The Sim Cafe~

The Future of Healthcare Training in the Age of Virtual Reality with Dr. Jo Davies

Deb Season 3 Episode 72

Embark on a captivating journey with Dr. Jo Davies, a distinguished healthcare and simulation expert, as she recounts her 30-year adventure that has taken her talents from the valleys of Wales to the sands of the Middle East and the coasts of Australia. In our latest episode, she unveils the groundbreaking "Virtual Reality: A Welsh Reality" project, a transformative step in marrying VR with simulation pedagogy. As the world grappled with a pandemic, Jo's insights into virtual training have become a beacon of innovation in medical education, ensuring students could continue their critical learning despite global lockdowns. Prepare to be engrossed by tales of creating immersive learning environments with multiplayer systems, all designed to elevate the training of future healthcare professionals.

We then dive into the practicalities and triumphs of integrating virtual reality into the healthcare education landscape, as Jo sheds light on the meticulous process of curriculum design. Witness the conception of seven VR modules, each meticulously crafted to replicate high-stakes medical emergencies and procedures. These modules, developed in an incredible seven-month sprint, didn't just simulate medical scenarios; they brought them to life, complete with 360 filming, computer-generated imagery, and the pressing need for teamwork in live medical situations. Dr. Davies' narrative doesn't just touch on the technology—it delves into the human element, discussing the expansion of VR's reach into university classrooms and beyond, the inclusivity of content for diverse patient care, and the nuanced feedback from students who've had their education transformed by this novel approach to learning. Join us for an eye-opening discussion that might just redefine the future of clinical education.

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Check out Iris Health Solutions Limited today. Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host, Deb Tauber, and co-host, Jerrod Jeffries, as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in and learn something new from The Sim Cafe.

Deb Tauber:

Welcome to another episode of The Sim Cafe. Today, we're so fortunate to have Dr Jo Davies. She'll be talking with us about all things simulation, and she's coming from Wales, so once again, this is an international episode. Welcome, Jerrod and today we're so fortunate to have Dr Jo Davis and she's going to be talking with us about all things simulation, and she's coming from Wales, so once again, an international episode. Welcome, Jerrod.

Jerrod Jeffries:

Thank you and really excited for our guests today here. I mean, we're just chatting a little bit before we hit record and quite the international exposure. So I always love when we can pull new threads from different countries and concentrate them into one but also make sure that that knowledge is being disseminated a little more effectively. So excited for our guest here today.

Deb Tauber:

So thank you Dr. Davies, and you mentioned before we could call you Jo, so we'll call you Jo. Why don't you tell our listeners a little bit about yourself and your extensive history and simulation?

Dr. Jo Davis:

Thank you, Deb and Jerrod, it's lovely to be here. So my journey really in healthcare started in 1994 but around 20 years ago I started to have an interest through clinical practice. I worked for many years as a labour ward midwife so I worked a lot in tertiary units doing midwifery and saw the real need for more hands-on training, especially with a lot of the high-risk cases. So I became really interested in simulation and started to do it as we often did sort of quite informally, just sort of make, looking at programs, trying to work things out as a clinician and how best to train. And I was actually traveling internationally at the time.

Dr. Jo Davis:

So even though I trained in the UK, I've actually worked in the Middle East and Australia and some really wonderful countries doing clinical practice and education.

Dr. Jo Davis:

And it was really when I got to Australia and was very lucky to work in a great simulation center in Brisbane work in a great simulation centre in Brisbane I started to become highly interested in sim and did my master's degree in education with a real sim focus and that led to helping to develop sim programmes, helping to train faculty, and then I had a wonderful opportunity to then work on more programme and simulation designs.

Dr. Jo Davis:

Part of the work I've done is to help open some hospitals and simulation centers, and the last major project I worked before my job at Swansea University was on a project in Qatar to help open a women and children's hospital and open a large simulation center there, and we actually used that project. Within that project, we used simulation for systems testing as well, which was fantastic before we opened the hospital. And all of that experience and work led to me joining Swansea University in 2021 when I returned home with my husband to live in sunny Wales and was very lucky that at the time, the university and the Welsh government were looking at new strategies for simulation and interprofessional learning and I met the associate dean and sort of. The rest is history. We just worked on a very big project to open a couple of new sites one main simulation and immersive learning center and another campus site with three immersive simulation suites. So sorry it's very long winded, but it's because I've been doing this for 30 years, so it's a long, long answer.

Deb Tauber:

No, and when you've been doing it that long, you've got a lot of experience and we really appreciate your experience and how you're going to provide some more insights today and this episode we're going to focus on virtual reality Jo, you worked on Higher Education Funding Council of Wales, which is a grant awarded project called Virtual Reality, a Welsh reality, through your work at Swansea University. What was your initial motivation for this project?

Dr. Jo Davis:

Yeah, that's a great question. I think initially my interest in more immersive learning technologies was very much linked to our roles in simulation leading simulation, looking at the latest technology and innovations. But a real spark for me came during COVID, when I was a part of a project it was actually a competition through a collaboration with Cardiff University and our College of Engineering. So I work for the College of Medicine, health and Life Sciences and we did a collaboration on developing virtual reality for tracheostomy training and it was a real need in the health boards because it was harder to do mass education, it was hard to maintain competencies and pull people out of practice. So we entered a competition to design a platform to be able to train not only single learn single users but multiplayer, this multiplayer system to create immersive environments for tracheostomy. And we were very fortunate that we won that competition.

Dr. Jo Davis:

So we awarded funds and that led to the interest in me applying for a grant from the Higher Education Funding Council of Wales to see if we could further develop a platform where we could align simulation standards with virtual reality. And what I mean by that is what all we were finding with some of the packages that we were trialing is that it didn't mirror perhaps the same simulation pedagogical standards that we were used to. So where are the clear learning objectives? Where's the pre-brief? Where's the opportunity to do some familiarization, which we call the sandbox in our VR platform? How do we run the scenario and then actually debrief within the virtual environment and even do playback of that scenario? So I was there really to help the designers mirror some of the simulation standards, as well as working with content experts to create wonderful content for the Hefky project.

Deb Tauber:

Now, you worked with the Welsh company called Rescape. Rescape, am I saying it?

Jerrod Jeffries:

Yeah, Rescape yeah.

Deb Tauber:

Okay, can you share how you worked alongside this industry to achieve your desired goals?

Dr. Jo Davis:

Yeah, so Rescape actually is a company from Cardiff who one of our requirements for this project was to be bilingual, so we were looking for content that could be developed in English and Welsh. So we really wanted to have an approach where we work with industry, our health board partners and the university as an academic partner. So we formed a sort of board or a working group to think about. First of all, we did an extensive needs assessment across a health board called how and our health board, which is a health board here in wales, and among the university staff and faculty and students to say where are some of the gaps in curriculum or where do you feel VR could be of help. And that helped us to select the content or the topic areas, the simulation scenarios, because we had the opportunity to create seven modules of learning.

Dr. Jo Davis:

So once we'd formed this group, we then had our VR champions, a bit like our sim champions when we're writing scenarios, and they were the real content expertise.

Dr. Jo Davis:

They provided that content expertise through the health board and our academic clinical staff and myself and a co-PI called Dr David Lee helped a lot with the pedagogical design. Dr David Lee helped a lot with the pedagogical design and then re-skateboard that real VR expertise, not only with the platform but really how to create and tell stories through virtual reality. And that helped us to think about the types of virtual reality we could use, whether that was 360 video with some question and answers, or whether that was creating those avatars or CGI characters, and whether we could make them more about a case and working together as a team within a case, or whether we could actually, with one of our scenarios, which was Delirium, we actually sort of flipped the VR and did. The objectives was all about empathy and creating empathy and having a lived experience of what it felt like to have delirium. So they really helped to sort of shape how well the curriculum can be achieved in a virtual reality platform.

Deb Tauber:

Was it a struggle to get the faculty to buy into this virtual reality?

Dr. Jo Davis:

I think doing the needs assessment really helped, I think, to have them come up with their ideas and what they felt they needed from virtual reality, rather than just being given a package saying choose a scenario and try and fit it into a curriculum. We sort of did. We just created, really, a simple Microsoft form forms but asked leading questions around. You know, is there any gaps in your curriculum? How could this be integrated? Where do you feel VR could be of benefit? So they've really helped partner the creation of the virtual reality and now they're going to take that and help implement it into their programs, whether in the University of the Health Board, and also be part of our research project to collect data on the efficiency and effectiveness of the virtual reality platform and content.

Jerrod Jeffries:

So this is ongoing, then, already.

Dr. Jo Davis:

Yes, it's ongoing. So I think one of our biggest challenges was with it being grant funded. We had limited time for creation because you have to spend money in a certain time frame, so what we focused on for our phase sort of one build was very much the content creation and the platform design making sure we got that right when you say phase one.

Jerrod Jeffries:

What timeline are we looking at? Is this 2023 or?

Dr. Jo Davis:

So yeah, so that was yes, 2023, sorry, so we had a year. So from January to December, the tender process took a lot longer than we thought it would because of the amount of money. So it's actually double the time, which put put us under a little bit more pressure. So originally we were going to try and do 10 modules of learning and then we actually wrote back to HEFQ and said because of the compressed time, can we do seven modules of learning to be able to achieve it within those timelines but still keep the same amount of funding so that we could get more developers within the project?

Dr. Jo Davis:

So we had seven months to create seven modules of learning which was a real project management triumph, I think, there from all the team members involved, Because it was we had to be. We sort of ran multiple streams so we had the seven streams running and developing that content and testing it, and how many project phases do you have?

Dr. Jo Davis:

So we have three. We had the sort of design build phase which was up to December, and then we've just completed sort of our test phase in terms of platform A few of our learners I suppose we would call it a pilot, isn't it? In research, more focused on content accuracy, which we actually did a lot in that initial build phase we were making sure the content was correct. But this pilot phase is really more about functionality. Is it clear? Can they go through the steps you know, unaided, really, in the virtual reality platform? And we're now after Easter break, so going into April, we're just about to roll out our major research project, which is across sites. So we'll be running it here at Swansea University, our St David's Park site and throughout our health board, and that's really testing the seven modules with different learners.

Jerrod Jeffries:

So is that when phase two really starts, or is that so I would say that this, um sorry, would be phase three.

Dr. Jo Davis:

So we said, phase two was that pilot, sort of almost that alpha pilot, and now this is sort of the main research phase up to December gotcha so what are the modules, what are the seven modules?

Dr. Jo Davis:

So we've got a range. So we have one called SPINI, which is a neonatal examination of the newborn, the systematic neonatal examination of the newborn, and there's some really interesting features in these VR. But what I love is you can check for the red reflexes in the eyes and you can see the anatomy and physiology of the heart when they're doing the heart checks. You can check the dislocated hips and see. You can sort of see through the avatar to see if the hips are dislocated, and so that one is one of my favorites, but I think I'm biased because I'm a midwife.

Dr. Jo Davis:

Then we have a delirium case case. So we used a combination because we're pulling the modules um, each module has up to three sessions so you can sort of think about your curriculum design. So some of the sessions are based around 360 filming where we could add some Q&A's, so it's a bit of like that pre-knowledge, just testing the knowledge around a subject, moving on to sort of CGI, clinical skills type activities and then the multiplayer which is our team and team performance based objectives. So we have a delirium case, we have a pediatric diabetic ketoacidosis, we have a hypervolemic shock, we have a do not resuscitate or do not attempt resuscitation, CP, which is interesting because when they go into the debriefing space just before they start a proper debrief, they actually also fill out the documentation, because that's often a gap and where the learners in the medical program are struggling a little bit.

Deb Tauber:

So they can, they can practice there, they actually fill out a DNR form.

Dr. Jo Davis:

Yes, so on the, on the form they fill out the. Actually, I'm sorry, it's the certification of death documentation. Yes, okay so um, oh, we've also got. I'm sorry, remember. The other two are blood and blood transfusion, so they go through blood and blood transfusion and then they have an anaphylactic reaction. So we've got a mild to a moderate anaphylactic reaction that they do in the team performance. And then we've also just completed some training around ANTT, so IV cannulation and wound around the principles of ANTT because we were noticing fatigue and compliance after COVID.

Jerrod Jeffries:

Gotcha. So in hearing these seven and you did all of them in seven months what type of mechanisms did you even use in order to keep, keep delivering and keep everything on track?

Dr. Jo Davis:

I think that's a really good question and that was probably one of the biggest challenges we had, but it was just really project management. So within the original grant, I made sure that I had a project manager and we were actually fortunate that the person that we hired was one of our previous masters students in virtual reality that had a project management background. So it was almost like the perfect candidate, to say.

Dr. Jo Davis:

I understand what it takes to design and I understand project management. We had regular oversight by coming together as a health board partner and a university in terms of the progress. So we had regular progress updates. But we really just made sure we had those developed sort of the teams. So we had the seven teams, we had content leads, oversight from the academic team and then the industry partners, and part of our funding was to make sure I did quite a bit of market research before I applied for the second grant to say what does it take to do this and what are the costs of having extra developers at hand to try and develop at scale?

Dr. Jo Davis:

Really, because I think that's part of some of our challenges in healthcare that if virtual reality is highly expensive and takes a long time to develop, we are going to struggle to implement it at scale in our healthcare systems. So what we tried to do was build a platform of what we call reusable learning objects. So we based a lot of our cases around the ABCDE framework framework and then, as we develop, we developed perhaps the most complex first, such as a pediatric diabetic ketoacidosis, so that we already had a hospital bed, we already had a crash cart, we already had a glucose machine, and then we could reuse some of those in the other, in the other scenarios, so we could build at pace and scale.

Jerrod Jeffries:

So I mean, with these seven out and you're kind of actually in the pilot phase into phase three, so to speak.

Deb Tauber:

Yeah.

Jerrod Jeffries:

So how are you going to measure impact or success over time within this phase three? Is that by module? Is that by number of users? Is that by number of learning hours?

Dr. Jo Davis:

Can you give me a little more context on all that.

Dr. Jo Davis:

Yeah, I think it's really a combination actually of all of those things. So we're going to be collecting data in two ways. One is through the headsets. So, for example, with a 360 application you can collect data on things like time to completion and did they answer the questions correctly. We're going to be running the multiplayer the same pretty much as we would run a simulation, because that's sort of that same structure and philosophy and collect data on our take-homes and we we use a debrief model and we have the take to practice and also do pre and post, pre and post surveys and focus groups.

Dr. Jo Davis:

So it's going to be a little bit intense for the next eight months doing all of that, but we're going to try and run it where we have a topic of the month and between the health board and the and the university we have, I don't know, a hyperbolemic shock month or something like that, where we actually go out and say, okay, let's focus a little bit on this, let's think about the research.

Dr. Jo Davis:

But I think the most important thing for us is also to educate or speak to the teams about how do you integrate VR into a curriculum, so we can sort of kill two birds with one stone, so it isn't just another add on, it's how could this be genuinely used? So our objectives for measurement are not only the educational outcomes and the objectives for the learner, but also we're collecting data on the use of the platform and the use of VR, and also secondary objectives, actually and I think this is really important for academia is return on investments. If we have these products, and we've invested a lot of money in them, what does it give us, what does it allow us to do? And even if that's just bringing up some faculty time, that's a huge thing at the moment, isn't it? With the pressures on academics?

Deb Tauber:

yes, yes o , have you heard anything from any of your learners about how this virtual reality experience was utilized in a in a live situation by them?

Dr. Jo Davis:

That's really interesting. I think the two things that have stood out for me is a comment from a medical student that was learning in the virtual or really piloting it for us and they had a neuro neurodiversity and what they said is it's the best education they've ever done because they had time and chance to just really be in the moment, go at their own pace. But what stood out for them is they didn't feel the pressure of competitive students. It gave them that space to learn.

Dr. Jo Davis:

We haven't had any direct links yet because it's so early on around sort of perhaps outcomes the way we have in simulation around wow, I adapted this bit of knowledge and really had that effect. Yet, however, early feedback from some of the students that have done things like spini or delirium they're just saying it's so realistic. We feel really prepared and because we tried to select some topics where there was no limitations with our simulations, such as what the mannequins can do for things like a neonatal examination of the newborn, I think it helped to bridge a gap. It's like a lot of things we do in simulation. We're not trying to necessarily replace things.

Deb Tauber:

We're trying to say how can this sort of add to the blended curriculum that we offer Fantastic, and I can kind of imagine that that might be the response because it is so new.

Dr. Jo Davis:

But it's encouraging to hear what some of your learners are are saying about the experience yeah, and I think one thing sorry, I had the heck you sort of project in mind, but I was actually speaking to one of my colleagues yesterday when I visited our new site, which was a little bit of an amalgamation between what we do in simulation and the virtual reality tracheostomy training and they actually said they were running programs and training in tracheostomy where they really in the team performance the first time didn't do too well at all and they were shocked at that result because they thought they would be a lot more fluid as a team.

Dr. Jo Davis:

They repeated it in simulation and did some virtual reality and were much better after the debrief. But look the the week after they had the exact same case and they were saying that within that case they performed, they did really well, they were satisfied with the quality of the patient care, but if they hadn't have done that, they would have practiced the way they did in the first simulation and it made them realize the power of it. So I know that isn't all VR, it's sim, but we have to plug some sim as well, don't we?

Jerrod Jeffries:

And then Jo. So what's next here?

Dr. Jo Davis:

Yeah, wow, so, um, I think we really want to focus in on collecting some great data on the outcomes of implementing vr. Uh, one of the areas of interest is trying to really not only look at the impact and the effectiveness of vr, but how do we roll this out at scale and how do we have a learner-driven approach to some of the curriculum that we're embedding.

Dr. Jo Davis:

So part of that is our work within the university so offering not only virtual reality within our classrooms but having side rooms set up where you can practice in your own pace, in your own time, and then thinking about using, adopting ways where headsets can go out so students can take them home, as we actually many people may have already done that this isn't new, but we certainly haven't done it here where we offer that hyperflex model of curriculum delivery and virtual reality, of curriculum delivery in virtual reality.

Dr. Jo Davis:

But I also think we need to link back to the health boards, where we have a lot more just-in-time training, and how do we roll VR out at scale within a complex NHS system. So that's a sort of area of interest so we are looking at we've just applied for another joint grant with Cardiff and we're looking just for other opportunities to build on this platform. We see this as a real just core build. The platform's looking really good, it's got all those SIM standards in, as I said, but now really content is king, isn't it? So we need to build those VR scenarios the same way we're building our simulation scenarios.

Deb Tauber:

Jo, do you have plans for more modules? You explained to us and discussed with us the seven of them. What's coming so?

Dr. Jo Davis:

when we did the needs assessment we had about 32 suggestions. So we had sort of a process where we had two reviewers and we came together and we sort of thought the only fair way was to do a bit of a marking score of what we were looking for for the virtual reality sessions. So we chose sort of the top seven, the seven that scored the highest. So we do already have a lot of other ideas that we would like to explore, but I think it's like everything because that was done a year ago or 14 months ago. I think it's good to readdress that, especially if we start basing some of our ideas off what we know is working well from our initial platform. So I would probably think about doing another survey. But our main goal would be to really apply for more grants.

Dr. Jo Davis:

We have got a few suggestions for virtual reality grants around suicide prevention and resilience. There's a lot of requests for mental health VR scenarios, addiction scenarios, addiction some of those real social issues and sensitive issues that we might be able to address in virtual reality, or certainly prepping our learners to support families and patients with such conditions. And we've also just started work on a Mass Eye project funded grant around our deaf and hard of hearing community. So we've done a wonderful project with our deaf and hard of hearing community with our PI, Julia Terry, who's really pulled us together to try and look at educating nurses on how to care for patients who are deaf and hard of hearing not just nurses or the healthcare professionals, but it has a nurse focus.

Jerrod Jeffries:

I love how concentrated and focused you're on data. You're collecting data across so many different avenues. One thing that I also remember from the beginning is you mentioned that it was developed not only in English, but also in Welsh. My question is what percent of people are taking it in Welsh?

Dr. Jo Davis:

Yeah, that's a gosh. That's a great question and, to be honest, I wouldn't know the statistics I I'll definitely look at. Look at that. But we offer with the in the faculty of medicine, health and life sciences. We offer entire courses in welsh. So one of our system champions and one of our new second champion, Sharon Jones, is fluent in Welsh and teaches Welsh, so she was part of the team that did some filming for us. But we just offer all students the opportunity to study in Welsh if they want to. So it's even built into a lot of our systems. When we do, you know, we work with Immersive UK and when we're working building our scenarios in systems like Iris, we have a Welsh version as well, a Welsh copy, which is lovely, yeah.

Deb Tauber:

Wonderful. Now what surprised you most about the project?

Dr. Jo Davis:

Wow, I think, the reaction of the learners because I got caught up in the project. So I got really caught up. I think, Gerard, you talked about wow, you did seven in seven months and I was caught up with the real project management. And I was also so conscious when you're developing any curriculum for medicine, health and life sciences, the accuracy has to be there. You know it's high stakes, you know we have a responsibility to our communities, families and learners to get this right.

Dr. Jo Davis:

So I got quite caught up in almost the tasks of it and then suddenly we were doing this testing phase with the learners and just the reactions where I was thinking, gosh, we might, we could have done that a little bit better, or does that avatar work? What the reactions have just blown me away and also their honesty, which I love because that's what we need to study. You know where they're finding it difficult, where they think that improvements could be made. But I think the most surprised I've been across both projects is how quickly people pick up VR, because I feel that a lot of learners, me included, were thinking what a great idea, but I don't really want to do it because I'm not that techie and I don't. I don't know if I'll get this and you know, I'm not a gamer, but yes, I

Dr. Jo Davis:

actually collected specific data on this in for the first project, sbri, and on average, statistically it it was 2.6. So we said three after three attempts they felt comfortable enough to really actually measure the learning, because that's what we have to be careful of. What are we measuring? Are we measuring someone's ability to do vr or are we actually measuring genuine learning that's occurring in vr? So what we make sure is, as part of our pre-brief and our familiarization, that people that when I talked about those reusable learning objects, we've pulled those into the sandbox so they have opportunity to play and get used to if they're using hand trackers. They can use the hand trackers if they have to answer questions with their eyes, because some of you know we have hand tracking as well as using the hand trackers within the virtual reality systems. We orientate them to that and familiarize themselves. Again, those simulation standards get to know your equipment. Make sure we know that we're measuring the learning, not our ability to do VR. Yeah, Jo.

Deb Tauber:

Now if you were to leave our listeners with some of the biggest things that you would like them to keep in mind as they start to introduce their faculty to virtual reality, what would that be?

Dr. Jo Davis:

I think be brave and give it a go and work with your local industry on, you know, just trying it, because I think a lot of the time you have to think.

Dr. Jo Davis:

Once you've done, you know, sorry I would always say follow your curricular design process. So once you've done your needs assessment, I'll go back to my Kern six steps before I people shout at me. But I think once you've you've thought about the real need within your program, initially I would just say give it a go because I think you'll be surprised at the reaction from the learners, I also think, probably being realistic to what it can currently do. So we know that often it's not great for tactile learning. We still need those simulations and that actual practice because haptic feedback we're not quite over that technological curve. Even though there is haptic gloves and things are coming, they're still expensive and not mainstream. So I think you have to be aware of what virtual reality can do and where it fits well into a curriculum. So you're looking at more of decision making. You know knowledge transfer, some applications of how you would work in teams in that environment, but it's not necessarily a great tool for some types of educators, some forms of objectives.

Deb Tauber:

Thank you. Now, if our listeners wanted to get ahold hold hold of you to ask you some questions, how would they go about doing that?

Dr. Jo Davis:

Yeah, so they can contact me in two ways. So via my email address, which is @swanseaacuk swanseaacuk, or we have a generic SUSIM because I run a Swansea uni sim center and program. So they can contact me on susim at swanseaac. uk. This has been wonderful, Jo.

Jerrod Jeffries:

I'm really, really and I love the push on innovation towards VR. I love that you're adopting needs assessment. You're taking the process. Your project manager probably deserves a raise. But other than that, this is great, and great to see that there's regional focus and competency within Wales surrounding this. Hopefully, it gets picked up and pushed and I think that the support on it is spot on. So thank you for sharing the time and your knowledge with us.

Deb Tauber:

Thank you so much. Yeah, thank you very much and happy simulating.

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