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“Education is where we will narrow the gap between rich and poor.” This statement from James Hayes, CEO and founder of Virtual Medical Coaching, explains how a clinical radiologist/educator adopted innovations in virtual technology to achieve safer, more accessible medical training. Virtual Medical Coaching (VMC) uses augmented/virtual reality (AR/VR) and 3D gaming graphics to simulate the clinical process of taking medical imagery without recurrent exposure to radiation or required access to expensive equipment. Removing the barriers to better health education encourages better health professionals, resulting in a healthier population.
Christchurch based, Edtec company Virtual Medical Coaching presently offers healthcare simulation for learners and educators in radiography and childbirth, with simulations in CT, MRI, and mammography in development. Founded in December 2016, VMC straddles the education, health, and technology industries. The company name refers to both its innovation and action, a no-frills identifier for a team of eleven. Using commercial VR consoles and headsets paired with adapted virtual simulations, VMC offers students a way to remotely connect with real-time feedback and big data analytics for radiography training without jeopardizing safety, ethics, compliance or patient care. VMC’s current client base is hospitals, universities and colleges. The technology’s capability for remote learning means that clientele are worldwide, and its customizable features mean that no matter the cultural or geographical distance, users receive the same standard of education.
VMC’s prototype and primary service is the radiography simulation. Hayes was able to lend his significant expertise as a clinical radiographer of ten years and a lecturer to the development and continued assessment of this programming. As the process of taking an x-ray requires specific placement and manipulation of the patient, the VR simulation sends vibrations through the handheld controllers. This feedback occurs as users attempt to correctly place the digital patient’s body in the right position on the digital x-ray table to secure accurate imagery. Tension felt by the users moving the controllers simulates the resistance clinicians may feel when handling the shoulder’s rotator cuff for instance. The end-to-end virtual simulation also includes adaptive pre and post self-assessment for users to individualize and consolidate the learning process. The development of the midwifery pilot for VMC occurred in partnership with midwives and neonatal experts and is a more recent endeavor. However, the same feedback and analytics that positioned VMC as industry leaders has been integrated with medical expertise to offer education equality in multiple healthcare areas.
The screen onlookers see whilst students are experiencing the 3D radiography suite in VR
Ministry of Health reports indicate that radiography is a growing career choice in New Zealand. According to the national Census, 1,797 medical imaging technologists and sonographers worked in New Zealand in 2018. Given the recognizable demand, prioritizing quality education that provides hands-on feedback should be uninhibited for radiographers in training. However, accessing this level of education is currently determined by the availability of medical imaging machinery, limited by the requirement to be on campus, and compromised by ionizing radiation exposure. Hayes recognized these limitations throughout his time spent as a radiography educator; noticing that the first time students got to experience live feedback from the imagery process was when they were working with patients in a hospital setting. Understanding that even students who are competent within the classroom cannot fully translate this competency to the workplace without logging hours with the medical imagery machine's feedback, which caused Hayes to think “we’ve got to have better ways in education”.
In November of 2016, the gaming industry launched a commercial VR headset and console. What was once a ten thousand dollar unit with laborious setup was now a tenth of the price and is being advertised as the new PlayStation/X-box. Hayes was introduced to this technology via friends who worked in software engineering, who were clearly excited by the mass market introduction of this technology. In an interview conducted for this profile, Hayes explains that he remembers being shown an archery simulation using the VR set and feeling the real-time feedback in his hand as he pulled and released the bow. He asked, “could this be adapted to be in a hospital rather than a castle?” The answer was yes, and a month later Hayes went part time in his role at ARA Polytechnic to develop what is now known as Virtual Medical Coaching.
“We, as educators, have to provide (learners) the resources… (If resources) can’t scale and offer education globally, then it isn’t equitable." - James Hayes, Aim2Flourish Interview.
Medical imagery machinery is not cheap nor is it easily portable. For example, a low-field MRI machine will cost up to 1.2 million USD, with newer technologies selling for 3 to 5 million USD. A 2019 Statistica report indicated approximately 61 MRI machines operate within NZ. Once again, as the demands of the health system monopolize these resources, education institutes are forced to either fund their own machine access or find substitutes. Hayes identified this as a recurrent problem on a five year time loop; the cycle of inaccessible and expensive education opportunities widens the gap between the wealthy and poor. Physical location also further complicates and disadvantages some students' learning journeys, as accessing imagery machines or substitutes requires an in-person classroom setting. Hayes talks of the conveniency of other learning centres, libraries that are open 24/7, and online learning that allows students to log in from any location. While post-Covid educators have been forced to adapt to online learning environments, VMC adapted specifically for these to give anyone with an internet connection an opportunity to engage in quality education.
As many tech entrepreneurs will tell you, running lean and asset light is a benefit to their digital platforms. However, the business model that VMC operates extends lean theory to circular economy. Because most VR units and the accompanying systems will run on a basic graphics card and computer, clients can utilize their existing technology. For universities, this can mean repurposing office computers and underutilized classrooms to create an accurate radiography suite. Considering the cost of a commercial VR unit is significantly less than an MRI machine, and consequentially far more in line with most University budgets, it is easy to see why VMC promote their services as cost effective. VMC, primarily in response to Covid, even released a desktop/mobile version of their radiography simulation. While this did not offer as extensive feedback as the AR/VR assisted module did, it was still deemed successful as an educational tool. To be able to have a responsive digital radiography suite in your back pocket is an impressive feat in healthcare and education technology.
Because VMC sought to solve a problem with the scalability of existing education models, a problem that had plagued healthcare educators and institutes for some time. Upon arriving at an economical and sustainable solution, they received significant accolades. VMC were semi-finalists for New Zealand Innovator of the Year 2021, winners of the Global Health & Pharma Magazine Medical Simulation Innovators of the Year 2021, and earned the Microsoft Supreme Prize for developing and implementing innovative, world-first, VR training in 2020. It could be argued that such recognition brought with it momentum for VMC, however, it was Hayes’ pursuit of relationships with internationally recognized education institutes (such as the University of Exeter and Bangor University in the UK, Andrés Bello University in South America, and CQUniversity in Australia) that resulted in VMC’s introduction to global testing grounds. The publicity that followed as leading news outlets profiled VMC only further confirmed that their scalable solution had value and impact.
For radiography educators and learners, it offers significant advantage to their learning/teaching to have access to a portable, open access simulation. However, for midwifery educators and learners, it can mean life or death. Due to the fixed nature of imagery equipment, medical imagery will always be conducted within a hospital setting, whereas childbirth can occur whenever and wherever. Hayes speaks humorously about the development of VMC’s childbirth simulation; he reminisces about the birth of his daughter and when asked to cut the cord, he realized that those in the room had far more knowledge about the birthing process than he did! But what if the experts were not present in the room or the room was in a remote location? The implications of a widely available realistic childbirth education tool are significant. Considering there are only 1.9 million midwives working worldwide, as per the World Health Organisation's most recent statistics, the likelihood that not all mothers experiencing childbirth will have access to a midwife is high. Yet according to Datareportal 2022, 5.03 billion people globally have access to the internet. Not to suggest that an in-person midwife can be substituted, but providing a user with accessible tools to mitigate childbirth risks in emergency circumstances is a realistic solution to global midwife shortages.
A final feature worth discussing is VMC’s diverse presentation of patients. Customizable settings allow educators to reflect the cultural and physical diversity students will face in their careers. Typically, radiography mannequins are representative of European or Pakeha patients, with no indicators of cultural or spiritual needs. VMC’s simulations can integrate patients with different ethnicities, body types, and even physical markings such as tattoos into the students learning environment. Recognizing cultural needs in areas such as midwifery is vitally important not just to the students but to their future patient's care; a moko (traditional Māori face tattoo), for example, may indicate a mother’s requirement for a Kaupapa Māori approach to her child’s birth. Providing healthcare education that supports the treatment of all patients equally, not only better prepares students, it also indicates to healthcare industries that engaging in an accurate representation of our multicultural society does benefit the health of the overall population.
Virtual Medical Coaching’s inspiring, solution-based innovation has been recognized worldwide. They have been profiled by CNN, BBC, and numerous national media outlets including One News, and awarded notable funding grants such as the Callaghan Innovation Grant. They have seen up to 5000 users active in one day, currently have three global pilots, and continue to innovate around the changing face of online education in the wake of global events such as Covid. But for VMC, the distribution of quality education will always be offered willingly and where appropriate, charitably. For example, Hayes discussed introducing their nursing simulation software to institutes in Ukraine free of charge. He further identified that this humanitarian approach was staying put, as the company constitution notes that as founder and CEO he will always maintain a majority share hold. Hayes also states, with pride, that his team is 60% female, a rarity in a typically male dominated industry of software/gaming tech. These tidbits shared indicate that the company, while driven by their AR/VR and programming innovation, is fueled by the common goal of equality.
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James Hayes, Founder and CEO
Virtual Medical Coaching optimizes AR/VR technology to offer hospitals and tertiary institutes realistic healthcare simulation. These simulations are intertwined with data and insights to provide individualized and immersive education. Virtual Medical Coaching are industry leaders in healthcare simulation; their world-first adaptive programs partner medical expertise with sustainable education solutions to offer accessible and inclusive, quality education.