Immersive virtual reality as a teaching tool for neuroanatomy

Collaborative 360° virtual reality training of medical students in clinical examinations

Simulation-based training in computer-generated environments has always played an important role in clinical medical education. Recently, there has been a growing interest in using 360° videos of real-life situations for training in health professions. Several studies report positive results from using 360° Virtual Reality for individuals, yet there are currently no studies on collaborative 360° Virtual Reality training. In this paper, we evaluate how 360° Virtual Reality can support collaborative training in clinical medical education. The study population consisted of 14 medical students in semester 5 of their Bachelor's programme. The students were divided into three groups before watching and annotating a 360° video of an authentic learning situation inside a collaborative immersive virtual reality space. The original video shows a problem-based examination of the collateral and cruciate ligaments of the knee performed by students under the supervision of a professor. After training in collaborative 360° Virtual Reality, students then had to perform the same tests in a physical examination. The students' performance was subsequently evaluated by a professor with expertise in knee examinations. The results show that 12 out of 14 students received a score of 2 for one or more tests, thereby meeting the required learning objective. One student received a score of 1 and one student did not perform any of the tests. The students actively use the tools provided by the software and different communicative strategies when working collaboratively in 360° Virtual Reality, which enables them to perform the tests in the physical examination by transferring their constructed knowledge. The results indicate that our pedagogical design in collaborative immersive 360° Virtual Reality can become a relevant addition to face-to-face clinical medical training.

Blending space and time to talk about cancer in extended reality

We introduce a proof-of-concept extended reality (XR) environment for discussing cancer, presenting genomic information from multiple tumour sites in the context of 3D tumour models generated from CT scans. This tool enhances multidisciplinary discussions. Clinicians and cancer researchers explored its use in oncology, sharing perspectives on XR's potential for use in molecular tumour boards, clinician-patient communication, and education. XR serves as a universal language, fostering collaborative decision-making in oncology.

Efficacy of virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

Anatomy is the cornerstone of medical education. Virtual reality (VR) and augmented reality (AR) technologies are becoming increasingly popular in the development of anatomy education. Various studies have evaluated VR and AR in anatomy education. This meta-analysis aims to evaluate the effectiveness of VR and AR in anatomical education. The protocol was registered in Prospero. Scopus, PubMed, Web of Science, and Cochrane Library databases were searched. From the 4487 articles gathered, 24 randomized controlled trials were finally selected according to inclusion criteria. According to the results of the meta-analysis, VR had a moderate and significant effect on the improvement of knowledge scores in comparison with other methods (standardized mean difference = 0.58; 95% CI = 0.22, 0.95; p < 0.01). Due to the high degree of heterogeneity (I2 = 87.44%), subgroup analyses and meta-regression were performed on eight variables. In enhancing the "attitude," VR was found to be more "useful" than other methods (p = 0.01); however, no significant difference was found for "enjoyable" and "easy to use" statements. Compared with other methods, the effect of AR on knowledge scores was non-significant (SMD = -0.02; 95% CI = -0.39, 0.34; p = 0.90); also, in subgroup analyses and meta-regression, the results were non-significant. The results indicate that, unlike AR, VR could be used as an effective tool for teaching anatomy in medical education. Given the observed heterogeneity across the included studies, further research is warranted to identify those variables that may impact the efficacy of VR and AR in anatomy education.

Immersive Photorealistic Three-Dimensional Neurosurgical Anatomy of the Cerebral Arteries: A Photogrammetry-Based Anatomic Study

BACKGROUND AND OBJECTIVES

Neurosurgeons need a profound knowledge of the surgical anatomy of the cerebral arteries to safely treat patients. This is a challenge because of numerous branches, segments, and tortuosity of the main blood vessels that supply the brain. The objective of this study was to create high-quality three-dimensional (3D) anatomic photorealistic models based on dissections of the brain arterial anatomy and to incorporate this data into a virtual reality (VR) environment.

METHODS

Two formaldehyde-fixed heads were used. The vessels were injected with radiopaque material and colored silicone and latex. Before the dissections, the specimens were computed tomography scanned. Stratigraphical anatomic dissection of the neck and brain was performed to present the relevant vascular anatomy. A simplified surface scanning method using a mobile phone-based photogrammetry application was used, and the data were incorporated into a VR 3D modeling software for post-processing and presentation.

RESULTS

Fifteen detailed layered photorealistic and two computed tomography angiography-based 3D models were generated. The models allow manipulation in VR environment with sufficient photographic detail to present the structures of interest. Topographical relevant anatomic structures and landmarks were annotated and uploaded for web-viewing and in VR. Despite that the VR application is a dedicated 3D modeling platform, it provided all necessary tools to be suitable for self-VR study and multiplayer scenarios with several participants in one immersive environment.

CONCLUSION

Cerebral vascular anatomy presented with photogrammetry surface scanning method allows sufficient detail to present individual vessel's course and even small perforating arteries in photorealistic 3D models. These features, including VR visualization, provide new teaching prospects. The whole study was done with simplified algorithms and free or open-source software platforms allowing creation of 3D databases especially useful in cases with limited body donor-based dissection training availability.

Theoretical foundations and implications of augmented reality, virtual reality, and mixed reality for immersive learning in health professions education

BACKGROUND

Augmented Reality (AR), Virtual Reality (VR) and Mixed Reality (MR) are emerging technologies that can create immersive learning environments for health professions education. However, there is a lack of systematic reviews on how these technologies are used, what benefits they offer, and what instructional design models or theories guide their use.

AIM

This scoping review aims to provide a global overview of the usage and potential benefits of AR/VR/MR tools for education and training of students and professionals in the healthcare domain, and to investigate whether any instructional design models or theories have been applied when using these tools.

METHODOLOGY

A systematic search was conducted in several electronic databases to identify peer-reviewed studies published between and including 2015 and 2020 that reported on the use of AR/VR/MR in health professions education. The selected studies were coded and analyzed according to various criteria, such as domains of healthcare, types of participants, types of study design and methodologies, rationales behind the use of AR/VR/MR, types of learning and behavioral outcomes, and findings of the studies. The (Morrison et al. John Wiley & Sons, 2010) model was used as a reference to map the instructional design aspects of the studies.

RESULTS

A total of 184 studies were included in the review. The majority of studies focused on the use of VR, followed by AR and MR. The predominant domains of healthcare using these technologies were surgery and anatomy, and the most common types of participants were medical and nursing students. The most frequent types of study design and methodologies were usability studies and randomized controlled trials. The most typical rationales behind the use of AR/VR/MR were to overcome limitations of traditional methods, to provide immersive and realistic training, and to improve students' motivations and engagements. The most standard types of learning and behavioral outcomes were cognitive and psychomotor skills. The majority of studies reported positive or partially positive effects of AR/VR/MR on learning outcomes. Only a few studies explicitly mentioned the use of instructional design models or theories to guide the design and implementation of AR/VR/MR interventions.

DISCUSSION AND CONCLUSION

The review revealed that AR/VR/MR are promising tools for enhancing health professions education, especially for training surgical and anatomical skills. However, there is a need for more rigorous and theory-based research to investigate the optimal design and integration of these technologies in the curriculum, and to explore their impact on other domains of healthcare and other types of learning outcomes, such as affective and collaborative skills. The review also suggested that the (Morrison et al. John Wiley & Sons, 2010) model can be a useful framework to inform the instructional design of AR/VR/MR interventions, as it covers various elements and factors that need to be considered in the design process.

Enhancing educational experience through establishing a VR database in craniosynostosis: report from a single institute and systematic literature review

Background

Craniosynostosis is a type of skull deformity caused by premature ossification of cranial sutures in children. Given its variability and anatomical complexity, three-dimensional visualization is crucial for effective teaching and understanding. We developed a VR database with 3D models to depict these deformities and evaluated its impact on teaching efficiency, motivation, and memorability.

Methods

We included all craniosynostosis cases with preoperative CT imaging treated at our institution from 2012 to 2022. Preoperative CT scans were imported into SpectoVR using a transfer function to visualize bony structures. Measurements, sub-segmentation, and anatomical teaching were performed in a fully immersive 3D VR experience using a headset. Teaching sessions were conducted in group settings where students and medical personnel explored and discussed the 3D models together, guided by a host. Participants' experiences were evaluated with a questionnaire assessing understanding, memorization, and motivation on a scale from 1 (poor) to 5 (outstanding).

Results

The questionnaire showed high satisfaction scores (mean 4.49 ± 0.25). Participants (n = 17) found the VR models comprehensible and navigable (mean 4.47 ± 0.62), with intuitive operation (mean 4.35 ± 0.79). Understanding pathology (mean 4.29 ± 0.77) and surgical procedures (mean 4.63 ± 0.5) was very satisfactory. The models improved anatomical visualization (mean 4.71 ± 0.47) and teaching effectiveness (mean 4.76 ± 0.56), with participants reporting enhanced comprehension and memorization, leading to an efficient learning process.

Conclusion

Establishing a 3D VR database for teaching craniosynostosis shows advantages in understanding and memorization and increases motivation for the study process, thereby allowing for more efficient learning. Future applications in patient consent and teaching in other medical areas should be explored.

A study on the impact of open source metaverse immersive teaching method on emergency skills training for medical undergraduate students

BACKGROUND

In recent years, the traditional simulation-based medical teaching approach has faced challenges in meeting the requirements of practical emergency medicine education. This study utilized open-source tools and software to develop immersive panoramic videos using virtual reality technology for emergency medical teaching. It aims to investigate the efficacy of this novel teaching methodology. This transformation shifted the focus from physical simulation to virtual simulation in medical education, establishing a metaverse for emergency medical teaching.

METHODS

In accordance with the curriculum guidelines, the instructors produced panoramic videos demonstrating procedures such as spinal injury management, humeral fracture with abdominal wall intestinal tube prolapse, head and chest composite injuries, cardiopulmonary resuscitation, and tracheal intubation. Using Unity software, a virtual training application for bronchoscopy was developed and integrated into the PICO4 VR all-in-one device to create a metaverse teaching environment. Fourth-year medical undergraduate students were allocated into either an experimental group (n = 26) or a control group (n = 30) based on student IDs. The experimental group received instruction through the metaverse immersive teaching method, while the control group followed the traditional simulation-based medical teaching approach. Both groups participated in theoretical and practical lessons as usual. Subsequently, all students underwent a four-station Objective Structured Clinical Examination (OSCE) to assess the effectiveness of the teaching methods based on their performance. Additionally, students in the experimental group provided subjective evaluations to assess their acceptance of the new teaching approach.

RESULTS

Before the training commenced, there were no significant statistical differences in the first aid test scores between the experimental and control groups. Following the training, the experimental group outperformed the control group in the four-station OSCE examination, with all P-values being less than 0.05. The satisfaction rate among the experimental group regarding the new teaching method reached 88.46%, reflecting levels of satisfaction and extreme satisfaction.

CONCLUSION

The open-source metaverse immersive teaching method has demonstrated a positive impact on enhancing the emergency skills of medical undergraduate students, with a high level of acceptance among students. In comparison to traditional simulated medical teaching methods, this approach requires less time and space, incurring lower costs, and is deemed worthy of wider adoption.

A comparison of virtual reality and three-dimensional multiplanar educational methods for student learning of cone beam computed tomography interpretations

OBJECTIVES

The purpose of this study was to compare student learning of cone beam computed tomography (CBCT) interpretation using immersive virtual reality (VR) and three-dimensional multiplanar (MP) reconstructions.

METHODS

Sixty first-year dental students were randomly allocated to two groups, VR and MP, and underwent a one-on-one educational intervention to identify anatomic structures using CBCT data. All participants completed three multiple-choice questionnaires (MCQs) before (T1), immediately after (T2), and 2 weeks following (T3) the intervention. Additionally, pre-survey, post-survey, NASA Task Load Index (NASA-TLX), and presence questionnaires were completed. Analysis of objective measures of performance on MCQs and subjective data from the questionnaires was completed (α = 0.05).

RESULTS

There was a significant increase in test performance and informational recall between T1-T2 and T1-T3 for VR and MP groups (p < 0.001). However, there were no significant differences in performance on MCQs between T2 and T3. Analysis of the Presence questionnaire indicated that the VR group felt decreased distraction (p = 0.013), increased realism (p = 0.035), and increased involvement (p = 0.047) during the educational intervention when compared with the MP group. Analysis of the NASA-TLX indicated that the VR group experienced more physical demand (p < 0.01) but similar cognitive demand when compared with the MP group. Qualitative responses indicated that the VR group had a more dynamic sense of visualization and manipulation compared to the MP group.

CONCLUSION

Results from this study show that VR is as effective as traditional MP methods of CBCT interpretation learning. Further benefits of VR educational intervention include increased involvement, realism and less distraction.

A comparison of virtual reality anatomy models to prosections in station-based anatomy teaching

Immersive virtual reality (i-VR) is a powerful tool that can be used to explore virtual models in three dimensions. It could therefore be a valuable tool to supplement anatomical teaching by providing opportunities to explore spatial anatomical relationships in a virtual environment. However, there is a lack of consensus in the literature as to its effectiveness as a teaching modality when compared to the use of cadaveric material. The aim of our study was to compare the effectiveness of i-VR in facilitating understanding of different anatomical regions when compared with cadaveric prosections for a cohort of first- and second-year undergraduate medical students. Students (n = 92) enrolled in the MBBS program at Queen Mary University of London undertook an assessment, answering questions using either Oculus i-VR headsets, the Human Anatomy VR™ application, or prosection materials. Utilizing ANOVA with Sidak's multiple comparison test, we found no significant difference between prosections and i-VR scores in the abdomen (p = 0.6745), upper limb (p = 0.8557), or lower limb groups (p = 0.9973), suggesting that i-VR may be a viable alternative to prosections in these regions. However, students scored significantly higher when using prosections when compared to i-VR for the thoracic region (p < 0.0001). This may be due to a greater need for visuospatial understanding of 3D relationships when viewing anatomical cavities, which is challenged by a virtual environment. Our study supports the use of i-VR in anatomical teaching but highlights that there is significant variation in the efficacy of this tool for the study of different anatomical regions.

Validation of the motivated strategies for learning questionnaire and instructional materials motivation survey

PURPOSE

To validate the Motivated Strategies for Learning Questionnaire (MSLQ), which measures learner motivations; and the Instructional Materials Motivation Survey (IMMS), which measures the motivational properties of educational activities.

METHODS

Participants (333 pharmacists, physicians, and advanced practice providers) completed the MSLQ, IMMS, Congruence-Personalization Questionnaire (CPQ), and a knowledge test immediately following an online learning module (April 2021). We randomly divided data for split-sample analysis using confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and the multitrait-multimethod matrix.

RESULTS

Cronbach alpha was ≥0.70 for most domains. CFA using sample 1 demonstrated suboptimal fit for both instruments, including 3 negatively-worded IMMS items with particularly low loadings. Revised IMMS (RIMMS) scores (which omit negatively-worded items) demonstrated better fit. Guided by EFA, we identified a novel 3-domain, 11-item 'MSLQ-Short Form-Revised' (MSLQ-SFR, with domains: Interest, Self-efficacy, and Attribution) and the 4-domain, 12-item RIMMS as the best models. CFA using sample 2 confirmed good fit. Correlations among MSLQ-SFR, RIMMS, and CPQ scores aligned with predictions; correlations with knowledge scores were small.

CONCLUSIONS

Original MSLQ and IMMS scores show poor model fit, with negatively-worded items notably divergent. Revised, shorter models-the MSLQ-SFR and RIMMS-show satisfactory model fit (internal structure) and relations with other variables.

A review on cultivating effective learning: synthesizing educational theories and virtual reality for enhanced educational experiences

Immersive technology, especially virtual reality (VR), transforms education. It offers immersive and interactive learning experiences. This study presents a systematic review focusing on VR's integration with educational theories in higher education. The review evaluates the literature on VR applications combined with pedagogical frameworks. It aims to identify effective strategies for enhancing educational experiences through VR. The process involved analyzing studies about VR and educational theories, focusing on methodologies, outcomes, and effectiveness. Findings show that VR improves learning outcomes when aligned with theories such as constructivism, experiential learning, and collaborative learning. These integrations offer personalized, immersive, and interactive learning experiences. The study highlights the importance of incorporating educational principles into VR application development. It suggests a promising direction for future research and implementation in education. This approach aims to maximize VR's pedagogical value, enhancing learning outcomes across educational settings.

[Multidimensional formats of surgical anatomy in otorhinolaryngology student teaching-a comparison of effectivity]

BACKGROUND

Technological change in healthcare and the digital transformation of teaching require innovations in student teaching in medicine. New technologies are needed to enable the delivery and use of diverse teaching and learning formats by educational institutions independent of time and place. The aim of this study is to analyze the effectiveness of different multidimensional formats in student teaching in surgical ENT medical anatomy.

MATERIALS AND METHODS

During the summer semester 2022 and winter semester 2022/2023, the digital teaching and learning program was expanded by testing different visualization formats (3D glasses, cardboards, or VR glasses) with students in the context of a highly standardized surgical procedure, namely cochlear implantation. A pre- and post-intervention knowledge assessment was carried out in all groups, followed by an evaluation.

RESULTS

Of 183 students, 91 students fully participated in the study. The post-intervention knowledge assessment showed a significant increase in correct answers regardless of visualization format. In a direct comparison, the operating room (OR) group answered correctly significantly more often than the cardboard group (p = 0.0424). The majority of students would like to see 3D teaching as an integral part of the teaching program (87.9%) and more streaming of live surgeries (93.4%). They see the use of the various technologies as a very good addition to conventional surgical teaching (72.5%), as good visualization (89%) increases retention (74.7%) and motivation (81.3%).

CONCLUSION

Application and use of new visualization technologies in everyday clinical practice is a promising approach to expanding student training. Mobile, interactive, and personalized technical formats can be adapted to the learning behavior of students. Last but not least, the use of new media influences learning motivation. An expansion of digital teaching and learning formats can be expressly recommended on the basis of this study.

Personalization above anonymization? A role for considering the humanity and spirituality of the dead in anatomical education

Clinical anatomy education is meant to prepare students for caring for the living, often by working with the dead. By their nature many clinical anatomy education programs privilege topographical form  over the donor's humanity. This inbalance between the living and the dead generates tensions between the tangible and the spiritual insofar as semblances of the humanity of donors endure even in depictions and derivatives. This article argues that considering the relevance of spirituality, and what endures of a donor's humanity after death, would enhance contemporary anatomy education and the ethical treatment of human body donors (and derivatives). In developing this argument, we (the authors) address the historical connection between spirituality and anatomy, including the anatomical locations of the soul. This serves as a basis for examining the role of the mimetic-or imitative-potential of deceased human donors as representations of the living. We deliberate on the ways in which the depersonalization and anonymization of those donating challenge the mimetic purpose of human body donors and the extent to which such practices are misaligned with the health care shift  from a biomedical to a biopsychosocial model. Weighing up the risks and opportunities of anonymization versus personalization of human body donors, we propose curricula that could serve to enhance the personalization of human donors to support students learning topographical form. In doing so, we argue that the personalization of human donors and depictions could prevent the ill effects of digital representations going "viral," and enhance opportunities for donors to help the general public learn more about the human form.

3D visualization technology for Learning human anatomy among medical students and residents: a meta- and regression analysis

BACKGROUND

3D visualization technology applies computers and other devices to create a realistic virtual world for individuals with various sensory experiences such as 3D vision, touch, and smell to gain a more effective understanding of the relationships between real spatial structures and organizations. The purpose of this study was to comprehensively evaluate the effectiveness of 3D visualization technology in human anatomy teaching/training and explore the potential factors that affect the training effects to better guide the teaching of classroom/laboratory anatomy.

METHODS

We conducted a meta-analysis of randomized controlled studies on teaching human anatomy using 3D visualization technology. We extensively searched three authoritative databases, PubMed, Web of Science, and Embase; the main outcomes were the participants' test scores and satisfaction, while the secondary outcomes were time consumption and enjoyment. Heterogeneity by I² was statistically determined because I²> 50%; therefore, a random-effects model was employed, using data processing software such as RevMan, Stata, and VOSviewer to process data, apply standardized mean difference and 95% confidence interval, and subgroup analysis to evaluate test results, and then conduct research through sensitivity analysis and meta-regression analysis.

RESULTS

Thirty-nine randomized controlled trials (2,959 participants) were screened and included in this study. The system analysis of the main results showed that compared with other methods, including data from all regions 3D visualization technology moderately improved test scores as well as satisfaction and enjoyment; however, the time that students took to complete the test was not significantly reduced. Meta-regression analysis also showed that regional factorsaffected test scores, whereas other factors had no significant impact. When the literature from China was excluded, the satisfaction and happiness of the 3D virtual-reality group were statistically significant compared to those of the traditional group; however, the test results and time consumption were not statistically significant.

CONCLUSION

3D visualization technology is an effective way to improve learners' satisfaction with and enjoyment of human anatomical learning, but it cannot reduce the time required for testers to complete the test. 3D visualization technology may struggle to improve the testers' scores. The literature test results from China are more prone to positive results and affected by regional bias.

User acceptance of neuroanatomy virtual reality course: Contrasting views between undergraduate and postgraduate students

Virtual Reality (VR) offers cost-efficient and effective tools for spatial 3-dimensional neuroanatomy learning. Enhancing users-system relationship is necessary for successful adoption of the system. The current study aimed to evaluate students' acceptance of VR for neuroanatomy. An exploratory qualitative case study based on Unified Theory of Acceptance and Use of Technology (UTAUT) framework carried out at [details omitted for double-anonymized peer review]. Participants in this study were students participating in a VR session, followed by a semi-structured interview. Deductive framework analysis employed to retrieve students' perspective and experience. A total of six undergraduate and 13 postgraduate students participated in this study. The following UTAUT constructs validated to be significant: Performance Expectancy, Effort Expectancy and Facilitating Conditions. System usability, depth of lesson and hardware optimizations are among concern for further improvements. In conclusion, students are accepting VR as a neuroanatomy learning resource. The findings of this research highlight the importance of system performance and user-centred approach in technology development for educational purposes.

Anatomic Review in 3D Augmented Reality Alters Craniotomy Planning Among Residents

OBJECTIVE

Objectively examine the effect of 3D-Augmented Reality anatomic review on craniotomy planning among neurosurgical residents as it pertains to craniotomy size, skull positioning, and knowledge of significant anatomic relationships.

METHODS

Postgraduate year 1-7 neurosurgery residents were instructed to review standard 2D radiographs, pin a skull, and tailor a craniotomy for 6 different lesions and case vignettes. Participants then reviewed the lesion in a 3D-augmented reality (AR) environment, followed by repeating the craniotomy station for a variety of lesion types and locations (superficial, subcortical, deep, skull base). Quiz with case-specific anatomic and surgical questions followed by an exit survey for qualitative impressions.

RESULTS

Eleven of thirteen eligible residents participated. Skull position significantly changed in 5 out of 6 cases after 3D-AR view (P < 0.05, 20° angular adjustment). No significant change in incision length or craniotomy size. Subgroup analysis of junior versus senior residents revealed that craniotomy size was significantly altered in 2 out of 6 cases. Qualitative testimonials (Likert scale 5 = strongly agree) reported a change in craniotomy approach after 3D-review (3.5), improved appreciation of anatomy (4.2), increased confidence in surgical approach (4.33 junior residents, 3.5 senior residents), smaller incision (3.5 junior residents, 1.75 senior residents), better appreciation of white matter tracts (4.6).

CONCLUSIONS

The augmented reality platform offers a medium to examine surgical planning skills. Residents uniformly appreciated 3D-AR as a valuable tool for improving appreciation of critical anatomic structures and their relationship to lesional pathology. 3D-AR review significantly altered skull positioning for various lesions and craniotomy approaches, particularly among junior residents.

Immersive virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

The purpose of this review was to (1) analyze the effectiveness of immersive virtual reality (iVR) and augmented reality (AR) as teaching/learning resources (collectively called XR-technologies) for gaining anatomy knowledge compared to traditional approaches and (2) gauge students' perceptions of the usefulness of these technologies as learning tools. This meta-analysis, previously registered in PROSPERO (CRD42023423017), followed PRISMA guidelines. A systematic bibliographical search, without time parameters, was conducted through four databases until June 2023. A meta-analytic approach investigated knowledge gains and XR's usefulness for learning. Pooled effect sizes were estimated using Cohen's standardized mean difference (SMD) and 95% confidence intervals (95% CI). A single-group proportional meta-analysis was conducted to quantify the percentage of students who considered XR devices useful for their learning. Twenty-seven experimental studies, reporting data from 2199 health sciences students, were included for analysis. XR-technologies yielded higher knowledge gains than traditional approaches (SMD = 0.40; 95% CI = 0.22 to 0.60), especially when used as supplemental/complementary learning resources (SMD = 0.52; 95% CI = 0.40 to 0.63). Specifically, knowledge performance using XR devices outperformed textbooks and atlases (SMD = 0.32; 95% CI = 0.10 to 0.54) and didactic lectures (SMD = 1.00; 95% CI = 0.57 to 1.42), especially among undergraduate students (SMD = 0.41; 95% CI = 0.20 to 0.62). XR devices were perceived to be more useful for learning than traditional approaches (SMD = 0.54; 95% CI = 0.04 to 1), and 80% of all students who used XR devices reported these devices as useful for learning anatomy. Learners using XR technologies demonstrated increased anatomy knowledge gains and considered these technologies useful for learning anatomy.

Neuroanatomy in virtual reality: Development and pedagogical evaluation of photogrammetry-based 3D brain models

Anatomy studies are an essential part of medical training. The study of neuroanatomy in particular presents students with a unique challenge of three-dimensional spatial understanding. Virtual Reality (VR) has been suggested to address this challenge, yet the majority of previous reports have implemented computer-generated or imaging-based models rather than models of real brain specimens. Using photogrammetry of real human bodies and advanced editing software, we developed 3D models of a real human brain at different stages of dissection. Models were placed in a custom-built virtual laboratory, where students can walk around freely, explore, and manipulate (i.e., lift the models, rotate them for different viewpoints, etc.). Sixty participants were randomly assigned to one of three learning groups: VR, 3D printed models or read-only, and given 1 h to study the white matter tracts of the cerebrum, followed by theoretical and practical exams and a learning experience questionnaire. We show that following self-guided learning in virtual reality, students demonstrate a gain in spatial understanding and an increased satisfaction with the learning experience, compared with traditional learning approaches. We conclude that the models and virtual lab described in this work may enhance learning experience and improve learning outcomes.

The Evaluation of Virtual Reality Neuroanatomical Training Utilizing Photorealistic 3D Models in Limited Body Donation Program Settings

Background Neuroanatomy is one of the most complex areas of anatomy to teach to medical students. Traditional study methods such as atlases and textbooks are mandatory but require significant effort to conceptualize the three-dimensional (3D) aspects of the neuroanatomical regions of interest. Objectives To test the feasibility of human anatomy teaching medical students in a virtual reality (VR) immersive environment using photorealistic three-dimensional models (PR3DM) of human anatomy, in a limited anatomical body donation program. Methods We used surface scanning technology (photogrammetry) to create PR3DM of brain dissections. The 3D models were uploaded to VR headsets and used in immersive environment classes to teach second-year medical students. Twenty-eight medical students (mean age 20.11, SD 1.42), among which 19 females (n=28/67.9%) and nine males (n=28/32.1%), participated in the study. The students had either none or minimal experience with the use of VR devices. The duration of the study was three months. After completing the curriculum, a survey was done to examine the results. Results The average rating of the students for their overall experience with the method is 4.57/5 (SD=0.63). The "Possibility to study models from many points of view" and "Good Visualization of the models" were the most agreed upon advantages, with 24 students (n=28, 85.7%), and 95% confidence intervals (CI) [0.6643, 0.9532]. The limited availability of the VR headsets was the major disadvantage as perceived by the students, with 11 students (n=28, 39.3%), 95% CI [0.2213, 0.5927] having voted for the option. The majority of the students (25) (n=28, 89.2%, SD=0.31) agreed with the statement that the use of VR facilitated their neuroanatomy education. Conclusion This study shows the future potential of this model of training in limited cadaver dissection options to provide students with modern technological methods of training. Our first results indicate a prominent level of student satisfaction from VR training with minimum negative reactions to the nature of headsets. The proof of concept for the application of photorealistic models in VR neuroanatomy training combined with the initial results of appreciation among the students predisposes the application of the method on a larger scale, adding a nuance to the traditional anatomy training methods. The low number of headsets used in the study limits the generalization of the results but offers possibilities for future perspectives of research.

Intraoperative Videogrammetry and Photogrammetry for Photorealistic Neurosurgical 3-Dimensional Models Generated Using Operative Microscope: Technical Note

BACKGROUND AND OBJECTIVES

Intraoperative orientation during microsurgery has a prolonged learning curve among neurosurgical residents. Three-dimensional (3D) understanding of anatomy can be facilitated with realistic 3D anatomic models created from photogrammetry, where a series of 2-dimensional images is converted into a 3D model. This study implements an algorithm that can create photorealistic intraoperative 3D models to exemplify important steps of the operation, operative corridors, and surgical perspectives.

METHODS

We implemented photograph-based and video-based scanning algorithms for uptakes using the operating room (OR) microscope, targeted for superficial structures, after surgical exposure, and deep operative corridors, in cranial microsurgery. The algorithm required between 30-45 photographs (superficial scanning), 45-65 photographs (deep scanning), or approximately 1 minute of video recording of the entire operative field to create a 3D model. A multicenter approach in 3 neurosurgical departments was applied to test reproducibility and refine the method.

RESULTS

Twenty-five 3D models were created of some of the most common neurosurgical approaches-frontolateral, pterional, retrosigmoid, frontal, and temporal craniotomy. The 3D models present important steps of the surgical approaches and allow rotation, zooming, and panning of the model, enabling visualization from different surgical perspectives. The superficial and medium depth structures were consistently presented through the 3D models, whereas scanning of the deepest structures presented some technical challenges, which were gradually overcome with refinement of the image capturing process.

CONCLUSION

Intraoperative photogrammetry is an accessible method to create 3D educational material to show complex anatomy and demonstrate concepts of intraoperative orientation. Detailed interactive 3D models, displaying stepwise surgical case-based anatomy, can be used to help understand details of the operative corridor. Further development includes refining or automatization of image acquisition intraoperatively and evaluation of other applications of the resulting 3D models in training and surgical planning.

A new practical approach using TeamSTEPPS strategies and tools: - an educational design

BACKGROUND

Teamwork has played a critical role in ensuring patients' safety and preventing human errors in surgery. With advancements in educational technologies, including virtual reality, it is necessary to develop new teaching methods for interpersonal teamwork based on local needs assessments in countries with indigenous cultures. This study aimed to design and develop a new method of teaching teamwork in cesarean section surgery using virtual reality; we further evaluated the effects of this method on healthcare professionals' knowledge and attitudes about teamwork.

METHODS

This study was designed using the ADDIE instructional design model. The TeamSTEPPS Learning Benchmarks questionnaire was used to assess the educational needs of 85 participants who were members of the cesarean section surgery team. A specialized panel analyzed the extracted needs, and the scenario was compiled during the design stage. Finally, four virtual reality contents were created using 360-video H.265 format, which were prepared from specified scenarios in the development of the educational program. The TeamSTEPPS Learning Benchmarks questionnaire was used to measure knowledge, and the T-TAQ was used to measure the participants' attitudes.

RESULTS

Six micro- skills were identified as training needs, including briefing, debriefing, cross-monitoring, I'M SAFE checklist, call-out and check-back, and two-challenge rule. Intervention results showed that the virtual reality content improved teamwork competencies in an interprofessional team performing cesarean section surgery. A significant increase was observed in the mean score of knowledge and attitude after the intervention.

CONCLUSION

Through addressing the need for teamwork training, utilizing the TeamSTEPPS strategy, and incorporating new educational technologies like virtual reality, the collaboration among surgical team members can be enhanced.

Multiple stations in an integrated design of cardiovascular system morphology for medical undergraduate

The morphology knowledge is essential for clinical, diagnostic and surgical practice in medicine. However, it is a great challenge teaching this science in an integrated curriculum, since it has the need of active methods associated with technology, in a total impaired workload. Therefore, this work described an educational design of multiple practice stations in order to teach morphology of the cardiovascular system in the undergraduate medical education. This activity was conducted in the Multicampi School of Medical Sciences of Federal University of Rio Grande do Norte (UFRN) in Caicó/Brazil. Four anatomy stations and four embryology and histology stations of heart and blood vessels were drawn up. Anatomy stations approached cardiac cycle and cardiac valves (1 A); mediastinum and pericardium (2 A); internal morphology and heart conduction system (3 A) and external morphology of heart (4 A). Whereas embryology and histology stations approached embryogenesis of the heart (1B); cardiac microanatomy and fetal circulation (2B); and vascular microanatomy (3B;4B). All the stations emphasized cognitive and psychomotor fields associated with clinical correlations to active application of morphology knowledge. The multiple stations were considered as an organized, productive, enlightening and riveting alternative to medical students and teaching staff. This innovative experience integrated and energized the three areas of morphological sciences, resignifying the teaching and learning of cardiovascular system morphology.

Randomised controlled trial: role of virtual interactive 3-dimensional models in anatomical and medical education

Purpose: Virtual interactive 3-dimensional models (VI3DM) and immersive virtual reality are implemented in medical education and surgical training. VI3DM allow learners to view and interact with a virtual 3D object and help in conceptualising learning objectives that demand high cognitive and visuo-spatial skills. However, the effects of VI3DM in medical education are unknown. We aimed to determine whether VI3DM are helpful in conceptualising complex anatomical structures. Materials and methods: We included 5 specimens, which were assessed by 200 first-year medical students categorised into experimental (n = 100) and control (n = 100) groups using a systemic randomisation method after matching for age and sex. The experimental group was given VI3DM as interventional learning resources while the control group was given 2-dimensional photographs as conventional learning resources for self-directed learning for 30 minutes. Participants completed a questionnaire before and after the learning session to assess their knowledge related to external features, attachments, and relations of anatomical specimens. Results: The scores of the experimental group improved significantly in the post-test compared to those of the control group for all 5 specimens included in the study (p < 0.05, confidence interval = 95%, unpaired student's t-test). Conclusions: VI3DM can help conceptualise external features, attachments, and relations of anatomical structures.

Virtual reality and augmented reality smartphone applications for upskilling care home workers in hand hygiene: a realist multi-site feasibility, usability, acceptability, and efficacy study

OBJECTIVES

To assess the feasibility and implementation, usability, acceptability and efficacy of virtual reality (VR), and augmented reality (AR) smartphone applications for upskilling care home workers in hand hygiene and to explore underlying learning mechanisms.

MATERIALS AND METHODS

Care homes in Northwest England were recruited. We took a mixed-methods and pre-test and post-test approach by analyzing uptake and completion rates of AR, immersive VR or non-immersive VR training, validated and bespoke questionnaires, observations, videos, and interviews. Quantitative data were analyzed descriptively. Qualitative data were analyzed using a combined inductive and deductive approach.

RESULTS

Forty-eight care staff completed AR training (n = 19), immersive VR training (n = 21), or non-immersive VR training (n = 8). The immersive VR and AR training had good usability with System Usability Scale scores of 84.40 and 77.89 (of 100), respectively. They had high acceptability, with 95% of staff supporting further use. The non-immersive VR training had borderline poor usability, scoring 67.19 and only 63% would support further use. There was minimal improved knowledge, with an average of 6% increase to the knowledge questionnaire. Average hand hygiene technique scores increased from 4.77 (of 11) to 7.23 after the training. Repeated practice, task realism, feedback and reminding, and interactivity were important learning mechanisms triggered by AR/VR. Feasibility and implementation considerations included managerial support, physical space, providing support, screen size, lagging Internet, and fitting the headset.

CONCLUSIONS

AR and immersive VR apps are feasible, usable, and acceptable for delivering training. Future work should explore whether they are more effective than previous training and ensure equity in training opportunities.

Physician views of artificial intelligence in otolaryngology and rhinology: A mixed methods study

Objective

The study aimed to investigate otolaryngologists' knowledge, trust, acceptance, and concerns with clinical applications of artificial intelligence (AI).

Methods

This study used mixed methods with survey and semistructured interviews. Survey was e-mailed to American Rhinologic Society members, of which a volunteer sample of 86 members responded. Nineteen otolaryngologists were purposefully recruited and interviewed until thematic saturation was achieved.

Results

Seventy-six respondents (10% response rate) completed the majority of the survey: 49% worked in academic settings and 43% completed residency 10 or fewer years ago. Of 19 interviewees, 58% worked in academic settings, and 47% completed residency 10 or fewer years ago. Familiarity: Only 8% of survey respondents reported having AI training in residency, although 72% had familiarity with general AI concepts; 0 interviewees had personal experience with AI in clinical settings. Expected uses: Of the surveyed otolaryngologists, 82% would use an AI-based clinical decision aid and 74% were comfortable with AI proposing treatment recommendations. However, only 44% of participants would trust AI to identify malignancy and 53% to interpret radiographic images. Interviewees trusted AI for simple tasks, such as labeling septal deviation, more than complex ones, such as identifying tumors. Factors influencing AI adoption: 89% of survey participants would use AI if it improved patient satisfaction, 78% would be willing to use AI if experts and studies validated the technologies, and 73% would only use AI if it increased efficiency. Sixty-one percent of survey respondents expected AI incorporation into clinical practice within 5 years. Interviewees emphasized that AI adoption depends on its similarity to their clinical judgment and to expert opinion. Concerns included nuanced or complex cases, poor design or accuracy, and the personal nature of physician-patient relationships.

Conclusion

Few physicians have experience with AI technologies but expect rapid adoption in the clinic, highlighting the urgent need for clinical education and research. Otolaryngologists are most receptive to AI "augmenting" physician expertise and administrative capacity, with respect for physician autonomy and maintaining relationships with patients.

Level of Evidence

Level VI, descriptive or qualitative study.

Virtual Reality in Preoperative Planning of Complex Cranial Surgery

OBJECTIVE

Changing paradigms of neurosurgical training and limited operative exposure during the residency period have made it necessary to evaluate newer technologies for training. Virtual reality (VR) technology provides three-dimensional reconstruction of routine imaging, along with the ability to see as well as interact. The application of VR technology in operative planning, which is an important part of neurosurgical training, has been incompletely studied so far.

METHODS

Sixteen final-year residents, post-M.Ch. (magister chirurgiae) residents, and fellows were included as study participants. They were divided into 2 groups based on their seniority for further analysis. Five complex cranial cases were selected and a multiple-choice question-based test was prepared by the authors, with 5 questions for each of the cases. The pretest score was determined based on performance on the test after participants accessed routine preoperative imaging. The posttest score was calculated after use of the VR system (ImmersiveTouch VR System, ImmersiveTouch Inc.). Analysis was performed by the investigators, who were blinded to the identity of the participant. Subanalysis based on the type of case and type of question was performed. Feedback was obtained from each participant regarding VR use.

RESULTS

There was an overall improvement in scores from pretest to posttest, which was also noted in the analysis based on the participants' seniority. This improvement was noted to be more for the vascular cases (15.89%) compared with the tumor cases (7.84%). Participants also fared better in questions related to surgical anatomy and surgical approach, compared with questions based on the diagnosis. There was overall positive feedback from participants regarding VR use, and most participants wanted VR to become a routine part of operative planning.

CONCLUSIONS

Our study shows that there is improvement in understanding of surgical aspects after use of this VR system.

Virtual reality used in undergraduate orthodontic education

INTRODUCTION

Undergraduate dental students frequently have reduced clinical experience which presents a challenge for their dental education. Previously, we developed a virtual reality (VR) simulating the whole clinical treatment process of a patient with angle Class II division 1 malocclusion, and the VR also helped to explain some important orthodontic concepts. As a novel teaching tool, this study aims to compare the effects of VR versus traditional case analysis by Power Point (PPT) in inspiring student learning motivation and evaluating learning experience.

MATERIALS AND METHODS

A randomized, cross-over, stratified sampling method was taken to divide the fourth-year undergraduate dental students equally into two groups. The two groups were crossed over to use VR and PPT.

RESULTS

For the whole study, results indicated that students in the VR group showed higher learning motivation (including attention, relevance, confidence and satisfaction) than in the PPT group, but the differences between VR and PPT groups were not very big, and the median of the differences located at 0. For learning experience, students thought VR to be more useful, more enjoyable and more engaging, but the median of differences also located at 0. Notably, the majority of students had higher recommendations for VR than PPT, and the median difference located at 1. However, when the two phases were analysed separately, some items showed no significant differences between VR and PPT learning.

CONCLUSION

VR is a very useful adjunct to education compared to traditional case analysis by PPT, but we cannot exaggerate its benefits. Educators should make good use of VR to solve the difficult problems in education.

Advancing IR in Underserved Regions: Interventional Radiology Simulation Near and Far

Simulation facilitates learning by imitating real-world systems or processes utilizing educational tools and models. Various fields, including business, aviation, and education use simulation for training. In healthcare, simulation provides trainees opportunities to develop procedural skills in a safe environment, building their understanding through hands-on interactions and experiences rather than passive didactics. Simulation is classified into low, medium, and high fidelity, based on how closely it mimics real-life experience. Its use in education is a valuable adjunct to instructional support and training with multiple potential benefits. Interventional radiology (IR) trainees can build technical and clinical proficiency prior to working directly on a patient. Simulation promotes experiential learning, constructivist learning, and student centeredness, thus giving students control over their learning and knowledge acquisition. More recently, the creative use of remote simulation has augmented traditional virtual didactic lectures, thereby further engaging international learners and enhancing remote collaboration. Despite the challenges to implementation, the addition of simulation in IR education is proving invaluable to supporting trainees and physicians in underserved regions.

Augmented and virtual reality in spine surgery

Augmented Reality (AR) and Virtual Reality (VR) have developed unprecedentedly in recent years, providing interesting opportunities for medical applications. Their integration into clinical assessment, surgical workflow, and training has shown tremendous potential to improve daily life activity in spine surgery. The paper explores the utilization of VR and AR in spine surgery, with their applications, benefits, challenges, and forthcoming prospects.

The Impact of Virtual Interactive Three-Dimensional Model in the Conceptualization of the Anatomy of the Sacrum: A Randomized Controlled Trial

Introduction Virtual interactive three-dimensional model (VI3DM) is an emerging technology with promising futures in medical education. It allows learners to view and interact with the three-dimensional (3D) object in an isolated virtual environment, as well as on screen-based platforms. This technology seems more helpful in understanding the learning objectives that demand high cognitive and visuospatial skills. The sacrum, part of the posterior wall of the bony pelvis, is a structure of interest to medical professionals and forensic experts. Understanding the anatomy and relations of the sacrum demands good spatial understanding. Hypothetically, virtual 3D models should help in learning the anatomy of the sacrum along with its relations and attachments. This study was conducted to find out the effect of low-cost digital 3D models on the anatomical knowledge of the study. Aims and objectives The goal of the work was to identify the role of virtual 3D models in the conceptualization of the anatomy of the sacrum. The study's objectives were to identify the impact of virtual 3D models on students' knowledge of the external features, relations, attachments, and joints formed by the sacrum. Material and methods Two hundred first-year medical students (168 males and 32 females) who participated in the study after providing informed consent were divided into two equal groups, a control group (n=100) and an experimental group (n=100), after matching the age, gender, and anatomical knowledge of the sacrum. We used two-dimensional (2D) images and virtual interactive 3D models of the sacrum as control and intervention, respectively, in this randomized controlled study. We conducted a post-test quiz after the 30-minute session of self-directed learning. Results The mean difference between the post-test score and the pre-test score of the experimental group (4.1±1.6 ) was significantly higher than the difference between the post-test and pre-test scores of the control group (2.5±1.2). The virtual interactive 3D model of the sacrum was significantly effective in the conceptualization of the sacrum anatomy. Conclusion A virtual interactive 3D model is an effective tool to conceptualize the anatomy of the sacrum and can be explored for its use in further complex anatomical structures. Digital 3D models can become a platform for the application of various virtual realities (VR) and artificial intelligences in medical education.

Immersive Virtual Reality and Cadaveric Bone are Equally Effective in Skeletal Anatomy Education: A Randomized Crossover Noninferiority Trial

OBJECTIVE

Immersive virtual reality (IVR) technology is transforming medical education. Our aim was to compare the effectiveness of IVR with cadaveric bone models in teaching skeletal anatomy.

DESIGN

A randomized crossover noninferiority trial was conducted.

SETTING

Anatomy laboratory of a large medical school.

PARTICIPANTS

Incoming first-year medical students. Participants were randomized to IVR or cadaveric groups studying upper limb skeletal anatomy, and then were crossed over to use the opposite tool, to study lower limb skeletal anatomy. Participants in both groups completed a pre-and postintervention knowledge test. The primary endpoint of the study was change in performance from the pre-to postintervention knowledge test. Surveys were completed to assess participant's impressions on IVR as an educational tool.

RESULTS

Fifty first-year medical students met inclusion criteria and were randomized. Among all students, the average score on the preintervention knowledge test was 14.6% (standard deviation (SD) = 18.2%) and 25.0% (SD = 17%) for upper and lower limbs, respectively. Percentage increase in scores between pre-and postintervention knowledge test, was 15.0% in the upper limb IVR group, and 16.7% for upper limb cadaveric bones (p = 0.286). For the lower limb, score increase was 22.6% in the IVR and 22.5% in the cadaveric bone group (p = 0.936). 79% of participants found that IVR was most valuable for teaching 3-dimensional orientation, anatomical relationships, and key landmarks. Majority of participants were favorable towards combination use of traditional methods and IVR technology for learning skeletal anatomy (LSM>3).

CONCLUSIONS

In this randomized controlled trial, there was no significant difference in knowledge after using IVR or cadaveric bones for skeletal anatomy education. These findings have further implications for medical schools that face challenges in acquiring human cadavers and cadaveric parts.

Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study

BACKGROUND

Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation.

OBJECTIVE

This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills.

METHODS

Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant's total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups' mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX).

RESULTS

We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups' standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach α of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21).

CONCLUSIONS

This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment.

Impact of Virtual and Augmented Reality on Quality of Medical Education During the COVID-19 Pandemic: A Systematic Review

Background

The COVID-19 pandemic and the subsequent mandatory social distancing led to widespread disruption of medical education. This contributed to the accelerated introduction of virtual reality (VR) and augmented reality (AR) technology in medical education.

Objective

The objective of this quantitative narrative synthesis review is to summarize the recent quantitative evidence on the impact of VR and AR on medical education.

Methods

A literature search for articles published between March 11, 2020 and January 31, 2022 was conducted using the following electronic databases: Embase, PubMed, MEDLINE, CINAHL, PsycINFO, AMED, EMCARE, BNI, and HMIC. Data on trainee confidence, skill transfer, information retention, and overall experience were extracted.

Results

The literature search generated 448 results, of which 13 met the eligibility criteria. The studies reported positive outcomes in trainee confidence and self-reported knowledge enhancement. Additionally, studies identified significant improvement in the time required to complete surgical procedures in those trained on VR (mean procedure time 97.62±35.59) compared to traditional methods (mean procedure time 121.34±12.17). However, participants also reported technical and physical challenges with the equipment (26%, 23 of 87).

Conclusions

Based on the studies reviewed, immersive technologies offer the greatest benefit in surgical skills teaching and as a replacement for lecture- and online-based learning. The review identified gaps that could be areas for future research.

The effect of immersion on sense of presence and affect when experiencing an educational scenario in virtual reality: A randomized controlled study

Virtual reality (VR) technology has been used to learn skills for decades. While no standardized measure exists for learning outcomes in VR training, commonly explored outcomes are immersion, sense of presence and emotions.

Methods

In this paper, the objective was to investigate these outcomes in two VR conditions, immersive and desktop in a randomized controlled trial with a parallel design. The sample consisted of 134 university students (70 women, mean age 23 years, SD = 2.99). These were randomized using a covariate-adaptive randomization procedure based on stratification by gender into two interventions; play out a VR scenario in either desktop (control group) or immersive VR (intervention group). The setting was a university lab.

Results

There was a significant within subject effect for positive affect and a significant between-group effect for the immersive compared to desktop VR groups. Positive affect was reduced after interacting with the VR scenario in both the immersive and desktop versions, however, positive affect was overall higher in the immersive, compared to the desktop version. The results show higher scores for sense of presence (d = 0.90, p < 0.001) and positive affect pre- and post-scenario in the immersive VR condition (d = 0.42, p = 0.017 and d = 0.54, p = 0.002) compared to the desktop condition.

Conclusion

Immersive VR may be beneficial in higher education as it promotes high levels of sense of presence as well as positive emotions. When it comes to changing the immediate emotions of the students, type of VR does not seem to matter. The project was funded by the Norwegian Directorate for Higher Education and Skills.

Photorealistic 3-Dimensional Models of the Anatomy and Neurosurgical Approaches to the V2, V3, and V4 Segments of the Vertebral Artery

BACKGROUND

The vertebral artery (VA) has a tortuous course subdivided into 4 segments (V1-V4). For neurosurgeons, a thorough knowledge of the 3-dimensional (3D) anatomy at different segments is a prerequisite for safe surgery. New technologies allowing creation of photorealistic 3D models may enhance the anatomic understanding of this complex region.

OBJECTIVE

To create photorealistic 3D models illustrating the anatomy and surgical steps needed for safe neurosurgical exposure of the VA.

METHODS

We dissected 2 latex injected cadaver heads. Anatomic layered dissections were performed on the first specimen. On the second specimen, the two classical approaches to the VA (far lateral and anterolateral) were realized. Every step of dissection was scanned using photogrammetry technology that allowed processing of 3D data from 2-dimensional photographs by a simplified algorithm mainly based on a dedicated mobile phone application and open-source 3D modeling software. For selected microscopic 3D anatomy, we used an operating microscope to generate 3D models.

RESULTS

Classic anatomic (n=17) and microsurgical (n=12) 3D photorealistic models based on cadaver dissections were created. The models allow observation of the spatial relations of each anatomic structure of interest and have an immersive view of the approaches to the V2-V4 segments of the VA. Once generated, these models may easily be shared on any digital device or web-based platforms for 3D visualization.

CONCLUSIONS

Photorealistic 3D scanning technology is a promising tool to present complex anatomy in a more comprehensive way. These 3D models can be used for education, training, and potentially preoperative planning.

Virtual reality simulation of panoramic radiographic anatomy for dental students

PURPOSE

This work aimed to utilize virtual reality (VR) in dental radiographic anatomical interpretation in junior dental students and test if it can enhance student learning, engagement, and performance.

METHODS

VR software for panoramic anatomy was developed. Sixty-nine first-year dental students were divided into a control group (lecture-based) and an experimental group (VR) to learn panoramic radiographic anatomy. Both groups were then tested on knowledge via a 20-question quiz. Student feedback on VR experience was collected via an online survey.

RESULTS

There was a statistically significant difference between lecture-based and VR students in the correct identification of anatomical landmarks. Lecture-based students scored higher in identifying the ear lobe, hyoid bone, condylar neck, and external oblique ridge, whereas VR students scored higher in identifying zygoma (Chi-squared test, p < 0.005). The VR group reported high evaluation on all perception items of the online feedback survey on their experience (Student t-test, p < 0.005).

CONCLUSIONS

Lecture-based students generally showed better performance in panoramic radiographic anatomy. Several structures were not correctly identified in both groups of novice students. The positive feedback of VR experience encourages future implementation in education to augment conventional methods of radiographic anatomy in dentistry with considerations to repeated exposures throughout undergraduate dental education.

WeChat as a platform for blending problem/case-based learning and paper review methods in undergraduate paediatric orthopaedics internships: a feasibility and effectiveness study

BACKGROUND

Paediatric orthopaedics is a significant and difficult for undergraduate students to master. During the COVID-19 pandemic, we used the WeChat platform to combine the advantages offered by problem-based learning (PBL), case-based learning (CBL) and paper review teaching methods to establish a new blended online teaching model and demonstrated its feasibility and effectiveness.

OBJECTIVE

This study aims to demonstrate the feasibility and effectiveness of a new blended pedagogical method that uses the WeChat platform and combines PBL, CBL and paper review.

METHODS

We enrolled 22 students participating in the Department of Paediatric Orthopaedics. They participated in the WeChat blended pedagogy mode. Their departmental rotation examination scores were compared with those of 23 students who participated in the traditional teaching method. Moreover, an anonymous questionnaire was used to evaluate students' perceptions and experiences.

RESULTS

The total average scores of students who participated in the WeChat blended pedagogy mode and the traditional teaching method were 47.27 and 44.52, respectively. There were no statistically significant differences between the online teaching mode and the traditional teaching method in terms of possessing professional accomplishment, gaining knowledge and promoting interpersonal skills (P = 0.07, P = 0.12 and P = 0.65, respectively). In terms of independent clinical thinking, self-improving capability and improving clinical skills, the scores associated with the WeChat blended pedagogy mode were 8.00, 8.00 and 6.00, whereas those associated with the traditional teaching method were 6.70, 6.87 and 7.48. The overall satisfaction with the WeChat blended pedagogy mode reached 100%. A total of 64%, 86%, 68%, 64% and 59% of students chose very large or large in response to the items concerning professional accomplishment, knowledge absorption, independent clinical thinking skills, English reading and literature exploring capacity, as well as interpersonal skills, respectively. Fifteen participants claimed that the WeChat blended pedagogy mode was less helpful to them with regard to promoting the improvement of their clinical skills. Nine students claimed that the WeChat blended pedagogy mode was time-consuming.

CONCLUSIONS

Our study verified the feasibility and effectiveness of the WeChat blended pedagogy mode for undergraduate paediatric orthopaedics internships.

TRIAL REGISTRATION

Retrospectively registered.

Knowledge Attainment and Engagement Among Medical Students: A Comparison of Three Forms of Online Learning

OBJECTIVE

This study compared knowledge attainment and student enjoyment and engagement between clinical case vignette, patient-testimony videos and mixed reality (MR) teaching via the Microsoft HoloLens 2, all delivered remotely to third year medical students. The feasibility of conducting MR teaching on a large scale was also assessed.

SETTING & PARTICIPANTS

Medical students in Year 3 at Imperial College London participated in three online teaching sessions, one in each format. All students were expected to attend these scheduled teaching sessions and to complete the formative assessment. Inclusion of their data used as part of the research trial was optional.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was performance on a formative assessment, which served to compare knowledge attainment between three forms of online learning. Moreover, we aimed to explore student engagement with each form of learning via a questionnaire, and also feasibility of applying MR as a teaching tool on a large scale. Comparisons between performances on the formative assessment between the three groups were investigated using a repeated measures two-way ANOVA. Engagement and enjoyment were also analysed in the same manner.

RESULTS

A total of 252 students participated in the study. Knowledge attainment of students using MR was comparable with the other two methods. Participants reported higher enjoyment and engagement (p<0.001) for the case vignette method, compared with MR and video-based teaching. There was no difference in enjoyment or engagement ratings between MR and the video-based methods.

CONCLUSION

This study demonstrated that the implementation of MR is an effective, acceptable, and feasible way of teaching clinical medicine to undergraduate students on a large scale. However, case-based tutorials were found to be favoured most by students. Future work could further explore the best uses for MR teaching within the medical curriculum.

A Large-Scale, Multiplayer Virtual Reality Deployment: A Novel Approach to Distance Education in Human Anatomy

The arrival of COVID-19 restrictions and the increasing demand of online instruction options posed challenges to education communities worldwide, especially in human anatomy. In response, Colorado State University developed and deployed an 8-week-long large-scale virtual reality (VR) course to supplement online human anatomy instruction. Students (n = 75) received a VR-capable laptop and head-mounted display and participated in weekly synchronous group laboratory sessions with instructors. The software enabled students to remotely collaborate in a common virtual space to work with human anatomy using an artist-rendered cadaver. Qualitative data were collected on student engagement, confidence, and reactions to the new technology. Quantitative data assessed student knowledge acquisition and retention of anatomical spatial relationships. Results indicated that students performed better in the online course (mean = 82.27%) when compared to previous in-person laboratories (mean = 80.08%). The utilization of VR promoted student engagement and increased opportunities for student interaction with teaching assistants, peers, and course content. Notably, students reported benefits that focused on unique aspects of their virtual learning environment, including the ability to infinitely scale the cadaver and walk inside and around anatomical structures. Results suggested that using VR was equivalent to 2D methods in student learning and retention of anatomical relationships. Overall, the virtual classroom maintained the rigor of traditional gross anatomy laboratories without negatively impacting student examination scores and provided a high level of accessibility, without compromising learner engagement.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01751-w.

Faculty Perception of Student Engagement in Online Anatomy Laboratory Courses During the COVID-19 Pandemic

When the social distancing guidelines, as a result of the COVID-19 pandemic, caused universities to close campuses, there was a rapid shift in the course delivery methods of human gross anatomy laboratory sessions. Courses were delivered online, and this change created new challenges for anatomy faculty to engage students effectively. This profoundly impacted student-instructor interactions, the quality of the learning environment, and successful student outcomes. Because of the importance of student interaction and engagement for hands-on laboratory courses like anatomy, which rely on cadaver dissections and in-person learning communities, as well as the novel opportunity, this qualitative study sought to explore the faculty perspectives of transitioning their in-person laboratory sessions online and unearth their experience with student engagement in this new teaching format. The Delphi technique was used to explore this experience in two rounds of qualitative inquiry using questionnaires and semi-structured interviews, and thematic analysis was used to analyze the data, identifying codes and building themes. The study utilized indicators of student engagement in online courses to formulate four themes: instructor presence, social presence, cognitive presence, and reliable technology design and access. These were constructed based on the factors faculty used to maintain engagement, new challenges they faced, and strategies deployed to overcome these challenges and engage students in the new learning format. These are supported by strategies such as using video and multimedia, ice-breaker activities, chat and discussion features, immediate and personalized feedback, and virtual meeting via synchronous sessions. These themes highlight important lessons that faculty designing online anatomy laboratory courses can use to guide their course design, and institutions and instructional design faculty can use to inform best practices and faculty development efforts. Additionally, the study calls for further research to design a standardized and global assessment tool that measures student engagement in the online learning environment.

A scoping review on the trends of digital anatomy education

Digital technologies are changing the landscape of anatomy education. To reveal the trend of digital anatomy education across medical science disciplines, searches were performed using PubMed, EMBASE, and MEDLINE bibliographic databases for research articles published from January 2010 to June 2021 (inclusive). The search was restricted to publications written in English language and to articles describing teaching tools in undergraduate and postgraduate anatomy and pre-vocational clinical anatomy training courses. Among 156 included studies across six health disciplines, 35% used three-dimensional (3D) digital printing tools, 24.2% augmented reality (AR), 22.3% virtual reality (VR), 11.5% web-based programs, and 4.5% tablet-based apps. There was a clear discipline-dependent preference in the choice and employment of digital anatomy education. AR and VR were the more commonly adopted digital tools for medical and surgical anatomy education, while 3D printing is more broadly used for nursing, allied health and dental health education compared to other digital resources. Digital modalities were predominantly adopted for applied interactive anatomy education and primarily in advanced anatomy curricula such as regional anatomy and neuroanatomy. Moreover, there was a steep increase in VR anatomy combining digital simulation for surgical anatomy training. There is a consistent increase in the adoption of digital modalities in anatomy education across all included health disciplines. AR and VR anatomy incorporating digital simulation will play a more prominent role in medical education of the future. Combining multimodal digital resources that supports blended and interactive learning will further modernize anatomy education, moving medical education further away from its didactic history.

Virtual Reality as a Complementary Learning Tool in Anatomy Education for Medical Students

Virtual reality seems to be a promising tool to improve the study of anatomy; however, its efficacy compared to traditional methods remains unclear. This randomized experimental study included 42 first-semester medical students enrolled in a Morphology discipline, divided into two groups. Each group was interchangeably assigned to use virtual reality plus traditional methods or traditional methods alone in a four-section crossover design. Participants' scores in four distinct tests were compared between groups, as well as a motivation questionnaire. The results showed that virtual reality does not provide significant increase on scores neither short-, medium-, and long-term analysis. Nonetheless, in the motivation questionnaire, participants agreed virtual reality provides a better tridimensional view of the human body and therefore is a potential complementary tool when learning anatomy. We conclude virtual reality does not seem to have an impact on academic performance, but it was perceived as an engaging and promising complementary tool for the study of anatomy.

Virtual reality learning: A randomized controlled trial assessing medical student knowledge of fetal development

OBJECTIVE

To investigate whether a virtual reality learning environment (VRLE) enhanced student understanding and knowledge compared with a traditional tutorial.

METHOD

A randomized controlled trial involving medical students from University College Dublin, Ireland. Participants were assigned to an intervention (VRLE involving a 15-min learning experience on the stages of fetal development) or control (PowerPoint tutorial on the same topic) group. Multiple choice questionnaires (MCQs) assessed knowledge at three time points: preintervention, immediately postintervention, and 1 week postintervention. Primary outcomes were differences in MCQ knowledge scores postintervention between groups. Secondary outcomes included attitudes on the learning experience assessed using the Student Satisfaction and Self-Confidence in Learning Scale (SCLS) and the Virtual Reality Design Scale (VRDS).

RESULTS

No statistically significant between-group differences were found in the primary outcome assessing postintervention knowledge scores. Within-group differences in knowledge scores were significant among the three time points for both the intervention (P < 0.01 [95% confidence interval, 5.33-6.19]) and control (P = 0.02 [95% confidence interval, 5.74-6.49]) groups. Mean levels of satisfaction and self-confidence in learning were higher in the intervention group compared with the control group: 54.2 (standard deviation, 7.5) and 50.5 (standard deviation, 7.2), respectively (P = 0.21).

CONCLUSION

VRLEs are a learning tool that can support knowledge development.

The Effects of Immersive Virtual Reality Applications on Enhancing the Learning Outcomes of Undergraduate Health Care Students: Systematic Review With Meta-synthesis

BACKGROUND

Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students' competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment.

OBJECTIVE

This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods.

METHODS

MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students' learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P<.05 was used to test for statistical significance using SPSS (version 28; IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool.

RESULTS

A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15; 95% CI 16.3%-67.7%; P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90%; P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool.

CONCLUSIONS

This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger sample size and robust study design are required to evaluate the effects of IVR teaching.

TRIAL REGISTRATION

International prospective register of systematic reviews (PROSPERO) CRD42022313706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=313706.

Use of Extended Reality in Medical Education: An Integrative Review

Extended reality (XR) has emerged as an innovative simulation-based learning modality. An integrative review was undertaken to explore the nature of evidence, usage, and effectiveness of XR modalities in medical education. One hundred and thirty-three (N = 133) studies and articles were reviewed. XR technologies are commonly reported in surgical and anatomical education, and the evidence suggests XR may be as effective as traditional medical education teaching methods and, potentially, a more cost-effective means of curriculum delivery. Further research to compare different variations of XR technologies and best applications in medical education and training are required to advance the field.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01698-4.

Determinants of Learning Anatomy in an Immersive Virtual Reality Environment - A Scoping Review

Given the decline of cadavers as anatomy teaching tools, immersive virtual reality (VR) technology has gained popularity as a potential alternative. To better understand how to maximize the educational potential of VR, this scoping review aimed to identify potential determinants of learning anatomy in an immersive VR environment. A literature search yielded 4523 studies, 25 of which were included after screening. Six common factors were derived from secondary outcomes in these papers: cognitive load, cybersickness, student perceptions, stereopsis, spatial understanding, and interactivity. Further objective research investigating the impact of these factors on anatomy examination performance is required.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01701-y.

Virtual Reality Head-Mounted Displays in Medical Education: A Systematic Review

SUMMARY STATEMENT

Simulation-based training using virtual reality head-mounted displays (VR-HMD) is increasingly being used within the field of medical education. This article systematically reviews and appraises the quality of the literature on the use of VR-HMDs in medical education. A search in the databases PubMed/MEDLINE, Embase, ERIC, Scopus, Web of Science, Cochrane Library, and PsychINFO was carried out. Studies were screened according to predefined exclusion criteria, and quality was assessed using the Medical Education Research Study Quality Instrument. In total, 41 articles were included and thematically divided into 5 groups: anatomy, procedural skills, surgical procedures, communication skills, and clinical decision making. Participants highly appreciated using VR-HMD and rated it better than most other training methods. Virtual reality head-mounted display outperformed traditional methods of learning surgical procedures. Although VR-HMD showed promising results when learning anatomy, it was not considered better than other available study materials. No conclusive findings could be synthesized regarding the remaining 3 groups.

Immersive Virtual Reality in Basic Point-of-Care Ultrasound Training: A Randomized Controlled Trial

This study was aimed at comparing the learning efficacy of a traditional instructor-led lesson with that of a completely virtual, self-directed lesson in immersive virtual reality (IVR) in teaching basic point-of-care ultrasound (PoCUS) skills. We conducted a blinded, non-inferiority, parallel-group, randomized controlled trial in which final-year medical students were randomized to an instructor-led (n = 53) or IVR (n = 51) lesson. Participants' learning efficacy was evaluated by blinded assessors, who rated each participant's performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) assessment tool.The mean total scores for participants were 11.0 points (95% confidence interval: 9.8-12.2) for the instructor-led lesson and 10.3 points (95% confidence interval: 9.0-11.5) for the IVR lesson. No significant differences were observed between the groups with respect to total score (p = 0.36) or subgroup objectives of the OSAUS score (p = 0.34 for familiarity, p = 0.45 for image optimization, p = 0.96 for systematic approach and p = 0.07 for interpretation). Maintenance costs for both courses were estimated at 400 euros each. Startup costs for the instructor-led course were estimated 16 times higher than those for the IVR course. The learning efficacy of an instructor-led lesson on basic US did not differ significantly from that of a self-directed lesson in IVR, as assessed using the OSAUS. The results suggest that IVR could be an equivalent alternative to instructor-led lessons in future basic US courses, but further research is warranted to clarify the role of IVR in PoCUS courses.