Presentation provided for the Society for Critical Care Medicine - Texas Chapter in the use of Virtual Reality for Medical and Health Professions Education.

1. Distance Learning: Virtual Reality in the
Health Sciences
Beyond smoke and mirrors towards pedagogy, research, and implementation
Eric B. Bauman, PhD, FSSH
Society for Critical Care Medicine – October 9, 2021 ©Bauman 2021 all Rights Reserved

2. Disclosures and Affiliations
Professional
• Clinical Playground, LLC
– Managing Member
• Arch Virtual
– Senior Medical, Healthcare, and Academic Advisor
• Forensic Analytics, LLC
– Managing Member
• Associate Professor (Adjunct) MGH Institute of Health Professions
Stocks
• Minor Positions: CAE Healthcare, Pfizer, Zynga, Mind Medicine, AbbVie
Other
• Springer Publishing: Author
• PeerJ: Editor
• Editorial Board: Journal of Nursing Research and Practice
• Reviewer: Various Journals
. . . . . . . . . . . ©Bauman 2021 all Rights Reserved
Eric B. Bauman, PhD, FSSH, RN

3. Objectives
• Participants will be introduced to relevant terms
and definitions found within the health sciences
digital educational paradigm specific to virtual
reality.
• Participants will be introduced to contemporary
pedagogy that supports the digital medical and
health sciences educational narrative.
• Participants will review preliminary findings of a
study specific to engagement with virtual reality
environments for interprofessional education in
the health sciences.
. . . . . . . . . . . ©Bauman 2021 all Rights Reserved

4. Terms and Definitions
Virtual World/Environment
Virtual World/Environment: An environment that hosts a synchronous
digital environment, persistent network of people, represented as
avatars, facilitated by networked computers.
• A well- designed VE allows for computational offloading; learners can concentrate on
learning material rather than imagining details of the scenario
(Bell, 2008)
©Bauman 2021 all Rights Reserved
. . . . . . . . . . .

5. Terms and Definitions
Virtual Reality
• The Term Virtual Reality seems to be confounding and
evolving:
– Something like the Holodeck in Star Trek
– Persistent and synchronous
– Wearable hardware that leverages digital technology to
immerse the participant in a near reality experience
– Promotes the suspension of disbelief
“…VR allows skills and content to be repeated through
deliberate practice, helping instructors measure competence
(Ericsson, 2006) and validate learning outcomes…”
(Ericsson, 2006; Gaba 2004; Samosorn, Gilbert, Bauman, Khine and Mcgonigle, 2020)
©Bauman 2021 all Rights Reserved

6. • Presence
– A subjective and psychological phenomenon seen as the outcome or a
direct function of immersion.
• Spatial Presence
• Sensory Presence
• Social Realism
Terms and Definitions
Presence
Example: When immersed in a virtual
environment such as a Virtual Reality (VR)
space in a manner such that the participant
has ability to “walk the plank”, many
participants will experience physiological
symptoms and sensations of fear as though
they are actually walking the plank in the real
world.
https://media.vrgames.io/20191209225222/MixedRealityVive_Landscape_RPE.png
©Bauman 2021 all Rights Reserved

7. • Immersive
– Visually immersive spatial representations of data, which
engage vestibular and proprioceptive senses.
– For the purposes of this discussion this is achieved via
Virtual Environments displayed through contemporary
head-mounted VR displays, in contrast to traditional
screen-based displays.
Terms and Definitions
Immersive
©Bauman 2021 all Rights Reserved
. . . . . . . . . . .

8. Pedagogy
Traditional Experiential Theory
• Kolb – Experiential Learning Cycle
• Schön – Reflection “in” and “on” Action
• Benner – Thinking in Action
Simulation, particularly mannikin-based simulation is
steeped with experiential learning theory. Could theorists
like Kolb, Schön and Benner have predicted the rapid
advances in technology being used for clinical education?
Are these theories still applicable for innovative simulation,
including virtual reality solutions, and other strategies
found in the digital learning landscape?
©Bauman 2021 all Rights Reserved

9. Contemporary concepts and theory supporting
Mobile Apps & Game-Based Learning
Pedagogy
Today we will review
• Simulation to Practice Pathway1
• Bauman’s Layered Learning Model1
Which are rooted in the following
• Socially Situated Cognition2
• Designed Experience3
• Ecology of Culturally Competent Design4
• Digital Wisdom5
E.B.Bauman1 J.P. Gee2 K. Squire3 E.B. Bauman & I.A. Games4 M. Prensky5
©Bauman 2021 all Rights Reserved

10. Simulation to Practice Pathway
Better Preparation = Deliberate Practice = Better Patient Outcome
Knowledge
Acquisition
Simulation-Based
Experience
Clinical
Practice
© Bauman 2007
©Bauman 2021 all Rights Reserved

11. Clinical Practice
Simulation
Experience
Knowledge Acquisition
Behavior
Didactic
Rethought Simulation to Practice Pathway
© Bauman 2010 © Bauman 2012 © Bauman
2017© Bauman 2019
Games
Cognitive Aid
Games
©Bauman 2017 all Rights Reserved
Games & Simulation to Practice Pathway
©Bauman 2021 all Rights Reserved

12. Bauman’s Layered Learning Model
Didactic
Preparation
Games, XR,
Interactive
Applications
Task Trainer,
Simulator,
SPs
Real World
Experience
Situated learning experiences link didactic content
with practical hands-on experiences
©Bauman 2021 all Rights Reserved
Bauman, 2016; Bauman, Adams, Pederson, Vaughan, Klompmaker, et al,2014; Bauman, Gilbert & Vaughan, 2017; Bauman, Ralston-Berg & Gilbert, 2018

13. Learning As Performance
Learning Performance
Behavioral Change
(Aka – The Sweet Spot)
©Bauman 2021 all Rights Reserved

14. • This study seeks to understand the comparative experience of the
participants of meetings and meeting satisfaction in a web/video
conference platform (Zoom) versus a virtual reality immersive platform
(spatial.io) that required the use of a head mounted device.​
The Study
What is comparative experience of web conference versus virtual reality
Melissa Morris, MSN, CPN, CHSE, RN
Doctoral Student – MGH Institute of Health Professions
©Bauman 2021 all Rights Reserved

15. • Frustration accessing and getting
on VR Platform
• Lack of cohesiveness of the team
• Distractions
Identified Themes
©Bauman 2021 all Rights Reserved

16. • Frustration accessing and getting on VR Platform
• Function of orientation to hardware and software
Identified Theme: Frustration
©Bauman 2021 all Rights Reserved

17. • Social constructs and norms – F2F versus Virtual
Environments
Identified Theme: Lack of Cohesiveness
©Bauman 2021 all Rights Reserved

18. • Zoom: People are multi-tasking; Others may not
be aware:
• An individuals’ distractedness didn’t seem
to distract others in the group.
• Spatial.io: People are distracted by other artifacts in the
environment and are distracting other people in the
environment.
• Hybrid environments are less desirable than all in
immersive VR or all in Zoom
• Some on Zoom and some live F2F is
undesirable
• Some in spatial.io using headsets and others
using 2D screen capture is undesirable
Identified Theme: Distraction
©Bauman 2021 all Rights Reserved

19. My Crystal Ball: Where are we headed
• Educational Experiences leveraging Technology should solve a
problem
• Map back to curriculum objectives
• The Goal of Educational Games, Sims & Immersive Experiences
should be to prepare learners for real world experiences
• NOT to suspend them in the game or simulation environment
• Students must see the game, sim, or immersive experience as valuable
• Will playing the game or engaging the experience increase performance?
• Virtual Reality is finally starting to work and will be integrated as
mobile learning platforms
• Beyond proof of concept and the beautiful corner
• Patients and Students are already demanding that clinicians &
educators embrace technology
• If you don’t embrace technology the best students will go elsewhere
• Patients have always sought out cutting-edge practice and will continue to do so
©Bauman 2021 all Rights Reserved
Mini, Micro, Integrated, Mobile

20. Selected Readings & References
• Aleckson, J., & Ralston-Berg, P. (2011). MindMeld: Micro-Collaboration between eLearning designers and instructor experts. Madison, WI: Atwood Publishing
• Azuma, R., Baillot, Y., Behringer, R., Feiner, S., Julier, S., & MacIntyre, B. (2001). Recent advances in augmented reality. NAVAL
RESEARCH LAB WASHINGTON DC
• Bauman, E. B. (2016). Games, Virtual Environments, Mobile Applications and a Futurist's Crystal Ball. Clinical Simulation in Nursing, 12(14), 109-114.
• Bauman, E. B. (2012). Game-based Teaching and Simulation in Nursing & Healthcare. New York, NY: Springer Publishing
• Company.
• Bauman, E. (2007). High fidelity simulation in healthcare. Ph.D. dissertation, The University of Wisconsin – Madison, United
States. Dissertations & Theses @ CIC Institutions database. (Publication no. AAT 3294196 ISBN: 9780549383109 ProQuest
document ID: 1453230861).
• Bauman, E.B, Adams, R.A., Pederson, D., Vaughan, G., Klompmaker, D., et al (2014). Building a better donkey: A game-based layered learning approach to veterinary medical education. GLS 10 conference
proceedings, Carnegie Mellon University ETC Press, 372-375. ISSN 2164-6651 (print), ISSN 2164-666X (online)
• Bauman, E.B. and Games, I.A. (2011). Contemporary theory for immersive worlds: Addressing engagement, culture, and diversity. In A. Cheney and R. Sanders (Eds) Teaching and Learning in 3D Immersive
Worlds: Pedagogical models and constructivist approaches. IGI Global.
• Bauman, E. B., Gilbert, G. E., & Vaughan, G. (2017). Short-term gains in histology knowledge: A veterinary gaming application. PeerJ Preprints, 5, e3421v1.
https://doi.org/https://doi.org/10.7287/peerj.preprints.3421v1
• Bauman, E. B., Ralston-Berg, P., & Gilbert, G. E. (2018). The nexus of game development: Curricular integration & faculty development. In R. Gordon & D. McGonigle (Eds.), Virtual
simulation in nursing education. Springer Publishing Company, LLC. https://doi.org/10.1891/9780826169648.0009
• Bell, M. W. (2008). Toward a definition of “virtual worlds”. Journal For Virtual Worlds Research, 1(1).
• Benner P. From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley; 1984
• Broussard., J (2012). Making the MMOst of Your Online Class. Teaching and Curriculum Dialog.
• Deterding, S., Dixon, D., Khalid, R., Lennart, N. (2011). MindTrek’11, September 28-30, 2011, Tampere, Finland.
• Ericsson, K. A. (2006). The influence of experience and deliberate practice on the development of superior expert performance. In Ericsson, K., Charness, N., Feltovich, P., & Hoffman, R. (Eds.), Cambridge Hand-
book of Expertise and Expert Performance. New York, NY: Cambridge University Press. (pp. 683-703).
• Fitz-Walter, Z. (2012). http://gamasutra.com/blogs/ZacharyFitzWalter/20120426/169287/
Gamification_Thoughts_on_definition_and_design.php
• Games, I. and Bauman, E. (2011) Virtual worlds: An environment for cultural sensitivity education in the health sciences. International Journal of Web Based Communities 7(2), 189-205, doi:
10.1504/IJWBC.2011.039510
• Gaba, D. M. (2004). The future vision of simulation in health care. BMJ Quality & Safety, 13(suppl 1), i2-i10.
• Gee, J.P. (2003). What videogames have to teach us about learning and literacy. New York, NY: Palgrave-McMillan.
• Goldstone, R. L., & Son, J. Y. (2005). The transfer of scientific principles using concrete and idealized simulations. Journal of the Learning Sci- ences, 14(1), 69-110. https://doi.org/10.1207/s15327809jls1401_4.
• Jenson, M. (2012). Engaging the learner: Gamification strives to keep the user’s interest. T &D, January, 2012,
41-44.
• Kolb D. Experiential learning: Experience as the source of learning and development. Upper Saddle River, NJ: Prentice Hall; 1984.
• Palmarini, R., Erkoyuncu, J. A., Roy, R., & Torabmostaedi, H. (2018). A systematic review of augmented reality applications in
maintenance. Robotics and Computer-Integrated Manufacturing, 49, 215-228.
• Prensky, M. (2001). Digital natives, digital immigrants part 1. On the Horizon, 9(5), 2-6.
• Prensky, M. (2010). Teaching digital natives: Partnering for real learning. Corwin Press.
• Prensky, M. R. (2012). From digital natives to digital wisdom: Hopeful essays for 21st century learning. Corwin Press.
• Samosorn, A. B., Gilbert, G. E., Bauman, E. B., Khine, J., & McGonigle, D. (2020). Teaching airway insertion skills to nursing faculty and students using virtual reality: A pilot study. Clinical Simulation in
Nursing, 39, 18-26.
• Schön DA. The reflective practitioner: How professionals think in action. New York: Basic Books; 1983.
• Squire, K.D. (2006). From Content to Context: Videogames as Designed Experience. Educational Researcher, 35(8), 19-29.
• Zimmerman, E (2011) Games+Learning+Society Confernece, Madison, WI.
©Bauman 2021 all Rights Reserved

21. Questions & Contact Information
www.clinicalplayground.com
ebauman@clinicalplaygound.com
@Bauman1967
Clinical Playground, LLC
https://www.slideshare.net/ebauman
www.linkedin.com/in/ericbbauman/
©Bauman 2021 all Rights Reserved