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Yep. Thanks very much on to fill. Thank you so much for asking me to speak today. The talks have bean really inspiring really interesting. Lots of different perspectives that we were just saying. In fact, I feel like I should go home and I and start making notes and all the ideas on inspiration that that is going on in my head, trying to capture some of that. But I think for wouldn't speak to me. So I better stay here. And I'm going to talk about, um, pure pillory examination as an ophthalmologist. So this will probably go so papillary Examination is something that we want all our healthcare professional graduates to know. Why is this Well, when you shine a light out and I whether the pupil constricts or whether it does nothing or whether it even dilates when you swing the torch onto it Kind of great diagnostic importance on people abnormalities or a key presenting feature off a range of different conditions from acute glaucoma within the ophthalmology world. But also optic neuritis is part of multiple sclerosis or giant cell arteritis or intracranial PCA aneurysms presenting to urgent care for example on. So we want all our graduates to know people abnormalities on. So it's not just a nocturnal aji thing. It it's also something that we want other medics working in general practice and Edie to know. But it's not just something that we want medics to know. It's something that applies to really a range of healthcare professionals, nurses doing all abs on the ward, paramedics at the scene of an accident, optometrist having patients walk into their practice with a headache, for example. So how do we teach people abnormalities? Well, the traditional starting point, of course, historically has been textbooks on online videos presented through various media on these are still used, you know they have. Their advantage is they're usually the means by which students start to learn the anatomy on physiology behind a clinical skill, which is clearly important. But clearly the learning is very limited. I bet if I asked the doctors amongst you in the final your medical students to think of a DVT thyroid glands that's enlarged or cardiac murmur that you don't think back to the point slide or the textbook. You learn this form. You're thinking of an actual patient that you saw with this sign so clearly. Textbooks and videos have limited learning potential because they are passive. So what factors help us learn better? Well, entire conferences, PhDs, books and even careers are based on trying to assess what factors help us learn better. For example, in motion attached to learning helps learning, which is interesting but pertinence to what I'm talking about. Doing something, not just listening or reading or watching something, but doing something helps learning. Unhand simulation. So if simulated patients, this great bunch of ometer actors to come along and makeup histories and pretend they have signs on simulated patients are the really, really important factor off learning how to negotiate the conduct off a clinical examination with a really person, which is a really important skill. But certainly when it comes to pupil abnormalities, there's a limit to what abnormalities can be simulated. Really, it's only one, which is the fix Dilated pupil. When you pop the stinky drop in there, I first thing in the morning. Of course, there are medical manikins automotives on. They could be really brilliant. The really brilliant ones also tend to be really expensive on. Of course, they live in the simulation center. You can't bring them home just like simulated patients. It's considered bad form to bring your simulated patient home to practice examination on disseminated Patients and Monica are great, but they're limited. Resource on the challenge is that we want all our medical students on healthcare professionals our graduation to have seen a range of clinical abnormalities before they're sending in a really cubicle or real clinical room with the real patient under real abnormality on. So we stand students out on clinical placement, hoping that the number of months of placement they have in the range of attachments expose them to arrange of clinical abnormalities. And they'll get to see and maybe even to examine different people abnormalities. Occasionally we even give them a log book. Clearly, it generally works. Are medical graduates are excellent. Clearly they have targets and standards that have to be reached. But at the same time, certainly when it comes to pupil abnormalities, look, it's opportunistic. And so the solution it seemed to me some years ago was really obvious, announce virtual reality. And so I worked with a coating company sent a real who are Northern Ireland based firm who developed. We are educational ups, really terrific bunch of people to work with both before the developments are during it. On in particular, since the development, they've been so helpful on redeveloped on up to examine people's. And it's just something I think that's worth showcasing, hopefully to maybe inspire some scholarly activity, some development, you know, some extension of the idea. All our final year. Medical students and Queens University do an exercise called the Simulated I Clinic that some here have done on this semester. One of the six stations was the virtual reality up, so we'd over 200 students going through this out, and I was there for each time. So it's an interesting experience. What have I learned? Well, first of all, most off the medical students, interestingly, had never used the ER or only used fleetingly. So when they put on the head set, there was invariably kind of surprised on uneven short reaction, as they always a positive reaction, a delighted type of shock when they entered this virtual world on here, If you screen shots from the virtual world, the head shots the users view that they saw in the top left as you look, you can see the reception room that the upstarts in with clipboards on buttons beside a range of people abnormalities. And you can press any of the buttons to select people abnormality, which includes normal on random. In the top middle. You see that simulated patient herself who will have the people abnormality that the users just selected on a button for greet patient where you hear me droning on for about 20 seconds, but just to remind students of the importance that off a conversation that might actually happen with the real person, then in the top, right, As you look, you see the view from the far side of the clinical room without light coming. Dine from the ceiling that, ideally, and people examination should be turned off in the bottom left is you. Look, this is the money shot. This is the people of examination itself, going on on the bottom right. As you look, it shows a couple of clipboard showing the assessment that users conducive. They want to that Ask them what they saw, what they think the diagnosis is and gives a bit of feedback on in the bottom middle. Then you ice on host of the importance of wearing glasses if they fit under the headset. And most cases glasses did fit, but that was occasionally an issue as well. But most students agreed. Not like. I'm well aware that into these positive results fed a few factors. I'm sure very much this is an expression of the normally value on the fun off the feet are up, but you know, these are mature. Finally, your students and I hope in the mix is they're genuine assessment off the potential educational effectiveness off this up. Perhaps there's always the comments, however. We're really interesting, perhaps revealed Mawr with eight comments to look at in the top left, someone said that it annoyed me to see an A P D, which I've never seen before on in the bottom left. You see, someone said I had not seen people re defects in real practice. By finally ER, they hadn't seen people really defects, so this was beneficial. That kind of brings home to me the usefulness of this in the top, right? Someone wrote it would be a great up and use it at home if I could. On the headset was maybe, you know, cost 300 points, plus 50 points for the hard carrying case from Oculus. It's really initially attended as a gaming device on, You know, compared to other gaming devices, it's in the same ballpark. It's not astronomically expensive for a home user on someone said that I love to have more exposure to this platform. In the top left, someone said it should be ruled out across the curriculum on the bottom left as you look, you can see a really interesting comment that off someone who said that it takes the anxiety I'd off performing in front of students. Plus so you could make mistakes for a bottom, which was really interesting. I suppose there's a bit of potential loss of face when you're performing a skill at the bedside in front of a teacher in front of peers, perhaps, and even in front of the SP. But this was completely private. This is an SP who would never judge you. No, With the quest, you can cast what's going on project, what's going on on to any screen, which is interesting potential for assessment, but you don't have to in the top right as you look, someone suggested what we hope to do, which is expand the use of the up to fundoscopy but also to feels on eye movements and acuity on. Someone was really enthusiastic about it. This was really heartening in capital letters. They love the ER on something so innovative, a bit different to keep the learning process interesting. I mean, I feel really lucky, and I'm not just saying this, but our medical students are so engaged, uninterested on their great bunch to work with. But clearly anything that can increase the fun on engagement off learning is to be commanded. So I think it's important. However, with all this excitement and positivity to put, we are in context. And when we're building a medical graduate, if you want to think of it like a building project, the VR isn't a blueprint. It's not a pedagogy. It's just a tool. Know it's quite a fancy tool. It's like a fancy spanner, but it has to be used in a plant way as part of an overall architectural philosophy. More plan, if you like, But it is a tool that facilitates deliberate learning on deliberate practice, so this is this. I'm very proud of this acronym. I thought of this all by myself yesterday. To be honest, I haven't Googled it because I'm quite sure it exists. And I don't want to punch in my one my smugness coming up with this yesterday and certainly the concepts are new at all. But for me, it's what deliberate practice is all about. It what the er allies, which is repetition intentionality about the practice, faith that it's going to work when you turn up and put your minutes and hours into this that is going to lead to results of course, fund motivation to continue on engagement. So I'm just going to read the site deliberately because I think the summary, in a way, is that VR offers an opportunity for students to engage in clinically relevant, deliberate practice with an S P who will never tire on, have whatever people abnormality you choose it. Toe Have Rafael Grossman's talk was really exciting and inspiring, showcasing all the different tools that his world are already here on certain. EVR is definitely coming to medical education, whether we like it or not on it's incumbent on us to make sure that when it's used, but it's used in a valid way that it does what we want it to on. It's used in an effective, evidence based way, cause the temptation is to be seduced by the fun and the tech side of it on it is fun on interesting, but we have to use it usefully on again, a point I was going to make that a cyst noted in the chart Rafael Chrisman also made is that we mustn't ever lose sight of the load star and everything we're doing, which is the patient. And I loved his phrase a bite tech, rescuing that time with the patient. And it's exactly what I was going to say that we need to learn the clinical skills and usually we learn these skills with patients. But they are offers a way to accelerate the learning so that when we turn up to the patients were already proficient in the clinical skill. We need to practice it on the patient, but we can focus our resources on those wider human elements of interacting with a real person. But it's gonna be really fun in the coming years to see how this technology right on. Uh, I'm happy. Amanda made the point. Really? Er but enthusing older people. I don't think she used the word older, but I felt I felt it. Directed every amongst others, but very happy to receive e mails on people who are interested in exploring scholarly activity around this. Up on. Thank you all for listening. Go. Thanks for the presentation. Very impressed by it. Looking at what you're teaching it comes across to me is very similar to some of the preparation for the advanced life support and pediatric Life Support which looks findings and make a decision on your next step. So one is there anything in what you're teaching that makes the virtual virtual reality approach? Um completely necessary? Could this be done with a mouse and video? So we do have could just be done by myself Or video. I mean, we do have video off someone examining people's on their videos of lovely examples of people abnormalities, but I think the key thing that adds to the learning benefits off this that gives it on experiential nature Is Thean Mersch in on mean? Even though the graphics aren't exactly human, like they don't have to be super high fidelity for the brain to buy it on. I mean, when I'm doing the people up, I don't get in Adrenaline rush Riddell itty of graphics. You know, I can say I got on adrenaline rush. Bit of a random example, but it makes the point that the brain buys this. This is immersive. This is much more learning value than passive nature of just watching something. Thanks when you thank you.