Whether it takes place in nursing school or continuing medical education, medical simulations are crucial in the training and skills development of nurses and other healthcare workers. Medical simulations let nurses and nursing students apply the knowledge they’ve learned in the classroom in a controlled, hands-on setting before stepping foot in the clinic. An integrative review of simulation based learning compiled data from recent studies and found that article-focused simulation based learning more effective than classroom learning and an effective way for students to improve skills and client care [1]. High fidelity simulators are especially important for nursing students to gain experience before being assigned to critical care [2].
Medical simulation in nursing education can take many different forms with varying degrees of fidelity, like low-tech task trainers for basic skills, human actors for interpersonal skills, and screen based training for clinical knowledge assessments [3]. This article will focus on two important forms of medical training, nursing mannequin simulation and virtual reality simulation, and compare the costs and benefits of each.
Nursing mannequin simulation is a kind of medical simulation training that uses mannequins, or manikins, of various complexity to emulate different healthcare situations. Patient simulation mannequins help learners develop their skills, competencies, and confidence in a clinical setting with an object that can emulate a human patient to some degree [4]. Mannequins come in different levels of fidelity to fit different needs. Low fidelity medical simulation mannequins incorporate simple mechanics into a human-shaped form and are primarily useful for task training. High fidelity mannequins are often visually more lifelike and contain complex mechanical and electronic components that can replicate vital signs and physiological responses to learner actions. Although students report better learning experiences with high fidelity mannequins, research does not connect fidelity with better educational outcomes [5, 6].
Nursing mannequin simulation requires some suspension of disbelief, but interestingly the degree to which believability hurts or helps is complex and varies from person to person. Learners who have a harder time suspending disbelief see the mannequin as a doll, and those who can tend to perceive it as a patient [4]. Undergraduate nurses in one study reported that it was difficult to relate to the mannequins as real humans. Therefore they were inadequate to help develop their nurse-patient interpersonal skills [7]. However, when learners perceive the mannequin as a human patient, they tend to report better relational and communicative skill development and their perceptions of themselves as nurses [4].
Recent advances in the affordability and quality of virtual reality headsets are spurring a new wave of public interest in the technology. Market research shows that in 2018, over 34.6 million people in the United States used VR technology at least once per month [8]. Modern VR headsets generally come in two forms: tethered to a computing or gaming device or completely wireless standalone units. While generally regarded as entertainment technology for gaming, VR is increasingly being recognized as a powerful educational tool in the medical fields. Although studies examining VR in nursing education are limited, early results are auspicious. One study found no difference between in-person learning and virtual reality in team training exercises between nurses and physicians [9]. This is important, as it could allow for communication skill-building in virtual clinics with humans or AI patients in the future. In a time where public health policies have limited the degree to which healthcare students can interact with one another or volunteers, a safe, effective, and contact-free learning environment is promising. Nursing students in another study reported that virtual reality medical simulation was “convenient to practice,” a “fast skill learning process,” and provided a “stress-free learning environment” [10]. Advanced VR software could eliminate the single complaint, a “lack of realism” that is a shared complaint between both VR training and nursing mannequin simulation.
It is apparent that both VR medical simulations and nursing mannequin simulations are powerful tools to build knowledge and clinical skills. Both techniques have their advantages and disadvantages, and each has situations in which one is more appropriate and effective than the other. On this basis alone, both are powerful tools and necessities in medical education. Based on cost, however, VR medical simulation possesses a clear advantage over nursing mannequin training.
To understand why, one must first break down the outright and hidden costs of both forms of simulation training. Running a medical simulation facility featuring nursing mannequin simulations is labor-intensive and requires dedicated space. It requires full-time staff and expert instructors, and extensive setup time is necessary between sessions. Each mannequin is expensive, and simulations require materials for the procedure being taught. Since staffing is essential and mannequins are limited, training must be scheduled significantly ahead of time, and learners can expect a wait. Sevinsky et al. determined that a facility running a single central line course a month for 10 learners would cost around $64,050 per year. This equates to a cost of about $530 per learner for the center before any profits are made [11].
While a cost-analysis study is yet to be performed on a nursing virtual reality simulation, many factors suggest a stark reduction in cost. Virtual reality simulation does not require a dedicated space; any room with enough space to move around safely will do. Full-time staff and instructors are not necessary for successful VR training if using a tested training software suite like SimX. Even assuming one trainer will be on staff, for the cost of one $5,000 mannequin, the same facility could purchase 10 standalone VR headsets at the somewhat steep price of $500 each. Each of the hypothetical 10 learners could train at the same time, drastically reducing the time of each session, substantially reducing the time an in-person trainer would need to spend supervising the session. Moreover, a central line mannequin can only be used for central line training. Virtual reality software can run as many different kinds of training that are available on the online marketplace for the software suite, making the initial investment in the software itself cover training for numerous subjects. Even with a fully decked-out software suite like SimX pro, virtual reality training’s initial cost is less than a single nursing simulation mannequin.
Both mannequins and virtual reality have their place, and there are training subjects for which VR is not appropriate. However, in situations where both are equally effective, virtual reality simulation training is the clear winner when it comes to value, versatility, and immersion. Because of this, VR technology like SimX is a sound investment in the future of medical education and the skillset of future nurses.
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