Establishing Objective Measures of Clinical Competence in Undergraduate Medical Education Through Immersive Virtual Reality

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.

Subjective learning gain from a simulation-based health management course: a mixed methods study

Objectives

Simulations are increasingly being offered as part of the educational experience of healthcare students. We used a Health Management Scenario Simulation system to create a course. This study aimed to evaluate learning gains before and after the course.

Methods

Based on the learning strategies of framing, simulation, and debriefing, the Health Management Scenario Simulation course lasted 4 weeks and was conducted online. Learning gain was assessed using a comparative self-assessment questionnaire administered electronically at the beginning and end of the course. We organized focus group interviews and collected quantitative data after students completed the simulations and the questionnaire. These data were subjected to descriptive statistical analysis and thematic grouping using frequency counting.

Results

There were 195 health management students enrolled in the course. In total, 265 anonymously completed questionnaires were received, 141 (72.31%) on the pre-simulation and 124 (63.59%) on the post-simulation. All questionnaire item gain values were positive, except the item "I can identify common health risk factors," which showed no change. The skills domain showed the highest learning gain, ranging from 16 to 22%. Six students participated in the focus-group study. The main themes that emerged from students' reflections were learner-centeredness, competencies, and career development.

Conclusion

Students acquired health management skills through the simulation, which contributed to the development of basic attitudes and skills in their professional careers. Students' comments highlighted the value of practicing health management skills in a simulated environment.

The impact of simulation-based training in medical education: A review

Simulation-based training (SBT) has emerged as a transformative approach in medical education, significantly enhancing healthcare professionals' learning experience and clinical competency. This article explores the impact of SBT, tracing its historical development and examining the various types of simulations utilized today, including high-fidelity mannequins, virtual reality environments, standardized patients, and hybrid simulations. These methods offer a safe and controlled environment for students to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The benefits of SBT are manifold, including enhanced skill acquisition, error reduction, and the opportunity for repeated practice without risk to actual patients. Immediate feedback and structured debriefing further solidify learning, making Simulation an invaluable tool in medical education. However, the implementation of SBT is challenging. It requires substantial financial investment, specialized equipment, and trained faculty. Additionally, there are concerns about the realism of simulations and the transferability of skills to real-world clinical settings. Despite these challenges, numerous case studies and empirical research underscore the effectiveness of SBT compared to traditional methods. Looking ahead, advancements in technology, such as artificial intelligence and improved virtual reality applications, promise to enhance the efficacy and accessibility of simulation training. The integration of Simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide. This article affirms the crucial role of SBT in preparing the next generation of healthcare professionals and its ongoing evolution driven by technological innovations.

Virtual, augmented, and mixed reality: potential clinical and training applications in pediatrics

BACKGROUND

COVID-19 pandemic has significantly impacted the field of medical training, necessitating innovative approaches to education and practice. During this period, the use of novel technologies like virtual reality (VR), augmented reality (AR), and mixed reality (MR) has become increasingly vital. These technologies offer the advantage of transcending the limitations of time and space, thus enabling medical professionals to access various personalized programs for both education and service delivery. This shift is particularly relevant in the realm of pediatric medicine, where traditional training and clinical methods face unique challenges.

PURPOSE

The primary aim of this study is to explore the application of VR, AR, and MR technologies in pediatric medical settings, with a focus on both clinical applications and the training of pediatric medical professionals. We aim to comprehensively search and review studies that have utilized these technologies in the treatment of pediatric patients and the education of healthcare providers in this field.

METHODS

Peer-reviewed articles published in PubMed, the Cochrane Library, ScienceDirect, Google Scholar, and Scopus from January 1, 2018, to March 1, 2023, were comprehensively searched. The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analyses) guidelines. Among the 89 studies, 63 investigated the clinical applications of VR (n=60) or AR (n=3) in pediatric patients, and 25 investigated the applications of VR (n=19), AR (n=5), or MR (n=1) for training medical professionals.

RESULTS

A total of 36 randomized controlled trials (RCTs) for clinical application (n=31) and medical training (n=5) were retrieved. Among the RCTs, 21 reported significant improvements in clinical applications (n=17) and medical training (n=4).

CONCLUSION

Despite a few limitations in conducting research on innovative technology, such research has rapidly expanded, indicating that an increasing number of researchers are involved in pediatric research using these technologies.

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.

A scoping review to assess the effects of virtual reality in medical education and clinical care

Due to the challenges and restrictions posed by COVID-19 pandemic, technology and digital solutions played an important role in the rendering of necessary healthcare services, notably in medical education and clinical care. The aim of this scoping review was to analyze and sum up the most recent developments in Virtual Reality (VR) use for therapeutic care and medical education, with a focus on training medical students and patients. We identified 3743 studies, of which 28 were ultimately selected for the review. The search strategy followed the most recent Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping review (PRISMA-ScR) guidelines. 11 studies (39.3%) in the field of medical education assessed different domains, such as knowledge, skills, attitudes, confidence, self-efficacy, and empathy. 17 studies (60.7%) focused on clinical care, particularly in the areas of mental health, and rehabilitation. Among these, 13 studies also investigated user experiences and feasibility in addition to clinical outcomes. Overall, the findings of our review reported considerable improvements in terms of medical education and clinical care. VR systems were also found to be safe, engaging, and beneficial by the studies' participants. There were huge variations in studies with respect to the study designs, VR contents, devices, evaluation methods, and treatment periods. In the future, studies may focus on creating definitive guidelines that can help in improving patient care further. Hence, there is an urgent need for researchers to collaborate with the VR industry and healthcare professionals to foster a better understanding of contents and simulation development.

The perceived value and impact of virtual simulation-based education on students' learning: a mixed methods study

BACKGROUND

Virtual simulations are used throughout healthcare training programs to enable development of clinical skills, however the potential for virtual simulation to enhance cognitive and affective skills is less well understood. This study explored pre-clinical optometry students' perceptions of the impact of virtual simulation on the development of core competency skills including patient-centred care, communication, scientific literacy, and evidence-based practice.

METHODS

A mixed methods study was conducted using pre-existing anonymized data from an electronic survey distributed to pre-clinical optometry students enrolled in the double degree Bachelor of Vision Science/Master of Optometry at Deakin University, Australia. The data were interpreted using descriptive statistics and qualitative analysis using constant comparison for thematic analysis.

RESULTS

A total of 51 responses were analyzed. Students reported that virtual simulation motivated them to become an optometrist (93%) and to learn beyond the course material (77%). Students reported that after participating in the virtual simulation, their core competency skills improved: patient-centered care (100%) evidence-based practice (93%) and clinical reasoning (93%). The themes identified through qualitative analysis were: enablers to cognitive experience in virtual simulation in optometry education, realism of the virtual simulation design, dimensions of fidelity in virtual simulations design replicated the complexity of the optometric environment, virtual simulation as an enabler for learning and assessment in optometry education, a place to develop cognitive and affective skills and application of learning in the virtual simulation developed an appreciation of future roles and professional identity.

CONCLUSION

Optometry students perceived virtual simulation in optometric education as a valuable training and assessment strategy enabled by qualities that generate contextual, cognitive, functional, task and psychological fidelity. The data provide insight to inform how optometry educators can incorporate simulation into the curriculum.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice

Virtual simulation (VS) as an emerging interactive pedagogical strategy has been paid more and more attentions in the undergraduate medical education. Because of the fast development of modern computer simulation technologies, more and more advanced and emerging VS-based instructional practices are constantly increasing to promote medical education in diverse forms. In order to describe an overview of the current trends in VS-based medical teaching and learning, this scoping review presented a worldwide analysis of 92 recently published articles of VS in the undergraduate medical teaching and learning. The results indicated that 98% of included articles were from Europe, North America, and Asia, suggesting a possible inequity in digital medical education. Half (52%) studies reported the immersive virtual reality (VR) application. Evidence for educational effectiveness of VS in medical students’ knowledge or skills was sufficient as per Kirkpatrick’s model of outcome evaluation. Recently, VS has been widely integrated in surgical procedural training, emergency and pediatric emergency medicine training, teaching of basic medical sciences, medical radiation and imaging, puncture or catheterization training, interprofessional medical education, and other case-based learning experiences. Some challenges, such as accessibility of VS instructional resources, lack of infrastructure, “decoupling” users from reality, as well as how to increase students’ motivation and engagement, should be addressed.

Virtual Reality in Medical Students' Education: Scoping Review

BACKGROUND

Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education.

OBJECTIVE

The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research.

METHODS

We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

RESULTS

Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR.

CONCLUSIONS

Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-046986.

Remote Virtual Reality Teaching: Closing an Educational Gap During a Global Pandemic

OBJECTIVE

Resident physicians are expected to recognize patients requiring escalation of care on day 1 of residency, as outlined by the Association of American Medical Colleges. Opportunities for medical students to assess patients at the bedside or through traditional simulation-based medical education have decreased because of coronavirus disease 2019 restrictions. Virtual reality (VR) delivered remotely via video teleconferencing may address this educational gap.

METHODS

A prospective pilot study targeting third-year pediatric clerkship students at a large academic children's hospital was conducted from April to December 2020. Groups of 6 to 15 students participated in a 1.5-hour video teleconferencing session with a physician facilitator donning a VR headset and screen sharing interactive VR cases of a hospitalized infant with respiratory distress. Students completed surveys assessing the immersion and tolerability of the virtual experience and reported its perceived effectiveness to traditional educational modalities. Comparisons were analyzed with binomial testing.

RESULTS

Participants included third-year medical students on their pediatric clerkship. A total of 140 students participated in the sessions, with 63% completing the survey. A majority of students reported VR captured their attention (78%) with minimal side effects. Students reported remote VR training as more effective (P < .001) than reading and online learning and equally or more effective (P < .001) than didactic teaching. Most students (80%) rated remote VR as less effective than bedside teaching.

CONCLUSIONS

This pilot reveals the feasibility of remote group clinical training with VR via a video conferencing platform, addressing a key experience gap while navigating coronavirus disease 2019 limitations on training.