About Liverpool University NHS Foundation Trust

Liverpool University NHS Foundation Trust is one of the largest academic organisations in the North West. The Trust has hospitals across four sites, with all staff sharing the ‘foundations of passion and pride’ in their roles. One of these is Mr Andrew Kinshuck, the Training Lead for ENT (ear, nose, throat) Specialist Trainees in the North West. He reached out to ExR Education to support with a project that Holly Mould, one of the Trust’s Academic Foundation Doctors he supervises, is running. Holly's interest in simulation and technology led to discussions around how our medical virtual reality (VR) could be used to evaluate the ENT clinical skills of junior doctors at the Trust.

The Brief

ENT emergencies and core procedures are common, but they can be covered by junior doctors who lack experience in this specialism. The primary audience for this medical VR project became this group of healthcare professionals, with the target of widening access to important training.

“I approached ExR to help me to develop some 360-degree videos and simulations. I wanted to develop an education package for teaching foundation year ENT procedures in a cost-effective, accessible, and immersive modality. 

I wanted to develop a series of 360-degree videos and VR simulations to teach ENT procedures as this is an innovative way of teaching procedures to a large number of trainees.”

Holly Mould, Academic Foundation Doctor at Liverpool University NHS Foundation Trust

Engaging and Cost-Effective ENT Surgical Training

Traditional training for ENT core procedures is expensive. It's also slow – training centres are expensive, and expert staff have packed diaries. Our immersive medial VR simulation tools are the opposite. 

• The 360° videos and simulations are readily available for all the Trust’s doctors to watch, pause, and replay whenever they need direction – they're not limited by dates or distance to access core training. 
• The content is freely accessible for everyone with a NHS login, eradicating the expense of training staff en masse. 
• Filming could be scheduled at times when the Trust’s experts were free to take centre stage and demonstrate the ENT procedures.

By creating this series of 360-degree videos on common ENT surgical procedures and the single VR simulation on anterior nasal packaging, Liverpool University NHS Foundation Trust can widen access to training for junior doctors – and beyond. Simultaneously, we’re breaking the barriers to engaging, effective teaching for the Trust whilst meeting our own core value of democratising access to healthcare education.

Browse the growing collection

Transforming 10 ENT Procedures into 360°VR

The first piece of content Holly asked us to develop was a series of videos to teach ENT procedural steps to foundation year doctors.

“I approached ExR with the idea, and we booked a date for filming and I was given a rundown of the timeline and steps involved. The process was really simple – I devised scripts for each procedure and recruited colleagues to help with filming [them].”

Holly Mould, Academic Foundation Doctor at Liverpool University NHS Foundation Trust

It took just a single day for Nick Culley, our 360° production specialist (and MD), to film ten 360° videos and one VR simulation. 

“Nick filmed on the day and was very easy to communicate and work with. The filming process was very easy and quick, and we got all 10 procedures filmed in less than a day. The simulation was developed relatively quickly, and I was able to test it out and give feedback as it was being developed and subsequently evaluated.”

Holly Mould, Academic Foundation Doctor at Liverpool University NHS Foundation Trust

Virtual Reality for Epistaxis Training

We also co-created a dedicated epistaxis (nosebleed) module with the Trust for our platform. The epistaxis training is made up of both 360° videos and a fully immersive VR simulation.

“Doing the training a few times (3-4) would make me very confident in the skill of nasal packing.”

Participant

View the epistaxis module  

How We Produced VR Learning Tools for ENT Procedures

To co-create the 360-degree films with the Trust, we: 

1. Held meetings with Holly and Mr Kinshuck to discuss the unmet needs of ENT education 
2. Made decisions around specific modules to focus on
3. Drafted, tweaked, and then finalised scripts for the VR content
4. Put together a plan for the filming locations and dates, plus the required staff from the Trust
5. Spent a day filming the ENT procedures at [name of site/hospital]
6. Edited the films
7. Released the videos to the ExR platform with the necessary supporting learning outcomes

For the VR simulation around anterior nasal packing, there were a few additional steps. 

• After the script had been signed off, we created a storyboard for the simulation which needed expert subject matter review.
• Once that was given the green light, our Games Artist began developing the simulation.
• Following the necessary rounds of testing and tweaks, the simulation was finalised and released to the ExR platform.

View the films

Feedback from Filming

Positive comments came in the form of the professionals taking part in the production about the software production itself, too. Several commented on the ‘clarity’ of instructions given and how they valued us taking the time break the procedure down into stepwise instructions. One participant particularly valued the time taken for consenting patients and hand sanitising as it:

“Forces reflection on content and makes it more likely for things to be replicated in real life.”

Participant

How ENT Training is Transforming with VR

We're proud this co-creation activity has enabled another realm of content to be freely accessible to the healthcare professionals who crucially need it. Thanks to Liverpool University NHS Foundation Trust’s participation in the project, we’re helping to fill some of the gaps in the system’s curriculum.

“My main aims were met. Foundation year doctors have found it an engaging and enjoyable way to learn. There was an increase in procedural knowledge post-use and there have been suggestions for other procedures which the tech may be used to learn, which I hope to pursue with ExR further! Now that the material is available on ExR's site, I hope that others will be able to gain from the content too.”

Holly Mould, Academic Foundation Doctor at Liverpool University NHS Foundation Trust

And the best part is we’re doing it in an engaging way. Initial evaluations of junior doctors using these VR tools to train on ENT procedures have demonstrated that knowledge, confidence, and competence have all greatly increased. What's more, we’ve been able to statistically show the power of combining 360-degree films and VR simulation – user confidence doubled after the training had been completed, and knowledge tripled.

“[The finished software is] as close to practicing in-person as you can be.”

Participant

Users of both the 360-degree video and VR learning tools found the software easy to use, stating that it was ‘intuitive’, ‘simple’, and ‘user-friendly’. We were also proud to hear comments surrounding the immersion, novelty, and ease of use of these medical VR tools which are enabling them to focus on the activity. 

The ExR Difference

And that’s the thing – all this content is readily available for NHS employees and students to use day in, day out. Just as much as it supports junior doctors to practice in a safe yet realistic immersive setting, it’s also empowering specialist ENT doctors to upskill.

“[There was] no pressure about getting things wrong because it was all virtual.”

Participant

ExR truly is unique. 

Our single platform hosts all content for the educational benefit of the NHS for free. If you’d like to find out how your Trust could benefit from co-creating medical VR training videos with us in a ‘simple, quality, and efficient’ manner (Holly’s words, not ours), then our team would love to hear from you.