Before COVID-19 hit, Jackie Heisler, PhD, MPH, RRT, an associate professor and director of clinical education in the respiratory care baccalaureate program at the Indiana University of Pennsylvania in Indiana, PA, never really gave online clinical education much thought. After all, even students taking part in online classes received their hands-on education in a real live clinical setting. After COVID-19 closed down clinical education, it was a different story.
Like many of her colleagues, she was in a panic to find materials to meet the objectives of her clinical courses.
“I was concerned how quickly this material could be located and implemented into the curriculum at such short notice,” she said.
A dearth of resources
Faculty members searched respiratory textbooks and contacted sales representatives to see if they could help in locating virtual patient scenarios, but without success. While there are plenty of resources out there to address this need in nursing, they are basically nonexistent for respiratory curriculums, says Dr. Heisler.
She decided to turn to her fellow educators in the AARC Education Section.
“After visiting the AARC Education Section discussion list, I noticed many other educators had the same concerns and reservations,” she said.
Many were willing to help, but despite their best efforts, the only thing that turned up with a small respiratory component that was embedded in a virtual reality platform for nurses.
“This did not serve our needs,” Dr. Heisler said.
We need more
Dr. Heisler and her colleagues decided to keep some of their more creative online activities and try to make them work during the pandemic, but ultimately, she says they need more.
“Most students and clinicians are hands-on learners,” she said. “With the right resources, utilizing this concept to see a scenario play out with the student interacting with decision-making skills is beneficial.”
According to Dr. Heisler, outcomes related to psychomotor skill performance support the use of virtual reality as an educational intervention.
Other RT programs are on the same page. Jasmine Brown, MS, RRT, RRT-ACCS, COPD-Ed, CHSE, assistant professor and director of clinical education in the department at Middle Georgia University in Macon, calls virtual reality an immersive learning experience that allows the participant to adapt to the changing environment and emotion of the simulation.
She believes VR can help health care educators teach patient assessment skills and foster decision-making abilities in their students, noting these are daunting tasks in person, let alone online. She was a fan of VR for RT students even before the pandemic and is an even bigger fan now.
“I feel VR is a vital tool that can help students to visualize the patient and practice clinical skills,” Brown said.
Dr. Heisler says true VR provides a combination of human‐computer interfaces, graphics, sensor technology, high‐end computing, and other modern technologies that all work together to enable a user to interact actively with an artificial computer‐generated environment. The 3D experience enables students to engage in different situations without physically leaving the classroom or home setting.
“This makes the educational experience invaluable,” said Dr. Heisler, emphasizing VR technology is a good learning tool for students with different needs and learning styles. “It also provides opportunities for group work and peer teaching. Students who struggle to be part of a classroom setting can be accepted by their peers thanks to their technology skills,” she said.
Of course, true VR is expensive. Other approaches that incorporate VR concepts into lower cost models may work for respiratory care. Samantha Davis, MS, RRT, CHSE, is director of clinical education and simulation at Boise State University in Idaho. She believes educators can benefit from a technology known as “virtual simulation” as well.
“Virtual simulation can be accomplished through technologies that have recently gained popularity since working from home, such as Zoom or WebEx,” explained Davis. “I have experience with both of these things, but specific to COVID-19, I have used virtual simulation.” Unlike virtual reality education (VRE), which requires a costly, high end computer and hardware that cannot, practically speaking, be placed in each student’s home, virtual simulation is much more accessible.
Davis believes students can adapt to this type of teaching.
“Virtual simulation provides an excellent opportunity for students to stay involved with each other and with clinical content that they do not have access to during COVID-19,” she said. “With clinical rotations suspended, engaging in clinical decision-making helps to keep ideas fresh and students prepared to re-enter the clinical setting.”
She has conducted four virtual simulation sessions each week during this final part of the spring semester, relying mainly on video clips and web-based games available on open access due to the time constraints. But once she returns to campus this summer, she has big plans to create content of her own — and share it with her colleagues as well.
“I intend to develop additional scenarios in preparation for the fall semester,” Davis said. “These will be provided as open access resources to the RT community.”
Her key take-home messages for her fellow educators are to:
- Keep it simple (quality simulation doesn’t have to be ground-breaking to be effective, she says).
- Seek out content experts and simulation experts alike to gain valuable insights into the creation of your scenarios.
- Tap into available resources at your school, such as instructional designers, IT specialists, and online faculty and support services.
Collaboration is key
Jasmine Brown says she would welcome the opportunity to collaborate with colleagues like Davis and suggests that once educators complete this very challenging semester, an ad hoc committee could be formed to tackle the job.
“If the predictions of the coronavirus hold true, we could be looking at the same limitations next fall and winter,” she warned. “Perhaps various RT programs could pull together — especially those that are part of an institution that already uses VR — and collaborate with some of the VR software companies to develop RT specific scenarios. Centrally storing these developed scenarios on the AARC website would make them readily accessible and affordable, and hopefully add another benefit to AARC membership.”
She suggests educators get started on this task by creating buy-in among their colleagues, reaching out to software companies to let them know RT needs this kind of technology, surveying members of the RT community to find out who holds the Certified Healthcare Simulation Education (CHSE) credential and recruiting them to the ad hoc committee, creating a needs assessment, and then ultimately, conducting research into how this new technology impacted students in terms of scores on RT student board exams and the like.
“Using simulation as a tool to educate students . . . has proven to improve critical thinking skills,” Brown said. “Because respiratory care is a critical care-focused discipline, this method of learning really suits our profession.”
Necessity will be the mother of invention
“There is no replacement for the face-to-face, live clinical teaching environment,” Dr. Heisler said. “However, the lack of respiratory-focused VRE is a missing link that needs to be addressed so our educational programs are training in the present to better prepare our future respiratory care professionals.”
Since educators are lifelong learners, she believes they are up to the challenge.
“Perhaps one positive that will have come from the COVID-19 pandemic is that we learned to think differently about how we deliver our education to our respiratory care students,” she said.
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