Using Immersive Technology to Train Frontline Kidney Care Staff
By this time last year, Susan had been on the job hunt for a while – looking for an entry level opportunity in the fast-growing healthcare profession – before she finally came across an opening for a home dialysis patient care technician in her area. Fortunately, the position came with several months of paid training, so her lack of experience in the industry would not be an obstacle in getting up to speed in her new role.
Susan landed the job and was soon scheduled to begin training the following month through a combination of online learning (at home) and in-person classroom instruction at the company’s regional training facility.
The learning curve was steep, especially for not having the healthcare experience that a few of her classmates had gained through recent direct care roles. Susan had always been an average performer on tests, and this case was no different. She was able to learn the information contained in the online classes and reading materials, and it served her well in taking the written exams.
Then something unexpected happened.
When Susan showed up to her first week of in-person training, very little seemed familiar. The information she had covered and memorized in the online classes did not translate well to the hands-on practical tasks in front of her. In fact, she was not even sure whether the instructor was covering the same material, let alone which material she ought to be focusing on most.
This went on for the duration of Susan’s training. She was able to pass written tests based on the textbooks and reading materials, but would feel completely unprepared for the dynamic, realistic learning environment.
Though Susan’s training program was originally supposed to last 12 weeks, she and many of her classmates needed close to 6 months to feel adequately prepared for their role and responsibilities.
But this training issue is much larger and more encompassing than Susan and her new employer's experiences. This is just one example of the ongoing struggle between theory and practice when it comes to the ways our learning programs are designed, and the way humans are actually wired to learn.
A Broader Training Challenge
Consider the situation facing any direct care worker like Susan, recently hired by a dialysis provider to serve patients in their homes. The nurse or patient care technician must be educated and trained on all aspects of the specific dialysis machine being used. This includes a cognitive understanding of the machine such as each part, its function, and the steps needed to follow to use the machine. This also includes a behavioral understanding of the machine such as how to connect all of the relevant parts, in what order, as well as how to hook a patient up to the machine and run it. Behavioral learning can only occur through experience.
Although the details are beyond the scope of this report and can be found here, suffice it to say that cognitive learning occurs in the prefrontal cortex of the brain, and requires working memory and attention, both of which are limited capacity resources (see Figure 1). Behavioral learning occurs in the striatum, a subcortical structure in the brain and requires real-time immediate feedback to increase the prevalence of correct behaviors, and decrease the prevalence of incorrect behaviors. Experiential learning involves the sights, sounds, tactile and olfactory aspects of a learning environment by engaging the occipital, parietal, and temporal lobes of the brain.
Figure 1: Learning and performance systems in the brain.
Figure 2 shows the timeline for the typical approach to dialysis device training. Time-to-train is on the x-axis and behavioral competence with the dialysis machine is on the y-axis. The figure depicts the type of training as well as the learning and performance regions in the brain activated by that training. The most common approach is to begin with library or textbook education in the form of text, slide shows, and perhaps video. Notice that library education engages only the cognitive system in the brain, and thus no behavioral competence is obtained. This learning takes place in an experiential vacuum. This is challenging and time-consuming, and taxes working memory and attention to the limit. Library and textbook education often culminates in a competence test that must be passed to move on to hands-on clinical training with an instructor. In this example, cognitive training takes 6 months.
Figure 2: Timeline of traditional dialysis device training.
Although not always the case, it is important that the library and textbook education content, and the hands-on clinical training content are aligned. All too often the topics covered do not match which slows learning. Usually the clinical training is conducted in a group setting with the clinical educator demonstrating the use of the dialysis machine and the nurses-in-training mimicking these procedures. This engages cognitive and experiential centers in the brain. Because the emphasis is on a group setting, each nurse gets only periodic one-on-one brain training. This is denoted by the partially filled pink circle in the figure. Behavioral training is also time-consuming and culminates in a behavioral competence test, at which point the RN is deemed ready to go out in the field. In this example, hands-on clinical training requires an additional 3 months. Ongoing “on-the-job” training, if any, is generally sporadic at best, leading to gradual increases in behavioral competence.
Figure 3 shows the timeline for an immersive technology approach to dialysis device training. Training begins with a series of 360 virtual reality (VR) experiences aimed at providing all of the same information present in library education, but from an experiential standpoint. Critically, immersive education of this sort engages cognitive and experiential learning centers in the brain in synchrony. This spreads the wealth of information and spreads the burden reducing cognitive load. This speeds learning and retention allowing the nurse to demonstrate cognitive competence more quickly and with more confidence. Critically, and unlike typical library training, VR experiences can be constructed that present the nurse-in-training with challenging situations that they may rarely see on-the-job, but ones that can be fatal. They can experience stressful situations such as an unruly patient. This builds a broad knowledge base and situational awareness that does not develop with traditional approaches. Although no behavioral competence is developed, the nurse-in-training is primed for behavior change.In this example, initial training occurs within 1.5 months.
Figure 3: Timeline of immersive technology dialysis device training.
Once cognitive competence is demonstrated, the nurse-in-training enters the interactive VR or augmented reality (AR) training phase. Here a virtual instructor guides the nurse-in-training through the care, maintenance, and use of the dialysis device. Because the training is one-to-one, cognitive, behavioral and experiential systems in the brain are engaged in synchrony throughout all of the training, which speeds the development of the relevant behavioral repertoire, and quickly culminates in behavioral competence. The nurse is now cognitively and behaviorally competent in 3 months, compared to the 9 months for traditional training. With VR and AR, ongoing training is also possible. Thus, the nurse can stay current on the operation of new dialysis devices and technology as it comes on the market.
A Hybrid Approach
Of course, hybrid approaches are also worth exploring that can provide immediate value for Susan and her employers. As just one example, it would be highly advantageous to either replace the library and textbook education, or to complement it, with 360 VR education. This engages cognitive and experiential learning centers in the brain in synchrony, and builds the broad-based situational awareness that an RN needs, and that is not addressed with library and textbook education. This could be followed by traditional hands-on clinical training to be complemented with interactive VR/AR assets in the next phase of development.
Dialysis device education and training that relies on immersive technologies, such as VR and AR, as opposed to traditional approaches that rely on library and hands-on clinical training, lead to faster learning and stronger retention of relevant information. Broad-based behavioral repertoires and situational awareness develop quickly and naturally in nurses. Nurses are on-the-job ready quickly and with confidence – one experience at a time.