Once a term, 60 medical students from Imperial College London gather in a large room at Charing Cross Hospital to attend the scene of a cardiac arrest. There’s blood – lots of it – and a bedside nurse performing chest compressions.
One doctor is furiously taking notes, while another is standing anxiously over the heart rate monitor.
“What should we do next?” they ask the medical students.
Except, there’s no victim. The torso receiving PCR is made of rubber, and the worried doctors are all actors. Exceptionally, there’s not a drop of blood on the floor, despite the many red-soaked gauze wraps being shuffled in and out of view.
That’s because the 60 medical students are each wearing a virtual reality (VR) headset, waving their hands around the room and stumbling slightly – like a swarm of zombie doctors.
“It’s a bit like a silent disco,” says Dr Risheka Walls, digital development lead at Imperial’s School of Medicine. “Except with a few yelps here and there.”
Imperial is the first medical school in the world to use VR to train future doctors. Though the university often scores in the top ten in the UK for medicine, professors ushered in a shake-up several years ago after noticing that many of their students were graduating feeling unprepared for practice.
“You just can’t guarantee that they’ll see these sorts of emergencies in real life – you have to be in the right place at the right time,” says Professor Amir Sam, head of Imperial’s School of Medicine.
“We take about 700 medical students each year. But you wouldn’t be able to send 700 students to 700 cardiac arrests – you’d have to be waking up every day praying for something terrible to happen.”
With funding from Health Education England, an arm’s-length Government body, Imperial recruited Dr Walls in 2019 to develop a VR alternative in-house. Dr Walls says she was inspired by the frequent simulations used on her husband’s airline pilot training, which left her wondering why VR is largely overlooked in medicine.
Three years into the project, Imperial’s swish new digital media lab has launched three VR training videos and has several others in the works, including a simulation about an epileptic fit. And now, for the first time, the university is integrating the technology into its assessments.
VR allows teachers to “gamify” tests and lessons, according to Professor Sam, offering a more valuable experience for students than many real-life emergencies.
“You can pause in the middle of a resuscitation using VR. You can’t do that in real life,” he says. “Plus, you might just be so flustered at a real-life situation that you don’t take anything in.”
The university has also started simulating non-emergency situations that are hard to learn from a textbook, such as dealing with an angry family.
Anyone who has ever watched 24 Hours in A&E, or found themselves in the emergency room on a busy day in hospital, will know that half the job for medics is keeping people calm.
So how do you learn that without being flung into a roomful of frustrated patients? You can’t – but it helps if those patients are actors.
In Imperial’s VR simulation of an angry family, students are led into a hospital room full of people with their arms crossed. A woman shakes her fist at you, explaining that her elderly husband with dementia isn’t swallowing properly, meaning he can’t eat or take his usual tablets. Her son butts in to tell you that the family have been left unattended for several hours, with his father’s health deteriorating. It feels like you’ve been summoned to the headteacher’s office for a good telling off.
“This sort of anger-inducing situation is very common, especially on weekends when there’s often a lapse in communications,” says Dr Walls.
“It’s very rare that someone is negligent – it’s more because the situation is emotionally charged. And more often than not, the doctor coming into the room has inherited the notes from the person on the shift before them.”
But, as Imperial students quickly learn, finding excuses will do little to help de-escalate a tense situation. As in the university’s other simulations, the angry family scenario is punctuated with a series of questions that students have 10 seconds to respond to. The remote controllers convert their hands into a pair of blue plastic gloves to select an answer with, from a selection that pops up inside the hospital room. The worse their choice, the angrier the family gets.
The simulation is 360°, meaning students can walk around the room, with the sounds of voices skewing as they turn their heads away. “The whole point of the VR is that it’s realistic,” says Professor Sam. “Basically we’re taking what’s in a textbook, or multiple choice assessment, and we’re applying it to a real situation.”
But students want to get their hands ever dirtier, he explains. Feedback forms have consistently found that trainee medics at Imperial want to use their virtual gloves to perform blood tests and dissections – things that the university is now exploring.
It means VR could soon replace anatomy – the grizzly, traditional method of dissecting a real human body. A virtual alternative might not only be a silver-lining for the faint-hearted, but could also majorly reduce costs for universities and allow them to attract more students.
In the UK, it’s illegal to buy or sell human remains, meaning medical schools have to rely entirely on the goodwill of people to donate their bodies to science. But cadavers can still cost universities between £2,000 and £3,000 for the transportation, preservation and storage of each body.
“The main thing that VR offers for us is scaleability,” says Dr Walls. Before Imperial started developing the technology, students would go off one by one on placements, and report back on the sporadic emergencies they witnessed on shift. Now, the university can ensure the whole year group has seen a cardiac arrest within a single week.
According to Professor Sam, VR could provide a solution to the UK’s deep-rooted struggle to train enough doctors, while making those doctors more confident in the process.
It emerged last week that NHS England is spending £3bn a year on agency medics to plug staffing gaps, with one hospital trust paying more than £5,200 for a doctor for a single shift.
“If you want to increase the number of medical students you can take, which we need to do desperately, then this is the way,” says Professor Sam. “VR really is the future.”