Chronic kidney disease is an under-recognized public health risk, causing more deaths than breast cancer or prostate cancer. Kidney disease ranks as the ninth leading cause of death in America, and approximately 20% of dollars in traditional Medicare—$114 billion a year—are spent addressing kidney disease in Americans. One of the best ways to reduce the prevalence of kidney disease, and to slow its progression once the disease takes hold, is through high-quality education and training.
In this report, we address four specific aspects of kidney care that could be enhanced with high-quality education and training. These include high-quality education and training around:
Kidney Structure and Function: What it does, how it works and where it fits more broadly in the renal system.
Kidney Problems: The warning signs and nature of kidney disease, and ways to mitigate risk.
Kidney Treatment: Treatment options, including the pros and cons of in-clinic dialysis versus at-home dialysis.
Dialysis Machine Care, Maintenance, and Use: The care and maintenance of home dialysis machines and step-by-step knowledge of how to use the systems.
By far the most common approach to healthcare education, including nearly all aspects of kidney education and training, is to have patients and their caregivers read written documents, view PowerPoints or watch videos. From a psychology and neuroscience perspective, this traditional approach to training predominantly engages the cognitive skills learning system in the brain. While these traditional approaches like text, diagrams and schematics are 2-Dimensional, static, and abstract representations, the kidneys and dialysis machines themselves are 3-Dimensional and dynamic. The amount of cognitive resources, in the form of working memory and attention, needed to construct a 3D dynamic representation in the brain, from 2D, static and abstract knowledge (even when supplemented with video) is a nearly impossible task — and one that is prone to error.
Now consider an interactive storytelling with VR approach to kidney education and training. Suppose that an individual can watch the kidney or a dialysis machine in action. Suppose they can step inside the kidney in a 360-degree immersive experience while a narrative unfolds describing the structure and function, problems and treatments. Or perhaps they can see the hemodialysis machine in action while learning the steps associated with care, maintenance and use from an experienced educator. What’s more, as in the case of one-on-one teaching, learners now have on-demand access to the best educators available on any given topic, wherever and whenever they need it.
From a psychology and neuroscience perspective, this approach engages the cognitive, experiential and emotional learning systems in the brain. Critically, a VR approach like this engages all three brain systems simultaneously and in concert. This builds context-rich, and highly interconnected memory representations that provide the high-quality education and training needed.
We now briefly contrast traditional with VR approaches to the four specific kidney education and training use cases outlined above.
Kidney Structure and Function
The traditional approach to education and training around kidney structure and function is to read a textbook on the renal system that includes text-based descriptions, labeled schematics, and diagrams. From this 2D static representation, one must construct a 3D dynamic representation of the structure of the kidney and its function in the renal system. This is at best cognitively challenging, and at worst nearly impossible and error prone for most learners. On the other hand, imagine donning a VR headset and seeing a 3D dynamic kidney in front of your eyes. With the wave of a hand or a touch on the virtual organ, it expands and you are inside of the kidney watching it filter waste and extra fluid from the body. Next you see a 3D representation of the complete renal system with the kidney highlighted and its function within the system being described with text and audio voice over. Imagine being able to repeat this experience as many times as you like and from any and all angles as you maneuver yourself around the organ, as well as inside and out. From this VR experience you will obtain a vast amount of knowledge, but also strong visual and experiential representations of the kidney and its role in your body's renal system.
As with education on the structure and function of the kidney, the traditional approach to education and training around kidney problems is text, schematic and diagram based. Again, the learner is faced with the challenge of constructing a 3D dynamic representation in the brain from 2D static abstract knowledge. This is challenging, time consuming, and error prone. On the other hand, imagine a VR experience much like the one created for kidney structure and function, but one that focuses instead on potential kidney problems, symptoms, and ways to mitigate risk. One might be shown the effects of acute kidney injury (AKI) or kidney disease that can be viewed from any angle, inside or out. One might then meet a patient with kidney problems. They could describe some of the symptoms and how terrible it felt before starting treatments, and could offer suggestions for how to mitigate risk and live a healthy lifestyle. Taken together, this VR approach provides a rich experiential context that strengthens learning of kidney problems, and complements that with a personal story that provides an emotional understanding.
As elaborated in our recent blog post, traditional approaches to education and training around dialysis modalities is also sub-optimal. For example, the kidney patient might read a document that provides a general overview of in-center hemodialysis (HD) and aspects of the patient’s lifestyle that might change as a result of the HD treatments. Similarly, the patient might read another document that provides a general overview of home hemodialysis (HHD). They might read about the need for a care partner to assist them with the dialysis process, and the safety measures that are specific to HHD. Patients are left feeling under-informed, are slow to make a decision, and are often fearful of certain prevailing myths about these options. The best programs we have seen will include a human and hands-on approach, where real patients are introduced to share their own stories and time is spent with the machines to familiarize patients with their options firsthand. However, this approach is rare, lacks consistency, and does not scale particularly well.
Now consider an interactive storytelling with VR approach to patient education around in-center hemodialysis versus home hemodialysis (HHD). Suppose the patient is immersed in a 360-degree environment where they could experience in-center HD and HHD from a first-person perspective (i.e., that of the patient) and a third-person perspective (i.e., that of the caregiver). While immersed in this experience, a narrative unfolds for the patient that describes the relevant steps while the patient is experiencing them, and includes narrative regarding the strengths and weaknesses of the two modalities, as well as common fears that turned out to be completely fine. Because the experience is so rich and engages so many parts of the brain, the patient feels like they understand what each modality “feels” like. This will leave the patient poised to make a fast and accurate dialysis modality decision. Importantly, this approach enables us to control the delivery of a highly effective educational experience, and one that scales to every patient, when and where it is needed.
Dialysis Machine Care, Maintenance, and Use
Once a patient chooses a dialysis modality such as in-home hemodialysis, they and their caregiver (such as a spouse, family member, or professional caregiver) must be educated and trained on the care, maintenance and use of the home hemodialysis machine so that no complications arise. This usually begins with patients and their caregivers reading documents describing the device and outlining the steps needed to care, maintain and use the device. This is usually supplemented with classroom and hands-on training with an expert. Although clearly superior to document training alone, this is time-consuming, costly, and is difficult to scale.
Now imagine a VR approach to training (for an elaborated description follow this link). The patient and their caregiver don a VR headset and are immersed in a 360 experience with an expert trainer showing how to care, maintain, and use the home hemodialysis machine. The patient and caregiver can watch as the expert demonstrates and verbally describes the step-by-step procedures needed to care and maintain the device. The patient and caregiver can view this from a third-person perspective, but also from the first-person perspective. The expert can demonstrate common pitfalls and how to address them, while describing them verbally. The patient and caregiver can view the VR experience and can complete knowledge checks at the end to ensure that they have the requisite knowledge. They can view the experience as many times as they like until they are confident in their own skills. The patient and caregiver could then receive additional hands on training from a live expert, but in this case the patient’s and their caregiver’s level of competence and confidence will be much higher than with textbook training.
Alternatively, they might utilize an interactive VR experience or perhaps an augmented reality tool that would guide them through the care, maintenance and use while receiving real-time corrective feedback. As each step is completed, the patient and caregiver are rewarded with success and then moves onto the next step in the process. The patient and caregiver can practice the process as many times as they like, and even under time pressure. Critically, this is a completely safe environment for all participants.
In this report we outline four specific applications of immersive technologies in kidney care education and training. These span the range from a basic understanding of kidney structure and function, to the development of expertise in the care, maintenance and use of a home hemodialysis machine. The report was written with a focus on patients and their caregivers, but all of these applications are directly relevant to healthcare professionals as well. When patients, caregivers and healthcare professionals complete the same VR training, a shared experience results that enhances communication, empathy and understanding. The detailed cognitive, behavioral, emotional and experiential understanding that emerges from VR education and training can improve kidney care across the board.
This shared experience and effective communication between patients, caregivers and healthcare professionals that can result is what sets successful kidney care providers apart from the rest. With VR training for patients, caregivers and healthcare professionals you can achieve this goal—one experience at a time.