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Virtual reality training for intensive care nursingDHM ECMO-VR
For the German Heart Centre Munich (DHM), we developed ECMO-VR, a virtual reality training for intensive care nurses. It teaches how to handle ECMO, a high-risk therapy in which a machine supports the heart and lungs.
The training is divided into six consecutive chapters, from basic knowledge to an open simulation. The ECMO Pro version adds emergency scenarios. Nurses train with a VR headset, independent of location and shift schedule, and without a patient connected to the device.
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Didactic concept
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3D modeling and animation
What was the task?
The DHM wanted to give nurses a safe and flexible way to learn ECMO treatment and refresh their knowledge. Until then, the hospital faced three hurdles:
- Little time: Qualified nurses are scarce. Everyday hospital work leaves hardly any room for long or external training courses.
- Learning on the patient: Much about ECMO cannot be taught as a dry run. How device and body respond to each other only becomes visible once a patient is connected.
- Complex technology: The dependencies between device and body are multi-layered, and there is little margin for error.
The training therefore had to work in short units that fit any shift schedule. It had to allow mistakes, reduce inhibitions through repetition and let nurses experience routines and special cases as well as operation.
Why virtual reality for ECMO?
Because VR can show what stays hidden in real life. ECMO-VR adds a layer on top of the real image that makes processes inside the device and the body visible, as if both were cut open.
Nurses see how gas flows through the system and where the blood is enriched with oxygen again. Until now, this knowledge was taught on paper or with static illustrations. In VR, it becomes a process that can be observed and understood. In addition, a digital twin of a baby shows different patient conditions.
How did we find out what nurses need?
Through observation in the intensive care unit, interviews and several workshops with prototypes. The DHM study center put us in touch with nurses and physicians.
First, we wanted to get to know ECMO and how it is handled as precisely as possible. In field research, we observed everyday life in the intensive care unit. In interviews, we asked about preferences and difficulties. The workshops then focused on how medical staff want to learn. We tested didactics, tone and design on prototypes again and again before they went into the application.
Which learning model is the training based on?
On the cognitive apprenticeship model, an apprenticeship like in a craft workshop. First comes demonstration, then guidance, and then the guidance gradually steps back until learners work independently.
This resulted in six chapters:
- Basic knowledge: What is ECMO, how does it differ from ECLS, how does it work, which cannula configurations exist? This is followed by the life-sustaining and monitoring components and how they relate to each other.
- Demonstration: the ECMO protocol from everyday ward life in its phases, from checking the tubing system with a light through pressure measurement, gas blender and heat exchanger to the patient monitor.
- At the patient: skin conditions, possible bleeding and neurological conditions, shown on the digital twin.
- Guided shift-start check: Learners carry out the check themselves, working through a list step by step.
- Coached routine: Learners act largely independently and only receive hints.
- Open simulation: Learners work without help and have to pass the simulation.
ECMO Pro adds simulated emergency scenarios that learners have to assess correctly and manage.
Why is there no mascot and no points?
Because the target group did not want them. In the workshops, we tested different forms of a coach, including a mascot. For medical training, the nurses asked for a neutral, calm tone.
We also deliberately did without gamification. Playful elements engage people in many industries, but here they would have artificially lengthened content that is already extensive. For medical staff, they were more of a distraction and did not match the seriousness of the situation at the ECMO.
What was the biggest challenge?
Filtering out of a great deal of experience what is really needed for working at the ECMO. The human body and the machine influence each other on many levels. Every conversation with physicians and nurses brought up new special cases and exceptions.
Our job was to turn this wealth of knowledge into understandable chapters and to prioritize: where is depth needed, where is an overview enough? Along the way, we also advised the DHM study center and the physicians on didactics.
Who worked on ECMO-VR?
An interdisciplinary team of UX and service design, industrial design, interface design, 3D modeling and animation, together with the DHM study center. UX and service design took on project management and didactics and moderated the workshops and tests with medical staff. Our 3D team designed the digital twin and the visualized processes in device and body.
We developed the VR application entirely in-house.
Awards
Focus Open Silver 2023
International Design Award Baden-Württemberg
delina Award 2024
Winner · LEARNTEC innovation award for digital education
eLearning Award 2024
Simulation category · eLearning Journal
What does the DHM gain?
- Learning without risk: Nurses practice ECMO treatment and are allowed to make mistakes without endangering a patient.
- Learning around the shift schedule: The units are short, location-independent and available around the clock. External training dates are no longer needed.
- Visible connections: What happens in the device and the body becomes visible as a process instead of being described on paper.
- Fewer inhibitions: Repetition in a protected space lowers the threshold for engaging with ECMO. Knowledge can be refreshed at any time.
- Training that suits the target group: Didactics, tone and design are based on observation, interviews and tests with medical staff.
The ECMO project is certainly one of the most innovative projects we currently have at the DHM.
Prof. Dr. Peter Ewert
German Heart Centre Munich
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Frequently asked questions
What is ECMO-VR?
ECMO-VR is a virtual reality training for nurses at the German Heart Centre Munich. In six chapters, it teaches how to handle ECMO, from basic knowledge to an open simulation. The ECMO Pro version also includes emergency scenarios.
Why is virtual reality suitable for medical training?
In VR, people can practice without endangering patients, and mistakes are allowed. VR can also make visible what stays hidden in reality, such as the gas flow in a device or the enrichment of blood with oxygen.
What is cognitive apprenticeship?
A learning model based on a craft apprenticeship: first demonstration, then guidance, then the guidance gradually steps back. In ECMO-VR, this leads from the demonstration through guided and coached practice to the independent simulation.
Why does ECMO-VR do without gamification?
Workshops with nurses showed that playful elements lengthen the extensive content and distract from the seriousness of the situation. What they wanted was a neutral, calm tone without a mascot.
Which services did UP Designstudio provide for ECMO-VR?
User research in the intensive care unit, interviews and workshops, the didactic concept, service design, UX and interface design, 3D modeling and animation including the digital twin, and the development of the VR application.