Last week I attended the Renal Research Institute’s 21st International Conference on Dialysis Advances in Kidney Disease 2019. The conference has a general nephrology track, a nurse care team track, and a pediatric nephrology track, with international speakers and attendees providing a broad, vibrant learning environment. The program always presents innovative projects, and this year some highlights included AlloHD, Lysibodies, and Virtual Reality-based (VR) training in nephrology. All of this is cool stuff (you should look up AlloHD), but the presentation on VR and peritoneal dialysis (PD) training caught my 3D eye.
Boris Kantzow, Weltenmacher GmbH CEO, oversees the company’s efforts to use virtual and augmented technologies to enhance training and education. Kantzow’s company partnered with nephrologist Panagiota Zgoura to create a virtual reality peritoneal dialysis (PD) training experience. Let’s take a look at the advantages this offers for patients, caregivers, and clinical staff.
VR as an immersion technology emulates the physical world through digital simulation. Per Wikipedia, it provides the “perception of being physically present in a non-physical world.” VR is a good training tool since it situates the trainee in a learning environment without placing them in any danger or risk for complications. Tactile immersion is also possible with VR, enabling subjects to experience performing a skill.
Learning research shows benefit to trainees seeing and feeling a new task rather than reading about it step by step. VR immersion, which has a tactile component, is well-suited to PD training, such as learning how to do a PD exchange. The VR experience created by Weltenmacher GmbH prompts patients to reach out in the virtual world to grasp the PD tubing in one hand and hold the PD catheter connector with the other to experience connecting the 2 sides in virtual reality.
VR vs AR
VR may have popped up on your radar in 2014 when Facebook bought Oculus, a big VR developer and headset designer. This occurred about the time Google glass, which provides an augmented reality (AR) experience as opposed to a VR experience, was falling out of favor. In 2015 VR looked like the winner compared to AR, but VR has since had its setbacks, including unwieldy headsets and the propensity to cause motion sickness in some gaming applications.
Today AR is back in fashion with mobile applications that enhance shopping and entertainment. For example, AR shopping apps may improve the ability to see how furniture will look in your space or provide more detail about a product you are viewing. Transportation AR enhances details about bus and mass transit routes. An interesting AR app “Hacking the Heist” placed stolen paintings back on the walls of the Isabella Stewart Gardner Museum in Boston, although the museum requests that the app not be used. AR makes life more interesting or easy by enhancing daily tasks, not taking you out of your current reality.
Is VR hype or help?
During the RRI presentation, Kantzow noted that the rocky road for VR acceptance and utilization is a common life-cycle pattern for new technology. The Garnter Hype Cycle, a proprietary tool created by the Gartner research and consultancy group, describes the typical life cycle of technology from concept through maturity to commercial adoption. See if you can recognize where VR falls on the path:
- “Technology trigger” with concepts and prototypes
- “Peak of inflated expectations” with lots of publicity and chatter by early adopters
- “Trough of disillusionment” where flaws rule the day and there is failure and disappointment
- “Slope of enlightenment” where new applications are discovered, advanced generations of the technology are introduced, and there is broader interest in using the technology
- “Plateau of productivity” when there is wide implementation and good market adoption
If you put VR at the “Slope of enlightenment” you’d be in line with IT industry assessments. VR has found new purpose recently in medical applications, where it has been used for teaching surgical techniques and endoscopy training. VR offers a tactile immersive experience without putting any patients at risk.
Is VR in PD training an advantage?
Kantzow and Zgoura thought of using VR for PD training for several reasons which are outlined in a recent publication in Blood Purification. The VR tool is a response to the recent ISPD guidelines recommending PD training standardization and optimization to reduce peritonitis rates. The VR PD training environment involves movement, interaction with the virtual environment, and a virtual trainer to enhance skills acquisition.
VR not only has possibilities for PD patient and caregiver training, but also for new home therapy (HT) clinical staff training. The VR experience is standardized, so every participant has the same experience, but the experience is tailored to role and individual level of experience. Also, the VR experience reduces variability created by using different trainers, which means all HT staff can get the same training and every patient can have a standard training experience.
In an HT training session VR can reduce the time a patient and HT clinician are working 1:1, which may free up some precious HT clinician time. With VR, patients have a tactile training experience without going through a lot of supplies or risking touch contamination. The tactile VR experience also begins to build muscle memory for performing the PD exchange.
As outlined in the Blood Purification article, the group is planning a randomized controlled trial to determine if VR training results in improved clinical outcomes such as reduced peritonitis rates in PD.
The VR headset is goofy, but the experience is fascinating. VR holds promise as a viable training tool for tactile skills in medicine that need to be mastered without creating risk or complications. I have 2 small scars on my left forearm where we practiced bleeding times on fellow 2nd year students in medical school. No question I would have preferred a virtual experience instead of a real scar, and yet, it was clear I needed at least a little practice before subjecting a patient to my skills.
VR has been around a while, so don’t feel like you’re an early adopter if you have the chance to try it out. It’s a good time to have your eyes wide open for innovative learning opportunities.
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.
Image from www.canstockimage.com