Episode 22: 'VIRTUAL REALITY' with Dr Evelyn Chan

This week we speak with 'doctorpreneur' Dr Evelyn Chan.  Dr Chan is a peadiatric doctor turned CEO and co-founder of Virtual Reality start up Smileyscope.

Evelyn studied medicine and surgery at Monash University in Australia before becoming a Rhodes Scholar at the University of Oxford where she studied medical anthropology and public health. She then worked at the Boston Consulting Group, specialising in public sector and healthcare strategy. 
 
As the CEO and co-founder of Smileyscope Evelyn is now working to change the experiences of children in clinical settings.  Smileyscope grew out of Everlyn’s own clinical experience and aims to transform paediatric needle procedures through patient-centred Virtual Reality. 

As we will hear some of the advantages that Evelyn has found in her work is that VR is able to decrease patient pain and anxiety and makes it quicker and safer for clinicians to perform procedures.  

Evelyn gives us a great insight into the process that she went through in getting her company to where it is today and in doing so conducted the largest clinical study on VR in a paediatric setting anywhere in the world.  She shares some great insights into lessons learned and we really hope you enjoy this conversation as much as we did.

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Theme Music - ‘Mountain’
–
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths

Podcast artwork thanks to The Podcast Design Experts

Transcript

Evelyn: 0:00

I noticed in paediatrics that there were lots of children. The first question they would ask me was, am I going to get a shot today? Or do I need a blood test? Or, you know, it seemed to eclipse the whole conversation about what they came in for. They were just very fixated and wanted to know and was stressing about this one question. What I had noticed when I'd sort of done a lot of shifts with it. Children, you know, if you can calm them down, if you can calm the parents down and make it a much more relaxed experience that IV or that needle can go in a lot more easily? So I think it was about how can we scale that best practice and make it a much more safe and enjoyable experience for children.

David: 0:48

This is Episode 10 of the second season of the Not Mini Adults Podcast Pioneers for Children's Health Care and Well Being. My name is David Cole and once again, I'm joined by my wife Hannah. We are the co founders of children's charity Thinking of Oscar this week, we are joined by Dr. Evelyn Chan. Dr. Chan is a paediatric doctor turned CEO and co founder of virtual reality startup Smileyscope. Evelyn studied medicine and surgery at Monasch University in Australia, before becoming a Rhodes Scholar at the University of Oxford. Where she studied medical anthropology and public health as the CEO and co founder of Smileyscope. She is now working to change the experiences of children in clinical settings. Smileyscope grew out of Evelyn's own clinical experience and aims to transform paediatric needle procedures through patient centred virtual reality. As we will hear some of the advantages that Evelyn has found in her work is that VR is able to decrease patient pain and anxiety and make it quicker and safer for clinicians to perform procedures. Evelyn gives us a great insight into the process that she went through in getting her company to where it is today. In doing so conducted the largest clinical study of VR, in a paediatric setting anywhere in the world. She shares some great insights into lessons learned. We really hope you enjoyed this conversation as much as we did. Evelyn. Hi, thank you so much for joining us on the Not Mini Adults Podcast. We're so delighted to have you.

Evelyn: 2:25

Thanks so much, David and Hannah. Great to be here.

David: 2:31

You're currently in Australia, so you're the second person that we've had on the podcast from from Australia, although, as we were kind of discussing, when we first met, actually, you kind of spend your time between between the US and Oz but obviously, due to COVID, you're kind of staying put I guess, at this point in time.

Evelyn: 2:54

That's right. Yeah.

David: 2:56

So before we kind of get into it. Virtual reality is something that we've been wanting to discuss for a long time. We've had, I think, quite a few inquiries coming to us and talking about, you know, is this, is this something that is is real, is this something that we should be looking at? Is this something that we would fund? Or do you know, kind of things or what have you. So it's definitely a topic that really interests us? I think, you know, many people out there, but I guess the best best place to start is, you know, how did you get to where you are in terms of working in VR? But really kind of what what motivated you to be wanting to work with children to begin with?

Evelyn: 3:42

Yes, I suppose I'll start with the latter half of the question. I think paediatrics was the first part of the journey. For me, I grew up with a younger brother with severe autism. So he's nonverbal, needed 24 hour care. My parents had some poor sort of health experiences early on with him, you know. I think there was this theory around refrigerator parents and all sorts of things like that. I think it was a couple of negative interactions really put them off the health system early on. Saying that as a sort of older child. I was about 9 or 10, when he was born, I could really see how that impacted them and their mental health and their relationship. But also how it impacted our sort of ongoing healthcare there on. Because afterwards, it was like, I don't really feel like going to bring him to the doctor if things were going wrong. So I think early on, I sort of thought if you could really change that trajectory of healthcare. Have those fantastic experiences early on, then you would actually be able to have a great relationship moving forward and it could change the trajectory of someone's healthcare and how they thought about their disease or sought health care. So I think, you know, growing up I felt I love the science and I loved the art of medicine. So that just seemed like a natural place to go, you know, paediatrics, you could make a great impact early on. Hopefully bend the curve and change that trajectory. Then from, I suppose the second part was around virtual reality, and that that came a lot later. So I think with VR I had noticed that. I mean, I suppose first up, I should say, with patient care, I had noticed in paediatrics that there were lots of children. The first question they would ask me was, am I going to get a shot today? Or do I need a blood test? Or, you know, it seemed to eclipse the whole conversation about what they came in for. They were just very fixated and wanted to know and were stressing about this one question. What I had noticed when I had sort of done a lot of shifts was that children, you know, if you can calm them down, if you calm the parents down and make it a much more relaxed experience that IV or that needle can go in a lot more easily? So I think it was about how can we scale that best practice and make it a much more safe and enjoyable experience for children. So I actually didn't come across VR until a couple of years ago. I'd sort of heard words about it being the next big thing. But then when I tried it on myself, I sort of thought, you know, this could potentially be a fascinating, scalable technology where a child can virtually escaped to the procedure room at the sort of important points where it would be really helpful for a child to be somewhere else and be able to reframe that experience. Think about it differently. So that was kind of where I started thinking about VR, and its applicability in certain parts of healthcare.

David: 6:53

The patient experience has been something that we've been, I guess, it was pretty much the first thing that we did when we started the charity. So when Oscar was in hospital, you know, blood tests and canulations and what have you, we're pretty horrendous for all of us, obviously, mostly for him. But for the play specialists, for the nurses, for the doctors and everything else. So when we had the opportunity, then one of the first things that we funded was an Acuvein. So a vein finder, because we felt that it was something that would have been beneficial to him. So when you were, before you kind of moved into the tech side of things? What What kinds of things were you seeing that were working or not, and the experience that people were, you know, that the children were getting, whilst they were in hospital?

Evelyn: 7:46

Yes, I suppose we're talking about the fundamentals of sort of procedural care. There's sort of the physical positioning, so making sure the child is feeling safe. So we usually sit them up on the parent or the parent giving them a big hug rather than them lying down because I feel a lot more vulnerable that way. Obviously, the psychological distraction. So whether that be bubbles, toys, their favourite game, you know, a clown, a doctor or something like that and then the pharmacological side. So if we can give them a local anaesthetic or some way of decreasing the pain on their side, that's important as well. Then, you know, for younger children, it would be also providing sucrose or sugar, essentially, which has been shown to decrease the pain as well. Or in younger children again, breastfeeding is also something that can be quite supportive around procedures. So I think we always say, you know, we want all those fundamental tenants that have procedural care.

Hannah: 8:49

Someone had mentioned to us early on that if you could, cant get the exact phrasing way, so correct me if you remember exactly where this came from DC. If you could distract a child then their perception of pain would be reduced. What are the correlations there? You talked about sucrose, which I didn't know before that it could actually reduce pain, I just thought it was a distraction, you know, helpful distraction. But are there actually, you know, when you're bringing the toy in for example, is it that they're distracted? And they feel less pain or they're distracted? So the pain is less noticeable? If you see what I mean?

Evelyn: 9:30

It's a good question. So I mean, I suppose the theory comes back to this idea of their gated pain theory. So this idea that if you can engage more of the senses, then you have less bandwidth, I suppose, or less ability to pay attention to that pain. So I think that's why VR became a really interesting, you know, technology for us because we're saying, you know, rather than it being a 2D, TV or moving image where suddenly doing 3D it's much more immersive, it's actually interactive. So you're engaging more of that, you know, more of the attention than if you're watching a television. So it is I suppose that theory that, you know, you're not being able to pay attention to the pain and anxiety doesn't register as much.

Hannah: 10:20

Yeah. Okay, that makes sense thank you.

David: 10:23

At what point did you kind of realise that VR could be or, you know, any kind of technology, but but VR in this scenario could actually play a really, you know, fundamental part in that kind of alleviation of pain and trying to help children through these procedures.

Evelyn: 10:44

I think we've sort of had seen it myself and experienced it and sort of thought how immersive it was. My co founder, Paul was an adult, respiratory physician and he was seeing a lot of patients who are transitioning from, you know, paediatric to adult care. He was saying, you know, he looked after children with cystic fibrosis. He said, you know, what do you do with these children? They're so traumatised, that they're asking to be put to sleep, to get an IV cannula in every three days, you know, there's so needle phobic, you know, what can we do to help? He was actually the one that put two and two together, because I'd said, You know, I came back from this really cool VR thing, it could be really interesting in healthcare. He said, you know, could this be really interesting, particularly for procedures, where there's a lot of pain and anxiety around that. So we looked at the literature, and we sort of found that the defence force in the 80s, in the US had actually done quite a lot of research around how virtual reality might be able to decrease the need, or the dose of opioid medication when they're doing very painful burns, dressings, changes on soldiers. So that was something that sort of thought, hang on, that's a really interesting concept now that VR is much more widely available. Also, rather than being hooked up to a gigantic computer, we could do it on our phone, essentially, you know, could we apply this to much more common, you know, less painful, but very common procedures?

David: 12:20

Then Smileyscope was born, I guess.

Evelyn: 12:23

Exactly. Yeah. We then started, I suppose much more on the research side of what could we find off the shelf for ourselves. So it was very much a, you know, the usual clinician story of, you know, we analysed all the literature, we looked through, I think it was about 13,000 papers, and we did a systematic review. Analysed the research that have been done. From that realise that there were a lot of gaps in the research and that had had very small, you know, numbers in the studies. So from there sort of thought, you know, how can we validate this into a much larger study. From there sort of looked around off the shelf products, and we sort of thought, you know, there are a couple of essential key criteria that we wanted. We wanted to ensure that the patient had something that was distracting, but it also needed to be predictable for the clinician, we didn't want them to move around. So you know, I didn't really want to give them a rollercoaster ride or a dinosaur walk when they would move suddenly and I've missed the vein. It also sort of needed to bring in the best practices that we already knew about. So that physical positioning, you know and the psychological distraction. Within psychological distraction, we know that things like deep breathing and visualisation and cognitive behavioural therapies are really important in that. So we couldn't find something that was really off the shelf that worked for us. So we ended up, you know, saying, let's try and create our own. So sort of started working with patients and families and clinicians to develop that.

Hannah: 14:00

Where the two activities happening in parallel? So did you conduct the clinical trial at the same time as making some progress in developing the product? Or did one fully inform the other? How did those two pieces of work fit together?

Evelyn: 14:18

Yeah, so I suppose we started with the research on, you know, the landscape and what had already been done before. Sort of did that systematic review and analysed all the data and sort of ended up saying, look, there's a correlation between VR being helpful compared to current modalities. Then that sort of research informed the next part, which was quite fun around the discovery. So we worked with about 100 patients and their families who had had, you know, from the spectrum of, they had great blood tests to really bad ones and said, where would you like to go if you could virtually escape the procedure room and you know, about 90% of Ozzy kids said they would like to go underwater? So then we sort of broke down the procedure into, you know, so what does that tornakit feel like? They would say maybe a diving band, and what would sort of the antiseptic wash feel like and they said, you know, waves washing over your arms. What would the needle feel like. We've got some really interesting answers, as you can imagine fromkids. But the one that we felt worked really well and was actually quite a common thing was fish nibbling, because you can imagine the fish being a Dory fish or, you know, a stingray, or whatever you want to. So that could kind of accommodate the different types of pain that a child could feel or in the case of, if they had local anaesthetic, they wouldn't really feel the pain, but it would just feel like something on their skin. So that was a really kind of good way of reframing the sensations. We kind of choreograph that. We worked with a digital team, which had worked with Disney before. So we learned some fascinating things about how you work with kids. You know, how you don't want the fish to approach them directly face on. It was kind of something like that, you know, the fish would swim around and loop around before they kind of land on your arm. All those sorts of techniques that I think we sort of really brought in that clinical and digital best practice. Once we created the VR, we then said, Let's go to clinical trials and actually test this out. So we sort of had pretty much the fully developed product, from the start when we started recruiting patients

Hannah: 16:36

Must have been an incredibly exciting journey, maybe with some unexpected twists and turns. So for example, when you were talking about the digital team that you were working with in the background that they brought in.

Evelyn: 16:48

Yeah, I think I learned a lot about, you know. Sprint reviews and all sorts of technical terms. But really enjoyed it. I think they were fantastic to work with. I think combining the two so we could really think about, you know, visually, how do we make this really beautiful, exciting and wonderful experience. As well as that sort of clinical side of how can we bring in what we already know, as best practice and make that fun, was a really enjoyable process.

David: 17:18

What else did the kids say in terms of what the needle could be?

Evelyn: 17:23

So one of the ones was a dolphin bumping you. So we do actually have them riding on a dolphin when they get their IV in? So that was something that we've could bring in. A whale spurting. Yeah, so lots of coral brushing across you. So yes, lots of different interesting sensations.

David: 17:47

No Great Whites taking chunks out of their arm thank goodness then.

Evelyn: 17:50

I think we did,but that was probably a teenager that's suggested that.

David: 17:55

Thats what I thought.

Hannah: 17:59

So then you go into the clinical trials and I know that this is the trial that you completed was the largest clinical trial of its kind for VR technology, is that correct?

Evelyn: 18:11

That's right, yeah, for procedural care. So essentially, we designed this, as we really wanted to make sure that we had the numbers to be able to have an informed result that we were confident would be statistically significant. So we also want it to be quite generalizable across different cohorts. So we sort of said, well, where are two departments where a lot of IVs and venipuncture, so blood draws happen. We thought, let's pick the emergency department, because often, you know, families will come in, they're often coming in with some other reason and don't expect to get a blood test or an IV. Then let's pick the children who come in from the community and usually well, but needing regular blood tests, so they've had this before. So we chose the phlebotomy or pathology outpatient lab as well. So we did this in two large hospitals in Melbourne, and we recruited from there and we ended up getting about 120 to 130 patients in each of those groups. So the in the emergency department and in the phlebotomy lab. From there we sort of then recruited them said, you know, there's an option when we're testing this new VR technology. But we want to do it like a randomised control trial. So it's kind of like a pharmaceutical trial in the sense that you don't know which group you're going to be allocated to beforehand. All the questions are very standardised. So then we found that, you know, we're kind of have this envelope and once we've sort of asked them all the baseline questions. We would find out which group they were allocated to. The children in the VR group would have the VR experience and then the children In the standard of care group would get still best practice care. So it was a very active control. It wasn't like we put them in the room without anything. Then after that we sort of compared sort of their baseline pain and anxiety that was reported by the child, the caregiver or the parent. There was the procedure list and also an observer. So that we had those four different people giving their perspective so that we could actually kind of match and make sure that they were directionally in the same sort of, you know, precinct of what the pain or anxiety would be like. We also measure things like, you know, first stick success and how long it took to do the procedure as well. Then from that, we actually found that, interestingly, in the virtual reality group, that there was a significant drop in pain and anxiety. Parents reported less distress from the child as well, up to 75%, less distress. We actually found that there was less need to restrain children or hold down the procedural arm. So by about half, and that sort of meant that you wouldn't need as much force and you wouldn't need to necessarily bring in an additional person to support the arm.

David: 21:36

What age range were you working with in this clinical trial?

Evelyn: 21:43

Yeah, so I suppose that was another really interesting thing. We wanted to ensure that children, when they first have their first permanent memories, around the age of three or four years old, would be able to have a good experience of their first needles. So, you know, most children have four year old vaccinations. So we sort of thought 4 to 11 was kind of age range. Virtual Reality, as you probably know, most people recommend, sort of 10 years and above with the commercial headsets. We did bring this to the ethics board, and we said, Look, this is going to be a very short procedure, you know, three to five minutes, you know, they can take it off if they want to. I suppose, you know, we were also doing a lot of the adverse effects, side effects collecting as well, so that we could see whether there was any difference in the children who were given the VR compared to the control group. What we ended up finding was actually that the children in the VR group didn't have any sort of differences in the the side effects reported. Now the Common side effects of the era, you know, eyestrain, dizziness, they might feel nauseous. There are also some things that can be correlated with being nervous in general. So I think there were some children in both groups that were just anxious about the blood test. So it's hard to really pull and see, you know, what was VR and what was, you know, what was just anxiety about the blood test? But there were no differences between those two groups?

Hannah: 23:22

Did you find that VR suited the younger age bracket equally as the older age bracket, or vice versa? Or was there part of that demographic that you felt was going to be your optimal age range to target moving forward?

Evelyn: 23:40

It's a great question. I wish we had an even bigger trial where we could break down age groups. Maybe that's something we do in future is figure out, you know, where, you know, and what works best for children. But one of the interesting things that we noticed from the trial was when we worked with our digital company, we said, let's target this for children about the age of five. We're actually finding anecdotally that children around six or seven, were responding better to it. I think they cognitively understood that we're still going to have the blood test, this was going to help support them through the blood test. So I think they, they were able to enjoy that more. I think when you're stressed you're not cognitively at your best either. I think that was something that we've kept in mind as we develop future products is, you know, when we're aiming for a five year old, you know, we probably got to think about simplifying the language a little bit because just to factor in the stress and anxiety of being in hospital.

David: 24:43

Yeah, there's so there's so many questions going through my head around that because thinking when you said, you know, it's the first it's that first experience that a child might have in hospital. The first thing that they experienced is that someone sticks a needle in their arm. It's not a great one. Especially at the age of three and four, when they're starting to really kind of have memories and go ahead with it. It's just fascinating as to where that kind of level is that they will actually make a difference. Where they fully aware of what was actually happening to them. So I'm just trying to think, you know, we've got a nearly three year old now. If we told him that he was about to have a blood test, would he actually realise and understand what that meant? Especially if you put a headset on, not that any of our children have used VR, as such, but they're all you know, associated screen time and what have you. Do they do they fully understand, or are they aware of what is going to be happening to them I guess?

Evelyn: 25:54

Yeah, I mean, I think by the age of four, and I mean, I suppose there's a big spectrum, right. But I think they usually can understand what's imaginary and what's the real thing. So we were quite clear when we explained it to them, that you know, that we're still going to get the blood test and that they were able to get I suppose a distraction. One of the things that they could do was sort of have a peek and look around so that they could kind of move between both worlds. We didn't want them fully in the VR. In the VR world. Still be there and understand what was going on, but just reframe it differently. I think it was just that seven year old group kind of really understood it straightaway and it was a very easy explanation.

David: 26:42

How many children were actually in the trial in the end?

Evelyn: 26:46

Yeah, so a total of 253 children and so roughly half were in the VR group.

David: 26:54

I think one of the interesting things is that whenever you talk about funding for paediatric startups or paediatric innovations. One of the first things that people talk about is the inability in some respects and obviously, it depends on the technology, it depends on what they're trying to do the trial or the drug trial, or whatever it is, but the inability to actually do ,or the feasibility of doing trials with kids. So is there anything that you have learned that you can share in terms of best practice or, you know, thoughts just around that, that element of it?

Evelyn: 27:33

Yeah, it's a good question. I've only ever done paediatric trials. So I think, you know, when you're working in paediatric hospitals, you just realise there's going to be that extra level of scrutiny around side effects and impact on children and ensuring this consent. Instead of the older children acent, which I suppose you know, they've got to agree to it as well. But I think apart from that, I think it's just understanding that, you know, bringing in children into a clinical trial and being able to understand the perspectives and the dynamics is important. So, you know, our qualitative research, so the sort of comments and quotes that we collected. Sort of understanding the child and ensuring that the tools that we measured, were clinically validated for children was really important as well. But I think otherwise, it is very much like a standard. randomised control trial.

Hannah: 28:32

What about from the point of view of getting investment? So and I'm thinking in the same way, you know, the same sort of perspective as David said. Sort of lessons learned that others listening might learn from that. Did you face any unique challenges when you were trying to get investors on board? As a human and as a parent what you're doing sounds really sensible. But you know, we've had some conversations where we know that paediatric segment is a smaller market opportunity to be addressing. What did that mean for you when you were having those types of conversations?

Evelyn: 29:18

Yeah, I mean, I think investment is challenging for everyone. Probably for us, we were like quite a bit further down in a development before we thought we need to get investment because, you know, initially, this was something that Paul and I wanted to create for our own clinical practice. So it was very much sort of that traditional following, sort of how do we do it an internal hospital clinical trial. I think it was really only after the clinical trial and we took away the devices from the hospital after we did the investigation. Then clinicians came back and said, you know, actually we'd really like to use these please. How much should we be paying? Then suddenly we were thinking about the business model. How do we expand the business side of things. So I think for us having that clinical trial and the evidence base there already was really helpful. I think probably there are definitely challenges with paediatric care and being able to demonstrate how these can impact patients long term, if you can intervene early was important. I think just getting the right funders on board, people who understand it's a big problem and that this can have a huge impact. So we've ended up sort of just through many, many meetings, finding the right people and having the discussions around, you know, what's important for them, and ensuring it aligns with, you know, what our aims and aspirations are.

David: 30:51

Sales 101 that. Give them what they want and then take it away. Show them what they could have then take it away. Yeah. So you can get it back. So are you are you still practising from a clinical perspective?

Evelyn: 31:07

No, not today. So I decided to step away from that and focus on Smileyscope full time.

David: 31:17

If we didn't have a global pandemic, what would your kind of life look like in terms of working with Smileyscope and working with hospitals? Because as we kind of touched on at the beginning, you, I guess, you go between Australia and the US at this point in time?

Evelyn: 31:33

Yeah, so I think one of the great things about my job is it's sort of always changing. You know, one day, I'll be talking to clinicians about using the headset, about research about potential other applications. The next day, I'm sort of talking to investors. I'm sort of pitching at competitions. I'm sort of thinking about how do we kind of increase the value proposition, understanding the broader trends in healthcare, you know, with digital health is booming in many ways right now. But, you know, VR is still relatively new in healthcare and sort of what are the stepping stones? What are the elements that we need to really bring this into mainstream care? I spend quite a lot of my time in Australia, I suppose my clinical networks are established here. Our software team is here as well. Sort of thinking about how do we expand with us and the cultural and healthcare differences about working in the US has been very interesting, but also quite a challenge to navigate.

David: 32:43

Yeah, but I guess even more so now that you're doing it allremotely? Where have you got Smileyscope working in hospitals currently?

Evelyn: 32:54

Yes, we do. So we've got them in a lot of the large paediatric hospitals in Australia and quite a few of the paediatric departments in general hospitals as well. We built this initially for venous access. So IV canulas, and blood draws. Just because we thought that was one of the most common and feared needle procedures that children report that obviously it's being used a lot in vaccinations at the moment. So we're working with a lot of clinics and hospitals on, you know, how can we get children to return to care around COVID. There's been a slip in the number of children staying up to date with vaccines. So how can we try and bring them back and encourage them there. Then sort of on the other procedures in the hospital, you know, in the emergency department, there'll be suturing, or stitching up wounds, there'll be plasters to be applied or removed, which can be quite scary as well. So all sorts of interesting sort of procedures in the emergency department. Then it's starting to be used in things like port access, so for chemotherapy. Then for children with, you know, through Cerebral Palsy, there's Botox injections, which are quite horrible. They have about, you know, they might have up to 20 injections in a session, and to help sort of relax their muscles. So Smiley Scope being used there. We're hoping to do a bit more research around that as well. How can we support children when there's multiple procedures involved?

Hannah: 34:33

Ultimately, would you have different virtual experiences dependent upon the procedure that's taking place. Because you said at the beginning, when you were talking about there's a flow and so now there's a fish nibbling here or now there's something brushing past you and you know, at that point, you must have a way of knowing what's going on, you know, within the VR experience, so that, you know, now is the point in time at which you're going to conduct this part of the procedure. That's going to vary, depending on the use case, if you like, you know, as you've just described it a few minutes ago.

Evelyn: 35:09

Yeah, so once clinicians started telling us, they're applying it to different areas and procedures. What we've done with the needle procedures is we've actually built in sort of a menu option beforehand, so you can choose which body part you'd like the fish to come into. For a port access it would be kind of around the collarbone, that the fish will come in and nibble or if it's, you know, they're doing a tummy injection, we can have them nibbling there as well. So it is kind of more focused around different procedures. Then we're sort of starting to work on other areas as well, where clinicians are said, you know, I'd really like to have some support around. One example is MRI machines. So VR can't go into the MRI, at least not in its usual form. But there are a lot of children who would like to have a mock MRI or practice MRI beforehand. As clinicians, we'd also like to test whether they can sit still and lie still there long enough for an MRI procedure, which can be, you know, between, you know, 15 minutes to half an hour. So it's a long time to lie still in a very noisy tunnel. So we're able to simulate that and also be able to make it a more enjoyable experience. So, you know, we've got one storyline that we're working on at the moment where for younger children again, we worked closely with a lot of children around what would you like to experience. They have like a bakery theme. So you've got this giant donut, which is the MRI. There, you know, lots of noises around the bakery while you're helping Puggles, the penguin, sort of make donuts. Then for the aura children, it's more of a space theme. They're shooting through space and seeing comments and hearing the rocket ship going through space. So I think being at a reframe and make these a more enjoyable experience, cognitively and then supporting how they get through that procedure. That's something that we've created a new experience for.

David: 37:18

So what next? You talk a little bit about and we'll make sure that in the shownotes, and what have you that we we can put some links to your website and some of the videos and what have you, but you talk about that in the future, you'd like to have a kind of suite of products. You've kind of touched on on a few of them, but what's your you know, what's your long term, what would you ideally like to get to?

Evelyn: 37:43

So I think for us, we realised that, you know, medical procedures, very scary for patients. So really, you know, that's the kind of pointy end of medicine that we want to focus on is how can we improve patient experience? How can we improve efficiencies in procedures, and through sort of being able to support patients? For us, we're not really we're pretty tech agnostic. So VR has been a fantastic support for, you know, during a needle procedure. It's also great for, you know, experiencing things that you might be going through for an MRI, for example or even sometimes when they're doing minor procedures. Where they might be in the theatre or surgical suites. But you can be awake. So we're sort of thinking about VR from those perspectives. But also, you know, how do we provide the education beforehand so that patients can get it in a way that's child friendly, that they can understand easily? Then, so we're sort of starting to think about areas like self injectables and using AR and other interactive technologies. So we've got one, which is, you know, where you actually swing the phone into your abdomen? So you can feel, how fast it needs to be? What sort of pressure and how long do you have to hold for to ensure that you've got, you know, safely given your insulin injection or your epi pen, for example. So we're sort of looking at all different types of tech on how can you improve procedures?

David: 39:20

Sorry, I've just got to ask this. I have a relatively, you know, good understanding albeit you know, at a basic level of what VR and AR is, but can you just just describe what AR is, as opposed to virtual reality. Augmented reality as opposed to virtual reality?

Evelyn: 39:39

Yeah, so augmented reality. I mean, I suppose it's a spectrum again, but augmented reality is where you've got parts of real life and parts of like, you know, parts, which are kind of put on to a real life experience. So I think Pokemon GO would be the most common thing people would understand it would be augmented reality. Where you can still see the street, but you can see some Pokemon characters. And VR is much more like the virtual experience where you're literally in a different virtual world. But I suppose as different layers of what the computer is generated in terms of the environment that you're in.

David: 40:18

Perfect. Evelyn, thank you so much. From my tech brain point of view, as it were, there's so many questions I have, and we could go on for for ages. But just kind of bearing in mind, it's early in the morning with you don't want to keep you all day as it were. But one of the questions that we ask everybody that comes on the podcast is if you had a magic wand and you could do anything to change, you could change anything within paediatric healthcare. What what would it be?

Evelyn: 40:56

Really tricky one. I mean, I think this is probably even broader than just paediatrics. But I think, sort of effective and equitable implementation. So that uptake of best practice is often quite slow and uneven in medicine. Imagine the leaps and bounds that we could achieve in health care if we could implement all of those known best practices that we've sort of researched and being able to prove and already know about, you know, if we could implement that across the world. We would be in a fantastic state.

David: 41:31

Absolutely. No, as I think we discussed the kind of democratisation of knowledge in whatever geis that is, yeah, absolutely important. So well, thank you so much for joining us on the podcast. It's been it's been a real pleasure talking to you and so interesting what you're doing we wish you you know, so much luck with with it. I'm sure it's going to be you know, successful. Hopefully, in the not too distant future, you're going to be able to, you know, travel again, and start to really get Smileyscope out here as much as you possibly an.

Evelyn: 42:03

Guys, thanks so much, David. And Hannah, I've had a great time speaking with you and amazing work. Thank you

David: 42:10

Thank you.

Hannah: 42:11

Thank you

David: 42:20

Thank you again for joining us on the Not Mini Adults Podcast. A big thank you to Dr. Evelyn Chan for joining us and sharing her story. We're so grateful to everyone that tunes in on a weekly basis to listen to the stories and the interviews that we have. If you know of anyone that you think that we should be talking to, then please do get in touch. You can find all the details for Smileyscope and of course hinking of Oscar in the show otes. We have two more episodes eft in this second season of he podcast before we take some ime off over Christmas. So lease do join us again then.