Boston Children’s Hospital is one of the top pediatric hospitals in the U.S. It is home to the world’s largest pediatric research program and is the primary pediatric teaching hospital for Harvard Medical School.
Like many health care education institutions, Boston Children’s struggled to deliver realistic training scenarios that simulate high-pressure events, such as a patient in sepsis
Boston Children’s Hospital created a department dedicated to developing extended reality (XR) training programs that meet the goals of clinical educators.
Realistic Simulations in Medical Training

In health care, seconds matter. There’s no time to second-guess decisions or look around for supplies. Role playing is commonly used to help nurses practice until they can respond to real-life scenarios with a cool head and muscle memory.
Boston Children’s Hospital, one of the nation’s premier teaching hospitals, needed a scalable, cost-effective way to deliver effective, high-quality training simulations. The traditional method of a healthy person pretending to be sick or hurt lacks realism, and it’s hard to replicate the same set of conditions over and over.
So the hospital created the Immersive Design Systems department to design, develop, and implement simulations in virtual reality. These simulations let nurses practice skills over and over, and recreate situations that are difficult or impossible to fake in a role play.
To meet the needs of the various departments at the hospital, Immersive Design works in multiple modalities, including VR, AR, MR, and 360-degree screen-based training. The XR training is not meant to replace or compete with traditional training on manikins and real people. Instead, it’s an enhancement that adds to traditional training and makes it more effective.
One simulation teaches nurses to locate items on a code cart, so in a crisis situation they know exactly where to find what they need.
“We intentionally designed the audio in the cart simulation to be chaotic, mimicking the noises you would hear in a code situation in a real hospital setting: people yelling, the charge nurse urging the nurse to administer medication quickly, etc. We’ve received feedback from nurses who said they recalled the training during real-life situations, helping them stay calm and focused.”
Angelina Gu
XR Designer
How Boston Children’s Keeps XR Learners on Task

Boston Children’s has 35 XR devices, which can access a variety of content on multiple platforms. While this makes them flexible in meeting the diverse needs of educators, it also introduced the problem of keeping learners on task.
“It became really diverse and unpredictable, and we don’t want them fumbling through different games and software. We want them to go straight into training,” Angelina said. Standardizing the user interface was really important for a consistent experience.”
The hospital found its solution in ArborXR’s Kiosk Mode, which locks down a headset to a single app or suite of apps. The user can only see and access what the educator has unlocked for them.
Kiosk Mode eliminates distractions and relieves first-time users from the anxiety of navigating to the right app. Educators can remotely view what the user sees in the headset, so they can monitor progress, guide the learner past obstacles, and troubleshoot in real time. They can also cast the remote view onto a big screen, so new hires in the same cohort can see what the VR experience is like before it’s their turn.
How an MDM Solved Hardware Headaches
Another challenge the hospital faced early in its VR journey was mistimed hardware and software updates. They couldn’t control when these updates happened, and sometimes a headset and the program it was running would try to update at the same time.
“If a headset updates mid-session, it disrupts the learning experience,” Angelina said. “Some people won’t even report the issue; they’ll try to troubleshoot it themselves, which doesn’t help.”
The solution was mobile device management (MDM), which they found in ArborXR. The MDM enables Immersive Design Systems to configure, maintain, and update the headsets remotely. It also keeps data secure, deploys the right apps at the right times, customizes settings, and tracks the location, power level, and usage of each device, all from a central hub.
How XR is Transforming Nursing Education

Nurses at Boston Children’s report increased confidence in their ability to respond to real-world scenarios after training in XR. The training more accurately reflects situations a nurse might encounter, including difficult-to-simulate situations like a patient going into sepsis or having a negative reaction to a blood transfusion.
XR provides a safe, controlled environment where students can practice the same skills over and over to improve their competence. When the time comes to apply those skills on the job, they can operate almost on instinct.
The simulations also provide an opportunity to practice soft skills. In the simulation, nurses can’t see one another, forcing them to verbalize their concerns and actions. These communication habits result in more effective collaboration in the real world.
Finally, XR training helps nurses learn stress management skills that will benefit them throughout their career. Medical training is notoriously stressful, and the pressure doesn’t let up once nurses are in the field. In its cardiac ICU nursing orientation, for example, Boston Children’s integrated meditation apps alongside the training to encourage learners to calm down and manage their stress levels.
Is XR the Future of Medical Training?
With the success Boston Children’s has had in incorporating extended reality into its clinical education, Angelina believes the technology will soon become a staple in health care simulations.
The data-driven insights of XR training will enable clinical training programs to create more learner-centered content, she predicted. As the field evolves, VR training in health care will move beyond its role-play roots to incorporate principles of adult learning.
If you’ve wondered how to effectively train people at scale in your organization, take inspiration from Boston Children’s model. Get in touch with us today, and let the experts at ArborXR show you how extended reality can elevate your training program in a scalable, cost-effective way.
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