Examining the impact of virtual reality on clinical decision making - An integrative review

Reviewing the current state of virtual reality integration in medical education - a scoping review

BACKGROUND

In medical education, new technologies like Virtual Reality (VR) are increasingly integrated to enhance digital learning. Originally used to train surgical procedures, now use cases also cover emergency scenarios and non-technical skills like clinical decision-making. This scoping review aims to provide an overview of VR in medical education, including requirements, advantages, disadvantages, as well as evaluation methods and respective study results to establish a foundation for future VR integration into medical curricula.

METHODS

This review follows the updated JBI methodology for scoping reviews and adheres to the respective PRISMA extension. We included reviews in English or German language from 2012 to March 2022 that examine the use of VR in education for medical and nursing students, registered nurses, and qualified physicians. Data extraction focused on medical specialties, subjects, curricula, technical/didactic requirements, evaluation methods and study outcomes as well as advantages and disadvantages of VR.

RESULTS

A total of 763 records were identified. After eligibility assessment, 69 studies were included. Nearly half of them were published between 2021 and 2022, predominantly from high-income countries. Most reviews focused on surgical training in laparoscopic and minimally invasive procedures (43.5%) and included studies with qualified physicians as participants (43.5%). Technical, didactic and organisational requirements were highlighted and evaluations covering performance time and quality, skills acquisition and validity, often showed positive outcomes. Accessibility, repeatability, cost-effectiveness, and improved skill development were reported as advantages, while financial challenges, technical limitations, lack of scientific evidence, and potential user discomfort were cited as disadvantages.

DISCUSSION

Despite a high potential of VR in medical education, there are mandatory requirements for its integration into medical curricula addressing challenges related to finances, technical limitations, and didactic aspects. The reported lack of standardised and validated guidelines for evaluating VR training must be overcome to enable high-quality evidence for VR usage in medical education. Interdisciplinary teams of software developers, AI experts, designers, medical didactics experts and end users are required to design useful VR courses. Technical issues and compromised realism can be mitigated by further technological advancements.

Confounding factors affecting the clinical decision-making of nursing and midwifery students post-pandemic COVID-19: cross-sectional study in Jordan

BACKGROUND

The ability of a nurse to make effective clinical decisions is the most important factor that can affect the treatment quality. However, several factors can affect the ability of nursing and midwifery students to make effective clinical decisions.

OBJECTIVES

This study aims to identify the confounding factors that may affect the clinical decision making of nurses and thus patient outcomes after the COVID-19 pandemic in Jordan.

METHODS

A descriptive cross-sectional design was employed in this study. An online self-administered questionnaire was distributed to 269 nursing and midwifery students selected through purposive sampling, 224 of whom completed the questionnaire. The valid and reliable nursing decision-making instrument, which consisted of 24 items, was employed to gather the data, and descriptive statistics and simple linear regression were employed for the data analysis. Data was collected from November to the end of December 2022.

RESULTS

Among the respondents, 72.8% were female, and the average age was 20.79 years (SD = 1.44). The vast majority of the respondents (94.6%) was unmarried, and 74.1% were pursuing a nursing degree. The simple linear regression analysis showed that clinical decision making had a negative and significant relationship with social media usage of an average of 6 h a day (β=-0.085). Moreover, the male nursing students obtained lower clinical decision-making scores (β= -0.408) compared with the female nursing students.

CONCLUSION

Social media usage and gender have a considerable effect on the clinical decision making of the nursing and midwifery students. Therefore, the confounding factors that can affect the clinical decision making of nurses should be discussed further, and strategies to address such factors should be implemented.

Analysis of Knowledge and Satisfaction in Virtual Clinical Simulation among Nursing Students: A Mixed Study

Virtual simulation offers a powerful educational tool with considerable, albeit underexplored potential. This technology immerses students in lifelike digital scenarios, fostering the acquisition of knowledge and skills necessary for their future careers. This study aimed to assess knowledge acquisition and satisfaction outcomes among students using a virtual simulation teaching approach. The specific objectives were (1) to compare pre-and posttest knowledge acquisition, (2) to investigate the influence of prior professional experience on knowledge, and (3) to explore satisfaction levels with virtual simulation. One hundred and fifty-nine nursing students participated in a virtual simulation-based clinical intervention, entailing the resolution of a virtual adult patient hospitalized with respiratory pathology. Sociodemographic data and prior professional experience were collected, and knowledge was evaluated through pre-to-post tests. Satisfaction levels were assessed using open-ended questions. Quantitative data were analyzed using descriptive statistics, Wilcoxon, Mann-Whitney U, and Cohen's tests, while qualitative data underwent keyword-in-context analysis. Significant differences were noted between pre- and posttest knowledge levels, with prior experience showing no significant impact on knowledge acquisition. Participants reported high levels of satisfaction. Lexicometric analysis identified four clusters of words related to the key terms "simulation", "learn", "activity", and "knowledge". Virtual clinical simulation effectively enhances knowledge acquisition and fosters satisfaction, with students recognizing the positive impact of this approach on their learning. Consequently, virtual simulation contributes to the training of competent health professionals.

Exploring mobile mixed reality for critical thinking in nursing and healthcare education: A systematic review

BACKGROUND

The shortage of nursing and healthcare clinical placements has prompted the investigation of ways to supplement authentic learning. Mobile mixed reality has become increasingly available, however, the affordances and design principles for the facilitation of critical thinking are yet to be explored.

OBJECTIVE

To examine how mobile mixed reality facilitates critical thinking in nursing and healthcare higher education.

DESIGN

Systematic review.

REVIEW METHODS

A search in seven databases (MEDLINE, PsychINFO, AMED, ERIC, Scopus, Cochrane, and Web of Science) was conducted with 3488 titles and abstracts screened. The quality of the included studies was evaluated using the Mixed Methods Assessment Tool (MMAT).

RESULTS

A total of 12 studies with 1108 participants were included. The breadth of healthcare disciplines was limited to five disciplines that utilised bespoke scenarios on head-mounted displays. Most scenarios were emergency or critical response, with limited time for pre-brief, debrief, or overall user time. Only two studies directly measured critical thinking, with others including indirect reference to diagnoses, interpretation, analysis, or evaluation of healthcare scenarios. Affordances and design principles for the future development of mobile mixed reality for critical thinking in nursing and healthcare higher education are identified.

CONCLUSIONS

While some pedagogical affordances of mobile mixed reality can be identified in a narrow number of healthcare disciplines, there remain to be limited valid measures of critical thinking used to quantify effectiveness. Future studies would benefit from considering scenarios beyond emergency and critical responses, including longitudinal studies that reflect the development of critical thinking over time, and exploration of co-designed scenarios with and by nursing and healthcare students.

Virtual Reality and Simulation Videos as Effective Training Tools for Creating Safe and Inclusive Environments for Transgender People

BACKGROUND

University education is undergoing a paradigm shift towards active methodologies, such as virtual reality and training videos, which have proven to be valuable resources, especially in the health sciences. The scarcity of existing research on the topic prompted us to conduct this study, which seeks to measure the knowledge gained from the aforementioned tools by users, their level of satisfaction with them, and their perceived utility.

METHODS

This is a quasi-experimental intervention study analysing the impact of virtual objects as learning resources for undergraduate nursing students.

RESULTS

Fifty-four participants completed the training, yielding highly significant differences between their mean scores, with a high statistical power and a large effect size. A total of 85.46% of participants confirmed that the virtual resources helped them considerably to empathise with the experiences of trans people in healthcare settings. Students were comfortable using the virtual resources, very satisfied with the methodology employed, and would recommend the training received.

CONCLUSIONS

University teaching must adapt to meet the current legislations and changing health needs of society, and teaching staff must be prepared to implement new active teaching methodologies that make learning a more dynamic process. Considering these results, our study serves as a guide for other nursing educators who seek to promote inclusive healthcare regarding gender diversity. This study is not registered.