Augmented Reality Education Experience (AREduX): An Augmented Reality Experience and Experiential Education Medium to Teach Empathy to Healthcare Providers and Caregivers of Persons Living With Dementia.

Previous research indicates that greater empathy by healthcare providers (HCPs) and informal caregivers leads to better care and improved patient satisfaction and outcomes for persons living with dementia (PLWD). Since few programs exist to train HCPs to develop empathy, we created the augmented reality education experience (AREduX), a proof-of-concept prototype that employs augmented reality (AR) to simulate the physical and cognitive symptoms that PLWD experience. This unique experience simulates the effects of dementia for training purposes with the goal of promoting more empathetic responses from HCPs and informal caregivers when attending to a PLWD. This technical report provides an overview of the five phases of the research program, conceptualization, development and design, usability testing and prototype updating, testing of refined prototype including measuring participants' empathy pre/post interaction with the AREduX, and analysis and dissemination of results, but focuses on Phase 2, development and design. We believe that the AREduX will substantially contribute to the scientific literature on the development of empathy, address the knowledge gap that exists regarding evidence-based understanding of empathy as a construct, and contribute to further recommendations aligned with implementing AR as an experiential education method to enhance empathy among HCPs and caregivers of PLWD.

Twenty-first-Century Skills: Teaching Empathy to Health Professions Students.

A key component of therapeutic relationships is the ability of medical professionals to empathize with patients, as research indicates a link between a healthcare worker's ability to empathize with patients and improved patient outcomes. Empathy - the ability to perceive the meaning and feelings of another and to communicate those feelings to others - may be an innate concept, but it is shaped through behaviours and experiences. It is imperative, then, that post-secondary students entering the medical field be taught to develop empathy in order to facilitate positive patient outcomes. Embedding empathy-based education in the curriculum of medical, nursing, and allied health programs early in the course of study can help students understand the patient's perspective and facilitate positive therapeutic relationships early in students' professional careers. The shift from traditional teaching and learning styles to online learning has created deficiencies such as gaps in communication, empathy, and the development of emotional intelligence. To address these gaps, new and innovative ways to teach empathy, such as simulation, can be employed.

Focus Group Findings to Support the Preliminary Development of the Augmented Reality Education Experience (AREduX).

Dementia is considered a global health priority with projections of the disease set to increase dramatically across the world. Current support for persons living with dementia (PLWD) relies on long-term care and local service centers to provide education and support. Augmented reality-based programs continue to gain momentum across health sectors, becoming an innovative approach that provides an opportunity to have a visceral experience, which can deepen understanding and provide an embodied perspective of other groups within a relatively short time frame. There is increasing interest in developing approaches to aid patient care outcomes for PLWD and their caregivers. Hence, healthcare providers (HCPs) who are appropriately trained and equipped to provide quality care to PLWD are essential and of international concern. The purpose of this research program is to develop an augmented reality (AR) education experience (AREduX), a proof of concept prototype in the form of a digital resource that uses AR to simulate the physical and cognitive symptoms that PLWD experience. The findings from a stakeholder focus group will allow for the preliminary development of the AREduX.

Revisiting Pseudo-Haptics for Psychomotor Skills Development in Online Teaching.

In a centralized model of simulation-based education (Ce-SBE), the trainees practice clinical skills in simulated laboratories based on physical models, while in a decentralized model (De-SBE), the trainees practice these skills outside of these laboratories. Attention to De-SBE has drastically shifted to virtual learning environments (VLEs), serious games, and virtual simulations employing various digital technologies, including virtual, augmented, and mixed reality. In particular, remote learning has grown immensely during the COVID-19 pandemic as traditional in-person teaching and training activities are conducted online as a form of facilitating continuity in education. VLEs allow trainees to learn from virtual simulated health experiences in an interactive, engaging, and ethically safe manner, while providing educators the opportunity to implement simulated experiences to a larger number of learners. Despite these benefits, for certain types of clinical skills, such as psychomotor skills, VLEs have not yet reached their potential. This is primarily due to technical limitations and cost issues with the haptic devices required to simulate the sense of touch. Pseudo-haptic refers to the illusion of haptic stimulation in the absence of mechanical haptic interfaces and often combines the use of a passive input device (e.g., mouse) with visual and auditory feedback to simulate haptic properties (stiffness or friction of an object). Although the application of pseudo-haptics for psychomotor skills development is still in its infancy and currently trending due to the availability of consumer-level technologies, the potential to present haptic cues in the absence of active haptic devices may allow trainees to practice some tasks outside of research and training labs. The implications of pseudo-haptics are tremendous, particularly as remote learning becomes more widespread, and warrant further discussion.

Shifting to Delivering Simulation Virtually Within a Healthcare Education Setting.

The coronavirus disease 2019 (COVID-19) pandemic has changed how healthcare education is being delivered, creating a global shift towards virtual modalities. Various approaches, each with their own benefits and limitations, have been developed to bridge this gap and continue to provide comprehensive education to healthcare students. To understand which approach to implement, we must consider what each can offer and what is best suited for the situation. Much of this will focus on the learning goals and outcomes with research strongly favouring modalities focused on the areas of cognitive, affective, and behavioural skill acquisition as opposed to technical skills.  The use of simulated persons offers the most diverse application for these areas of focus. This approach can provide opportunities for both synchronous and asynchronous learning. While novel in its approach, virtual simulations can leverage existing success and performance indicators used for in-person approaches to best understand the experiences of the learners and the facilitators. Evidence can be compared with outcomes of previous in-person groups to understand how this approach can be best implemented into curricula/programs. Future applications are numerous for this modality and the development of pilot studies focused on smaller groups of learners will provide opportunities for educators and program developers to review and understand the challenges that may arise. Simulation is a widely drawn upon teaching-learning approach deeply rooted in experiential learning. With the purpose of replicating real-world scenarios to increase knowledge transfer and reduce the shock of encountering challenging real-world situations, simulated environments are proven to be an effective tool in building learners' self-confidence and bridging the gap between theory and practice within the healthcare realm. Simulation can be, and is, applied within healthcare-education contexts from undergraduate to graduate levels and into ongoing professional development.

Using Simulation-Based Methods to Support Demonstration of Competencies Required by Micro-Credential Courses.

The rise of the digital revolution has disrupted entire industries and job markets, leading individuals to either upgrade or transfer their skills in order to continue within their designated fields or transition to new workplace contexts. Employers expect their employees to apply their knowledge to real-world settings, analyze and solve problems, connect choices to actions, and innovate and create. Moreover, the COVID-19 pandemic has exacerbated changes to the educational landscape by forcing online and remote contexts; physical distancing and other preventive measures have necessitated a shift towards increasing the use of disruptive digital technologies- extended reality (e.g., virtual and augmented reality), gaming, and additive manufacturing-in simulation delivery. Yet Canada's economic and demographic data suggests that many new graduates struggle to transition from school to working life. The confluence of these factors has led to a need for both individuals and higher education institutions to upgrade and adapt to new digital techniques and modalities. As these needs grow, simulation-based education (SBE) techniques and technologies-already an integral part of training for some professions, including nursing, medicine, and various other health professions-are increasingly being used in digital contexts. In this editorial, we provide our perspective of the socio-technological movement associated with health-professions education (HPE) within the SBE context and examine the application and implementation of micro-credentialing within this field. We also discuss the various levels of expertise that learners may acquire. From this vantage point, we address how SBE can complement the assessment of competencies that learners must demonstrate to attain micro-credentials and explore micro-credentialing's advantages for, and use in, HPE.

A Model for an Online Learning Management System for Simulation-Based Acquisition of Psychomotor Skills in Health Professions Education.

The current coronavirus disease (COVID-19) pandemic has shifted traditional educational approaches in health professions education (HPE) from in-person to remote learning. Although pedagogical strategies have been developed and implemented rapidly to support cognitive and affective domains of learning in HPE, less progress has occurred in psychomotor skills acquisition. Psychomotor skills, referred to as technical skills training, are underpinned by educational theories and conceptual frameworks. Considering the widening gap in learning domains, this editorial provides an overview and recommendations for developing and implementing remote training supported by educational theories, such as deliberate practice, and conceptual frameworks in technical skills acquisition in HPE. We begin by discussing the unique curricular needs for remote psychomotor skills in medical teaching-learning contexts and subsequently present a theory-driven and evidence-based model for remote psychomotor skills acquisition.

CVRriculum Program Faculty Development Workshop: Outcomes and Suggestions for Improving the Way We Guide Instructors to Embed Virtual Reality Into Course Curriculum.

Experiential education and student engagement are a main source of student attraction and retention in post secondary milieus. To remain innovative, it is imperative that universities look beyond the internet and traditional multimedia mediums and incorporate novel ways and cutting-edge technologies that can drastically change the way students and educators experience learning. The application of technology as an approach to experiential education is becoming more popular and has extensively impacted universities and other higher education organizations around the world. One approach to support this change in education delivery is to use immersive technologies such as virtual reality (VR). Our team has conducted a pilot study that focuses on embedding VR as a medium to teach empathy within higher education milieus. We began the study by conducting a pilot faculty development workshop to provide an understanding of VR and ways it can be embedded as a pedagogical approach to support curriculum design. Five faculty members from a local university were recruited to participate. Outcomes suggest that embedding VR into the curriculum is a feasible approach that provides an engaging learning environment that is effective for teaching an array of interpersonal skills. The workshop laid the foundation for future faculty training programs guiding the use of VR, prompting a dialog regarding plans for future workshops across a pan-university context.

Implementing Virtual Simulated Person Methodology to Support the Shift to Online Learning: Technical Report.

The COVID-19 pandemic has dramatically changed how education is delivered worldwide. The resultant rise of e-learning, whereby teaching is undertaken remotely and on digital platforms, has extensively impacted universities and other higher education organizations around the world. One approach to support this change in education delivery is the use of virtual simulation approaches. Our team at SimXSpace has piloted a virtual workshop using Zoom, an online video-conferencing platform, and virtual simulated persons (SPs) to support communication and interpersonal skills among learners. The main objective of the pilot virtual workshop was to develop and implement the SP methodology remotely via the Zoom platform (Zoom Video Communications, San Jose, California) and to evaluate its effectiveness as an immersive environment for simulation. The virtual workshop involved four instructors who intend to implement virtual SPs within their courses, two workshop facilitators, and two SPs. The workshop was conducted synchronously using Zoom features. The workshop followed a predefined structure and was completed as planned. Outcomes suggest that remote simulation delivery using virtual SPs and delivered online via Zoom is feasible and provides an effective environment in which to conduct SP methodology to teach communication and interpersonal skills. The findings suggest that remote simulation and virtual SPs can support experiential education and provide an effective and engaging learning environment. The virtual workshop was successful and laid a foundation for future online training programs for the use of SP methodology. Moreover, it formed an effective outline for subsequent iterations of this virtual training workshop and prompted discussion of plans for future workshops with various programs across a pan-university context.

Understanding Learners' Experiences of Simulated Person Methodology in an Athletic Therapy Program.

Introduction Key skills required of today's students include critical thinking, problem-solving, creativity, innovation, collaboration, and communication. The acquisition of these skills is foundational to success in a variety of professions and contexts. This study complements a larger simulated person methodology (SPM) project that utilizes simulators (individuals who are trained to realistically reproduce scenarios by providing specific information, displaying signs and behaviours, and creating a realistic encounter in a consistent manner) to replicate real workplace issues, thus affording students an opportunity to apply knowledge and practice real-life skills necessary to the workplace. The primary objective of this study is to apply this innovative teaching approach in higher education as a means of developing proficient critical-thinking and interpersonal skills. Methods This pilot study uses an exploratory mixed-methods design to explore the experiences of 12 students enrolled in an athletic therapy (AT) certificate program that uses SPM. Our hypothesis is that SPM will have a positive impact on student learning and professional development. Results The students responded favourably to the use of SPM. Indeed, 80% "felt challenged and stimulated" and deemed SPM to be a "more effective method" of practicing communication skills than practicing with fellow students. These findings can inform future research and support work towards enhancing this methodology as a pedagogical approach. In tandem, this study and the larger SPM project are poised to provide an effective undergraduate education experience across various faculties at the pilot university. More work is required to align this teaching approach with the AT education program redesign.

SafeHome: A Serious Game to Promote Safe Environments for Persons Living with Dementia.

The dementia epidemic continues to affect families across Canada. The number of persons living with dementia (PLWD) is projected to reach 1.1 million over the next 20 years, placing further financial and resource constraints on the Canadian healthcare system. Caregiver education is vital in ensuring the quality of life and safety for PLWD and can increase the time they are able to live at home, which is correlated with positive outcomes for both PLWD and their caregivers, and a reduction in system costs. However, current educational support often requires individuals to travel to local, urban service care centers and educational content is often provided in English, which can exacerbate the difficulties faced by marginalized caregivers (e.g., immigrants and those living in rural settings) who are caring for PLWD.  To address this issue, a team of researchers developed a serious game called "SafeHome" that teaches safety strategies by having players identify and rectify potential hazards in the home setting that may negatively impact on PLWD outcomes, such as falls. A usability study was conducted using an adapted, validated questionnaire and semi-structured focus groups to better understand users' experience and obtain suggestions for the SafeHome serious game improvement. Results indicated that 80% of the participants were satisfied with the activities provided through SafeHome. All participants (n = 13) made recommendations for improving the usability, functionality, and comprehensiveness of the educational content. This feedback will inform future iterations of SafeHome and add valuable contributions to the growing literature on innovative e-learning resources that support PLWD and their caregivers.

Speaking Up Against Hierarchy: A Simulation Geared Towards Nursing Students.

Background As simulation science continues to advance, the focus previously put on scenario creation and debriefing must now be applied to other components of the learning experience. There is a need to examine the effectiveness of pre-simulation activities and how they relate to the overall simulation experience and learning outcomes. However, few randomized controlled trials have been conducted comparing different approaches in the pre-simulation preparatory phase and the impact on learning outcomes. Methods A randomized controlled trial was conducted with undergraduate nursing students (n=83) who were randomized to a traditional paper case study (control group) or an interactive pre-simulation activity (intervention group). The use of the two-challenge rule and Satisfaction and Self Confidence in Learning (SSL) was evaluated. Results The proportion of students who utilized the two-challenge rule in the intervention group was significantly higher than the control group. Results from the two independent-samples Wilcoxon-Mann-Whitney test showed a significant difference in the median of the total score of the SSL W=2.5, p <0.001, satisfaction W=6.0, p <0.001, and self-confidence W=68.0, p <0.001 in learning between third-year nursing students in the control and intervention groups. Conclusion Our results showed significant differences in the use of the two-challenge rule by students who completed an interactive pre-simulation activity (intervention group) compared to those who completed the paper case study (control group). Additionally, students in the intervention group were more self-confident and satisfied with the entire simulation intervention than the control group. From a pedagogical perspective, this study also emphasizes the need to ground simulations in theory. Moreover, there is value in using progressive frameworks, i.e., revised Medical Research Council (2014) in simulation design and research to ensure high quality. More studies are required to examine the right dosage and type of pre-simulation activity and impact on learning outcomes.

Piloting Simulations: A Systematic Refinement Strategy.

Introduction Few approaches articulate a systematic way to address confusing, missing, or underdeveloped simulation design features prior to implementing into coursework. To address this gap, we tested a novel, systematic refinement strategy to improve the design elements of two simulations. Methods Forty eligible participants (Year 3 undergraduate nursing students) evaluated two simulation scenarios (each followed by a debriefing session) through a novel and systematic refinement strategy across five iterations. Each simulation was evaluated using the validated Simulation Design Survey (SDS). Ratings were analyzed using descriptive data. Students also responded to an open-ended question in order to provide qualitative feedback regarding how to improve its features, i.e., scenario design and debriefing components. Written comments by students were analyzed using the principles of qualitative content analysis.  Results Descriptive statistics revealed a gradual increase in the mean scores of the SDS over each of the simulation refinement periods. For the first simulation, the SDS mean score reached a high on Day 5 of 4.86 (standard deviation (SD) = 0.14) in contrast to a score of 3.45 (SD = 0.17) on Day 1. For the second simulation, the SDS mean score was 4.75 (SD = 0.16) on Day 5, which represented a mean score increase of 1.01 from the score on Day 1.  Conclusions This novel refinement strategy improved the overall design elements of each of the simulations. The potential use of the SDS and open-ended feedback, guided by a refinement approach, merits further investigation.

Medical Aesthetics Training: Shifting to Collective Competence.

With increased demands for medical aesthetics procedures and the sudden profusion of newly licensed, and unlicensed, providers who are performing these medical aesthetics procedures also comes the responsibility to shift to collective competence. Collective competence refers to what occurs among professionals in action, emphasizing the sharing of experiences, knowledge, and perceptions among those who are providing services to the medical aesthetics client. Registered nurses and medical students are not taught to perform cosmetic procedures in basic nursing or medical programs and thus require a post-entry-level education to validate their competency. The current medical aesthetics apprenticeship training approach of see one, do one, and teach one focuses on teaching technical skills and thus does not sufficiently address the ever-changing health care context and the ambiguity in practitioner role. Recent scholars highlight that when health care failed or an error has been identified, it is rarely adduced to an individual's competence but rather is more likely to be a failure of the collective team. In this article, we are advocating for a change in how medical aesthetics practitioners are trained. In particular, it advocates creating opportunities within the curricula to train practitioners as a collective body, as opposed to providing training that focuses on the individual's competence and technical skills alone.

From bricks to buildings: adapting the Medical Research Council framework to develop programs of research in simulation education and training for the health professions.

SUMMARY STATEMENT: Presently, health care simulation research is largely conducted on a study-by-study basis. Although such "project-based" research generates a plethora of evidence, it can be chaotic and contradictory. A move toward sustained, thematic, theory-based programs of research is necessary to advance knowledge in the field. Recognizing that simulation is a complex intervention, we present a framework for developing research programs in simulation-based education adapted from the Medical Research Council (MRC) guidance. This framework calls for an iterative approach to developing, refining, evaluating, and implementing simulation interventions. The adapted framework guidance emphasizes: (1) identification of theory and existing evidence; (2) modeling and piloting interventions to clarify active ingredients and identify mechanisms linking the context, intervention, and outcomes; and (3) evaluation of intervention processes and outcomes in both the laboratory and real-world setting. The proposed framework will aid simulation researchers in developing more robust interventions that optimize simulation-based education and advance our understanding of simulation pedagogy.