Using the Pulse Engine to bring patients to life for immersive learning

​Kitware, Inc., the School of Nursing, Purdue University Global, and inciteVR bring you a White Paper sharing their experience using Unity, the Pulse Physiology Engine, and Oculus Quest to produce affordable and effective immersive learning that 'brings the patient to life' in immersive learning for Nurse Practitioner (NP) Clinical Skills.

This paper introduces how the Pulse Physiology Engine developed by Kitware, Inc. is used in the Clinic Immersives NP Skills Labs Enterprise and the impact this has had upon the NP Learners at the School of Nursing at Purdue University Global. It explores the use of an embedded physiology engine framework to both leverage empathy and broaden the diversity of clinical practice experiences.

The technologies, tools, and processes required to develop immersive simulations are available, affordable, and can go to scale. It is possible to design, produce, deliver, and support a personalized immersive learning experience for nursing clinical training that leverages presence, embodiment, empathy, and presents a hereto unseen level of engagement.

Skills are acquired more rapidly, with greater accuracy, and are retained longer through immersive learning (VR). The Pulse Physiology Engine affords leveraging empathy, where the patient story is brought to life in the immersive learning experience with real-world case data. This empathetic connection has a profound impact upon the persistence of learned skills.

Due to limitations of existing products in nursing education, the opportunity to customize patients and scenarios has been limited. The Pulse Physiology Engine empowers immersive learning with patient types and case scenarios that are customizable by the faculty to better prepare students to care for and manage patients from different racial and ethnic backgrounds.

Several racial and ethnic disparities in public health have been of growing concern and have been brought to the forefront amid the SARS-CoV-2 pandemic. Immersive learning (VR) can provide clinical scenarios with a range of patients from different racial and ethnic backgrounds to better prepare students to care for and manage patients within those populations addressing an urgent health care need.

Through sense-making, learners can use their reasoning, intuition, logic, and emotional intelligence to navigate successfully through 'case stories' to move from "what is" to "what it can be" based on the learner's decisions. We can create meaningful, interactive, and challenging worlds involving the learner as the conductor of their own development.

Narrative, role, decision-making (agency), and sense-making are all facilitated by using the Pulse Physiology Engine to 'bring the patient to life' with real-world case data. The result is a learner that cares about the 'story' of the simulation and their role in how it unfolds - which is entirely under their direct control. This empathetic connection to the learning experience is deep and long lasting - which contributes greatly to the persistence of learned skills.

Purdue University global has partnered with Incite VR to build an immersive acute care skills lab for students in the Adult Gerontology acute care Nurse practitioner (AGACNP) program to provide students with critical experiences in the acute care setting. The Adult-Gerontology Acute Care Nurse Practitioner program currently requires students to travel to a Purdue Global location to complete an in person skills intensive.

Due to COVID-19 safety precautions and travel restrictions, the SON had to develop a skills lab offering to the AGACNP students. The students were tasked with completing multiple immersive labs including: endotracheal intubation, paracentesis, thoracentesis, suturing and central line placements. The immersive skills lab experience allows nurse practitioner (NP) students to develop clinical lab skills using their own affordable mobile VR with unlimited access, anywhere-anytime, using hand tracking inputs to practice in either guided or expert modes. NP learners and faculty access the Clinic Immersives NP Skills Labs through a Cloud-based enterprise that provides application control, headset control, learner progress monitoring, and rich analytics reporting.

The AGACNP skills lab has been useful in teaching the student different procedural steps in which they may not have the opportunity to practice in the in-patient setting. This platform can identify student mis-steps or mistakes in the process in a safe virtual laboratory environment. Of the 53 students that participated in our inaugural acute care skills lab, all students were successful in connecting and accessing their skills lab via their Oculus Quest headset. In this experience, the completion rate of the lab was an astronomical 96.7%.

When compared with their previous immersive products in the classroom, inciteVR observed that the overall student engagement, success and perseverance to connect to the acute care lab was remarkable. 

The team at inciteVR has been using Unity for 9 years now, producing games and immersive experiences for Web, Windows, Mac, Android, iOS, desktop VR and mobile VR. During all these years we developed a vast number of frameworks and resources which we leverage in every new project we create. Four years of learner and faculty feedback from immersive learning products (VR/AI) has shown us that fidelity for immersive learning is more than just visual quality. The quality of interactions and the accuracy of behavior and data representations are equally important. 

Open source software naturally supports a service business model. This model helps others make effective use of the advanced algorithmic capabilities of Kitware's software platforms, avoid vendor lock-in, and build their own solutions and internal expertise.

While Kitware encourages open source software, data sharing, and open access publications whenever possible, the company also respects the need for proprietary solutions due to competitive, privacy, security, and regulatory restrictions. Kitware will work with any enterprise to integrate its open source platforms into its products and processes, even if portions of the solution remain closed.

Kitware's open source business model has helped it create a dynamic, impactful, challenging, and meaningful corporate culture and make significant contributions to customers and collaborators. These benefits are reflected in Kitware's mission and values.

The Pulse Physiology Engine is a series of mathematical models (engine) that represent human physiology and can power immersive learning and serious games for medical training. Pulse calculates the body's response to disease, trauma, and treatment in real-time, which improves the realism of training and enhances the training experience.

The Pulse Unity Asset is available for free on the Unity Asset Store. This Asset provides the Pulse C# API built for the Windows, Mac, Ubuntu, and Magic Leap platforms. Unity developers can easily import this assets to integrate the Pulse Physiology Engine into their Unity applications. An optional vitals monitor is also provided.

Download the paper:  Virtual Patient Modeling with the Pulse Physiology Engine