Virtual Reality Is Medical Training's Next Frontier
"Are you just going to let him die?"
There's a baby boy on a stretcher in a children's hospital emergency room. His mother is standing nearby, begging the doctors to do something, as her baby lies there. He is drooling and shaking; his diaper is soaked; he is making a disturbing snoring noise. An EMT comes in and says, "Doctor, this is a 1-year-old male found by the mother at home, having a seizure. The seizure's been lasting about seven minutes. Blood glucose on scene was 90." The EMT leaves.
A nurse exclaims to the doctor, "You have to do something! He is seizing! He is seizing!"
"Are you just going to let him die?" the mother wails.
The doctor has just a few seconds to make a decision. Should she put an oxygen mask on the baby? Give the baby Ativan or another anti-seizure medication? Quickly, she has to makes her choice, or the baby is going to die.
Well, not actually. This is a virtual reality simulation designed by doctors at Children's Hospital Los Angeles in conjunction with Oculus's VR for Good program and the companies AiSolve and Bioflight, intended to help medical students and residents get training in the kinds of low-frequency, high-stakes situations that children's ER doctors encounter — situations that are particularly expensive and logistically complicated to teach.
According to Dr. Joshua Sherman of CHLA and the USC Keck School of Medicine, VR helps solve several problems for medical training programs: expense, accessibility, and verisimilitude. (Sherman also helped develop the training.) Hands-on training for medical students and residents is time-consuming and expensive — mannequins run upwards of $50,000, plus maintenance and tech support — and also requires a room full of actual people to play the doctors and nurses. The other type of training currently used is screen-based training, but that doesn't closely mimic a real-life situation. VR manages to replicate the atmosphere of an emergency room situation while also being accessible — a trainee can easily do it on his or her own time. Besides the simulated nature of the experience, the main drawbacks right now are lack of voice control and inability to have more than one person in the experience at the same time. There's also currently only two training modules, so the applications are limited.
Sherman’s first VR experience was the Oculus Dreamdeck — which puts users at the top of a very tall building. Sherman, who is afraid of heights, felt his heart rate go up and his palms get sweaty. "I knew it was not real but I couldn't get myself to jump," he said. "When I felt that physiologic response and how similar it was to the real world, I immediately thought, why can't we use this to simulate the response on resuscitations? We can train people who we can't train in real life, up to an extent, so then when they face it in real life, it still will be very stressful but they will be able to select the correct items and protocols under pressure."
I'm not a doctor, nor am I training to be one, but when I tried the simulation (or as it's officially called, the "VR Pediatric Resuscitation Module 1: Status Epilepticus"), I found myself getting anxious about choosing the right protocol for this fake baby. Though I was guided through it by Clay Park VR founder and former Oculus developer relations specialist Shauna Heller, who produced the project, it was still nerve-racking to be inside this emergency room, responsible for saving the life of an infant.
Sherman said that's entirely the point. "We compared the physiology of stress in real-life emergency situations to that of people going through VR — their heart rate, breathing rate, and salivary cortisol, which is a stress hormone. The preliminary data shows that the heart rates definitely correlate between the real world and VR world."
Much like a video game, the simulations have different levels that students can progress through; the more advanced levels have more distractions. Marie Lafortune, a chief resident at CHLA, said she'd never used VR before and isn't good at video games, but quickly took to the medical simulation, which she described as a complement to mannequin- and screen-based training. "It can be more challenging to think straight in highly stressful situations," she said. "Virtual reality puts you in that situation. And there's also a virtual reality parent there that's triggering some emotional responses. She's like, 'My baby, do something to help my baby.' Inside you, you're hearing this parent and you are in a way almost distracted by them and you need to refocus. So you get to experience that stress and practice putting into action some of the medicine that you know or that you're learning."
Several other medical-related VR experiences exist — a neurosurgeon at UCLA uses it to interpret MRI scans, for example, and there's another group using it to help train people on doing colonoscopies, as well as people using it for psychological reasons like anxiety reduction and pain relief — but this seems to be the first specifically dedicated to children's emergency medicine. Oculus financed the entire project through its VR for Good initiative.
Though a spokesperson declined to give specific budget numbers, she told BuzzFeed News via email that the cost of the project was less than the cost of a year of medical simulation training at CHLA. With additional funding, Sherman envisions a future where medical schools and hospitals can have a library of VR training modules for different scenarios. "A trainee — a medical student, resident, or EMT — could go to their computer in their staff lounge or at home and decide, 'Today I want to practice how to take care of someone having a heart attack.' The next day, they could practice a seizure," he said. "I want this to be available internationally, in places where they don't have funds for mannequins."
Also on his wish list for the future is voice control — right now, the "doctor" can only respond to what's happening in the room by using hand controls — and team play, which would help people practice communication and teamwork. But that's all up in the air until the team can get more funding. Sherman has applied for federal grants and has approached different organizations, like epilepsy foundations, about helping to fund the VR training, but so far nothing has come through. He also recently presented at the National Board of Medical Examiners, which he said is potentially interested in using VR as an assessment tool.
"People want more research and more proof that it works before they throw down that kind of money to develop it," he said. "We're working on that and getting it out there. Spreading it might spark interest with people who might want to fund more."