virtual simulation

As the COVID-19 pandemic descended in March 2020, colleges and universities across the United States closed classrooms and transitioned to Zoom lectures. Nursing programs, however, faced a unique challenge. Not only did they need to quickly switch to online lectures, nursing programs needed a way to provide clinical placements when facilities across most of Oregon cancelled the hands-on learning experiences for students. Enter virtual simulation.

Virtual simulation, delivered via computer, allows students to practice and develop their clinical reasoning and judgement skills, and make decisions about patient care. Students are presented with a virtual patient, the patient’s medical record, and asked to guide their care. According to OHSU Clinical Assistant Professor Nick Miehl, PhD, RN, CHSE, the experience takes about six hours per case study. “The hands-on portion runs about 30 minutes, but there is pre-work for the students to prepare for the simulation and post-work including reflective activities and debriefing with faculty.”

While simulated experiences have been part of nursing education for decades, some schools, like Clatsop Community College, had no prior experience. “We reached out to our network of community college partners and solicited feedback on what virtual simulation vendors other programs would recommend,” said Doris Jepson, MSN, RN, Director of Nursing and Allied Health. “Our faculty then worked together to evaluate and select the tools we’re using.” Other programs, like Oregon Health and Science University (OHSU), planned to use virtual simulation at some locations, but rapidly expanded to offer virtual simulation at all five campuses in the state.

Though an unexpected departure from the Spring term syllabus, programs found the introduction of virtual simulation had some hidden benefits. Paula Gubrud-Howe, EdD, RN, Associate Professor at OHSU added, “It’s clearly a very powerful learning experience. The program allows for mastery learning, meaning students can go back and repeat the simulations multiple times until they master the skills.” According to Jepson, “Typically, at this stage of student learning, simple tasks are frightening. But faculty report the students seem more confident and less afraid. Students can make mistakes in the virtual environment and can learn a great deal from that.” Jepson’s student, Logan Burkhart, added, “In a real clinical situation, you only get one chance at an interaction, and while you may be able to learn from it, I found it was helpful to be able to learn from a situation and then repeat the situation to reinforce the changes I would have liked to make.”

Educators from Clatsop Community College and OHSU agree virtual simulation won’t completely replace the experience gained through hands-on clinical placements, including practice communicating with patients and co-workers, balancing the needs to multiple patients at once, and observing an interdisciplinary team in action. Burkhart said, “Even though the virtual simulation helped you know what you should do, it gives you no ability to practice how you should do it. You are nearly unable to communicate with the patient in the way you wish. I think communicating with patients and asking appropriate questions is a key skill we need to work on developing.”

In the end, virtual simulation may be here to stay in Oregon’s nursing programs. Gubrud-Howe, EdD, RN, said “We’re pretty convinced OHSU will be using virtual simulation at some level in the future.” Faculty at Clatsop Community College are also exploring ways to supplement hands-on clinical time with virtual simulation and case studies.

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