DREEAM has recently invested in new Augmented Reality (AR) technology that will enhance student experience and bring teaching into the 21st century. The investment in Microsofts HoloLens devices along with the platforms available on GigXR will enable us to deliver teaching in a virtual environment. 

AR Headset

Augmented reality (AR) often referred to as Mixed Reality (MR), refers to a set of mobile digital technologies that allow a three-dimensional computer-generated model in the form of a hologram to be overlaid on a real environment. This technology can be used to ‘create’ simulated patients for the purpose of learning in an Immersive Learning Environment (ILE). With the use of HoloLens devices, simulated patients (manikins) can be ‘brought to life’ in physical classroom environment. The learners can have the opportunity to interact with the Holo-patient in close proximity thereby bypassing the restrictions of the real clinical environment with all the risk involved, particularly during a pandemic outbreak. The learner gets the advantage of an immersive experience that bridges virtual and real-world, supplements reality, and have the potential to redefine how student/learners interact with the clinical/teaching environment.

‘Most MR devices use a headset such as Google Glasses or the Microsoft HoloLens that projects a hologram into the users’ physical environment. The HoloLens device is controlled by hand gestures in the air, using swiping or pinching movements like those made on an iPad or smartphone, or with voice commands’. With the headset on, the learner can see the patient, hear real sounds from the patient and see an objective data/ vital signs that can aid clinical reasoning. AR/MR devices are better tolerated than totally immersive Virtual Reality (VR) devices. AR/MR (such as the Micro HoloLens 2) is connected to the network over Wi-Fi rather than tethered to a PC. This enables increased mobility and application in almost any clinical and educational setting.

The Immersive Learning System (ILS) will expand the scope of traditional teaching and learning by bringing extended realty into the clinical training setting. The use of simulated Holo Patients that can be visualized via a HoloLens device will provide our healthcare professional students and trainees with opportunities of educational and engaging simulation activities.

uses of xr
https://www.youtube.com/watch?v=52InDICzTcs. Transforming Healthcare Delivery with Mixed Reality

Simulation has always been employed to cover a wide ranging aspect of the learning objectives in the emergency department curriculum at post graduate and undergraduate level. In a busy environment like the Emergency Department, where bedside teaching is not always possible, the learning objectives can be met through the ILS.

ILS can be used to meet the knowledge, skills and behavior domain objectives of the Royal college of Emergency Medicine August 2015 curriculum. The syllabus is expected to cover common competencies like decision making and clinical reasoning (CC5) for all levels of trainees and this can be learnt through safe simulation with the ILS. Some of the ACCS major presentations’ learning objectives stated in syllabus including (but not limited to) Anaphylaxis (CMP1), the septic patient (CMP4), the shocked patient (CMP5) and the unconscious patient (CMP6) can be covered using the HoloPatient simulated experience. This is very similar to what is expected at undergraduate level based on their curriculum in the ‘ACE Study guidebook’. The new RCEM curriculum has a more pragmatic approach that will help prevent the ‘tick box’ approach and the Speciality Learning Outcomes (SLOs) stated in this curriculum can also be taught and learnt using the ILS. These includes SLO1 - Care for physiologically stable adult patients presenting to acute care across the full range of complexity and SLO3-  Identify sick adult patients, be able to resuscitate and stabilize.

Ojo AR

Our inter-professional group teaching will receive a great boost from using the HoloPatient and anatomy models in a joint expanded virtual training and learning experience. Medical Students and Nursing students can ‘shadow’ the clinicians as they care for these simulated patient models in safe and non-intimidating space. The trainee ACPs, Clinical Support Workers (Nursing Assistant) and Emergency Department Practitioners (EDA) can make use of anatomy models to gain better understanding of human anatomy and clinical interpretation of vital signs.

simulation demo

We host and facilitate the regional teaching to trainees from other NHS Trust and medical groups (medicine and nursing) and also deliver instruction and learning to Clinical Phase One (year 3) and Clinical Phase 3 (year 5) medical students. A significant aspect of the student’s syllabus can be taught by simulation in a more immersed environment which can be close enough to the reality they will later experience on their clinical rotation. Trainees from other trusts can access the skills required in the timely assessment of critically unwell patients. Our new large cohort of International Medical Graduates who have not had any clinical experience in this country will benefit immensely from exploring various conditions in a safe and non-threatening environment without the challenges they may face at the bedside. All trainees have individual needs, and DREEAM can use the ILS to deliver a bespoke syllabus with the specific learning objective to meet the demand of a large group of trainees across several trusts. Mixed reality provides an intuitive and enjoyable way of learning for today’s digital natives. One pertinent advantage is that teaching and learning can be provided remotely to the trainees in situations where there are challenges of self-isolation like we have faced during the pandemic.


Photo: Transforming Healthcare Delivery with Mixed Reality. Youtube.com. https://www.youtube.com/watch?v=52InDICzTcs

SurgeryIn our current post-Covid world, access to clinical simulation labs is limited, and patient actors are not allowed into our clinical areas. The ILS will ensure that high-quality training is still happening regularly (including remotely). Learning in a safe environment with a model as close to reality as possible will remove the burden that is sometimes placed on the patient at the bedside when they are critically unwell. We hope that this will help us respect the preferences of our patients of not wanting trainees at the bedside for discussion. Moreover, the behaviours that are taught and learnt will improve the culture, communication and collaboration amongst all clinicians, enhancing patient-centred care. Improved clinical reasoning amongst students, trainees, and clinicians create an opportunity to manage our patient's symptoms better. ILS will improve patients' experience overall. DREEAM can use the ILS to enhance interprofessional education (IPE), during which learners can provide patient care in a virtual collaborative team environment. This joint work will improve the quality of patient care, decrease patients' length of stay, and reduce medical errors. Interprofessional learning (IPL) has been shown to create teams that better work together and improve the patient experience. ILS can provide many opportunities for IPL.

AR Group

The ILS is not for a single event or course, and there are no fixed numbers of places/individuals. DREEAM will use the ILS to support continuous education across various multidisciplinary groups on an ongoing basis. It can be adapted over time to deliver the syllabus of different curriculums. The licenses are renewable annually, and the accounts are transferrable from one learner to another. Immersive Learning appears more efficient than mannequins and in scenarios not suitable for delivery by our simulated patients. It can also be used in almost any location and does not require any unique resources, preparation, rooms or additional personnel to use.