Using extended reality to tackle the workforce shortage in healthcare

Q: What do you perceive as the greatest challenge in this space that we need to overcome?  

A: I think it’s resourcing for the hardware, and then the software and the time to develop content that’s meaningful. It’s really hard to generate business cases for this sort of training hardware and then to keep it all current. That’s the biggest challenge we’ve faced, and we’ve had to look to a lot of charity sector stuff to help overcome that. We’re very fortunate that we’ve got an active charities fundraising team, but many healthcare providers are not in that fortunate position. 

But even we struggle with that. And we have to make a really strong case for any sort of funding. We’ve got some for the women’s hospital site, but we now need to do something for the children’s site. They have a different breadth of professionals and age groups that they need to provide that sort of training and education material for in multidisciplinary teams. The women’s services and neonatal services are fairly discrete and they’ll use the same training in roughly the same sort of areas, whereas when you think about children’s care, that means that you need to have a whole different set of modalities and different MDT team members coming in there as a child grows. 

Q: What are the most fruitful opportunities that could have the greatest impact?  

A: We’ve got an ageing workforce, and the competition for that younger workforce is super high. Many recognise the challenges that being in health care can provide for young people, and a lot of people don’t want to go into that profession.
So the main opportunity is to allow people exposure to health care in a safe environment. We can really accelerate the learning of those people that we have coming into the profession so they feel confident in a very diverse set of roles, responsibilities and jobs. But you can do it in a safe virtual space – and really start to get that muscle memory of what health care is in different ways. 

For medical professionals particularly, you can have lots of different experiential learning with XR and VR. But it’s in a safe place. And you can replay it and review it and look back and reflect, so it’s much more dynamic and meaningful for them personally.  

Q: What does good look like and how do you measure impact?  

I think good looks like: we’ve got a really strong and wide library of skills and competencies that people can pick from that are being validated and peer-reviewed to make sure they are of good quality. The things that should be there are: that the real users of that get value out of it; that they feel that there’s enough breadth of content for them to look at; and that they can measure themselves on how they performed. 

The second bit is around that more qualitative side – they then feel confident to go and use this sort of technology. So if I’m looking to employ a surgeon that does minimally invasive surgery, we could do a little test on the simulator and say, “Here you go, see how you go with this set of skills and competencies.” And then we can see that they are competent – because anybody can say they are, but sometimes it’s about: if you can really do it, then doing keyhole surgery on me will mean my outcomes are more successful, and that’s a good win-win situation. 

Q: What is the most innovative application of extended reality technology in healthcare education you have come across?  

A: The one I like is the minimally invasive surgery one because it’s really difficult to do and you’ve got different bits of kit where you’ve got to put some instruments in a little hole. So there are some simulation boxes that allow you to do that and then get the muscle memory with the bits of kit and how you’re then moving little tweezers through things. 

There are a couple of good suppliers of that sort of technology. It’s super risky because you can’t see somebody’s body cavity open because you’re only looking down a camera, so that’s a good use of technology. When you couple that with pre-surgical planning with 3D images, you then start to really ramp up the two bits of technology that help get a roadmap – because you’ve gone in. you’ve taken the images, you’ve made a 3D image, you can see it all on the screen and also you’ve been able to properly practise doing the surgery using a simulator. So you can have a test run if you like in a virtual reality setting. It’s a little like a flight simulator for an aircraft pilot. They practise landing on a specific airport before they do it. Why don’t we use 3D modelling and a simulator to do that, so I know what I’m going to be doing before I go in there? 

We’re doing 3D images with some of our cardiac surgery. So we’re operating on babies with teeny-weeny hearts, and you can see images before you do that. And a lot of the anatomy of that is completely unknown because they often come with a heart defect. We’re starting to use that with our cardiac team so they can see an image beforehand, and they can make a decision about what’s the best MDT route. What we haven’t done yet is to couple it up with some sort of simulator where they can actually practise what they do. We put little patches in hearts, so if you’re operating on a heart that small, the patch is teensy-weensy. If we can match and merge those two technologies with some simulation beforehand, it makes it a whole heap of difference, particularly when you’re trying to think about what a novel way of doing something would look and feel like.

So that’s one example. And then there’s patient learning. Our neurorehabilitation team are using virtual reality gaming and also a neuro ball, which tests hand coordination and measurements. We’re seeing how they game and, when they do a certain task, they can then improve their motor function and dexterity. The child can see that, but also the practitioner can see that. So those are two examples where if you merge technology, you can then amplify its impact. 

Q:  How does your role and organisation fit into the bigger picture of large-scale adoption? 

We’re very fortunate at Birmingham Women’s and Children’s Hospital to be in cohort one of NHS England’s Insight programme. What that means is we get to speak to the people coming out of their clinical entrepreneurs programme, whether they be clinicians or parents or users.

So firstly we can see what innovators are coming out of the support that NHS England is offering to the clinical entrepreneurs programme. But also we can ask those on the entrepreneurs programme if they can extend something that might meet some of our challenges. We’ve already been able to adopt some things that other innovators have made, and I’ve been able to ask some other people to work with us. One of them is doing XR for midwifery training, and we’re able to be a pilot site for that.

And then the second bit is that we’re in a networked approach within our conurbation. We work a lot with Aston University and also with the Life Sciences Park in Birmingham. We’re able to approach the combined authority if it’s a local area business to try and accelerate what they’re doing. We also work with the University of Birmingham where we’re able to go to their academic side and say, “Have you got anybody that operates in this sort of field?” A really good example is that is one of the things that I was talking about earlier, on the mechanical engineering side of it. we’re able to go to that team, they’re able to help us and support us with doing the 3D images. Then we’re able to have the next conversation about, “Where are we going to go with this, are we going to make a sensor, are we going to start to do some prototypes?”
The final thing is that I’m on the technology-enhanced learning group, and I see what other education and learning centres are doing in that space. The advice and guidance they give is just phenomenal. So there are sort of lots of different areas where it’s not just us on our own. We’re in a bigger, wider network of support. 

Read associated blogs or download the XR in Healthcare Education paper by clicking here.

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