Virtual reality (VR) training can transform traditional learning, increase engagement and retention, and enable scalability and cost savings. Emily Cooper, SweetRush XR Producer, and Tobias Washington, Head of Talent Technologies, Innovation, and Creative Solutions at CHRISTUS Health have answers to important questions about the development and successful implementation of a VR safety training program.

At our webinar, VR Training Program Case Study: Aggressive Behavior De-escalation at a Healthcare Sector Organization, SweetRush and CHRISTUS Health shared the behind-the-scenes story of a VR learning program aimed at de-escalating aggressive behavior in healthcare settings.

Emily Cooper, SweetRush XR Producer, and Tobias Washington, Head of Talent Technologies, Innovation, and Creative Solutions at CHRISTUS Health, covered the insights and the benefits of VR as an essential, effective, and safe training solution. 

We want to thank the webinar participants for their excellent questions. As promised, here are answers to the questions we didn’t have time to answer live!

General VR Training Questions

What do you think of cardboard single-use headsets?

Cardboard single-use headsets were, at one point, a popular VR delivery method. As we explored their use for VR training, however, we came across some important factors to consider:

• Lowest common denominator. The delivery device for a cardboard headset is the smartphone. Therefore, when designing VR, you need to think about the lowest-performing smartphone in your target audience. This often calls for simplifying the experience and creates limitations on what you can design.
• Immersion. Without a doubt, immersion is a big factor in the VR training experience because it heightens engagement, which is certainly part of the formula for achieving an effective training program. It’s difficult to create a sense of immersion with the level of content you can produce for a cardboard headset.
• Price. Even though cardboard headsets are inexpensive, you will still need a smartphone to run the VR training. So if you need to provide all the equipment (and can’t rely on BYOD), the Oculus Quest VR headset, a premium stand-alone device, will cost you less than your average smartphone.

What do you think about VR training experiences? Are they more efficient than the traditional approach?

VR training is often more time-efficient than traditional training. VR is best suited to short burst training—10 to 20 minutes is the sweet spot. VR is not one-and-done training. Instead, learners can repeat the training and log multiple practice sessions. Learn more in Your Guide to VR Training Programs: Virtual Reality for Our New Reality.

We are looking to develop VR training programs. Personally, I have an Oculus Quest, and it makes me very dizzy. I can stay in my headset for only about 10 minutes. When thinking about deploying VR to an employee population, how do you mitigate that? Do you create a separate non-VR training for those who can’t tolerate VR? Also, are there any Americans with Disabilities Act (ADA) concerns to consider?

We’re sorry to hear you’re experiencing sensitivity in your headset; it’s true that it does happen for some people. Fortunately, a fair amount of research has been done in this area, and we monitor the latest findings to help optimize our VR learning programs. After all, our goal is to create VR experiences that are comfortable and enjoyable! 

In the research, there are strong correlations between how the VR content is created and optimized and the potential for experiencing dizziness. Technical elements, if done correctly, can help mitigate these adverse effects. Additionally, headset technology is getting better and better, which has reduced this problem over time and will continue to do so as the technology advances.

An alternative for people who are highly sensitive is a WebVR version. WebVR has limitations and isn’t the right choice for every learning program, but it can be used to create an experience that can be accessed through a browser rather than a headset.

Regarding ADA, understanding your audience members and their needs is your first step in determining whether VR is the right solution for your learning program. If designed with ADA needs in mind, VR can be a great solution for many people with disabilities; at the same time, as a visually driven platform that often requires physical movement, it can exclude some people. The World Wide Web Consortium has a good article about the issues and opportunities of VR accessibility. The article mentions some interesting disability-related uses for VR—for example, simulations that help people adjust to new disabilities or help learners empathize with people who have disabilities. 

Typically, which VR training approach is more expensive to develop? 360 video or computer-generated imagery (CGI)?

It depends! We recommend keeping an open mind as you define your performance and learning objectives at the start of your project. This will help you determine what VR environment you need and what you want learners to be able to do and practice in your program. A simple live-action 360 video experience may suffice. Or, on the other end of the spectrum, you may need a stereoscopic 360 camera and many actors, or you may choose something in between. The same goes for CGI: you may be able to use inexpensive stock assets, or it might be necessary to go full-blown motion capture style. Or, again, you may find a happy medium. Both 360 video and CGI can be done simply and relatively inexpensively, and both can be more complex and expensive. Your desired learning outcomes should always guide your choices.

How should I build a business case and persuade the business and budget owners (especially in the COVID-19 era) to invest in VR solutions? And what’s the best way to start an implementation in a company? Small group? Big program?

We have a great section on building a business case in our eBook Virtual Reality for Our New Reality. Here are some of our key recommendations:

• Invest in a few headsets for key team members. VR is a “see it to believe it” technology!
• Introduce VR as a Learning and Development (L&D) opportunity. We’ve had several clients do this by bringing us in for an XR workshop. Your stakeholders get to learn about the technology, and there’s time designated for brainstorming VR training use cases for your organization. (Note: We can do this workshop virtually.)
• Choose a performance challenge that’s significant and ongoing, as Tobias mentioned in the workshop.
• Start with a proof of concept—many of our clients have had great success doing this. This often means creating a small part of a bigger program. A proof of concept gives stakeholders a taste of what’s possible, gives you a chance to test the process (and your vendor), and results in a tangible program you can share.

Since you mentioned COVID-19, it’s worth stating that there are many new strong use cases for VR that allow people to practice together safely. Think about redirecting unused travel funds toward an investment in VR equipment and content.

About the CHRISTUS Project

Program and Project Management Questions

How many people were involved in this amazing project, and what roles did they play?

Thank you—we’re very proud of the collaboration! At SweetRush, we had one Instructional Designer, one XR Producer, one Project Manager, five 3D Designers and Animators, four Programmers, and two Audio Engineers. We also had a QA team that performed play testing.

On the CHRISTUS side, about 20 stakeholders and associates participated in the on-site XR Workshop with SweetRush. Throughout the development of the project, stakeholders were kept abreast of progress and weighed in at key milestones. Associates, who represented the target audience, shared ideas, experiences, and feedback. Throughout the process, it was important to engage those whom the training would affect. The specialized team of five to six people who worked permanently on the project with SweetRush was in weekly communication throughout the entire project. As the VR safety training is rolled out, we expect this team to grow.  

What testing techniques did you use throughout the process to make sure you were building the right user experience?

Great question. Put together, the members of the SweetRush SPARK team have deep experience in instructional design, game design, and VR and app development, so all of these disciplines inform our process and approaches to ensure an optimal learner experience.

Our process for any learning program starts with deeply understanding our audience, which we do by working closely with our client. The amazing stakeholders we worked with shared important insights about the learners at CHRISTUS and how we should tailor the experience to meet their needs.

At SweetRush, we’ve merged instructional design with game design, and our iterative design process lets us test approaches with our client and users and identify the approaches that resonate with learners.

During development, we look to optimize the experience from a performance perspective. In this case, each activity had many components, so ensuring that the experience ran smoothly in the headset was important.

Finally, we invest significant time in play testing, both internally at SweetRush and externally with our client. Play testing can show us where we need to tweak the user experience. One part of the program we focused on was getting the body movement tracking correct to give the user the accurate feedback. 

Development/Technical Questions

What engine did you build this VR training in? Unreal or Unity? How did you make this decision?

Unity engine. In our experience, Unity is more flexible with third-party technologies, which were essential for the voice and tone recognition and analysis requirements of this program. We also find that Unity enables faster custom development and implementation of new technologies. We use Unreal Engine in other situations, but in this case, given the requirements of the project, the Unity Engine was the right choice.

Program Design

Is the scoring directly related to how people are evaluated?

The goal is to tie the two parts of this safety training program (the classroom training portion and the VR training portion) to an overall clinical de-escalation program that CHRISTUS is implementing. Through the point system and data tracking of the VR, CHRISTUS will be able to see which individuals can correctly apply the proper approaches and techniques. As the program rolls out, CHRISTUS expects to see how it integrates into evaluation. 

Was timing a metric in completing an activity/exercise?

We considered using a timing metric during the design phase of the project. We tested how this could be implemented in each scenario and decided that a timing metric did not support our learning objectives. One of our goals was to give learners an environment in which they could learn at their own pace. The program definitely has stakes and consequences, but we chose to design them without integrating a time factor. 

Was there any decision-based branching in the simulations (e.g., going down a different path based on a particular response)?

The verbal de-escalation scenario includes “mini” decision-based branching narratives based on the learners’ answers. For every step of the scenario, the avatar reacts to what the learner says. Because the learner cannot progress to the next step without giving the correct answer, the scenario does not branch as entirely different narratives, but each step can have a narrative. 

Avatars

Aside from the facial diversity, was there a challenge in terms of the users’ spoken language (e.g., English, Spanish, European, etc.)?

The target audience for this project is hospital health care and security professionals, which is primarily an English-speaking audience. For this phase of the program, we decided to focus on processing one language. There has been some discussion about integrating additional languages into future versions of the program. 

Analytics

What tool did you use for analytics? Did you hand-code them or use a plug-in, off-the-shelf, or third-party tool?

The VR Dashboard was built internally by our SweetRush SPARK team. VR analytics and reporting have exciting potential for L&D. Compared with other training delivery methods, the VR headset lets us track more data about the learner experience. We can also use the data in real time to provide immediate feedback to the learners or trigger events in the headset based on their actions. Combined with a great assessment strategy outside the headset, analytics presents a significant opportunity as a pathway to improving learner experiences and learning outcomes.

Was this dashboard built specifically for this project, or is it a customized learning record store or learning management system that multiple projects are hosted on?

We customize the VR Dashboard to meet the needs of individual clients and projects, so it can be deployed separately, rather than living in a single platform. Because we created the code, we can adjust the way information is gathered and presented.

Distribution and Maintenance

Did you distribute the headsets to the trainees, or did they purchase the VR headsets?

The CHRISTUS team purchased the headsets and will distribute them to several of their ministry (hospital) locations, where training rooms will be created. 

Do you have designers/developers now that can update or make changes going forward?

As we shared in the webinar, the VR learning program created for CHRISTUS is a higher-complexity experience. It has a custom CGI world/environment, many avatars, and several integrated technologies for voice and tone recognition and analysis, body movement tracking, and analytics. Given its complex nature, the program will require an experienced VR team to maintain the program moving forward.

That said, some organizations are dedicating resources to exploring VR development internally, and some authoring tools coming on the market can create VR learning experiences with simple interactivity. As the technology advances and more organizations adopt VR, it’s easy to imagine a model similar to eLearning, in which organizations can create and maintain a certain level of complexity internally and can call on great vendor-partners to help with more complex and interactive programs.

For this project, CHRISTUS will work with SweetRush if any updates, changes, or additions are made moving forward. 

Applying the VR Training to Other Uses

How could the VR training solution be useful in a manufacturing environment?

The manufacturing industry is rich with opportunities for using VR as an L&D tool. VR training can help develop the specialized skill sets needed in the sector and to conduct safety training in manufacturing environments. If you need training in the use of specific machinery, you can replicate that training in a VR environment. Not only can you create a place to interact with expensive machinery safely, but you can also use haptic feedback to create sensory input within the training. Because of its immersive nature and ability to evoke emotional responses and offer interaction that mimics real-life behaviors, VR is a great solution for the manufacturing industry. 

Can this type of VR solution be used in community settings?

VR can be used in many settings, including education, community outreach, entertainment, and enterprise. If your community is trying to shift a thought process or behavior, VR could be a great option. For example, if a small community wants to promote acceptance and understanding, a VR experience that addresses unconscious bias may be the answer. The possibilities are endless. You could set up a VR center at a library, sanitizing headsets after each use, so people can participate.  

How can the Oculus Rift be used for health care?

The Oculus Rift can be used for technical and safety training simulations and soft skills and empathy training. Live training that is costly or dangerous is a good candidate for VR training. Read about VR training use cases in Your Guide to VR Training Programs: Virtual Reality for Our New Reality.

How can VR training improve health care?

In the VR world, learners have a safe place to practice, receive real-time feedback, and replay scenarios and activities multiple times. Instructors and peers can be “in the room” observing or providing guidance. Read about VR training use cases in Your Guide to VR Training Programs: Virtual Reality for Our New Reality.

VR Trends

What’s the next step in virtual reality?

Learning trends in VR include multilearner experiences, instructor-led learning experiences, voice recognition and tone analysis, body movement tracking, facial recognition, integration of biometrics, and learning analytics. Learn more in Your Guide to VR Training Programs: Virtual Reality for Our New Reality.

Could you talk more about biofeedback in VR training? How would it work, and what data could you gather?

Biofeedback is an exciting element of data capturing and tracking in VR. How biofeedback is used can range widely. It can include simplistic heart rate monitoring, in congruence with the training program, to see how learners react under different conditions. Or it can involve mapping brain activity and breathing patterns, tracking muscle contraction, and using this data and feedback to help change behavior and mental patterns in patients through VR training programs. 

For the most part, to track biometric feedback, you need wearable devices: outside trackers, monitors, or equipment to add biofeedback to your VR solution. This is an exciting advancement in our field, and we’re seeing several head-mounted display (headset) manufacturers explore how they can integrate some of this tracking in their headsets without the need for additional equipment. Because of the excitement and potential for enterprise around biofeedback, we can expect leading companies to put time and resources into this effort—meaning we can look forward to advances in this area. 

If you are eager to learn more about VR training programs, use cases, and success stories, download the Virtual Reality for Our New Reality eBook. 

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Whether you’re a VR learning newbie or virtual pioneer, there are insights to be gained from the groundbreaking work produced by the SweetRush SPARK team and its clients. In this article, SweetRush’s experts answer questions that came up in its recent virtual reality case study webinar.  

Hello, everyone—JC here! I hope you had a chance to join us on June 20 for our virtual reality case study webinar—if you didn’t, you missed my feeble attempts to say “hello” and “thank you” in multiple languages, which may ultimately get my passport revoked.

If you missed our lively session, I encourage you to check out the recording available over at eLearningIndustry.com.

Before we jump in, I want to give a big shout-out to my co-presenter, Blaire Bhojwani, Senior Director of Learning Innovation at Hilton. Not only is Blaire an incredible partner, she’s a generous and caring friend, and we really appreciate the time she took to share the work we’ve done together. Thank you, Blaire!

Thank you also to our friends at eLearning Industry and their webinar hostess with the mostest, Mel Chambers! 

Now, on to your burning questions.

Virtual Reality! What is it good for? 

Several questions came in during our virtual reality case study webinar about use cases for VR for specific industries—health care and professional services among them. Truth is, I doubt there is an industry out there that could not come up with a good reason to apply VR as a delivery modality for learning.

VR has always been a great solution for re-creating environments to practice skills safely—especially environments that are dangerous or costly to create, or travel to, in real life, and many companies are piloting VR for these use cases. However, where we’re seeing a lot of interest—and this ties to the two projects we showcased in the webinar—is VR learning for soft skills and empathy-building.

Collaborating with Hilton, we created two VR learning programs for two different audiences, yet they share a key objective: increasing empathy and appreciation for others. 

• One helps corporate team members appreciate the physicality and complexity of their fellow team members working in the hotels, through hands-on activities that give them a taste of those jobs.
• The other helps the hotel team members empathize with guests encountering problems during their stay—and through scenarios has them experience the wrong and right ways to respond to a guest’s challenges. 

There are other learning modalities that address these objectives, from role plays to branching scenarios and simulations. What makes VR an attractive—and effective—option is the ability to fully immerse learners into situations, where they can literally walk in the shoes of others and generate a real sense of empathy.

Just as research has shown the connection between engagement and retention, I predict we’ll see more research on the connection between immersion and retention. “Being there” is an experience that’s hard to forget.

What advances are you working on for VR learning programs for soft skills?

OK, I’ll be honest: No one really asked this question, but I have some cool stuff I want to share with you. The pace of advancement in VR is incredibly fast and (shout-out to the SPARK team) we’ve got a lot going on.

Sentiment Analysis

With sentiment analysis, we’re picking up differences in the learner’s tone of voice and adapting the experience based on that input. 

Let’s say in the VR world you’re giving your “colleague” a performance review. You say the right thing, but your tone is abrupt or lacking warmth. The VR program can give you that feedback and ask you to try again, once again monitoring your tone to see if you got closer to the best practice.

In the near future (yes, AI), I predict we’ll have the ability to program the avatar to react based on your tone. Amazing!

Body Tracking

With body tracking, we have the ability to “see” the way learners are holding and moving their bodies, including hand and arm movements and posture. Body language is such an important part of how we communicate, and now we can monitor that within a VR experience.

Again, at this point we can incorporate that information into feedback and remediation, and in the future we’ll very likely be able to program a real-time response to body movements.

Rift, Go, Quest, VIVE, Cardboard . . . What headset should we be using?

Unlike many VR developers, we’ve done our very best to remain headset-agnostic. (As eLearning developers, we are also authoring tool- and LMS-agnostic.) This forces us to stay on top of the headset race for supremacy, and for our clients it means that we’re flexible to use whatever system works for you.

If you’re new to VR, you may not know which system you need, and all of these options can be pretty overwhelming. And, here I am writing this in the summer of 2019, and three or six months from now it could be a different story. 

So let me share what we’ve seen from our experience as of today. Fair warning: this is by no means a comprehensive comparison of headset features—just a quick hit on some of the bigger players that our clients tend to gravitate toward.

Cardboard

Many people want to get started with Cardboard. I get that—it’s (seemingly) an inexpensive way to get started. And that’s what it’s best used for—getting started. It’s a quick way to get people into experiences and trying VR very easily. Good use cases for Cardboard might be marketing, prototyping, and tours of environments. 

For VR, it’s very limited in terms of complexity and experience. It’s 3DOF (3 degrees of freedom), which means you can’t walk around, you can only look around. It’s limited by the phone’s CPU and the available Wi-Fi.

Here’s the real kicker if you’re thinking about Cardboard for enterprise: the equipment is really the phone. So you need to look to your mobile learning strategy—are your employees using their own phones? Are you providing the phones? Phones are as expensive as a nice VR headset!

Oculus Rift

When Rift came on the scene, it was really exciting to see a system with some real horsepower and 6 DOF (six degrees of freedom), which means you can also walk around in the VR space, not just turn your head. That’s because it’s designed to work “tethered” (connected) to a nice gaming laptop (which gives us the horsepower) and has external sensors to track the position of the person wearing the headset. Our first VR learning program for Hilton was designed for the Rift.

Today, the new headsets on the market are untethered (mobile VR), and don’t require a gaming laptop, meaning they store the VR programs on the headset itself. An untethered 6DOF experience is obviously a lot more convenient, but for high-end VR experiences we may still choose the Rift (or HTC Vive Pro) to utilize the horsepower of the connected gaming laptop. Though, generally speaking, especially as untethered devices become more powerful, that is clearly the way of the future.

Oculus Go and Quest

Go, and the latest addition to the Oculus family, Quest, are these types of headsets—mobile, untethered. Just like the evolution of phones, each new headset is able to store more data and process more information faster—which makes the VR experience richer and more interactive.

The Quest is more powerful than the Go—and more expensive. And, for now, higher quality is more expensive. But because overall the headsets are getting more powerful, that won’t be a limiter for long.

Others: VIVE, Pico

VIVE is a strong competitor of Oculus and has its own line of products doing battle with Oculus—and that’s a good thing for the consumer. While more options means more to consider, it also means a continuous push for better products and market forces driving  prices down.

Our first VR learning program for Hilton was developed for dual delivery: the Rift and the VIVE, and that’s entirely possible if that meets your needs. Often VR development is happening in multiple areas of the company (sales and marketing, learning and development) targeted for different equipment, and there’s a definite advantage to sharing among these teams.

Pico is a new player coming online with a focus on the enterprise market—one that we’re watching closely.

How to choose?

When we work with clients who are new to VR, we often recommend starting with our SPARK XR Workshop. This is a full-day session in which we bring the different headsets to you, so you can try them hands-on.

The decision you make about headsets should factor in both your enterprise needs (and budget) and the learning experiences you want to provide. We can help you find the sweet spot! As consultants immersed in a quickly changing technology-driven marketplace, we have to pay close attention and advise clients. Our leaning at this time is that Oculus is emerging as the market leader and they have a lot of momentum . . . but the game is on, which makes being on the playing field challenging but also engaging and exciting. 

How many VR users can you have at one time?

OK, let’s start here: Each user needs to have his or her own headset. 

Now, let’s talk real estate. If you’re using the Rift, remember you also need a laptop setup, so that’s going to take more space. The untethered headsets require less space, but you still need some room. For example, the Quest recommends a 6.5’x 6.5’ space for game play.

Let’s say you have a big room—like a ballroom—for your VR location, and you want to pack ‘em in. Now you need to consider sound and voice. Each user needs to be able to hear the VR program, and, assuming there’s voice recognition in your program, the program needs to be able to hear the user clearly.

Now let’s say you want all of those users to be “inside” the same virtual world at the same time. Totally possible! How many users are in that experience will depend on what makes sense for your learning objectives and the activity we design.

Can you see what the user is doing when they’re inside the VR program?

We’ve learned that being able to direct users—particularly those new to VR—is often an essential need for facilitators. Our Controller App includes some cool features to help you do that.

Facilitators will be able to connect to a headset and see what the users see, as well as cast that to a TV screen with Apple TV. Imagine using this technique in the classroom, with one user in the headset and the others watching what’s happening on the screen. Great stuff.

Do I need a developer to get started with VR?

If you’re at least somewhat familiar with eLearning authoring tools, you know there are many, many tools available out on the market to help you create eLearning. The easiest tools to use—that just about anybody with pretty good technical skills can pick up and get started with—are also the most limited in terms of their capabilities. If you’re trying to accomplish something more complex and interactive, then typically, yeah, you do want to get some help from a developer.

The same is true(ish) for VR tools. The majority of the easy authoring tools are designed to work only with 360-degree video or photography. If you’re interested in using 3D environments, having users interact with 3D objects (as we showed in the case study webinar), that will most likely require a more sophisticated tool.

The greater the complexity and quality, and the more interaction you desire, the more you’ll need to start using more complicated tools that require more and more advanced programming skills. The VR design and development space and the tools that support it are just not as mature as the eLearning space, and the pace of change is daunting. This may sound self-serving, but I believe it to be true: Except for doing rudimentary development, you’ll need a developer. In every project we’ve taken on we’ve encountered problems and challenges that are technical, creative, and even extend to how instructional design fits in. At this point in the evolution of this modality, all these things demand highly skilled teams that have the expertise to work through the inevitable issues that will arise. 

Yeah, but how long is a VR project going to take?

Again, just like eLearning, the design and development timeline is really going to depend on the complexity of the end product.

At the low-complexity end, you’ve got your basic tour. That means you pop on your headset and explore a virtual environment. Tours use 360-degree photography and/or video that is shot and then “stitched together.”

At this end of the spectrum, we’ll do a storyboard, the shoot, the stitching, and then upload the final experience. That can take as little as a few weeks, assuming the environment you want to shoot is generally available.

So that’s very simple. Moving up the spectrum of complexity, you might add actual scenes with live actors and interactive elements. That will require storyboarding, casting, shooting, stitching, and programming. And of course all of this means more testing. Now you’re looking at closer to a few months to produce your VR learning program.

To create a custom 3D environment and 3D objects with which you can interact, you’re moving up the spectrum of complexity quite a bit. 

You’ll need to take pictures of the environment and then recreate them in 3D at the level of quality you want—the higher the level of quality, the more time it will take to get the textures and details just right. You might also add characters (avatars) and objects,  which also will need to be designed.

And if you’re using 3D, you most likely want to make it interactive, so there’s programming involved as well. These projects are typically four to six months, but depend a lot on the complexity and quality.

Where should I go to learn more about VR?

The community of VR users and developers is rapidly expanding. Here are some resources to keep you up to date on all the latest:

Well first, a shameless plug for our Emerging Technology Trends for L&D eBook, which I hope you’ll download—lots of good insights on VR, AR, and AI. And please do subscribe for regular updates from SweetRush.

Within L&D specifically, the Realities 360 conference is a great way to see some of the work that’s going on. We’ll be at Oculus’s OC6 conference in September participating in various ways . . . perhaps we’ll see you there! And the XRDC conference in San Francisco in October has a training track—we’ll be speaking, so if you attend, please come say hello!

Medium is subscription-based, but does tend to have a lot of articles published about VR and AR. The social media platform Reddit has a subreddit (discussion forum community) for virtual reality.

Also, follow the headset manufacturers on social media for the latest announcements about their products: Oculus, VIVE, Pico.