year’s program will determine that, Metcalfe-Smith said.
Cedars-Sinai is part of a growing number of medical schools and medical centers integrating augmented reality and VR into their training programs.
To date, training programs have mainly used the technologies to let medical students and new doctors practice surgical procedures, dissect virtual cadavers and refine bedside manner, said Jeff Becker, a senior analyst at market research firm Forrester. Case Western Reserve University in Cleveland uses mixed reality to teach anatomy, and the University of California at Irvine School of Medicine uses VR to teach soft skills, like how to handle end-of-life discussions.
Virti has been working to quantify outcomes using its system.
In a randomized controlled trial conducted earlier this year at the U.K.’s National Health Service, 92% of health workers were graded as having adequate understanding of infection control measures after completing Virti’s simulations, compared with just 16% of a control group that received standard training, according to the company.
Dr. Brandon Schwartz, an internal medicine resident at Cedars-Sinai, said being able to practice with VR has helped ease his stress about treating COVID-19 patients. In March, the medical school where Schwartz graduated closed its clinical rotations due to the pandemic, which meant he wasn’t able to get as much hands-on experience with patients as he’d wanted.
Using VR to walk through high-pressure situations, like how to resuscitate a COVID-19 patient, has been particularly helpful for making Schwartz feel more prepared. “I feel a lot more confident,” he said. “You still get that adrenaline rush, because you’re watching it in that (virtual) experience.”