Developing and using virtual reality based simulations of occupational therapy home visits as part of pre-registration teaching and learning
University of Derby
Innovative Deployment of Technologies
This educational development focusses on using new technology to develop new ways of working in education. Virtual reality based simulations of occupational therapy home visits have been developed for use with pre-registration occupational therapy students. The first home environment built, which has continued to be developed, is for a case study of a gentleman who is due to be discharged home from hospital after having a stroke.
First year students, prior to their first placement, are tasked with assessing what challenges the individual would face if returning home. Whilst some aspects of the home are more obvious; for example getting into the bath, other aspects are more subtle such as a low level switch on the fire or emptying the cat litter tray. Throughout the home, students click on objects to gain more detail, and from a drop down menu select the type of concerns they think the object may give rise to. Students then provide a narrative of their professional reasoning to support the choices they have made. Each room contains an extensive number of objects to click on and provide professional reasoning for.
For a quick tour and demonstration of how the simulation looks and is used, follow this link: http://www.kaltura.com/index.php/extwidget/preview/partner_id/1835882/uiconf_id/26818442/entry_id/1_gd23h546/embed/auto
Sabus et al (2011) identified that virtual home environments allow critique and reflection on clinical decision making; a master screen view of all students answers enables tutors to be proactive within the classroom to encourage students to critique the reasoning they are providing and improve, and ensure students are not missing looking at objects. Tutors then draw the group together for a discussion around whether the case should be discharged, if so what their main concerns are, and to ask for a verbal summary of the students professional reasoning to support their clinical decisions. This aspect is intended to mirror practice in terms of feeding back the findings of a home visit at a multidisciplinary team meeting.
An additional function has been developed whereby students automatically receive an email copy of their own answers and supporting professional reasoning to their university email account. At this point in the taught session students are directed to go back into the home environment to explore a set of sample answers (written by the tutors), as illustrated in the screen shot below. Students can consider the sample answers and compare them to their own to further reinforce learning and to encourage self-assessment; an essential skill for continuing professional development.
Students are actively encouraged to revisit the exercise independently throughout their studies, particularly to support their learning in the placement setting. This simulation is now being developed with options for potential equipment provision and environmental adaptation.
A second scenario, completed in a very similar format, has also been developed to consider visiting someone who has been discharged from hospital after an acute admission for major depression. Students are tasked in the same way with identifying issues of concern for the individual already living at home. Although the layout of the home is very similar, items pertaining to issues of self-neglect and significant vulnerability such as a broken window pane, lack of electricity and out of date food are evident; again there are an extensive number of objects to click on and opportunity to provide professional reasoning for the area of concern.
Students are also encouraged to consider objects as ‘clues’ that the individual was previously happy and healthy. When the students then debate their areas of concern and professional reasoning for these, they are encouraged to discuss the individuals previous occupational identity and how the environment may suggest that this has now been altered.
What are the Aims?
Whilst paper based resources, or even physical clinical skills suites can simulate home environments, it is exceedingly challenging to re-create an environment that mirrors the depth and detail of an individual’s home. Hence this project aimed to create a realistic virtual reality based home environment, which once created, can be used repeatedly without the extensive set up required in a physical environment.
A primary aim of the project is for students to develop a depth of professional reasoning in relation to community based practise prior to their first placement. This complies with the Department of Health (2011) recommendations that healthcare professionals should learn skills in a simulation environment prior to undertaking supervised practise. Another significant advantage of virtual simulations is that they enable learning without the risk of harm to service users or students (Sabus et al 2011, Kamel Boulos et al 2007). The simulation has enabled inclusion of real life issues that contain significant levels of risk such as large quantities of old refuse, cat litter that has not been emptied for some time, out of date foods, and large quantities of alcohol and fire risks.
Who was/is involved?
Senior Lecturers in Occupational Therapy at University of Derby, Learning Technologist at University of Derby, Occupational Therapy Practice Placement Educators from throughout the East Midlands.
What has changed/will change?
This ongoing project was initially developed using the stroke scenario and the second life platform (Second Life 2015). Formal research into students experiences initially focussed on whether they valued using virtual reality based simulations over paper based exercises (Rowe and Newberry 2012, 2013). Findings indicated the virtual simulations increased depth of understanding and confidence, and that students valued the realism, but highlighted some concerns with using the second life technology. In response to this, use of second life was discontinued and current research and development has focussed on student preferences for Open Sim based simulations (Open Sim 2015) versus the use of Unity (Unity 2015). Unity has been clearly favoured by the students in terms of ease of use and having less issues of motion sickness (Sutton 2014, Sutton, et al 2016), hence Unity is now used in both scenarios.
Findings of the research into how students valued the virtual simulation for the stroke scenario were shared with practice placement educators alongside a demonstration of the simulation. Practice were very keen for a mental health scenario to be developed, and suggested ideas for inclusion which have been incorporated into the second simulation.
The increased functionality of being able to monitor students accessing the exercises in their self-directed study time suggests students are starting to do this; ongoing monitoring will continue.
Student feedback has been sought after each block of taught sessions. During this academic year feedback was gained that indicated the size of type was difficult for some students to read, this has now been addressed with a larger type face. Main themes occurring from the student feedback this year included positive comments on the depth, detail and realism of the simulation which encouraged depth of understanding and learning, the availability of sample answers and that the simulation was easy to use. Two student quotes are listed below:
"The VLE sessions provided me with the effective educational tools to put ‘theory into practise’ in a safe and supportive environment. The attention to detail in the design helped to strengthen knowledge and facilitate further learning. A unique and valuable experience."
(Deborah Tunnicliffe First Year BSc (Hons) Occupational Therapy Student)
“It gave me time to work at my own pace which supported my dyslexia study needs well. It gave me more time to think and I was able to gain a more thorough understanding of environmental assessment, without having to rush and miss bits out to keep up with peers.”
(Liz Sanderson First Year BSc (Hons) Occupational Therapy Student
What lessons have we learnt?
A key learning point has been the importance of gaining feedback from all parties and taking an evolutionary approach to developments in response to these.
Initial discussions are taking place around use of the mental health scenario within the BSc (Hons) Nursing (Mental Health) programme, which may lead to an inter-professional learning opportunity in the future.
Potential has been identified that with minor modifications to the home environments, and different sets of drop down options and sample answers, the simulation could be used by environmental health students. Again this may lead to shared learning opportunities for staff and students across disciplines which more rarely interact.
Further developments are being considered around further inclusion of adaptive equipment, other clinical conditions and use as a student assessment.
Research is currently being undertaken by The University of Nottingham on behalf of the Stroke Association into the clinical use of the stroke simulation (Threapleton et al., 2015); data is being collected from practising occupational therapists and patients who have experienced a stroke. This will also then feed back into the use of the simulations in teaching, increasing further practice and service user involvement.
Karen Newberry, Senior Lecturer in Occupational Therapy, College of Health and Social Care, University of Derby firstname.lastname@example.org 01332 594035
Greg Sutton, Learning Technology Developer, Learning Enhancement, University of Derby email@example.com 01332 594245
Links to further information and resources
Department of Health. (2011) Framework for technology enhanced learning. DH/Workforce, available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131061.pdf (accessed 21 April 2016).
Kamel Boulos, M.N., Hetherington, L., Wheeler, S. (2007) Second life: an overview of the potential of 3-D virtual worlds in medical and health education. Health Information and Libraries Journal; 24: 233-245.
Open Sim. (2015) OpenSim, available at: http://opensimulator.org/wiki/Main_Page (accessed 20 July 2015).
Rowe, P., Newberry, K. (2012) Second Life virtual learning environment to develop pre-registration students’ clinical skills, Poster presented at BMJ International Forum on Health and Safety in Health Care, 17-20 April 2012, Paris, France.
Rowe, P., Newberry, K. (2013) An evaluation of a virtual world learning environment home visit simulation in preregistration Occupational Therapy education, Paper presented at COHEHRE Conference on Education for Citizenship and Participation in Health and Social Care, 16-19 April 2013, Savonia, Finland.
Sabus, C., Sabata, D., Antonacci, D. (2011) Use of virtual environment to facilitate instruction of an interprofessional home assessment. Journal of Allied Health; 40(4): 199-205.
Second Life. (2015) Second Life Official Site - virtual worlds, avatars, free 3D chatavailable, available at: http://secondlife.com/ (accessed 20 July 2015).
Sutton, G. P. (2014) Occupational Therapy home visit interaction. MSc thesis, University of Derby.
Sutton, G.P., Newberry, K., Threapleton, K. (2015) Evaluating unity created teaching tools within Occupational Therapy. Journal of Assistive Technologies; In press.
Threapleton, K., Newberry, K., Rowe, P. (2015) The application of virtual reality. Occupational Therapy News; 23 (8):28-29.
Unity. (2015) Unity - Game Engine, available at: https://unity3d.com/ (accessed 20 July 2015).