A hologram of a virtual patient that students can walk around, hear breathe and check the vital signs of was trialled last year by Otago Polytechnic’s School of Nursing.

The HoloPatient is a mixed reality app from Pearson Education that is designed to develop student’s clinical reasoning skills.

There are ten teaching scenarios available in the app, each accompanied by instructor resources that can be followed verbatim or used later as a teaching and debriefing guide. For each teaching session, students see a hologram of life-sized patient in front of them through the Microsoft HoloLens wearable headset. They can also walk around the person, hear them breathe via a small internal speaker in the headset, ‘air click’ keyboard commands to move their patient and view their vital signs.

Students wearing headsets to view the hologram patient 

Two-thirds (N=68) of the first-year cohort consented to take part in this evaluative research study. Eighteen groups, each of three to five students took turns to ‘consider the patient situation’ (step one of the clinical reasoning cycle pictured below) by examining HoloPatient Jerry – an actor filmed playing a standardised patient in a clinical simulation.

Jerry the hologram is a young mountain biker who presents with symptoms of anaphylactic shock related to an infected wound. In this learning experience, students gather information from careful observation, like noticing Jerry’s skin colour, posture etc, and listening to his breathing and sounds of discomfort.

Clinical reasoning cycle (University of Newcastle, 2009)

Seated in groups, students recorded visual and aural cues on colour-coded Post-it notes. They then processed this information (by moving and grouping the notes); identified problems, issues and gaps in their knowledge before establishing goals and deciding on their likely nursing actions (the next steps of clinical reasoning).

Because these are first-year students with limited clinical nursing experience, the session’s objective was for the students to follow the sequential steps of the clinical reasoning process. Accordingly, we did not brief students about Jerry’s condition as this may have interfered with their data gathering. However, before advancing to the second clip in the simulation scenario, students must have looked at Jerry’s back to pick up the vital cue, the large infected wound on his back.

Moving through clips 1, 2 and 3 of the scenario (Jerry’s condition worsens throughout), students used blue notes to record observations, pink notes to make a nursing diagnosis, and orange notes to write their intended nursing actions, taking them through to the fifth step of the clinical reasoning cycle.

“Jerry’ is a ‘virtual standardised patient’ – an actor who has been filmed and turned into a hologram (Pearson, 2018)

For clip 1, the majority (16 of the 18 groups) correctly recorded Jerry’s vital signs (B/P 124.84, respirations 20, pulse 88, temp. 38.4) and noticed his itchy skin (12 groups) and body rashes (11). Most thought he had an infection (14) or sepsis (13). Nursing actions included talking to the patient (9), getting more information (8), reducing his temperature (7), administering paracetamol and antibiotics if charted (6), and calling the doctor (5). For clip 2 the number of observations decreased, diagnoses focused on infection and sepsis, however only seven groups noticed the wound on his back. For clip 3, all groups noted Jerry’s rapid deterioration and loss of consciousness, instigating emergency CPR.

The students’ qualitative feedback indicated that “being able to see physical signs/symptoms was far more beneficial than explaining them” and the “visual and auditory perspective allows a lot of cues to develop a nursing assessment and planning”. Students also appreciated the reality of interacting with the hologram:

  • See the actual patient and not having to ‘act’ – real time”
  • “Got to do a scenario with a closer experience to real life”
  • “Able to observe/diagnose a patient without harm to an actual person”

Overall, the learner experience was favourable. The majority of students found that it was easy to pick up cues about the patient from the hologram. They also felt that the patient appeared to be very real. In regards to using the Microsoft HoloLens headset, students found that they did not need a lot of technical support and that it was relatively comfortable to use. Survey feedback confirmed that students enjoyed using this technology to learn assessment skills and that they supported this technology being implemented throughout the curriculum.

In conclusion, we found that students like using this technology and found it very realistic. They were in favour of adopting this technology as a teaching and learning tool and were excited about using it again. Our results indicate that it provides an exciting new way of safely exposing students to learning experiences not replicable outside of clinical or real-world contexts.

Dr Liz Ditzel and Emma Collins are Principal Lecturers at Otago Polytechnic’s School of Nursing.

References 

Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S Y-S., Noble, D., Norton, C.A., Roche, J., and Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today, 20, 515-520. DOI: 10.1-16/j.nedt.2009.10.020.

Pearson (2018). Introducing Holopatient. Retrieved from https://www.pearson.com/uk/web/pearsontq/news-and-blogs/2017/04/introducing-holopatient.html

University of Newcastle. (2009). Instructor Resources. Retrieved from http://www.utas.edu.au/__data/assets/pdf_file/0003/263487/Clinical-Reasoning-Instructor-Resources.pdf

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