Lost in space? Cognitive fit and cognitive load in 3D virtual environments

Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis

Background

The COVID-19 pandemic has given rise to more virtual simulation training. This study aimed to review the effectiveness of virtual simulations and their design features in developing clinical reasoning skills among nurses and nursing students.

Method

A systematic search in CINAHL, PubMed, Cochrane Library, Embase, ProQuest, PsycINFO, and Scopus was conducted. The PRISMA guidelines, Cochrane's risk of bias, and GRADE was used to assess the articles. Meta-analyses and random-effects meta-regression were performed.

Results

The search retrieved 11,105 articles, and 12 randomized controlled trials (RCTs) were included. Meta-analysis demonstrated a significant improvement in clinical reasoning based on applied knowledge and clinical performance among learners in the virtual simulation group compared with the control group. Meta-regression did not identify any significant covariates. Subgroup analyses revealed that virtual simulations with patient management contents, using multiple scenarios with nonimmersive experiences, conducted more than 30-minutes and postscenario feedback were more effective.

Conclusions

Virtual simulations can improve clinical reasoning skill. This study may inform nurse educators on how virtual simulation should be designed to optimize the development of clinical reasoning.

Designing for Confidence: The Impact of Visualizing Artificial Intelligence Decisions

Explainable artificial intelligence aims to bring transparency to artificial intelligence (AI) systems by translating, simplifying, and visualizing its decisions. While society remains skeptical about AI systems, studies show that transparent and explainable AI systems can help improve the Human-AI trust relationship. This manuscript presents two studies that assess three AI decision visualization attribution models that manipulate morphological clarity (MC) and two information presentation-order methods to determine each visualization’s impact on the Human-AI trust relationship through increased confidence and cognitive fit (CF). The first study, N = 206 (Avg. age = 37.87 ± 10.51, Male = 123), utilized information presentation methods and visualizations delivered through an online experiment to explore trust in AI by asking participants to complete a visual decision-making task. The second study, N = 19 (24.9 ± 8.3 years old, Male = 10), utilized eye-tracking technology and the same stimuli presentation methods to investigate if cognitive load, inferred through pupillometry measures, mediated the confidence-trust relationship. The results indicate that low MC positively impacts Human-AI trust and that the presentation order of information within an interface in terms of adjacency further influences user trust in AI. We conclude that while adjacency and MC significantly affect cognitive load, cognitive load alone does not mediate the confidence-trust relationship. Our findings interpreted through a combination of CF, situation awareness, and ecological interface design have implications for the design of future AI systems, which may facilitate better collaboration between humans and AI-based decision agents.

Frontal-occipital network alterations while viewing 2D & 3D movies: a source-level EEG and graph theory approach

Many researchers have measured the differences in electroencephalography (EEG) while viewing 2D and 3D movies to uncover the neuromechanism underlying distinct viewing experiences. Using whole-brain network analyses of scalp EEG, our previous study reported that beta and gamma bands presented higher global efficiencies while viewing 3D movies. However, scalp EEG is influenced by volume conduction, not allowing inference from a neuroanatomy perspective; thus, source reconstruction techniques are recommended. This paper is the first to measure the differences in the frontal-occipital networks in EEG source space during 2D and 3D movie viewing. EEG recordings from 40 subjects were performed during 2D and 3D movie viewing. We constructed frontal-occipital networks of alpha, beta, and gamma bands in EEG source space and analyzed network efficiencies. We found that the beta band exhibited higher global efficiency in 3D movie viewing than in 2D movie viewing; however, the alpha global efficiency was not statistically significant. In addition, a support vector machine (SVM) classifier, taking functional connectivities as classification features, was built to identify whether the frontal-occipital networks contain patterns that could distinguish 2D and 3D movie viewing. Using the 6 most important functional connectivity features of the beta band, we obtained the best accuracy of 0.933. Our findings shed light on uncovering the neuromechanism underlying distinct experiences while viewing 2D and 3D movies.

Scale development for analyzing the fit of real and virtual world integration: an example of Pokémon Go

Purpose

Augmented reality (AR) has become a trend, and the effects of Pokémon Go, the most popular online and mobile game, have been explored in many studies. However, few studies have developed questionnaires of fit to investigate the relationship between the fit and the integration of the game's virtual world and reality. The paper intends to integrate the models of stimulus-organism-response (S-O-R) and information systems success with cognitive fit theory to explore the fit and reactions of users in the integration of real and virtual worlds.

Design/methodology/approach

Following MacKenzie's scale development, two surveys were conducted. The first survey was conducted to perform a scale development of fit. The second survey was collected from 315 Pokémon Go players to validate the fit scale and it was analyzed via structural equation modeling.

Findings

The results show that scale development of fit has good reliability and validity. Furthermore, game information quality, game system quality and virtual (Pokémon) characteristics have significantly positive effects on cognitive and emotional fit. Cognitive and emotional fit have significant positive effects on user satisfaction, and user satisfaction has significant positive effects on continued intention to play. The results suggest that maintaining the quality of the game and improving the virtual interface will provide a better fit between the real and virtual worlds, enhancing user satisfaction with the fit as well as their intention for continued use.

Originality/value

Although fit has been widely studied in various contexts, the application of AR has been rarely discussed. This study develops a scale of fit and takes Pokémon Go as the subject to validate the fit measurement and discuss players' cognition and feelings regarding the game. The authors measure user reactions to different stimuli and explore cognitive and emotional fit as well as the integration of virtual worlds and reality. In sum, to the best of the authors’ knowledge, this is one of the earliest studies to explore and develop a cognitive and emotional fit scale for future researchers and practitioners.

Characterization of Indicators for Adaptive Human-Swarm Teaming

Swarm systems consist of large numbers of agents that collaborate autonomously. With an appropriate level of human control, swarm systems could be applied in a variety of contexts ranging from urban search and rescue situations to cyber defence. However, the successful deployment of the swarm in such applications is conditioned by the effective coupling between human and swarm. While adaptive autonomy promises to provide enhanced performance in human-machine interaction, distinct factors must be considered for its implementation within human-swarm interaction. This paper reviews the multidisciplinary literature on different aspects contributing to the facilitation of adaptive autonomy in human-swarm interaction. Specifically, five aspects that are necessary for an adaptive agent to operate properly are considered and discussed, including mission objectives, interaction, mission complexity, automation levels, and human states. We distill the corresponding indicators in each of the five aspects, and propose a framework, named MICAH (i.e., Mission-Interaction-Complexity-Automation-Human), which maps the primitive state indicators needed for adaptive human-swarm teaming.

Real Or Not Real: The Impact of the Physical Fidelity of Virtual Learning Resources on Learning Anatomy

Technological advancements have made it possible to create realistic virtual representations of the real world, although it is unclear in medical education whether high physical fidelity is required in virtual learning resources (VLRs). This study, therefore, aimed to compare the effectiveness of high-fidelity (HF) and low-fidelity (LF) VLRs for learning anatomy. For this study, HF and LF VLRs were developed for liver anatomy and participants were voluntarily recruited from two cohorts (cohorts 1 and 2). Knowledge outcomes were measured through pre- and post-tests, task outcomes including activity score and completion time were recorded and participants' perceptions of the VLRs were surveyed. A total of 333 participants (165 HF and 168 LF) took part in this study. Knowledge outcomes were higher for the HF activity in cohort 1 and for the LF activity in cohort 2, although not significantly. There were no significant differences in activity score within either cohort, although completion time was significantly longer for the HF activity in cohort 1 (P = 0.001). There were no significant differences within either cohort in perceptions of the VLRs regarding usefulness for reviewing conceptual knowledge, esthetics, quality, mental effort experienced, or future use, although the LF VLR was scored significantly higher regarding the value for understanding in cohort 1 (P = 0.027).This study suggests that high physical fidelity is not necessarily required for anatomy VLRs, although may potentially be valuable for improving knowledge outcomes. Also, level of prior knowledge may be an important factor when considering the physical fidelity of anatomy VLRs.

The integration of immersive virtual reality simulation in interprofessional education: A scoping review

BACKGROUND

Contemporary healthcare systems are in dire need of teamwork and interprofessional collaboration, however, existing curricula of health education programs offer few opportunities to build these capabilities. Virtual simulations enable interaction and cooperative learning for students pursuing health majors.

OBJECTIVE

To explore the effectiveness of immersive virtual reality simulation (IVRS) in interprofessional education (IPE) and the experience of students from various disciplines in a virtual clinical environment.

DESIGN, DATA SOURCES AND METHODS

A scoping review was conducted. Literature was systematically searched from CINAHL, EMBASE, ERIC, MEDLINE/PubMed, ProQuest, PsycINFO, Scopus, Science Direct, Cochrane Library and Open Grey databases. Among 2352 records, 12 research articles were found and analyzed.

RESULTS

The experiences of students participating in IVRS centered on enhanced cooperation and communication across their disciplines. They obtained a more accurate picture of the patient and developed an interdisciplinary care plan. After the IPE session, they had greater appreciation of the importance of a team approach and shared learning. Students acknowledged the usability of virtual worlds (VWs) and appreciated the immersive learning experience that was offered. They gained valuable insight into mutual roles and believed that this experience would benefit their role as a health care team member.

CONCLUSIONS

This study supports the usability of VWs for IPE. As a new teaching modality, the IVRS experience effectively promotes interprofessional collaboration and communication. Future advances in the use of these technologies are expected to revolutionize health science education.

Instructional Design of Virtual Learning Resources for Anatomy Education

Virtual learning resources (VLRs) developed using immersive technologies like virtual reality are becoming popular in medical education, particularly in anatomy. However, if VLRs are going to be more widely adopted, it is important that they are designed appropriately. The overarching aim of this study was to propose guidelines for the instructional design of VLRs for anatomy education. More specifically, the study grounded these guidelines within cognitive learning theories through an investigation of the cognitive load imposed by VLRs. This included a comparison of stereoscopic and desktop VLR deliveries and an evaluation of the impact of prior knowledge and university experience. Participants were voluntarily recruited to experience stereoscopic and desktop deliveries of a skull anatomy VLR (UNSW Sydney Ethics #HC16592). A MyndBand^® electroencephalography (EEG) headset was used to collect brainwave data and theta power was used as an objective cognitive load measure. The National Aeronautics and Space Administration task load index (NASA-TLX) was used to collect perceptions as a subjective measure. Both objective and subjective cognitive load measures were higher overall for the stereoscopic delivery and for participants with prior knowledge, and significantly higher for junior students (P = 0.038). Based on this study's results, those of several of our previous studies and the literature, various factors are important to consider in VLR design. These include delivery modality, their application to collaborative learning, physical fidelity, prior knowledge and prior university experience. Overall, the guidelines proposed based on these factors suggest that VLR design should be learner-centred and aim to reduce extraneous cognitive load.

An Immersive Multi-User Virtual Reality for Emergency Simulation Training: Usability Study

BACKGROUND

Virtual reality (VR) is increasingly used as simulation technology in emergency medicine education and training, in particular for training nontechnical skills. Experimental studies comparing teaching and learning in VR with traditional training media often demonstrate the equivalence or even superiority regarding particular variables of learning or training effectiveness.

OBJECTIVE

In the EPICSAVE (Enhanced Paramedic Vocational Training with Serious Games and Virtual Environments) project, a highly immersive room-scaled multi-user 3-dimensional VR simulation environment was developed. In this feasibility study, we wanted to gain initial insights into the training effectiveness and media use factors influencing learning and training in VR.

METHODS

The virtual emergency scenario was anaphylaxis grade III with shock, swelling of the upper and lower respiratory tract, as well as skin symptoms in a 5-year-old girl (virtual patient) visiting an indoor family amusement park with her grandfather (virtual agent). A cross-sectional, one-group pretest and posttest design was used to evaluate the training effectiveness and quality of the training execution. The sample included 18 active emergency physicians.

RESULTS

The 18 participants rated the VR simulation training positive in terms of training effectiveness and quality of the training execution. A strong, significant correlation (r=.53, P=.01) between experiencing presence and assessing training effectiveness was observed. Perceived limitations in usability and a relatively high extraneous cognitive load reduced this positive effect.

CONCLUSIONS

The training within the virtual simulation environment was rated as an effective educational approach. Specific media use factors appear to modulate training effectiveness (ie, improvement through "experience of presence" or reduction through perceived limitations in usability). These factors should be specific targets in the further development of this VR simulation training.

Design and evaluation of a 3D virtual environment for collaborative learning in interprofessional team care delivery

BACKGROUND

Collaborative learning in interprofessional team care delivery across different healthcare courses and institutions is constrained by geographical locations and tedious scheduling. Three dimensional virtual environments (3D-VE) are a viable and innovative tool to bring diverse healthcare students to learn together.

AIM

The aim of this study is to describe the development of a 3D-VE and to evaluate healthcare students' experiences of their collaborative learning in the environment.

METHOD

A mixed methods study design was employed. Participants from six healthcare courses (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) were recruited from three institutions to form six interprofessional teams to participate in team care delivery via a 3D-VE. Pre- and post-tests were conducted to evaluate the students' attitudes toward healthcare teams and interprofessional collaboration. Four focus groups were conducted with 27 healthcare students after they completed questionnaires to evaluate their perceived usability, the sociability of computer-supported collaborative learning, and senses of presence. Interview transcripts were analyzed using thematic analysis.

RESULT

The students demonstrated significant improvements in their attitudes toward healthcare teams (p < 0.05) and interprofessional collaboration (p < 0.001) after the collaborative learning. Four themes emerged from the focus group discussions: "feeling real", whereby the students felt immersed in their own roles; the virtual environment was perceived as "less threatening" compared to face-to-face interactions; "understanding each other's roles" among different healthcare professionals; and there were some "technical hiccups" related to sound quality and navigation. The participants reported positively on the usability (mean 3.48, SD 0.64), feasibility (mean 3.39, SD 0.60) and perceived sense of presence (mean 107.24, SD 17.78) of the 3D-VE in supporting collaborative learning.

CONCLUSION

Given its flexibility, practicality, and scalability, this 3D-VE serves as a promising tool for collaborative learning across different healthcare courses and institutions in preparing for future collaborative-ready workforces.

Comparing cognitive load levels among family members of the critically ill exposed to electronic decision aids

Cognitive load predicts one's ability to process information and learn from decision support interventions. The present study compared intrinsic and extraneous cognitive load levels resulting from exposure to two different electronic decision aids. A convenience sample of ninety-seven surrogate decision makers for critically ill patients were randomly assigned to receive either a single dose of a video-based or avatar-based decision aid. Intrinsic and extraneous cognitive load levels among recipients of the video-based decision support resource were lower than recipients of the avatar-based decision support resource. After controlling for age, the observed differences in intrinsic cognitive load were not significantly different, whereas the observed differences in extraneous cognitive load remained. Extraneous cognitive load is a modifiable factor to consider for future developers of decision support interventions that may determine the efficacy of efforts to support patients and family members with decision making.

The same video game in 2D, 3D or virtual reality - How does technology impact game evaluation and brand placements?

Video game technology is changing from 2D to 3D and virtual reality (VR) graphics. In this research, we analyze how an identical video game that is either played in a 2D, stereoscopic 3D or Head-Mounted-Display (HMD) VR version is experienced by the players, and how brands that are placed in the video game are affected. The game related variables, which are analyzed, are presence, attitude towards the video game and arousal while playing the video game. Brand placement related variables are attitude towards the placed brands and memory (recall and recognition) for the placed brands. 237 players took part in the main study and played a jump'n'run game consisting of three levels. Results indicate that presence was higher in the HMD VR than in the stereoscopic 3D than in the 2D video game, but neither arousal nor attitude towards the video game differed. Memory for the placed brands was lower in the HMD VR than in the stereoscopic 3D than in the 2D video game, whereas attitudes towards the brands were not affected. A post hoc study (n = 53) shows that cognitive load was highest in the VR game, and lowest in the 3D game. Subjects reported higher levels of dizziness and motion-sickness in the VR game than in the 3D and in the 2D game. Limitations are addressed and implications for researchers, marketers and video game developers are outlined.

Multilevel Visualization Using Enhanced Social Network Analysis with Smartphone Data

While technology matures and becomes more productive, mobile devices can be affordable and, consequently, fully integrated in people's lives. After their unexpected bloom and acceptance, Online Social Networks are now sources of valuable information. The authors therefore use them for tasks varying from direct marketing to forensic analysis. The authors have already seen Social Network Forensics techniques focused on particular networks implementing methods that collect data from user accounts. During the forensic analysis it is common to aggregate information from different sources but, usually, this procedure causes correlation problems. Here, the authors present their method to correlate data gathered from various social networks in combination with smartphones creating a new form of social map of the user under investigation. In addition, the authors introduce a multi level graph that utilises the correlated information from the smartphone and the social networks and demonstrates in three dimensions the relevance of each contact with the suspect.