This document proposes using virtual worlds and mannequin-based simulations together to teach patient assessment, decision-making, and communication skills. It suggests several approaches, including using virtual simulations for orientation and practice before physical simulations, or using them in parallel for parts of a scenario. This complementary approach could address challenges like scheduling limitations and lack of hands-on practice in virtual simulations alone. It emphasizes using virtual worlds to practice SBAR communication skills and allows for tracking learner data.

1. Background: Virtual World environment Background: Mannequin-based simulation.
Characters may be controlled by real learners or by
the computer.
Creating Complementary Learning Environments: All role players are co-located with physical
mannequin and they role play within the
All role players may be at remote locations.
Advantages:
Any time, anywhere access
Moving Between Virtual Worlds and Mannequin-based Simulations simulation.
Advantages:
Physical interaction supports hands-on pro-
Anonymity can make role playing easier.
All actions tracked for review and scoring. Eric B. Bauman, RN, PhD – Clinical Playground, LLC and DeVry Healthcare Group cedures.
Negatives:
Negatives:
Hands-on interaction not possible. Parvati Dev, PhD, and Wm LeRoy Heinrichs, MD, PhD – CliniSpace Courtesy: Montagu Clinical Simulation Center, UK. High cost and limited availability of access.
Problem Statement Methods (continued)
Sequential use of Physical and Virtual Simulation
Virtual and games-based learning environments and the mannequin-based simulation set- Numerous other combinations of simulation modalities are possible, to support other learning
ting can be used together to emphasize and teach patient assessment, decision-making and objectives. For example, learners may be introduced to a scenario via a physical mannequin.
effective SBAR-based communication. These environments provide a complementary Then they practice variants of the scenario using the virtual environment. Finally they return to
multi-medium approach to teaching and evaluating accurate performance and effective the physical mannequin to demonstrate proficiency.
communication among members of multi-professional teams of healthcare providers. To
date, such complementary use has been limited. Implications for Use in Simulation and Learning Resource Centers
Virtual environment and game-based learning environments should be considered as comple-
mentary to mannequin-based simulation. They are able to address challenges associated with
Simulation of mass casualty traditional simulation based curricula such as:
Transition to virtual ambulance envi- Transition to physical environ-
with real actors • Student orientation and preparedness
ronment for patient assessment and
ment of ED/OR with mannequin • Constraints in scheduling the physical simulator, and
SBAR communication with hospital
• Removal of the need to travel or commute to access the simulation.
The voice capability of virtual environments supports all aspects of communication training,
such as are defined in the TeamSTEPPS program. In particular, these environments are suitable
Methods Pre- and Post- use of Virtual Simulation. Mannequin is used for face-to-face exercise. for practising SBAR communication for handoffs and reporting within and between service
units.
The authors propose an integrative curriculum and research approach that leverages the
virtual or game-based learning environment to complement mannequin-based simulations. SBAR Communication Tool
This hybrid curriculum is illustrated in the adjacent illustrations. S - Situation
B - Background
[TOP] Sequential Use of Simulation Modalities. A - Assessment
In the first image, a typical mass casualty exercise is demonstrated with volunteers acting as R - Recommendations
victims and learners practicing Incident Command, triage and transport preparation. In the
second image, EMT learners practice patient assessment as well as communication with the Because these are computer-based applications, virtual and game-based learning environ-
hospital using SBAR technique. In the third image, learners practice hands-on procedures for Further practice in virtual ments include user action tracking and data collection in ways that are not always available in
the ED or OR using a physical mannequin.
Preparation in virtual environment for up- Actual exercise with physical
mannequin environment traditional clinical or physical simulation environments. Tracked data can be used for analysis of
coming mannequin simulation exercise
learning performance and for real-time or summative feedback for each learner or for the team.
[MIDDLE] Using a Virtual Environment to Support Mannequin-based Simulation. Evaluation matrixes can be programmed into the simulation, as inherent components of game
In the first image, learners enter a virtual environment that mimics the expected physical design, in ways that allow for just-in-time learning cues, reflective student self-evaluation, and
Simultaneous use of Physical and Virtual Simulation (Hybrid Simulation)
mannequin environment. They familiarize themselves with the environment, the patient objective instructor-based assessment of the student.
scenario, and the background study material. In the second image, well prepared, they now
practice the scenario with the physical mannequin. In the third image, they return to the vir- In summary, the facets defining effective simulation scenario design are congruent with the
tual environment to practise variants of the original scenario on their own time. facets of good game and simulation design within linked virtual and mannequin environments.
Practice goals, such as effective SBAR communication, can leverage multi-medium simulation
[BOTTOM] Simultaneous Parallel Use of Mannequin and Virtual Simulations. encounters to prepare nursing students for the demands of real-world clinical practice.
These images illustrate an actual exercise at the CAE Healthcare Users Conference in March
2012. A nurse in a physical simulation uses a simulated radio to communicate with and
guide the EMT in the virtual simulated ambulance. The EMT learner participates in the scene References
from his computer. When the virtual ambulance reaches the virtual hospital, the EMT learner Bauman EB. Game-Based Teaching and Simulation in Nursing and Health Care. Springer, 2012.
leaves the computer and pushes a gurney with a physical mannequin, prepared with IV etc,
into the physical simulated ED, and does a correct SBAR handoff to the ED nurse. The nurse Heinrichs WL, Harter P, Youngblood P, Kusumoto L, Dev P. Training Healthcare Personnel for
then takes over, and the simulation continues in the ED. Mass Casualty Incidents in a Virtual Emergency Department; VED II. Pre-hospital and Disaster
Nurse uses radio in physi- Nurse (picture-in-picture) speaks with EMT in 3D virtual environment of ambulance EMT uses “virtual radio” in virtual simulation Medicine. 25, 422-34, 2010.
cal simulation