Effects of Medical Education Program Using Virtual Reality: A Systematic Review and Meta-Analysis

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.

Development and Effectiveness Evaluation of 360-Degree Virtual Reality-Based Educational Intervention for Adult Patients Undergoing Colonoscopy

Providing patients with accurate and organized information about colonoscopy, while reducing anxiety, is critical to the procedure's success. This study evaluated the impact of an immersive 360° virtual reality (VR)-based educational intervention for first-time adult colonoscopy patients regarding anxiety, attitudes, knowledge, compliance with bowel preparation, and bowel cleanliness. A quasi-experimental design with a non-equivalent control group and non-synchronized pretest-post-test clinical trial was conducted with 40 patients in the experimental group and 40 in the control group. The 360° VR intervention included two sessions: precautions before colonoscopy and the colonoscopy process. The control group received education through individual verbal explanations with written materials. The findings indicated that the VR intervention significantly improved patients' colonoscopy-related anxiety, attitudes, adherence to bowel preparation instructions, and bowel cleanliness. Utilizing 360° VR as an educational tool has the potential to enhance the effectiveness of educational programs by providing realistic information and engaging patients. These findings suggest that 360° VR has the capacity to enhance screening rates and clinical outcomes by reducing negative perceptions associated with colonoscopy. Furthermore, the application of this method can extend to diverse diagnostic testing-related nursing situations in clinical settings.

Incorporating Technology Adoption in Medical Education: A Qualitative Study of Medical Students' Perspectives

Introduction

The integration of technology into medical education has witnessed significant growth in recent years, with tools such as virtual reality, artificial intelligence, and telemedicine gaining prominence. These tool in medical education, offering immersive, experiential learning experiences.

Methods

We approached medical students currently enrolled in medical education programs and who are familiar with and actively use AI in medical education. Initially, we invited 21 random students to participate in the study; however, only 13 agreed to interviews. Some students cited their busy exam schedules as the reason for not participating. The participants were informed of the objective of the study before the commencement of the recorded interviews. Semi-structured interviews were used to guide the record interviews. Audio recordings were transcribed and analyzed using Atlas.ti, a qualitative data analysis software.

Results

Participants exhibited a diverse range of perceptions and levels of awareness regarding VR, AI, and telemedicine technologies. Learning with virtual reality was considered to be fun, memorable, inclusive, and engaging by participants. The use of virtual reality technology is seen as complementing current teaching and learning approaches, helping to build learners' confidence, as well as providing medical students with a safe environment for problem-solving and trial-and-error learning. The students reported that AI was seen as a potential game-changer in the healthcare sector. Participants hoped that telemedicine would provide healthcare services to remote and underserved populations.

Conclusion

The study conducted focus group discussions with medical students and residents in Saudi Arabia to explore their views on integrating VR, AI, and telemedicine in medical education and practice. Their insights highlight the need for informed decision-making and strategic development to optimize the benefits and address challenges like initial investments, technical issues, ethics, and regulations. These considerations are crucial for fully realizing the potential benefits of technology in medical education globally.

The effectiveness of virtual reality technology in student nurse education: A systematic review and meta-analysis

AIM

The purpose of this study was to analyze the effectiveness of virtual reality technology in nursing education.

BACKGROUND

Virtual reality technology is regarded as one of the advanced and significant instructional tools in contemporary education. However, its effectiveness in nursing education remains a subject of debate, and there is currently limited comprehensive research discussing the impact of varying degrees of virtual technology on the educational effectiveness of nursing students.

DESIGN

Systematic review and meta-analysis.

METHODS

The present systematic review and meta-analysis were applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The PubMed, Embase, CINAHL, ProQuest, Cochrane Library, Web of Science, and Scopus were searched for relevant articles in the English language. The methodologies of the studies evaluated were assessed using Cochrane Risk of Bias2 (ROB 2) tool and Joanna Briggs Institute (JBI) assessment tool. We took the learning satisfaction, knowledge, and skill performance of nursing students as the primary outcomes, and nursing students' self-efficacy, learning motivation, cognitive load, clinical reasoning, and communication ability were assessment as secondary outcomes. The meta-analysis was performed using R 4.3.2 software according to PRISMA guidelines. Heterogeneity was assessed by I2 and P statistics. Standardized mean difference (SMD) and 95 % confidence intervals (CIs) were used as effective indicators.

RESULTS

Twenty-six studies were reviewed, which involved 1815 nursing students. The results showed that virtual reality teaching, especially immersive virtual reality, was effective in improving nursing students' learning satisfaction (SMD: 0.82, 95%CI: 0.53-1.11, P < 0.001), knowledge (SMD: 0.56, 95%CI: 0.34-0.77, P < 0.001), skill performance (SMD: 1.13, 95 % CI: 0.68-1.57, P < 0.001), and self-efficacy (SMD: 0.64, 95%CI: 0.21,1.07, P < 0.001) compared to traditional teaching methods. However, the effects of virtual reality technology on nursing students' motivation, cognitive load, clinical reasoning, and communication ability were not significant and require further research.

CONCLUSIONS

The results of this study show that virtual reality technology has a positive impact on nursing students. Nonetheless, it is crucial not to underestimate the effectiveness of traditional education methods, and future research could analyze the impact of different populations on nursing education while improving virtual reality technology, to more comprehensively explore how to improve the quality of nursing education. Moreover, it is imperative to emphasize the integration of virtual education interventions with real-world experiences promptly. This integration is essential for bridging the gap between the virtual learning environment and real-life scenarios effectively.

REGISTRATION NUMBER

CRD42023420497 (https://www.crd.york.ac.uk/PROSPERO/#recordDetails).

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.

Introducing Virtual Reality in a STEMI Coronary Syndrome Course: Qualitative Evaluation with Nurses and Doctors

In the increasing number of medical education topics taught with virtual reality (VR), the prehospital management of ST-segment elevation myocardial infarction (STEMI) had not been considered. This article proposes an implemented VR system for STEMI training and introduces it in an institutional course addressed to emergency nurses and case manager (CM) doctors. The system comprises three different applications to, respectively, allow (a) the course instructor to control the conditions of the virtual patient, (b) the CM to communicate with the nurse in the virtual field and receive from him/her the patient's parameters and electrocardiogram, and (c) the nurse to interact with the patient in the immersive VR scenario. We enrolled 17 course participants to collect their perceptions and opinions through a semistructured interview. The thematic analysis showed the system was appreciated (n = 17) and described as engaging (n = 4), challenging (n = 5), useful to improve self-confidence (n = 4), innovative (n = 5), and promising for training courses (n = 10). Realism was also appreciated (n = 13), although with some drawbacks (e.g., oversimplification; n = 5). Overall, participants described the course as an opportunity to share opinions (n = 8) and highlight issues (n = 4) and found it useful for novices (n = 5) and, as a refresh, for experienced personnel (n = 6). Some participants suggested improvements in the scenarios' type (n = 5) and variability (n = 5). Although most participants did not report usage difficulties with the VR system (n = 13), many described the need to get familiar with it (n = 13) and the specific gestures it requires (n = 10). Three suffered from cybersickness.

Twelve tips for teaching in virtual reality

Virtual reality (VR) is a technology that is seeing increasing use in medical education as a means to complement or prepare students for clinical practice in a safe space. Whilst effective for learning, it can be difficult to use effectively and requires significant planning to avoid the technological tail wagging the educational dog. We have run educational sessions using the technology to teach anatomy and clinical reasoning that have been well received by students at Queen Mary, University of London. In this article, we share 12 practical tips from our experiences on how to create and deliver learning using VR.

Effectiveness of Virtual Reality Training in Teaching Personal Protective Equipment Skills: A Randomized Clinical Trial

Importance

Training on the proper use of personal protective equipment (PPE) is critical for infection prevention among health care workers. Traditional methods, such as face-to-face and video-based training, can strain resources and present challenges.

Objective

To determine the effectiveness of 360° virtual reality (VR) training for PPE donning and doffing compared with face-to-face and video training in enhancing the PPE use skills of prospective health care practitioners.

Design, Setting, and Participants

A blinded, prospective, and randomized noninferiority clinical trial was conducted from August to December 2021 at Teikyo University School of Medicine in Tokyo, Japan, with a mixed population of medical students. Participants were second- to fourth-year medicine, medical technology, or pharmacy students aged 20 years or older with no prior PPE training. Participants were randomized into 1 of 3 training groups (VR, face-to-face, or video) based on their enrollment order. An intention-to-treat analysis was conducted.

Intervention

A 30-minute lecture on PPE procedures was delivered to all participants before the training. After the lecture, the VR group trained with an immersive 360° VR tool, the face-to-face group trained with actual PPE, and the video group trained by watching video footage on a computer and a projector. After 3 days, a standardized practical skills test was administered.

Main Outcomes and Measures

The primary outcome was the mean score on a 20-point practical skills test, and the secondary outcome was the percentage of correct execution.

Results

A total of 91 participants were recruited and randomized into 3 groups: VR (n = 30), face-to-face (n = 30), and video (n = 31) training. After excluding 1 participant due to illness, 90 participants (mean [SD] age, 24.2 [3.15] years; 54 males [60.0%]) completed the assessment. The mean (SD) scores were 17.70 (2.10) points for the VR group, 17.57 (2.45) points for the face-to-face group, and 15.87 (2.90) points for the video group. The VR group demonstrated no significant difference in performance from the face-to-face group. However, the VR group had significantly higher effectiveness than the video group (17.70 vs 15.87 points; P = .02).

Conclusions and Relevance

Results of this trial indicate that VR training was as effective as face-to-face training in enhancing PPE donning and doffing skills and was superior to video training. The findings suggest that VR training is a viable resource-conserving training option.

Trial Registration

Japan Registry of Clinical Trials Identifier: jRCT103021029.

Virtual Reality for Developing Patient-Facing Communication Skills in Medical and Graduate Education: Protocol for a Scoping Review

BACKGROUND

Clinician-patient communication is an integral component in providing quality medical care. However, research on clinician-patient communication has shown overall patient discontent with provider communication skills. While virtual reality (VR) is readily used for procedural-based learning in medical education, its potential for teaching patient-facing communication skills remains unexplored. This scoping review aims to evaluate the effectiveness and feasibility of VR applications used for patient-facing communication skills development in medical education.

OBJECTIVE

The primary objective is to synthesize and evaluate the effectiveness of available VR tools and applications used for patient-facing communication skills development in medical education. The secondary objectives are to (1) assess the feasibility of adapting VR applications to develop patient-facing communication skills in medical education and (2) provide an overview of the challenges associated with adapting VR applications to develop patient-facing communication skills in medical education.

METHODS

A total of 4 electronic databases (ERIC, Embase, PubMed, and MEDLINE) were searched for primary peer-reviewed articles published through April 11, 2023. Articles evaluating the implementation of non-, semi-, and fully immersive VR training for patient- or caregiver-facing communication skills training provided to graduate, medical, or other allied health care professions students were included. Studies that assessed augmented reality, mixed reality, artificial intelligence, or VR for non-communication-based training were excluded. Study selection will include a title, abstract, and full-text screening by 4 authors. Data from eligible studies will be extracted and entered into a database and presented in tabular format. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews.

RESULTS

As of April 11, 2023, the search strategy has been confirmed and the search has been completed. We are currently at the title and abstract screening stage. Once complete, the articles will undergo full-text screening according to eligibility criteria as described in the methods.

CONCLUSIONS

The findings of this review will inform the development of a graduate-level clinical skills research course within the Institute of Medical Science graduate department at the University of Toronto. It is also expected that these findings will be of interest to other health care-specific faculties inside and beyond our institution. Further, our scoping review will summarize the limited field of literature on VR use in medical communications training and identify areas for future inquiry.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53901.

Powerful medical education improves health care quality and return on investment

INTRODUCTION

Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness.

METHODS

This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations.

RESULTS

PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment.

CONCLUSIONS

The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care.

RiNeo MR: A mixed reality simulator for newborn life support training

Neonatal resuscitation is an uncommon, albeit critical task that is more likely to succeed if performed properly and promptly. In this context, simulation is an appropriate way for training and assessing the abilities of all medical staff involved in delivery room care. Recent studies have shown that learning is enhanced if the simulation experience is realistic and engaging. Hence, Virtual Reality can be beneficial for newborn resuscitation training. However, the difficulty of providing realistic haptic interaction limits its use. To overcome this constraint, we have designed RiNeo MR, a simulator for newborn life support training, combining a sensorized manikin to monitor in real time resuscitation skills, with a Virtual Reality application. The system includes a Virtual Reality headset, Leap Motion to track the user's hands, sensorized bag valve mask, and manikin to monitor head and mask positioning, ventilation, and chest compression. RiNeo MR can be used in two modalities: 2D to let the trainee practice resuscitation manoeuvres on the physical manikin, while receiving real time feedback; 3D that allows the user to be immersed in a virtual environment and practice in an hospital-like setting. In the 3D mode, virtual and real manikins are overlapped and communicate in real time. Tests on 16 subjects (11 controls without medical expertise and 5 paediatric residents) demonstrated that the simulator is well tolerated in terms of discomfort. Moreover, the simulator is high rated for user experience and system usability, suggesting that RiNeo MR can be a promising tool to improve newborn life support training. RiNeo MR is a proof of concept of a mixed-reality newborn life support simulator that can be a promising tool to spread newborn resuscitation high-quality training among healthcare providers involved in perinatal medicine.