In this week’s MiXR Studios podcast, we learn about nursing simulations and the roots of extended reality (XR) from Second Life. We talk with Michelle Aebersold, a clinical professor of nursing at the University of Michigan to learn more about her journey into XR. Michelle has been building interactive multi-user simulations at the School of Nursing starting with Second Life and continuing today using virtual reality (VR).

Michelle talks about her work with Dr. Prashant Mahajan at Michigan Medicine around team building and communication between nurses, pharmacists, and physicians. She has worked with folks at the Duderstadt Center to create “We Heart VR,” which uses virtual reality to improve patient outcomes in pediatric cardiac arrest. Her goal was to create a training that allows a multi-disciplinary team of healthcare providers to collaborate and use algorithms to treat an infant in cardiac arrest.

We also talk about some of her other projects such as using 360-degree video to demonstrate to healthcare providers what it is like for patients that are hard of hearing to engage in the healthcare system. Michelle’s latest project is one of the XR Initiative’s Innovation Fund awardees called “Getting Under the Skin.” This VR experience is being created with Dr. Christopher Friese to train nurses and patients on how to deliver chemotherapy treatment. We will use VR to create an experience like the “Magic School Bus” — shrinking down to see what is happening under the skin when the chemotherapy leakes out of the blood vessel.

I was grateful to spend some time with Michelle learning more about her vision for XR at Michigan and her journey. XR. Please share with us what you would like to learn more about in the XR space at [email protected]

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Transcript: MiXR Studios, Episode 3

Jeremy Nelson (00:10):
Hello. My name is Jeremy Nelson. Today we are talking with Michelle Aebersold who is a clinical professor and faculty lead for innovation research and technology development at the University of Michigan School of Nursing. And we’re going to be talking about simulations, collaborative VR and getting under the skin. Coming up next in our mixer podcast.

Jeremy Nelson (00:44):
Welcome. Hello Michelle, how are you?

Michelle Aebersold (00:46):
I’m doing well, thank you.

Jeremy Nelson (00:48):
Yeah, thank you for joining us today. We’re excited to have you on the podcast.

Michelle Aebersold (00:52):
I’m excited to be here.

Jeremy Nelson (00:54):
Yeah, well you obviously have been doing a lot of work in the XR space. You were one of the reasons I think the XR initiative was founded here at the University of Michigan and I’d love to just have you share more about your experience, what you’ve been doing, you know, recently as well as back to your second life days and just share, that would be great.

Michelle Aebersold (01:16):
Yeah, thanks. Yeah, it’s very exciting to see the whole XR initiative get started. I can remember back when there were a handful of the faculty that came together at the School of Information and we were just meeting each other and talking about what we want to do and what we’d like to do. And the whole thing has just kind of, you know, grown from there. So it’s, it’s really great to see, it’s great to see the university put some efforts and funding into this whole initiative. And I know that’s one of the things that we talked a lot about early on with those faculty that were interested is we don’t want this to just be little solo projects in one school or another school. We wanted to always make sure that there was some sort of connection across campus so that we could learn from each other and leverage the talents of each other and, you know, sort of form these collaborative groups.

Jeremy Nelson (02:17):
Yeah, no, I mean, I think I’ve, I’ve experienced that firsthand, you know, just coming into this initiative and seeing all the great work done across a number of our programs. And I think, I think it’s unique. I’ve talked to a number of other universities and there are pockets here and there and some are doing similar things, but I think we have a unique opportunity here to bring the cross discipline. Like that’s what Michigan’s known for as to this space.

Michelle Aebersold (02:40):
Yeah, I agree. I think that’s really exciting.

Jeremy Nelson (02:43):
Let’s, let’s talk a little bit about some of your work. I’ve seen some of your, your VR projects and you know, some of your trainings and simulation and just share a little bit more about what you’ve been doing and what you’ve learned through those projects.

Michelle Aebersold (02:56):
It’s been a journey and I have to say that, you know, the journey probably started back when I was a kid and just, you know, loved games, loved playing games, uh, really got into, you know, everything that was out there. So whether it was the Atari or you know, the Nintendos and, you know, even the old console games, um, it was just, it’s just been something that I’ve always enjoyed doing. And so I think that as I moved into this faculty role, one of the things that I knew that I really wanted to do was to leverage the whole idea of interactive playing simulation, all of that. Because to me that’s the best way to learn things. And so early on, um, I started setting up our simulation program at the school and we had a lot of things that we could do live in person with the simulators, but I knew that there was always a place for online types of environments.

Michelle Aebersold (04:03):
And second life, interestingly enough, was sort of just kind of coming into being at a lot of the universities in different schools were getting into it. So we actually in our nursing program, invested pretty heavily into second life in little pockets enjoying some of the work that was done on university campus. Uh, we had a Wolverine Island, we have a hospital, we had a training center and I even had some grant funding to do that. So it was great because I think that was a really nice springboard into some of the things that I’m doing now. One of the things that, um, we learned a lot about this type of interaction by using second life is the whole idea of sort of multiplayer. Um, I know that many of the sort of screen-based simulations that our students have been able to engage in often are just a single focus, which is good if you’re, you know, trying to increase their knowledge or you know, have them learn how to work through things.

Michelle Aebersold (05:11):
But it doesn’t really teach them as much about collaboration and about how to get along with other disciplines, how to communicate well. So we did a lot of that second life. So when I moved into the more immersive virtual space, that’s the first place I went is, you know, how can I make this multiplayer? How can I make this more interactive? And I know some of my colleagues that are in this space have gone in a different direction because they’re looking at this more from like a skill based. So how can I do procedures? That’s great, but I see the advantage of these virtual worlds really more than just how can I learn how to do something. But how can I learn how to do it when there are other people with me. So doing it and communicating, it’s just so much a part of what we do in healthcare and so much a part of what nurses do every day. They communicate with every other healthcare provider in the system and you know, from the nutrition staff and the housekeepers to the physicians and the social workers. And so if I didn’t make a place for that in the virtual world in immersive VR, then I think I would have missed out on some of the great opportunities.

Jeremy Nelson (06:27):
Sure, sure. Well I think it’s, it’s great that you’re focusing on this space in this area cause I think there are a lot of unique affordances that the technology can bring, especially with people being remote, like they are now and you know, different disciplines how you can train, and practice across that space.

Michelle Aebersold (06:45):
Yeah, I agree. And it, it was interesting cause I was just thinking about this today is you know how long before one of the requirements for our students on campus will be a laptop and a VR device. Because right now some of the things that we do, we’re a little bit limited in how much we can push them out if we’re relying on, you know, headsets, whether it’s a hollow lens type thing or an Oculus or HTC and those pieces of equipment are not something that every student has. So right now, you know, certainly they’re coming on campus to do that. But if we think, you know, maybe in a year from now where we’re at, especially with the changes that we’ve seen with Covid and the need to really do more remote type things, you know, will we expect our students to have at least a basic headset that they can use to engage in things. There’s so much we can do with just simple 360 video or programs that are developed just specifically for something like Oculus go or a Lenovo Mirage or you know, any of those types of things.

Jeremy Nelson (08:09):
Sure. Well I’ve even seen some of it now where that can be done on a tablet or a mobile phone and a headset, right? So some folks that don’t have it, at least get some entry point into 360 video and, and you know, it’s not as immersive. It’s not the same, but it allows more people to participate.

Michelle Aebersold (08:25):
Yeah. And I agree. I think that’s a great, great thing to, uh, to think about. I know that just the whole idea of being able to go into a video, even if it’s just on your tablet or your phone and be able to sort of move around within that space creates a lot of opportunities for exploration and, you know, you can add the headset or you know, even a simple device and really get that more immersive nature.

Jeremy Nelson (08:53):
Yeah. Yeah. Well, what, what, what’s, what’s an example of one of the VR projects that you’ve worked on with collaboration here that you like?

Michelle Aebersold (09:02):
So, um, probably the first one that I would like to talk about is the, uh, we heart VR is kind of what we called it. And this actually came out of one of our early visits, uh, with some of our faculty. And so Dr. Mahajan and I started sharing ideas and found out that we really both have this, um, interest in patient safety and particularly around team building and communication. So we came up with this idea of taking a sort of pediatric advanced cardiac life support type case and building that because the nice thing about doing something like that is it’s a very common algorithm that all professionals would know. And so we can get them in this multiplayer environment where, you know, they all come in and it’s this emergency room setting and you have a little baby there and you’ve got your cardiac monitor.

Michelle Aebersold (10:01):
So it becomes very real to them and it, it feels like what they might walk into any day of their busy lives. And so they can now engage in managing the care of the sick child. We can add a mom in there, you know, we can add some distractors and then they have to sort of figure out how to make their way through and then how to communicate with each other. So we had this vision. And then one of the things that I wanted to do, and again, this was early on, so I had this goal of how can we build capacity within our system as a university. So we partnered with Duderstadt to help us learn and build this. And so some of it was all of us just learning along the way. Um, you know, we didn’t know how to make this work.

Michelle Aebersold (10:52):
So you know, let’s try this. And we’ve been working on this for a few years now and you know, it’s, it’s not perfect, but the thing that is great about it is all the things that we learned along the way and the things that we had to problem solve and the things we invented. You know, I mean, we’ve invented some things that I know, um, you know, yeah, others probably did too, but you know, we can kind of put our claim on it and say, “Hey, this is what we did.” So I think that the early successes of that gave me confidence to, you know, kind of put myself out there and say, okay, you know, I got some grant funding, I did this, it’s good. What else can we do? And so a couple of the projects that I’m now getting into are really leveraging this idea of using not the high end devices but a lower end device to make it more accessible to folks.

Michelle Aebersold (11:49):
And so one is using 360 video to help our providers understand what it’s like when you are somebody who’s deaf or you know, significantly hard, profoundly hard of hearing, uh, to go to a doctor visit or to, you know, go into the hospital. Particularly now as everybody has to wear a mask and when you depend on reading lips, you know, it’s, it’s, it’s a big problem. So I think this is going to be a really interesting, um, way to use this, use this technology, use our tools and 360 video to create these immersive experiences and looking around, I know others are working on this type of thing. I think it’s going to be great. And then the project that, you know, excites me as much as that one is the work that we’re doing with you guys at Academic Innovation. Um, you know, I kinda think back to, you know, the, the days like I used to love some of these things on, you know, uh, TV and things for our kids, like, you know, Magic School Bus and you know, let’s shrink down and go through the body,

Michelle Aebersold (13:01):
and it’s just like, that is so cool. So kind of building on that, so Dr. Freeze and I, we have this grant and Dr. Freeze has done some amazing work and the whole area of personal protective equipment and, and how to deliver chemotherapy safely because, you know, chemotherapy is like poison. Um, you know, it kills cells. And so if you’re a nurse trying to deliver that drug, you’re really managing two people. You’re managing your patients and making sure that your patient is safe and tolerating that well. And then you have to manage your own protection to make sure that you’re not getting this drug on your body. You know that you’re wearing all the right equipment and you’re doing all the right things. And I’m somebody who’s like a really visual person. So it’s like when you talk about things in abstract, I have to imagine what that’s going to be like.

Michelle Aebersold (14:00):
And I’ve got this belief that if people, nurses, providers could really see what’s happening when they’re doing this, then it’s going to like stick in their mind. So you think about the things that you’ve seen or like things that have happened on a, like a major incident. Like everybody you know of our era will know 9/11 because it’s like permanently there, right? So I want to create that experience for these nurses and pharmacists when they’re handling chemotherapy. And in this particular project, what we want them to understand is this very toxic substance that we are delivering to our patients, sometimes leaks out of the blood vessel and they know that that happens, but they don’t always see that sort of downside or downstream effect of that. And they definitely don’t see what’s happening right away. And you know, there’s just this sort of need for a quick response.

Michelle Aebersold (15:03):
And quickly to manage this. So our goal with this and the reason why we call it, you know, sort of getting under the skin is to show the nurses, nurses in particular what it looks like inside the body and how quickly when this, this drug leaks outside the blood vessel, it needs to stay in the blood vessel. But when it leaks out where it shouldn’t and how quickly it destroys the skin around it and the cells, you know, even right down into like the DNA and that. So I think through this sort of visual journey that they will engage in as they come in and take care of their patient and then something happens and they can kind of engage in this visual journey inside the body to see what that looks like. You know, I’m really hoping that that makes an impression on them.

Michelle Aebersold (15:49):
So the next time they’re taking care of a patient and doing this, they’ll be able to reflect back on that. So yeah. And the nice thing about doing it in a device that is, you know, simple like the hololens and then include or not hololens, the Oculus go and then including options to create, as you said before, a tablet version or a phone version is going to allow us to really push this out, not just at our school but across the world to make this more global. Because one of the things that Dr. Freeze knows from his research is, are um, countries that are sort of, uh, lower income that don’t have all the resources. They’re also delivering these drugs. And many times it’s physicians doing it because they’re the only approved providers. And so we know something like this could actually be shared across, you know, the world with, you know, providers and students of other universities. So we’re just really excited about, you know, the, the, the potential of this to, you know, we’re hoping that it will really make an impact on people to understand a little bit better about this drug that they give.

Jeremy Nelson (17:04):
Yeah. No, I mean we’re, we’re super excited to have you as the recipient of our inaugural XR innovation fund and the impact that this type of experience will hopefully have on nurses here at Michigan as well as across the globe. And I think we can build on, you know, our existing platforms at the university with Coursera and Ed X and future learn with our, we’re coming up on 10 million learners globally that have taken enrolled in our enrollments globally in our courses. So I think this is another Avenue to disseminate the information.

Michelle Aebersold (17:36):
Yeah. That, you know, that would be just really a phenomenal way to do this because I know that, you know, we get, um, inquiries, um, for our, our workshop, our grant that we do on oncology safety and we get inquiries from other countries and, you know, can they participate. So, you know, being able to have these virtual options and then maybe eventually putting a lot of our program online, you know, through like a Coursera platform would be really, um, significant I think.

Jeremy Nelson (18:07):
There’s obviously a lot of exciting opportunities in XR in this space, but any concerns you have about the future of XR for teaching and learning and what we need to keep an eye out for?

Michelle Aebersold (18:17):
You know, I think that a couple of things, um, that I always think about and the first is, you know, how do we situate these types of learnings, um, as we deliver them. So sort of what’s the context and then how do we debrief our students afterwards. You know, that’s always been a huge part of simulation and we know that that’s so important to, you know, one, prepare them before the experience and then debrief them after the experience because that’s what helps them reflect back and sort of, you know, embed that learning in, in a good way so that they don’t end up with like misconceptions or, um, or just even feeling like a little bit emotionally kind of traumatized, which, which can happen. We know that from, from, you know, live simulation. So I think that that’s one of the things that I’m not sure everybody thinks about. Um, and I know that we don’t always have the best ways to sort of debrief. So we, we really have to keep that in mind. This isn’t just something we’re going to put out there and say, Oh, go have fun.

Michelle Aebersold (19:21):
You know, it’s, it’s not a video game. It’s an educational experience. And so that debriefing piece is very important and we can do that in a variety of ways. And we’re starting to see some research out there on debriefing around virtual type of simulations and what are some of the best practices. The other thing that I think that we really need to also be concerned about is, you know, the whole thing around student safety and one, safety using the devices and two, just making sure that as we are engaging in this and we, we may be collecting some student data, you get into the really whole area of computers and privacy and cyber attack and all of that. So I mean clearly we’ve seen the effect of zoom bombing as we’ve all gone online with not adequate protection. We’re going to end up with the same thing.

Michelle Aebersold (20:14):
You know, when you think about a student in their home and now they’ve got this device hooked up to the internet, you know, it kind of goes to that whole internet of things and now they’re sort of exposing themselves and they don’t even know it. They don’t realize it.

Jeremy Nelson (20:27):
Yeah. I mean it’s like it needs to be patched and updated and similar to a phone or a computer and so it has all those same vulnerabilities.

Michelle Aebersold (20:35):
Yeah, yeah. And I think like phones and stuff, we’ve done enough education for people that they understand that. But I don’t think, you know, we’re not doing the same education for these devices. And so I think people are going to be vulnerable.

Jeremy Nelson (20:48):
Oh, I think that that tied in nicely to the, you know, the Courtney Cogburn talk we had earlier this year as well as the Caveat Proman around both that trauma that can be induced in the debriefing. And then Dr. Cochran talked a lot about that, how important that is as you go through that, you know, her thousand cut journey, um, as well as just the number of data points that can be collected on an individual, you have to be done with that, that information. I think we have a responsibility to, to help set up some guidelines for how that’s used.

Michelle Aebersold (21:19):
Yeah, I agree.

Jeremy Nelson (21:20):
Well, you know, you know, we’re building this, you know, the XR initiative here at Michigan and the work that you and all your colleagues are doing. What do you want to see Michigan do to enhance the education for students with XR?

Michelle Aebersold (21:32):
So I think that, um, I see this, uh, from two approaches. One, I think it’s sort of getting out there to the students and letting them know what’s going on and what these options are. Because one thing I know about University of Michigan is we listen to our students. So I think that’s one way to really kind of spread this message is to get the students excited. I think the other way is to engage leadership in each of the schools, um, to help gain their support because without their support, then there isn’t going to be, um, that sort of push to get faculty involved and support faculty and help with training dollars and things like that. So, so I really do think it’s, you know, it’s maybe, maybe it’s a three tiered approach. It’s leadership at the schools, it’s students and getting them excited and then it’s getting the, pulling the faculty together.

Michelle Aebersold (22:26):
And I think we’ve done a really good job pulling faculty together right now. And I know we have a student group on campus. I’m not quite sure where all the leadership sits on this at the different school levels just because I’ve not communicated with them. I mean, I know with the schools that, that I’m involved in, you know, that I have great support. Um, and it seems like across campus there’s good support there. But I think again, you know, we just need to keep all of those folks engaged.

Jeremy Nelson (22:53):
Yeah. I mean I think it’s, I think it’s broad. I mean, we had what, 12, 13 schools sign up for the XR graduate certificate program. So I think the commitment appears to be there and it’s exciting and I think I agree with that approach. What else should we be talking about in this podcast? What other topics do you think would be interesting to you or to listeners?

Michelle Aebersold (23:13):
You know, I think one of the things that I always get questions from people about is where do I start? How do I even get involved in this? And you know, it’s, it’s, this is my passion. So I’ve spent a lot of time, you know, sort of sorting through and figuring that out. Um, but I think that there are faculty out there or others out there who might wanna engage in the space that don’t even know where to begin. So I think that’s one of the things that we owe, um, our colleagues and others is, you know, trying to, sort of get the word out. Like, where do you start? How do you even get engaged in this? What makes sense? You know, it’s not about, oh, let me just buy a piece of technology and then I’ll, you know, I’ll make it fit. It’s, you know, what are your learning objectives and how can you leverage technology to meet those learning objectives. So I think that’s part of what we really need to do on campus is to, you know, not just sort of speak within our own circles about what we’re doing, but we need to reach out to faculty who don’t know how to use any of this and try to help them sort of see what the possibilities are.

Jeremy Nelson (24:22):
Yeah, I mean I couldn’t agree more. That’s one of the reasons I started this XR podcast, uh, to, to begin to, to share the stories and, and help educate more folks. This has been a great conversation. I love your perspective. I’m excited to continue our work with you and then thank you so much for joining us today.

Michelle Aebersold (24:40):
Well, thank you and thank you Jeremy for all of the work that you and the folks at AI are doing to really support this initiative. Um, I think it’s awesome. There’s great, great potential here.

Jeremy Nelson (24:52):
Thank you. Thank you for joining us today. Our vision for the XR initiative is to enable education at scale that is hyper contextualized using XR tools and experiences. Please subscribe to our podcast and check out more about our work at ai.umich.edu/XR.