In this exclusive interview, we dive into the experiences and insights of Yolanda Ramirez and Marissa Gonzales, educators at Texas State Technical College. They share their journey with PeriopSim and PeriopSim VR, discussing how these innovative tools have transformed their teaching and enhanced their students' learning experiences.

How did you discover PeriopSim and PeriopSim VR?

Yolanda Ramirez - We first learned about PeriopSim shortly after we had shut down due to COVID-19. We were looking for a resource that we could use for online learning. We actually found it through the AST website as we were looking for different software systems related to surgical technology. Anna San Pedro was the one doing the research at the time and was the one who found PeriopSim for us. Anna set up a demo session with PeriopSim and we loved it. 

What appealed to you most about the technology initially? 

Yolanda Ramirez - We loved the fact that it incorporates instrumentation. Students use it in their first semester for instrument training. PeriopSim enhanced their learning with these instruments because we started off with the basic sets and slowly progressed through these during the first semester. All the focus in the curriculum is instrumentation during this time.

What feedback are you getting from the students? 

Yolanda Ramirez - They like it because it helps them quickly identify instruments and helps with their studying. It makes them more confident as far as identifying and selecting the instruments, and then they get really competitive with the scoring in PeriopSim too.

I appreciate that scoring was added to the content because everybody wants to be in the top five Everybody comes into the lab and says look, I'm in the top five, and then asks what's your score? It's been really good.

James Hay - Scoring gives students instant feedback, helping them track their progress compared to just looking at their competency level in the dashboard. They might be stuck at a certain competency level but then when they get the score they can hopefully see those incremental increases. 

How has teaching instrument names evolved, and how has that been going for you?

Yolanda Ramirez - What we call instruments here might be different than what you call them, different compared to North Texas, and even compared to the hospital in the next town.

I think that's the biggest learning curve, we're calling them by different names. The students really get used to it at the beginning. They make that first mistake and then they look for it, and find it. They usually do the experiences seven times before they use PeriopSim VR, so by the time they get to VR they already know that's the instrument name. It hasn't been too big of a challenge, they pretty much get it the first time around.

So you say they do it about seven times before they go to VR -  is that a threshold that they have to meet before they go into VR or is that an average?

Yolanda Ramirez - We usually have them complete it on their computer first, and we ask them to complete it a minimum of seven times. We have a list of their assignments and the dates that they're due.

That's one of the requirements to gain access to PeriopSim VR. This way, by the time they come here at the end of the week to do the VR portion, it takes them maybe 10 to 15 minutes to complete the experiences versus had they not done it those seven times. If not, they will probably take a little longer. Since we only had three VR headsets last semester and we had 28 students, it was a challenge to make sure we rotated all those students in and out of VR. This gave them enough time to complete the assignments and proved to be a good use of time.

So when it came to the purchasing of PeriopSim, did you use any special funding or grants to obtain the hardware and subscriptions?

Yolanda Ramirez - When we first purchased PeriopSim, we did use CARES funds.

Has purchasing evolved since then?

Yolanda Ramirez - Since then, Michael Cropper, who runs the XR curriculum programs for Texas State Technical College, took over the purchasing of PeriopSim VR. Michael's department paid for it last year and now it comes out of the surgical technology budget. We decided let's do this and it's part of the program's fees now.

We like and enjoy it, and the student feedback has been great. We have not had any student complaints other than homework and assignments, but as far as the software goes, they all love it.

Let’s talk about curriculum integration - How frequently do your learners utilize PeriopSim per week, and how do you assign it?

Marissa Gonzales - We'll start at instrumentation in the first semester and then as they advance we cover specific specialties, then they’ll do the procedural parts of it.

We assign PeriopSim and give them a week to complete experiences seven times on their own at home. Once they complete their PeriopSim assignments, we schedule them to come in on Fridays for PeriopSim VR. We schedule them for a certain amount of time, usually 15 minutes. Every week we do it again, but it also just depends on what specialty we’re covering. If it's not every week, it's every other week, but we definitely utilize it as much as we can and everywhere we can, and we've synced it up with our syllabus.

When PeriopSim desktop is assigned, are you grading them on what they're doing at home?

Marissa Gonzales -Their PeriopSim at-home work prepares them for assessment during lab time in PeriopSim VR. 

And how is that weighted?

Marissa Gonzales - We have a rubric that the students follow and It's shared with them. The students get graded according to how well they performed their seven attempts on the PeriopSim desktop. They can score up to 90 doing all seven, and then the incentive for that additional 10 points to get 100 is for them to come into the lab to do the VR part of it.

Is there a threshold that they have to meet in VR? For example, no errors, a certain time, or is it just completing the module?

Marissa Gonzales - just completed the module

Is there anything that you would like to see in VR for assessment purposes?

Marissa Gonzales - That's a good question. At this point, if the students were only doing it one time in VR then I'd probably say, OK, let's see what else we can add to it. But historically, the students are doing it multiple times because that high score is their incentive. 

Marissa Gonzales - It's that self-driven, where if it's not clear enough to them they will do it at least five times over and over in VR. It's the students themselves, they want to keep pushing for a better grade. 

Yolanda Ramirez - It has made learning fun, and it's enjoyable for them. They have their 15, 20-minute time slot and they take full advantage of that. If they don't get to do the experiences in VR, then at the end of the day they'll end up with a “B” in their grade book which would be a 90 out of 100, it’s that additional 10 points that move them up to an “A”. So there are two kinds of incentives there, a high score and getting an “A” for going into the lab and having a little bit of fun.

James Hay - The interface is very similar in both the desktop and VR. From my view, it's an easy transition for a student to go from PeriopSim into PeriopSim VR. So after seven playthroughs, they're already invested in it and I would be surprised if they didn't want to excel in VR. Now, granted other variables are introduced into the VR component of PeriopSim. A lot of the feedback that we get is that it makes learning fun, and the technology is fantastic.

Is there a point in your curriculum where you make a cut to VR?
Marissa Gonzales - In the first semester, they use both PeriopSim and PeriopSim VR, while our upperclassmen use only PeriopSim. The reason for that is that we have two cohorts and not enough headsets, and also scheduling conflicts, etc. 

Do students use it prior to or during clinicals, and what feedback have you received?

Marissa Gonzales - When they are utilizing PeriopSim VR it's right before clinicals. It gives them a confidence boost, and we tell them that this is what to get ready for and what to expect.

What has been the learner feedback on PeriopSim?

Marissa Gonzales - Again, they just have fun with it. Two, I think they come in as they're learning the procedural steps and they feel more confident about what it is that we ask for when we do mock scenarios or cover certain procedures. Again, it's that confidence boost that they need. 

Are you seeing an improvement in the learners' psychomotor skills and anxiety?

Marissa Gonzales - Yes. We’ve received great compliments from Dr. Devin about how he’s noticed a change in our students going into the OR. He's a very particular Doctor and he's recognized that also.

What challenges has PeriopSim addressed?

Yolanda Ramirez -The biggest challenge was student confidence and instrumentation identification, that was a much weaker point before this. That's all definitely improved.

Any Educator tips or recommendations?

Yolanda Ramirez -My advice would be to definitely incorporate PeriopSim into your curriculum, find slots where it's going fit for your needs for the students, and make it a graded component for each course.

We have three courses that we use PeriopSim in - The first one is our special topics course, which covers a lot of the instrumentation and also covers sterile processing components. It's heavily emphasized in instrumentation. That's where the students come in their first semester 

Then there’s Surgical Procedures 1. We cover all of the specialties and spend about two or three weeks in each specialty. For example, OBG we spend two or three weeks on. Each week is one procedure.

Every week the student has something to do, an assignment to do in PeriopSim. That’s my best advice, to incorporate it and utilize all of the features that PeriopSim has to offer.

I feel like a lot of people are still to this day intimidated by VR. Any Educator tips or recommendations when it comes to VR? 

Yolanda Ramirez - You know, it can be a little intimidating. I remember when we were first introduced to PeriopSim VR, Anna San Pedro said here’s the demo. Anna then asked did you like it? I replied, ‘Yes, I love it’. Anna then said OK - put it into the curriculum and make it work and

It was a significant challenge - finding the right time and place to incorporate it into the curriculum. Now we've got Michael and that has been great, helping us get everything set up.

What was the setup process like for you guys? What are your thoughts on getting IT involved and getting that support?

Yolanda Ramirez - Absolutely. Get IT involved. It took some effort to get everything set up. I know there were a few bumps in the beginning but it has worked out. 

While the software worked well, syncing the headsets with the TV was challenging. We purchased the TV for the headsets so that other people outside could see what was going on. Getting them to work in sync was tricky. Once we found the right headsets, everything ran pretty smoothly.

We still have some hiccups where we'll turn the headsets on and they’ll need a software update. This requires set-up time. Students will be ready to go but they can't proceed because of the software update, or it's not casting to the TV’s.

Funny you mention this, it’s very similar to those last-minute Windows updates. As the Customer Success Manager, I think one of the biggest challenges I find is when VR is first introduced to a Program Director or any staff for that matter, they're looking at the VR headsets as some novel device and I'm over here saying this needs to be treated like a computer. If you received new computers in your program, you wouldn't be setting those up, you would have IT set those up for you. I think once people make the connection these are actually computing devices it clicks, but trying to form that connection can be challenging.

Yolanda Ramirez - We found that to be one of our blind spots as well, and that was our mistake too. It was like, we got new toys! Wow, let's turn them on! Let's figure this out, it can't be that hard…

Marissa Gonzales - Wrong!! (Laughing)

Yolanda Ramirez - and you're wrong and start to need support. Then we’re left asking who can help us with this here on campus. Of course, IT they’re our guys, and they are here so they were able to help us get it all set up.