You cannot learn to swim with- out going into the water. What is true in the world of aquatics also holds true for the world of
paediatric emergency care. Doctors and
nurses who take care of children in life-threatening emergency situations have
to know literally hundreds of processes
and hand movements by heart in order
to be as quick and as error-free as possible in dealing with the precious child.
Books and online resources can help to
acquire certain knowledge, but they can
never replace the real thing.
This is a problem, because accept-able-for-all scenarios for students to
practice emergency care in real paediatric emergencies are difficult to
implement. Adult emergency care
is far easier to learn in real environments. This is because adults don’t
have nervous parents with them, and
also because there is usually more time
available in adult emergencies. Children tend to die quicker.
“Experiential learning is among the
best ways to practice paediatric emergencies,” said the paediatrician Dr Todd
Chang from Children’s Hospital Los
Angeles at WoHIT 2016 in Barcelona.
And indeed experiential learning is what
paediatric teaching hospitals have been
implementing all over the world for sev-
eral years now. The way to do it is to set up
mannequin-based simulations that often
take place in dedicated labs. These labs
look very similar to the real emergency
rooms in order to create an environment
that feels as real as possible.
But mannequin-based simulations
are not ideal for many reasons, according to Chang. Most of all, they are a
rather expensive way to pass expert
knowledge on to students: “Doing car-diopulmonary resuscitation repeatedly
on a mannequin will break it eventually.
Mannequin-training is also time-consuming. On average, we need one hour to
prepare a 30-minute mannequin-based
simulation, and another 30 minutes to
clean up.” Children’s hospital Los Angeles alone pays a whopping $430,000
(approx. €408,000) per year to train staff
Apart from the costs, there is
another difficulty with mannequins.
It is not always easy to maintain what
experts call ‘psychological fidelity’. In
order to provide the best possible train-
ing, mannequin-based simulations need
to replicate feelings and emotions of
the real emergency situations they are
about. This doesn’t always work, and one
reason is that even the most expensive
mannequins look and feel fake.
“Virtual reality transcends many
of the weaknesses we see in mannequin-based simulations,” said Chang.
This is why paediatricians and paediatric nurses of Children’s Hospital Los
Angeles embarked on an ambitious
virtual reality training project at the
beginning of 2016. The goal is to have
virtual reality goggles that students
can wear to practice various paediatric
emergencies, creating an experiential
learning environment that is both
more realistic and less costly than
This is no easy task, of course. It
cannot be done by some paediatricians
meeting casually after work a couple of
times and that is it. “What you need for
a project like this is a team of experts
in various fields,” said Chang. Only
together is it possible to reach maximum physical fidelity and maximum
functional fidelity, i.e. a virtual environment that looks and feels as real as
possible, and virtual cases that are built
on real-world cases and offer as many
possibilities to act and to make errors
as do real patients.
“Children’s hospital Los
Angeles alone pays $430,000
per year to train staff on
By Philipp Grätzel von Grätz
Life-threatening paediatric emergencies are rare, but if they happen, a lot is at stake.
Proper training of nurses and doctors is mandatory, since no parents will want
hospital staff to train on their child. Virtual reality could provide experiential learning
environments that are in many ways superior to mannequin-based training in
conventional ER labs.