When Constraints Expand Imagination: VEMS at Queen’s Internal Medicine

When Dr. Manveer Bal, Chief Resident at Queen's Internal Medicine, reached out, his goal was simple and ambitious at the same time:

How can we expand meaningful simulation exposure for internal medicine residents—without relying on physical simulation rooms?

Like many busy internal medicine programs, access to simulation spaces is often limited. Competing priorities, scheduling constraints, and clinical demands often mean that simulation is something residents want to do—but can’t do often enough.

So Dr. Bal tried something different.

He purchased a VEMS kit and got to work.

Expanding Simulation Capacity Without Expanding Infrastructure

One of the most powerful aspects of Visually Enhanced Mental Simulation (VEMS) is that it decouples simulation from physical space. You don’t need a sim centre or real clinical space. You don’t need elaborate setup.

You need a table. A team. And a case.

As Dr. Bal shared:

“One of the main reasons we had opted to incorporate VEMS into our simulation curriculum was the at time limited access we have to physical simulation rooms, and this has proven to be a fantastic way to expand our simulation capacity.”

This is one of the clearest advantages of VEMS in internal medicine:

• It fits into existing academic half-days

• It can run on wards, in conference rooms, or during protected teaching time

• It scales easily without major cost or infrastructure

Instead of simulation being an occasional event, it becomes a repeatable practice.

Fostering Psychologically Safe

Internal medicine teams are cognitively busy environments. Decision-making is layered, uncertainty is constant, and hierarchy can sometimes shape who speaks and who stays quiet.

Dr. Bal noted that psychological safety was front of mind in how they designed their sessions:

“...psychological safety has really influenced how we are thinking about our own simulation design.”

VEMS naturally lends itself to this. Because participants are gathered around a shared visual field—rather than performing in front of a mannequin or worrying about someone judging you behind the glass—the energy shifts:

• Discussion becomes collaborative rather than performative
  

• Cognitive processes are made visible

• Facilitators and participants are on the same team

It’s thinking out loud. Together.

Near-Peer Learning in Action

Perhaps the most exciting part of this story is who is leading it.

A Chief Resident. Designing simulation. For other residents. This is near-peer learning at its best.

When senior residents facilitate for junior colleagues:

• The clinical cases feel immediately relevant

• The cognitive load is appropriately calibrated

• The learning culture feels accessible and grounded

The hierarchy softens. Questions flow more freely. And learning becomes something the group builds together rather than something delivered from above.

Dr. Bal reflected:

“It was very well received by the residents…”

And beyond a single session, the ripple effect is already beginning:

“We are now exploring potential funding opportunities to secure additional VEMS sets to further increase simulation exposure for our residents.”

That’s how change spreads. One set. One session. One resident leader. We say, "Keep it up Manveer!"

What This Story Shows About VEMS in Internal Medicine

In busy internal medicine programs, VEMS offers:

• Scalability when simulation centre access is limited

• Flexibility to run sessions in almost any environment

• Psychological safety through shared visual cognition

• Near-peer mentorship that strengthens learning culture

And perhaps most importantly—it empowers motivated educators to act immediately.

Dr. Bal’s closing words meant a great deal:

“Thank you again for all that you do; it has had a meaningful impact on our program.”

But the real impact is what happens next: residents teaching residents, expanding access, and embedding simulation into the everyday rhythm of training. It is always amazing to see what people can do with a kit and an idea.

If you’re working in a program with limited simulation access but unlimited educational ambition, VEMS might be your starting point. Check out some of our products here