Boston Children’s Hospital: Transforming Nurse Training with XR

Angelina Gu:
Thank you. I really appreciate being here.

Brad Scoggin:
To start, could you share a little about your role at Immersive Design Systems?

Angelina Gu:
Absolutely! As an XR designer, I design, develop, and implement XR training solutions that are tailored to meet our clinical educators’ educational goals. We use XR technologies along with various authoring tools and platforms to rapidly create highly customized training solutions, ensuring smooth integration into our existing training curriculum.

Brad Scoggin:
What were some of the initial challenges that led the hospital to start exploring XR technology?

Angelina Gu:
Our XR initiative is part of Boston Children’s Hospital’s Immersive Design Systems, which is essentially a design lab focused on three areas: training and performance, human factors, and systems and device design solutions. Our ultimate goal is to empower our staff to perform at their best while minimizing mistakes and errors.

Our XR initiative offers a new perspective by leveraging cutting-edge XR technology. This helps us bridge gaps in training that traditional methods sometimes miss.

Brad Scoggin:
So, you’re using XR for training. Could you share specifics on what was missing in traditional training that XR is helping to address?

Angelina Gu:
We’re still in the early stages of experimenting with XR and discovering its most effective use cases. We already have several XR applications, and we believe they complement our other pillars, like medical device design. These technologies aren’t in competition with traditional methods but rather enhance them.

In fact, we’re working to integrate XR into existing training programs and align our practices with those in the simulation and training communities.

Will Stackable:
What specific skills are students learning and practicing in VR? Can you share an example of what the experience is like when they put on the headset?

Angelina Gu:
Our clinical educators come from a variety of clinical backgrounds, so their training needs are diverse. To meet these needs, we use multiple modalities, including virtual reality (VR), augmented reality (AR), mixed reality (MR), and 360° screen-based training.

For instance, one of our VR-based knowledge learning tools is a 360° virtual operating room we developed for the anesthesiology department. This helps trainees familiarize themselves with the operating room environment and the medications in the medication drawers before they ever step into a real operating room. This was especially useful during COVID when access to operating rooms was restricted.

We also developed a 360° coach card simulation to help staff understand what’s inside a code cart. This tool is also used to train staff on stocking code carts, providing a visual guide to ensure accuracy.

In terms of skill-based learning, we have a VR coach card nursing orientation for cardiac ICU nurses. This scenario-based training helps nurses practice drawing up medication during a code situation, all within a high-stress, realistic hospital environment. We’ve intentionally designed the audio to be chaotic, mimicking the noises you would hear in a real hospital setting—people yelling, the charge nurse urging the nurse to administer medication quickly, etc.

The benefit of using VR is that nurses can practice this in a safe environment repeatedly until they feel confident. We’ve received feedback from nurses who said that during real-life situations, they recalled the training, which helped them remain calm and focused.

We also use VR for scenario-based learning. For example, we’ve developed multi-user VR simulations for the medical-surgical ICU. Nurses can practice managing three different scenarios: sepsis, blood transfusion reactions, and infant bronchitis. These scenarios help them practice assessing vital signs, identifying symptoms, and acting quickly in critical situations.

One of the benefits of VR is that it forces nurses to communicate with each other in ways they might not in real life. In the simulation, nurses can’t see each other’s actions, so they have to verbalize concerns and collaborate more effectively.

Brad Scoggin:
That’s a very interesting benefit I hadn’t thought of before. These are all fascinating use cases! Where are you sourcing the content for these experiences? Are you creating it in-house, or working with third parties?

Angelina Gu:
We use a variety of authoring platforms for different needs. For augmented reality, we use platforms that provide step-by-step instructions, while for multi-user VR, we have platforms that allow us to make quick adjustments and gather user data efficiently. These platforms are generally stable, which reduces development time and troubleshooting.

That said, it’s important to align our educational goals with the capabilities of each platform. As engineers, it’s easy to get caught up in exploring every possible feature, but we must stay focused on the learning objectives and avoid overloading any single platform with too many tasks.

Brad Scoggin:
That makes sense. We’ve seen a lot of companies utilize authoring tools more and more. I’m curious—my wife is a doctor, and I got to see firsthand how stressful medical school can be. How have you seen VR help with stress and anxiety during the learning process?

Angelina Gu:
For our cardiac ICU nursing orientation, we’ve integrated meditation applications alongside the training. These tools help students calm themselves and manage stress while practicing the scenarios. We offer these meditation tools to students so they can use them on their own time, which provides a nice balance of stress relief and skill development.

Will Stackable:
What challenges did you face when implementing XR, and how did you overcome them? Any lessons learned that you could share?

Angelina Gu:
A big challenge we faced is that many of our trainees were first-time VR users, and they had concerns about using new technology. A lot of them would say things like, “I’m not tech-savvy,” which made them feel apprehensive about using the headset. They were often more focused on figuring out how the headset worked than on the actual training experience.

Additionally, VR can be isolating because it places users in a virtual environment where they feel physically removed from others. This can be intimidating for new users, so we’ve worked hard to reduce this perceived difficulty.

We ease them into VR by providing clear visualizations of what they will see when they put on the headset. We show them tutorial videos before the session, so they know what to expect. This approach helps alleviate some of the stress and uncertainty. We’ve also found that video tutorials are much more effective than paper guides or lectures in preparing users.

We also use the casting feature available on many commercial headsets, which allows us to project what the users see onto a big screen. This helps us identify any difficulties they’re encountering and gives other trainees a chance to see how the experience is going for their peers. After watching others, they’re generally more comfortable when it’s their turn to put on the headset.

By letting them see the training experience before putting on the headset, and using the casting feature to support them during the session, we help them get comfortable with the technology quickly, which lets them focus on learning instead of technical issues.

Brad Scoggin:
That’s such an important tip. It’s something we’ve heard from other successful programs as well—that video orientation is key to helping users overcome that initial barrier to VR adoption.

Will Stackable:
Other than that, when you were looking for a device management solution, what features were important for you in order to build a scalable program and do everything you needed to do?

Angelina Gu:
Absolutely. To follow up on your previous question, many of the commercial headsets we’re using have a really complicated user interface. Personally, I have trouble even finding our software—it’s just a lot of steps to click through. Also, many of these headsets come with some level of customization for the interface.

For us, it became really diverse and unpredictable, so we can’t always foresee what the users will see when they put on the headset. We don’t want them fumbling through different games and software. We want them to go straight into our training solutions. Standardizing the user interface is really important so that they have a consistent experience.

We try to anticipate any difficulties users might run into, which pairs well with training videos. When the user interface is standardized, all students will see the same thing when they use the headsets.

Will Stackable:
So, kiosk mode is essential, then? That makes a lot of sense, especially when you have devices out in the field. You mentioned that your students take them home. Are you regularly updating applications, or has managing the content on the headsets been a challenge?

Angelina Gu:
Yes, it’s been a big challenge. Initially, we couldn’t control the timing of software updates, and often, the software and hardware updates would conflict with each other. We had a significant issue where, after an update, the keyboard in our training application wouldn’t pop up. We couldn’t figure out where the issue came from because it could have been the hardware or the software, and we couldn’t control either of them.

What we really needed was a mobile device management (MDM) solution to halt automatic updates. We can’t control Meta’s auto-updating, but if we can manage the software updates, at least we can reduce the risk of students encountering issues when they put on the headset.

We want to make sure that when students use the headsets, they aren’t updating mid-session. If the headsets update during use, it could cause problems like not being able to log into the platform, which is the last thing we want. When that happens, we have to manually reset it, which disrupts the student’s learning experience and affects user satisfaction. They might even think, “Did I break it?” and some won’t even report the issue—they’ll try to troubleshoot themselves, which usually doesn’t help. So, we try to prevent these issues as much as possible.

Brad Scoggin:
That makes sense. We see a lot of companies scaling up and needing MDM, whether it’s for firmware updates or pushing content. And kiosk mode really helps simplify the experience for first-time users.
I also had a question that we didn’t touch on earlier. There is sometimes public apprehension about medical students doing training in VR, especially since it could involve life-threatening situations. How does a leading hospital like Boston Children’s respond to that concern?

Angelina Gu:
That’s a great question. When we train students, we focus on specific skills they need to develop—we’re not simulating the final result of the training. We integrate VR as part of the training curriculum, not as a replacement for mannequins or live simulations. Those advanced simulations will still be part of the training process.

With VR, we’re not aiming to replicate every single detail with the highest fidelity. We have very specific training goals in mind. VR is especially useful for practicing high-risk scenarios—situations that are hard to simulate with live mannequins or traditional simulations. In VR, we can provide a safe space for students to make mistakes. They can learn from those mistakes because they wouldn’t want to make them in real life.

For some of our high-risk training scenarios, like sepsis or blood transfusion reactions, we always have a facilitator or nursing educator nearby to guide the process. They can identify the correct steps taken in the scenario, and we also have pre-briefing and debriefing sessions. Even if some aspects of the scenario don’t align perfectly with the hospital’s policy, we adjust them to make sure the learning objectives are met.

You can’t expect VR simulations to replicate real-life situations perfectly, but we aim to focus on what really matters for learning.

Brad Scoggin:
I think you’ve hit on two really important points. First, we’ve seen this time and time again—VR, when done right, doesn’t replace traditional training; it augments it. And second, VR is ideal for training in dangerous or difficult situations that would be risky to replicate in the real world. You can practice these procedures again and again in VR with no real-world consequences, which is such a great use case for healthcare.

One last question as we wrap up: you’re in healthcare and using XR—how do you see VR evolving in healthcare over the next ten years?

Angelina Gu:
Definitely. Going back to one of my earlier points, I think XR training will become more integrated into the regular simulation models. In the future, simulation itself will incorporate best practices from various industries. Right now, much of our training focuses on the XR aspect, but I think we’ll see more convergence with traditional simulation techniques.

Designing learning courses that align with adult learning theories and learning science principles will become increasingly important. Because XR can provide a lot of data-driven insights, I think we’ll be able to maximize these capabilities in the future, creating more learner-centered training solutions.

We’ll use data to assess the competencies of both trainers and trainees. This will help us tailor training scenarios to address specific knowledge gaps. We’ll also use this data to continuously adapt and improve our training, making it more effective and impactful.

On top of that, XR technology will become more accessible. Right now, many VR headsets aren’t designed with first-time users in mind, and there aren’t enough accessibility settings. But I’m optimistic that, in the future, both the hardware and training scenarios will become more accessible and easier to use for a broader range of people.

Brad Scoggin:
That’s a great vision. You’ve already taken so many steps to make training more accessible, which is fantastic. Thank you so much for your time, Angelina. This has been a really insightful conversation, and we look forward to chatting again soon.

Angelina Gu:
Thank you for having me today! It was a pleasure.

Will Stackable:
This is a great example of using VR for training in situations that are difficult or dangerous to replicate in real life. It’s clear that this technology has a lot of potential in high-pressure environments.

What really stood out to me was the importance of thinking about the onboarding experience for VR. It’s easy to overlook the basic steps when you’re already comfortable with the technology, but for first-time users, it’s crucial to guide them through the initial steps. Her recommendation to create video content rather than relying on printed material was a great takeaway. It’s something we’ve heard from other successful programs, and it’s definitely worth emphasizing.

Brad Scoggin:
Yes, absolutely. That’s an important point, and I think it’s something that can make a huge difference in user adoption. Thanks again for taking the time to join us today. Be sure to check us out wherever you listen to podcasts, and we’ll see you next time!