The value of simulations in learning workplace skills

JAMES STELLAR

University of Albany, New York

NICOLE MCLEAN

InStage Co, Toronto, Canada

ADRIENNE DOOLEY

Play OnWords Therapeutic Services, St Thomas, US Virgin Islands

In 1929 Edwin Link invented the Link Trainer, a pneumatic flight simulator that could mimic the pitch, roll, and yaw of actual powered small plane flight. It provided pilots with practice at maneuvers which could be life-threatening if encountered for the first time in the real world (New World Encyclopedia Contributors, 2021). Prior to that from 1919-1926 the US post office saw 35 pilots killed flying mail, one for every 115,325 miles (“They Died Flying the Mail”, 2022). The flight simulator ended much of that by giving pilots a safe place to practice lifesaving flying skills. Today, sophisticated virtual reality flight simulators play a major role in training airline pilots, in addition to time flying under supervision. In the 1960s Peter Safer touted the medical efficacy of mouth-to-mouth resuscitation and that gave rise to a mannequin simulation, complete with a chest spring on which one could safely practice cardiopulmonary resuscitation skills (“History of Medical Simulation”, 2022). Today computerized versions provide medical staff with CPR training, although additional medical practice supervision is again required. Sophisticated virtual reality simulations of the body dissection are now making inroads into basic medical training (Herur-Rama et al., 2021).

For over 100 years, starting at the University of Cincinnati in engineering, cooperative education (Coop) programs have provided students with an opportunity to learn not only from periods of full-time study but also from alternating periods of paid full-time work (Niehaus, 2005). Around the world, such programs are also called Work-Integrated Learning (WIL) (McRae & Johnston, 2016). In other forms they are known as internships, apprenticeships, or even just experiential education. What they all have in common is the building of work-place skills to accompany the abstract knowledge of the field gained from academic study. The practical goal is the same - to help with the eventual transition to employment. The question here is whether simulations can work to build some of these workplace skills in students that would otherwise come from direct experience.

To address the above issue here, we consider as examples two very distinct simulation operations. The first is a Toronto-based company, InStage, that provides virtual simulation for a job interview using either virtual-reality or screen-based interaction with avatars in a presentation scenario like a structured job interview (“InStage Practice”, 2022). The experience is accompanied by a computer analysis of speech patterns such as the use of filler-words. The interview can be viewed by a live coach or simply done alone for practice. The second is based on the use of actors as part of a speech pathology training program at Massachusetts General Hospital Institute of Health Professions (Stellar et al., 2021). That approach use live actors in the real world or on screen to simulate patient interactions that will be seen in the clinic. Finally, we will briefly discuss why these simulations must be authentic to have an impact as viewed by neuroscience-based thinking about explicit (cognitive) and implicit (emotional) information processing.

AUTHENTIC VIRTUAL SIMULATION OF A JOB INTERVIEW

Every student needs to develop communication skills to effectively prepare for the workforce. It does not matter whether they are introducing themselves to a potential employer or interviewing for their dream job. The biggest skills gap that employers are seeking remains the same, soft skills, and verbal communication skills at large.

In 2016 Forbes cited a PayScale study where 63,924 were surveyed and highlighted that 46% of managers felt new graduates lack communication skills and that 39% felt they lacked public speaking skills specifically (Strauss, 2016).

In 2017, InStage, a virtual reality company out of Toronto, Canada, set out to change the way students develop these skills by combining simulation technology and artificial intelligence to create a safe and easily accessible environment for students to develop their communication skills. Since then, InStage has created hundreds of immersive job readiness simulations that students can use to practice interviews, elevator pitches, presentations, and more with a diverse cast of characters that makes it feel like they're talking to real people. Afterwards students immediately receive personalized feedback reports they can use to make improvements and track their progress.

Internal student surveys report the following data (“InStage Practice”, 2022):

• Students reported that the simulations were “believable”. 7.78/10 n=440 - (Scale of 1-10 scale (not believable at all (1) - fully believable (10).

• 74% of participants (n=156) reported an increase in confidence after a single practice session.

• 86% of participants (n=440) reported that online virtual simulations were “about the same” or “more effective” than in-person instruction. This is a promising outcome given the efficiency advantage of simulation-driven training vs human-driven training.

• 92% of students (n=440) report that simulation-based learning is enjoyable, increasing the likelihood that they will continue practicing.

For this simulation work, InStage has won the World's Best Education, Training, and Simulations at Amazon's Global AR/VR Challenge; and the Canadian representative at the 2021 World Ed-Tech forum London, England.

In summary, InStage technology fills several critical needs to help students meet employer expectations. By providing job readiness simulations that enable high repetition practice, students can make mistakes, build confidence, track their progress, and prepare for the real-world job interviews.

AUTHENTIC SIMULATION OF PATIENT INTERACTION IN SPEECH PATHOLOGY TRAINING

Many universities, hospitals, and institutes train speech pathologists, and a variety of health professionals, to eventually become practitioners. Consistent with the clinical hours that medical professionals must obtain to become licensed is their training in Speech Pathology practice. Simulations are not new to this field. They were explored and studied in Australia, are available online in America, where they have also been studied (Ellis, 2017; “Integrating Simulation Education”, 2020; Miles et al., 2015; “Simulation-based Learning Program”, 2022). They are part of the American Speech-Language- Hearing Association (ASHA) accreditation recommendations for up to 75 hours and are currently under study at Massachusetts General Hospital Institute of Health Professions (MGHIHP) (MGH Institute of Health Professions, 2021).

While modern versions of medical simulators (e.g. SimMan) exist that go beyond CPR to procedures like endoscopy, what interests us here is the use of actors to simulate complex and authentic patient interactions in a speech pathology setting (“Simman 3G Plus”, 2022). This work complements graduate clinical placement giving students a chance to experience a variety of circumstances likely to be encountered in practice. For example, one experience might emulate a parent interfering too much while accompanying a child in the speech therapy pathology session. At MGHIHP actors employed can be speech pathologists themselves who are deeply knowledgeable of the syndromes and the patient populations (Stellar et al., 2021). The institutional experience is that such simulations produce more advanced clinicians, resulting in an easier time getting an internship and ultimately a placement on graduation. Certainly, this program was very useful during the pandemic when patient-student interaction was limited. But now it has taken on a life of its own as a way of boosting preparedness for clinical placement. The interest in this area is also shown by the existence nearby of the Center for Medical Stimulation that is part of Harvard University and associated with MGHIHP (“Center for Medical Simulation”, 2022; Rossi, 2022).

Under the influence of ever-developing technology, immersive medical simulation appears to be taking off even in surgery and may become as common a form of training as in in modern flight training as mentioned above (Badash et al., 2016). What is unique about the use of actors in speech pathology is that they can simulate complex social situations that would otherwise require avatars. But that is not far from coming as they already exist in the InStage practice job interviews previously mentioned.

AUTHENTIC SIMULATION EXPERIENCES ENGAGE IMPLICIT BRAIN PROCESSING

Simulations are everywhere, from teacher training to radiology (Cohen et al., 2020; O'Connor et al., 2020). Simulations work, we suggest, because they engage the implicit processes of emotional decision-making as well as the explicit processes of cognitive decision-making that are seen in classical classroom-based education. The existence in general of two such processes is not new but was famously laid out in the 2011 book Thinking Fast and Slow by Daniel Kahneman and as is supported by research in the field of behavioral economics. To get this engagement, simulations must have a high degree of authenticity, should present verbal and non-verbal stimuli, and must be immersive. Both of our examples share these features. As noted, they also share features with the actual workplace experiences that are produced by Coop, WIL, internships, or other experiential education activities in college.

These two processes are also natural to the basic functioning of the brain. Briefly, the highest part of the brain anatomically and evolutionarily is the neocortex. It is where our explicit cognition occurs with abstract models of the world, language, etc. For example, the neocortex even gives us the basic the trajectory of a rolling ball that we can maintain when it goes out of sight behind a screen (Bertenthal et al., 2007). Even young children jump their eyes to the other side of the screen and wait for the ball to appear (“Eye tracking”, 2022). This is is not just eye-tracking. They have a much more powerful abstract concept of the ball's trajectory. Lower levels of the brain appear to store skill learning (like placing the feet in walking) or provide emotional reactions to stimuli or experiences that can be used to compute their value (Clark, 2015; “The Concept of the "Triune Brain", 2022). Here in these implicit processes, we would say is where the authenticity of the simulation comes in to play to evoke the emotional reaction, help develop soft-skills, and create immersion that grabs the student.

Experiential learning has long combined the explicit and implicit learning processes as seen as operating in Kolb's call for reflection to be a part of experiential learning to surface the implicit in the learning process (Kolb, 2014). Very long ago, it is what Blaise Pascale meant when he said, “The heart has its reasons of which reason does not know” (Pascal, 1995). We think higher education today is increasingly figuring out the power of this combination of explicit learning from the classroom and implicit learning from experience (“Center for Neuroscience and Experiential Education”, 2022). These institutions are seeing college graduates who are confident and mature in their field as well as knowledgeable and learned in their discipline. We believe that these are the types of students who more likely succeed after graduation whether in employment or in securing further professional education.

Authentic, compelling simulations can play a large role in this outcome (Buford et al., 2022). They can complement Coop or other WIL programs. They can reduce the expense of implementing experiential programs for institutions which wish to enter this area of operation. They are modern and impactful for the institution and the student. Going forward, we believe simulations will be important to all colleges and universities, well utilized by students, and make a difference in their success.

REFERENCES

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