Dr Chris Paton

LIFE is a research and engineering project I have led as Principal Investigator since 2014, based at the Centre for Tropical Medicine and Global Health at the University of Oxford. The platform delivers 3D-simulated clinical scenarios on ordinary Android and iOS phones, so that a doctor, nurse, or midwife can rehearse the time-critical algorithms for neonatal resuscitation, paediatric emergencies, and adult acute care in the same setting in which they will use them.

The premise of the project is straightforward: a large fraction of in-hospital deaths in low-resource settings are caused by emergencies for which an evidence-based algorithm already exists, and the gap is in recall and confident execution under time pressure. The standard treatment for that gap is in-person simulation training, which is expensive, episodic, and rarely available at the bedside. A smartphone-based simulator can be repeated as often as the learner needs, in the language they want, on hardware they already own, with no internet connection required at the point of use.

LIFE was built by a Kenya, UK collaborative team and has been used in implementation studies and randomised controlled trials in Kenya, Nigeria, Vietnam, and the United States. It powers the digital component of the international Helping Babies Breathe training programme and has been adapted into virtual reality (eHBB) for higher-fidelity refresher training.

How it works

Each scenario presents an animated 3D patient and clinical environment. The learner is asked to make sequential decisions, drug, dose, airway, position, defibrillation, that mirror the published algorithm. The simulator records every decision with millisecond timing, scores the learner against the canonical pathway, and replays the case with adaptive feedback drawn from a Bayesian learner model. Each session takes five to ten minutes; the same case can be repeated until the learner reaches mastery.

The platform runs entirely on-device after a one-time download, which matters for hospitals where the wifi is unreliable and the data is expensive. A separate dashboard, built on the open-source DHIS2 platform, lets training coordinators see aggregate progress across a hospital or a country programme without identifying individual learners.

Evidence base

The platform has been evaluated through a series of peer-reviewed studies, several of which I co-authored. Selected publications hosted in this repository:

• Wanyama et al. 2022. Lessons from the design, development and implementation of a three-dimensional (3D) neonatal resuscitation training smartphone application: Life-saving Instruction for Emergencies (LIFE). Advances in Simulation.
• Umoren et al. 2021. eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings. BMJ Open.
• Ezenwa et al. 2022. Using mobile virtual reality simulation to prepare for in-person Helping Babies Breathe training: secondary analysis of a randomised controlled trial. JMIR Medical Education.
• Tuti et al. 2020. Evaluation of adaptive feedback in a smartphone-based game on health care providers' learning gain: randomised controlled trial. Journal of Medical Internet Research.
• Edgcombe, Paton, English. 2016. Enhancing emergency care in low-income countries using mobile technology-based training tools. Archives of Disease in Childhood.

Awards and funding

LIFE has been recognised by two international prizes and has received public-research funding from UK and global health donors:

• Saving Lives at Birth: A Grand Challenge for Development. Round 6 transition-to-scale award for the LIFE platform's neonatal resuscitation training in sub-Saharan Africa. Saving Lives at Birth is a partnership of USAID, the Bill & Melinda Gates Foundation, the Government of Norway, Grand Challenges Canada, the UK Foreign, Commonwealth and Development Office, and the Korea International Cooperation Agency.
• VR for Impact. HTC Vive global prize for using virtual reality to accelerate progress on the Sustainable Development Goals, awarded for the eHBB virtual reality extension of the LIFE platform.
• Global Challenges Research Fund (GCRF) and UK Research and Innovation grants supporting the underlying research at the Centre for Tropical Medicine and Global Health.