Competence-Based Training and Immersion Virtual Reality: Paradigm-Shifting Advances in Medical Education

Virtual reality for assessment in undergraduate nursing and medical education - a systematic review

BACKGROUND

Virtual reality (VR) is increasingly used in healthcare education, offering immersive training experiences that are as effective as conventional methods, with benefits like cost-effectiveness, replicating complex scenarios, and reduced need for physical resources. However, the use of VR as an assessment tool is still emerging, particularly in nursing and medical education. The aim of this systematic review was to examine how immersive VR is used as an assessment tool for nursing and medical students.

METHODS

Embase, PubMed, PsycINFO, Cochrane, CINAHL, and ERIC were searched for articles that assessed nursing and/or medical students using immersive/HMD VR. The data was extracted, and content analysis was performed.

RESULTS

Twenty-six studies met the inclusion criteria, investigating VR assessments in various settings mostly emergencies. Assessments focused on core competencies Patient Care such as first triage, Interpersonal and Communication Skills (e.g., interprofessional communication), and Medical Knowledge (e.g., about coma), utilizing a range of assessment methods from knowledge to performance levels. VR was used either as an automated or supporting assessment tool. Practical considerations in VR implementation were also examined, such as hardware and software.

CONCLUSION

The use of VR in medical education assessment shows promise, particularly for emergency scenarios and performance-based tasks related to core competencies such as Patient Care, Interpersonal and Communication Skills, and Medical Knowledge. While this technology offers opportunities to automate assessments and reduce examiner workload, challenges related to software, costs, and feasibility must be addressed. Additionally, aligning learning objectives, teaching methods, and VR assessments through constructive alignment is essential to ensure effective implementation as both a teaching and evaluation tool.

Simulation in Regional Anaesthesia: A Narrative Review of Its History, Evolution and Future Prospects

Regional anaesthesia has seen a resurgence of sorts since the widespread advent of ultrasound into clinical practice. The ability to access hitherto inaccessible nerves and fascial planes in the human body whilst ensuring visualisation of the needle tip during block performance has opened the proverbial floodgates leading to its widespread adoption, further supported by a growing body of evidence for its many benefits in a patient's perioperative journey and pain management. The concomitant advancement of technology and the development of powerful simulation and artificial intelligence tools has given a much-needed impetus towards improving training and safe practice in regional anaesthesia. Methods: We performed a detailed search of databases, including PubMed Medline, Web of Science, EBSCO, Embase and the Cochrane Library, up to October 2024. Our search was conducted using phrases including (but not limited to) "history of anaesthesia", "history of simulation", "regional anaesthesia and simulation", AI and "artificial intelligence and anaesthesia".

Enhancing medical education for undergraduates: integrating virtual reality and case-based learning for shoulder joint

BACKGROUND

The integration of Virtual Reality (VR) with Case-Based Learning (CBL) has the potential to revolutionise undergraduate medical education, particularly in complex subjects such as the anatomy and rehabilitation of the shoulder joint. This study aimed to explore the effectiveness of this innovative approach in enhancing learning outcomes and knowledge retention.

METHODS

This study employed a parallel-group, assessor-blinded randomised controlled trial (RCT) design. A comprehensive five-week educational programme was developed, combining traditional lecture-based learning with VR-enhanced CBL. The study involved 82 undergraduate students from China Medical University, who were divided into groups receiving different combinations of VR and CBL. Student performance was evaluated through tests and questionnaires.

RESULTS

In the anatomy-related courses, the integration of VR technology with CBL yielded significantly higher results (87.71 ± 5.60) compared to traditional methods (82.59 ± 6.64), with a statistically significant difference (P < 0.05). This provides compelling evidence of VR's potential to enhance student engagement and knowledge retention. In the context of physiotherapy-related courses, however, while the test scores of the VR-combined CBL group (81.85 ± 5.99) were marginally higher than those of the traditional CBL group (79.02 ± 7.57), this difference was not statistically significant (P > 0.05).

CONCLUSION

The present study provides preliminary evidence for the benefits of incorporating VR into medical education, particularly in anatomy. While the results are promising, further research is needed to explore the optimal integration of VR and CBL in rehabilitation studies and to assess their long-term impact on student learning and clinical performance.

TRIAL REGISTRATION

The study was registered with Chinese Clinical Trials Registry (Registration Number: ChiCTR2400089295) on 05/09/2024.

Using Virtual Reality to teach ultrasound-guided needling skills for regional anaesthesia: A randomised controlled trial

STUDY OBJECTIVE

We previously designed and validated a virtual reality-based simulator to help train novices in ultrasound-guided needling skills necessary for safe and competent ultrasound-guided regional anaesthesia. This study was designed to compare the performance and error rates of novices trained by a human faculty aided with the assistance of this virtual reality simulator (virtual reality-assisted training), versus novices trained wholly by humans (conventional training).

DESIGN, SETTING, AND PARTICIPANTS

In this single centre, randomised controlled study, we used a standardised teaching protocol, rigorous blinding, iterative training of assessors, and validated global rating scale and composite error score checklists to assess skills learning of novice participants.

MAIN RESULTS

We recruited 45 novices and scored 270 assessments of performance and error rates. Inter-rater correlation coefficient of reliability of scoring between assessors for the global rating scale was 0.84 (95%CI 0.68-0.92) and for the composite error score checklist was 0.87 (95%CI 0.73-0.93). After adjustment for age, sex, Depression, Anxiety and Stress-21, and baseline score, there was no statistical difference for virtual reality-assisted training compared to conventional training in final global rating score (average treatment effect -3.30 (95%CI-13.07-6.48), p = 0.51) or in the final composite error score (average treatment effect 1.14 (95%CI -0.60-2.88), p = 0.20). Realism in the virtual reality simulator was similar to real-life when measured by the Presence Questionnaire, all components p > 0.79; and task workload assessed by the NASA-Task Load Index was not statistically different between groups, average treatment effect 5.02 (95%CI -3.51-13.54), p = 0.25. Results were achieved in the virtual reality-assisted group with half the human faculty involvement.

CONCLUSION

Novices trained using a hybrid, virtual reality-assisted teaching program showed no superiority to novices trained using a conventional teaching program, but with less burden on teaching resources.

The importance of simulation-based multi professional training in obstetric anesthesia: an update

PURPOSE OF REVIEW

Simulation-based training remains an integral component of medical education by providing a well tolerated, controlled, and replicable environment for healthcare professionals to enhance their skills and improve patient outcomes. Simulation technology applied to obstetric anesthesiology continues to evolve as a valuable tool for the training and assessment of the multidisciplinary obstetric care team.

RECENT FINDINGS

Simulation-based technology has continued to play a role in training and assessment, including recent work on interdisciplinary communication, recognition, and management of obstetric hemorrhage, and support in the low or strained resource setting. The COVID-19 pandemic has accelerated the evolution of simulation-based training away from a reliance on in-situ or high-fidelity manikin-based approaches toward an increasing utilization of modalities that allow for remote or asynchronous training.

SUMMARY

The evolution of simulation for interdisciplinary training and assessment in obstetric anesthesia has accelerated, playing a greater role in aspects of communication, management of hemorrhage and supporting low or strained resource settings. Augmented reality, virtual reality and mixed reality have advanced dramatically, spurred on by the need for remote and asynchronous simulation-based training during the pandemic.

Looking Ahead to the Frontier of Anesthesiology Education

In this issue of Anesthesia & Analgesia, a series of articles focus on the elemental changes to anesthesia training and education. Kealey and Naik review the status of competency-based medical training, a method through which learners are deliberately observed for progression to mastery in clinical management. This is contrast to the assumption that trainees will presumably reach the same intended endpoint merely by spending a pre-specified amount of time in post-graduate residency training. The advantages and disadvantages of the competency-based approach are reviewed. Alam and Matava describe how education has also changed to incorporate digital technology by way of immersive simulation. They detail the use of virtual and augmented reality to offer trainees the opportunity to engage in clinical exercises that are infrequently encountered in real practice, increase the exposure to challenging scenarios and foster real-time collaborations on a global scale. An accompanying editorial offers further perspective on the future of training in our specialty. The reader is strongly encouraged to review the cited articles for an in-depth appreciation of the concepts discussed.