Tech v Trust: scaling simulation for 21st C students Keynote for 4th International Conference on Medical Education Informatics (#MEI2021Conf) Using technologies to support and enhance our student learning has been deemed a ‘wicked challenge’ by successive Educause ‘New Media Horizons’ reports, in their annual scanning of educational ‘futures’ environments. The challenge is not the technology, nor access to wide range of resources – the challenge is with us as educators stepping up and seeking to implement at scale. Healthcare students have had to overcome the restrictions and implications of Covid-19 with many of their clinical skills moving online, and with limited opportunities to engage with their clinical practice partners. But what are the factors we should be considering when creating authentic learning experiences for our students? Reimaging our teaching practice is a contested area, and this talk will set out some potential responses for building capacity and emphasises the significant ‘trust’ plays in taking our work forward.

1. Tech v Trust: scaling simulation for the 21C
student
Debbie Holley, Professor of Learning Innovation, Department of Nursing Sciences, BU
find out more about our research: @debbieholley1 @N4LTH and #MEI2021Conf

2. Creating authentic learning experiences for our students

3. Why?
A desire to create that 'best learning moment'
The idea of best learning moments builds on the psychological concept of
cognitive absorption, or ‘flow’, defined as deep involvement or immersion in an
activity or task, often accompanied by feelings of enjoyment. People experience
this mental state and these feelings when engaged in an activity that is
appropriately challenging to their skill level, resulting in full concentration and
focus. Best learning moments can result in deep learning and high levels of
satisfaction, and they may also be particularly memorable.
Enriching the learning environment for our students:
Enriched realities extend what is possible in education and training and provide
dynamic, new experiences that engage learners immediately. They also open up
opportunities that are not available in the classroom, such as exploring places that
would be difficult, dangerous or impossible to visit for a learner – the surface of
Mars or the inside of a volcano, for example. With AR and VR, students can interact
and work together, manipulating virtual objects and moving around the setting
together... (OU Innovating pedagogies, 2021)
Image credit: Anthony Canton (Unsplash)

4. How to engage
our students ...offline,
online and inbetween...
• The JISC 'Student digital experience insights survey' was
recently released, summarising the experiences of over
20,000 HE students at a range of 28 HE institutions.
One surprising finding was that only 20% of students
gain any 'real life' simulation experiences as part of
their degree, and these tend to be in engineering
design and healthcare.
Link to JISC report:
https://www.jisc.ac.uk/sites/default/files/student-dei-he-
report-2020.pdf
360 video filming with our local trust
partners and students

5. Quick definition And Mixed Reality too...
Mixed reality
Ref: Milgram, P. and Kishino, F., 1994. A
taxonomy of mixed reality visual
displays. IEICE TRANSACTIONS on
Information and Systems, 77(12),
pp.1321-1329.

6. The Topal review
... citizens, patients and families will have a
pivotal role to play.
Patient activism, such as #wearenotwaiting
for patients with diabetes, exemplifies a
growing trend in empowered patients
demanding and taking greater control over
their own care.
Tackling digital exclusion while supporting the
workforce to develop new skills and practices
will be essential to ensure access and
adoption across all socio-economic groups.
Increased patient and public education
programmes, as well as practical facilitation,
will be needed to ensure that digital
technologies do not increase health
inequalities.
pp24

7. Clearly not as
simple as moving
online.. but the
main message is
however we decide
to move forward,
trust is the key...
The Topal Digital Medicine panel
recommendation 1:
"NHS online content should be a
vital trusted source of health
information and be resourced
appropriately." (DM1)

8. Wellbeing for
all
"developing appropriate
workforce skills and attitudes to
empower patients and citizens
to enhance their health and
wellbeing through digital
healthcare technologies"
Topal pp40

9. Framing digital
health
and wellbeing:
the EU context

10. The new EU Digcomp framework:
digital health and wellbeing

11. EU project:
looked at health
• Worked with health visitors in
the North-East of England
• Their working patterns had
changed – no longer say their
colleagues to have the
'informal checking out'
conversations.
• What did they want from
technology
• A proxy for the 'trusted'
other

12. https://labx.org/extreme-event/

13. VR Case Study: the
deteriorating
diabetic patient
Research:
• Randomised Control Trail (RCT) with 171
students
• Significant learning gain when using VR
• An inclusive learning tool
• Quick and intuitive to use
• VR made learning "more real" and engaging
• Instant feedback and personalized learning
• The students can repeat the exercise (distance
learning)
https://www.youtube.com/watch?v=AKpw1RbZ1hA

14. • Martian Attack:
• Our paramedic team ran
a simulation in
our underground car park
last month.
• 3D 360-film clips created
from the session
captured scenarios,
simulations and debrief, and
are hosted on Panopto, and
thus accessible by a range of
technologies, from google
cardboards, to OCULUS
Quest
Project lead: Adam Bancroft
https://bournemouth.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=d
91e4640-de42-45ee-beae-ad2f00cecebe

15. There is always a BUT...
Image credit: green chameleon on Unsplash

16. Digital poverty
“Without broadband we struggle to teach our children, order food and medicines, work or search for a job.
Citizens Advice (2020) found that during the first lockdown, certain groups, including people with children, disabled
people, people from Black, Asian or ethnic minority backgrounds, those who were shielding and young people were
particularly struggling with their broadband bill
An NUS survey (2020) reported BAME students, disabled students and lower socio-economic homes more severely
impacted
Image Credit: Fusion Medical Animation

17. Typical image: happy families using 'tech'
• Working-age adults (16-64s) in DE households are more than four times as likely as those in non-
DE households to not use the internet (13% vs. 3%), showing that differences in non-use of the
internet are driven both by age and by socio-economic group. (Online Nation Ofcom report 2020)

18. Office for Students: Digital poverty report 2020
52% of students report their
learning impacted by slow or
reliable internet connection
8% severely
71 per cent reported lack of
access to a quiet study
space, with 22 per cent
‘severely’ impacted
56 per cent said they lacked
access to appropriate online
course materials, with 9 per
cent ‘severely’ impacted
18 per cent were impacted
by lack of access to a
computer, laptop or tablet –
4 per cent said they were
‘severely’ impacted.
4% of students do not use
the internet

19. The challenge of Scale:

20. Scaling
technologies –
what are the
barriers?

21. Scaling Innovation • Bridging the missing middle: a design based approach
to scaling
Spread Depth Shift Sustainability Evolution
Scaling up is achieved by diffusion of the
innovation to large numbers of users.
Requires modifications to retain effectiveness
while reducing the resources and expertise
required.
Getting to scale produces deep
and consequential changes in
practice.
Requires evaluation and
research to understand and
enhance the causes of
effectiveness.
Ownership of the innovation
is assumed by users, who deepen
and sustain the innovation via
adaptation.
Requires moving beyond “brand”
to support users as co-evaluators, co-
designers, and co-scalers.
Sustaining scaled growth
means maintaining these
changes in practice over
substantial periods of time.
Requires robust design to
enable adapting to negative
shifts in context.
The innovation as revised by
its adapters is influential in
reshaping the thinking of its
designers.
Requires learning from
users’ adaptations about how to
rethink the innovation’s model.
Strengths
Weaknesses
Scan QR code to link to
Scaling paper

22. Summary:
health trends – how will you
respond?
• Broader adoption of artificial intelligence (AI) and
machine learning in population health​
• Virtual reality and augmented reality as routine
treatment for pain control after surgery and as an
adjunct for chronic pain control​
• Wearables and implantable health devices to enable
more routine detection of chronic conditions and
monitor treatment effectiveness​
• Increased use and impact of digital therapeutics to
enhance medical adherence and as an alternative
to traditional treatments, such as diabetes prevention
programs and other models relating to preventing
or mitigating the impact of chronic conditions​
• Broader use of voice recognition and intelligent
assistants to reduce clinical burden​
Image credit and report:
Prof Kevin Warwick, professor of cybernetics at Reading University and the microchip in his
arm
https://www.telegraph.co.uk/news/science/science-news/10888828/Captain-Cyborg-the-
man-behind-the-controversial-Turing-Test-claims.html

23. References and
resources:
Scaling:
• Coburn, C (2003). Rethinking Scale: Moving beyond numbers to deep and lasting change. Educational
Researcher 32, 6 (3-12) available online http://vocserve.berkeley.edu/faculty/CECoburn/coburnscale.pdf
• Dede, C (2007). Scaling Up: Evolving Innovations beyond Ideal Settings to Challenging Contexts of
Practice, available online: http://www.collegechangeseverything.org/dotAsset/d352af01-fb00-43c3-a956-
6a2f092a7c67.pdf
Augmented reality:
• Holley D., Hobbs M. (2019) Augmented Reality for Education. In: Peters
M., Heraud R. (eds) Encyclopedia of Educational Innovation. Springer,
Singapore https://doi.org/10.1007/978-981-13-2262-4 Online ISBN 978-981-13-2262-4
• Virtual reality
• Singleton, H PhD (unplished) https://microsites.bournemouth.ac.uk/flie/2019/02/01/what-did-mental-
health-nursing-students-think-of-vr-deteriorating-patient/Thanks to daden limited for the creation of the
resources!
• Heidi and Janet video of using VR for Nursing diabetes:
• https://www.youtube.com/watch?v=AKpw1RbZ1hA
• Prof Liz Falconer talking about Virtual Avebury:
• https://www.youtube.com/watch?v=LVNIQMqIU6g

24. References
• Beetham, H. (2015) Revisiting digital capability for 2015.
http://digitalcapability.JISCinvolve.org/wp/2015/06/11/revisiting-digital-
capability-for-2015/
• EU Learning Layers http://results.learning-layers.eu/
• European Commission (2014). Measuring Digital Skills across the EU: EU
wide indicators of Digital Competence
• Heath Education England: The Topal review (2019) preparing the
healthcare workforce to deliver the digital future https://topol.hee.nhs.uk/
• Health Foundation: Securing a positive health care technology legacy from
Covid – 19 https://www.health.org.uk/publications/long-reads/securing-a-
positive-health-care-technology-legacy-from-covid-19
• Milgram, P. and Kishino, F., 1994. A taxonomy of mixed reality
visual displays. IEICE TRANSACTIONS on Information and
Systems, 77(12), pp.1321-1329.