Interactive Virtual Simulation Software

We developed the IVS software in Unity 3D using the C# programming language [13 ]. The IVS software requires 2 monitors to be connected to the computer. One monitor displays a dashboard of buttons that are used by the facilitator to control the simulation content displayed on the second monitor. The dashboard is viewed only by the facilitator, and the second monitor displaying the content is viewed by the students. Each button on the dashboard corresponds to one piece of multimedia content, such as a video clip, image, or text. When a button is clicked on the dashboard, the corresponding content is displayed on the students’ monitor. The dashboard enables content to be displayed on the students’ monitor seamlessly and in any order. The multimedia content is imported into the software before the simulation. The software stores the content information and button data (eg, labels, colors, and order) in csv files. These files can be modified to assign content to buttons and to change the layout and design of the dashboard. During the simulation, the facilitator provides students with a Scenario, Background, Assessment, and Recommendation (SBAR) and asks them to describe the steps of the patient care. As the students describe their patient care, the facilitator displays the associated multimedia content on the students’ screen. For example, if students explain that they want to administer nitroglycerin medication, the facilitator will play the video clip of a nurse administering the medication. If students want to review the patient’s electrocardiogram, the facilitator will display an image of the electrocardiogram. When a button is clicked, the data are written to a log that the facilitator can later review to evaluate students’ performance.
The IVS software can be used to conduct a simulation locally or remotely. In a remote simulation, the facilitator connects with students via a videoconferencing application. The facilitator then uses the screen sharing feature to allow students to view the monitor displaying the simulation content, whereas the other monitor displaying the dashboard remains visible only to the facilitator. In this study, the simulation was controlled locally without the use of a videoconferencing application or the internet. In a previous study, we used the IVS software to conduct a remote simulation over Zoom [12 (link),14 ]. We found that streaming videos over Zoom caused a reduction in the frame rate, and the videos lagged on the students’ screens. Many students reported that the lagging videos were distracting to their learning experiences [12 (link)]. In this study, the simulation was conducted locally without the internet to eliminate this factor, allowing us to focus exclusively on interactivity.