This is what it's like inside an emergency medicine VR simulator

Two medical students discuss their experience of virtual reality training in emergency situations.

Emergencies are unpredictable, often occur out-of-hours and prioritise the patient rather than students, making it challenging to ensure a democratic learning experience. Students aren't guaranteed exposure to core emergencies during traditional ward-based teaching, leaving them feeling underprepared for practice as a doctor, as reflected by National Training Surveys.

At Imperial College London, we decided to create immersive, scalable and accessible simulation teaching, with built-in assessment and feedback. Through realistic, immersive virtual reality, we give students a truly interactive learning experience typically missing from traditional teaching.

These simulations - cardiac arrest and life-threatening asthma - empower students to make real-life decisions that influence the patient, making them feel as though they are 'really there' and providing them with 'safe space learning', which appeals to a range of learning styles.

These experiences have been successfully integrated into the undergraduate MBBS curriculum and will be shared nationally through NHS England, having already gained national and international press attention.

Written by Dr Risheka Walls, consultant physician, Imperial College Healthcare NHS Trust and digital development lead, Imperial College School of Medicine

Read about two students' experiences of Imperial's virtual reality training programme below.

Thivyaa Gangatharan, fifth-year student

"... an incredibly real experience"

Call me Gen-Z, or generation #NokiaBrick: when I was growing up, the concept of virtual reality (VR) was entirely unheard of. Contact lenses were high tech enough, and we could hardly imagine that special glasses could not just trick your mind, but your entire body, into believing that you were in a new dimension! I knew virtually nothing about VR back then, except that sometimes it was used in those simulators at museums to replicate Formula 1 racing.

So, picture this: an anatomy lab with 30 students, standing in a six-by-five grid, each wearing white goggles, headphones, and immersed in their own VR worlds. To an outsider, there's a sea of silence, interrupted only by the swish of arms flailing, and heads moving to respond to the VR stimuli.

But for those of us within the VR world, far from silence, we were immersed in a series of emergency scenarios - transported from a real-life anatomy lab to the foot of a hospital bed, with an unresponsive patient, alarms bleeping, and a healthcare team looking to us for help. Instead of using simulated graphics, the entire scenario had been filmed in a real hospital, making it an incredibly real experience.

After a doctor handed over the cardiac arrest, we were asked what we'd like to do next - ie, select our initial investigations, and then management. The video then paused for 10 seconds and a screen popped up with several options we could select from. Depending on what we selected, such as an ECG, the scenario then continued, and someone came to do an ECG. Then, the doctor turned to us and asked us to interpret the ECG, so again the video paused for 10 seconds, and an overlay of an ECG was shown, with accompanying options for diagnosis.

Again, we had to select the right answer. We were then asked about the medication and dose. And so this sequence continued - at each step of the management, we were asked to select what would happen next, under time pressure, effectively simulating a real-life emergency. By the end, I felt as though I had genuinely worked with that team to save the patient - something I will always remember!

VR student training

After the training

Looking back, I must admit that I was taken aback by how effective this teaching was. It gave me the opportunity to translate my textbook knowledge into real action without the threat of a patient's imminent mortality (as would be the case when I start FY1).

Given that I learn far better by 'doing' rather than rote memorising, I particularly appreciated the experiencing of learning by having to think on the spot, within 10 seconds, and see the consequences of me choosing one management option over the other. This is now glued in my memory far better than if I were to have simply circled an answer in a textbook.

Reflecting on the effectiveness of the widespread use of VR teaching, another benefit was that every student got to experience the same scenario, instead of being at the mercy of fate on placement. This meant that all students now have experience of being in and managing an acute cardiac arrest scenario - something that will also set us in good stead for our first days of FY1.

It also offers the opportunity for students to re-experience a scenario they may want more practice with, unlike with reals sims teaching. Although nothing can fully replace the real, hands-on experience of medical care, from my personal experience, I can certainly say that the benefits of VR mean that it is worth investing in for medical education, particularly for the clinical years.

I feel lucky to be one of the first students at Imperial to experience VR in medical education. It was a truly remarkable experience, and one that I will remember for years to come, and I very much look forward to seeing how VR continues to grow within medical education!

Chris Chong, final year student

"... huge potential to become a core staple in the medical curriculum"

My initial encounter with VR technology was at a game centre just a few weeks before trying Imperial's VR emergency simulator - I was transported to the 56th floor of the World Trade Centre and told to walk across a rocky 20cm wide wooden plank to another skyscraper, before being armed with weapons to hold off a horde of zombies.

Imperial's VR simulator was a slightly different scenario, and I was thrilled to be among the first cohort to experience this novel implementation.

We were split into groups of 30 students per month due to limited equipment. Each person received a headset and two Wii-like controllers for each hand. We were confronted with two different scenarios - one was an anaphylactic shock, and the other was myocardial infarction, which resulted in an adult cardiac arrest - scenarios that we were fairly familiar with throughout medical school.

Each scenario started off with a nurse's request for a patient to be reviewed, deterioration of the patient, followed by resolution. There were 10 SBA (single best answer) questions of varying difficulty within the 15-minute scenarios, with a 10-second countdown to select the answer. Only a couple of physical actions were required, such as picking up the Epipen from the tray. Having real-life actors added a dimension of authenticity and urgency, especially with the inclusion of the countdown timer, as I found myself panicking. I was disappointed by the lack of hands-on options available - for instance, we couldn't perform an A-E assessment, which constitutes an unmissable part of our initial patient screening. Moreover, the VR simulation wasn't able to facilitate teamwork as there wasn't much room to allow for conflict and disagreement.

Looking back, the VR simulation was a great tool to show the importance of decision-making under pressure, as well as how to handle emotional and psychologically stressful situations. I was surprised by how invested I was, even more than a small group simulation as the visual and auditory stimulation was so captivating. The possibility of being able to tune into an emergency simulation with my other medical colleagues on VR sets makes me very hopeful and excited.

If given the inclusion of more hands-on procedural skills, together with an expansion of more varied uncommon emergency scenarios, the VR experience has huge potential to become a core staple in the medical curriculum.

Photos: Digital Media Lab, Imperial College

This page was correct at publication on 12/07/2023. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Thivyaa Gangatharan

by Thivyaa Gangatharan

Thivyaa Gangatharan is a fifth-year medical student at Imperial College London. She has recently completed a first-class honours in Medical Anthropology from UCL and is interested in the decolonial, political, economic and anthropological backdrop to healthcare, as well as the intersection of wellbeing with the arts.

Chris Chong

by Chris Chong

Chris Chong is a recently graduated medical student from Imperial College London with a passion for surgery, med tech and healthcare management consulting. He has recently completed his consulting internship at Candesic and is now pursuing his second elective in plastic surgery in Colombia. Having organised numerous conferences, including the internationally acclaimed Giant Health Medtech Conference, he hopes to promulgate the newest advancements and uses of medical technology with medical students and doctors.