The Present and Future of Virtual Reality in Medical Education: A Narrative Review

Virtual reality (VR) uses computer-generated and three-dimensional environments to create immersive experiences through the use of interactive devices that simulate virtual environments in many forms, such as 3D, screen-based, or room-based. Users can engage in the environment with objects, characters, and scenes, making individuals assume they are experiencing a real-life scenario. VR has been adopted across medical and nursing fields to supplement clinically relevant and practical teaching. However, the effectiveness of this interactive form of learning has come a long way with improvements in accessibility, cost, and technicalities. The immersive simulated environment that VR has to offer today initially began with screen-based learning and then the 360-video method. These previously sought-out methods were eventually found to disconnect the students from engaging in the learning environment that present-day VR systems are designed to provide. Interactive VR offers a dynamic platform for medical training. These simulations benefit the learner by allowing them to interact within case scenarios and virtual wards, as well as with patients, colleagues, and relatives. To mimic real-life encounters, the student can take a patient's history and physical exam, investigate, diagnose, and provide treatment. The simulated patient can express emotions, concerns, and signs of a poor state of health. All these factors play into a healthcare provider's competency to think critically and clinically in decision-making. This practice is now being used in many surgical programs and medical education curricula. The use of simulation in VR is continuously being proven to decrease injury, increase operation speed, and improve overall outcomes in patient-centered care. VR simulation differs from in-person simulation training in that the VR modality of learning is more accessible and replicable than the latter. By comparing research studies and reviews of medical programs that incorporated VR into their curricula, we were able to assess the state of VR in medical education and where this technology could lead to future implementation in medical programs. Our review aimed to give insight into the existing evidence, the gaps in the use of VR in medical education, and the potential benefits this modality of learning can have going forward in this field of study. Medical students have demonstrated significantly enhanced knowledge gain when using immersive interactive VR over screen-based learning. Given the improvements in students' performance due to these dynamic and collaborative learning experiences, immersive VR training will become a standard in the development of clinical skills and ensure patient safety. Although the emphasis on empathy began later in the journey of gaining VR as a part of medical education, there is a need to gain those skills as early as possible in medical school. Implementing the use of VR as a supplement in medical education allows students to practice simulated patient encounters along with an array of different academic endeavors. By doing so, students will gain competency and confidence as they encounter patients during their clinical rotations and clinical practice.

Should Virtual Objective Structured Clinical Examination (OSCE) Teaching Replace or Complement Face-to-Face Teaching in the Post-COVID-19 Educational Environment: An Evaluation of an Innovative National COVID-19 Teaching Programme

Background The COVID-19 pandemic brought about drastic changes to medical education and examinations, with a shift to online lectures and webinars. Additionally, social restrictions in the United Kingdom (UK) inhibited students' ability to practice for objective structured clinical examination (OSCE) with their peers. Methods The Virtual OSCE buddy scheme (VOBS) provided a means to practice OSCE skills virtually by linking groups of 2-6 final-year medical students with a junior doctor who had recently passed their exams. Sessions were held virtually, tailored to the needs of each group, in a 3-month period prior to examinations. The scheme ran across two examination periods, 2020/21 and 2021/22, including a total of 13 universities throughout the UK. Results In 2020/21, 96% (n=227) of students described improved confidence in OSCE scenarios. Furthermore, 90% (n=213) reported improvement in communication, 89% (n=211) in diagnosis and clinical reasoning and 86% (n=203) in history-taking skills. Examination and procedural skills proved more challenging to practice virtually, with improvement reported by 31% (n=73) and 15% (n=36) of students, respectively. Ninety-three per cent (n=58) of buddies reported improved lesson planning abilities and 90% (n=57) felt more confident in their teaching. In 2021/22, 90% (n=133) of students felt more prepared for their OSCE. In key skills, improvement was reported by 87% (n=128) in communication, 84% (n=124) in diagnosis and clinical reasoning and 83% (n=123) in history-taking. In this cohort, 40% (n=59) reported improvement in examination skills and 24% (n=36) in procedural skills. Ninety per cent (n=83) of buddies reported an improvement in teaching skills, with 93% (n=85) increasing their confidence to teach. Conclusion VOBS demonstrates the benefits to students and teachers of near-peer OSCE teaching. Given the virtual nature, the main drawback is the inability to practice hands-on examination and procedural skills. This scheme provides insight to educators planning virtual teaching programmes in the future. With the evolution of technology, virtual examination and procedure practice may be possible in the near future. VOBS would suggest that currently, virtual OSCE teaching should be used to complement face-to-face teaching.

A collaborative strategy to improve geriatric medical education

INTRODUCTION

Age-related demographic change is not being matched by a growth in relevant undergraduate medical education, in particular communication skills pertinent to elderly patients. To address this, a workshop for medical students focusing on important communication skills techniques for interacting with patients with dementia was designed by clinicians from the Geriatric, General Practice and Psychiatry departments at the University of Oxford.

METHODS

One hundred and forty-four first-year clinical students (Year 4 of the 6-year course; Year 2 of the 4-year graduate-entry course) attended the teaching. One hundred and twenty-nine students returned feedback forms with 104 forms matched for individual performance before and after the session. Feedback forms assessed student-perceived confidence in communicating with patients with dementia before and after the session using a 4-point Likert scale with corresponding numerical value (low (1), medium (2), high (3), very high (4)).

RESULTS

Using the Wilcoxon Signed-Rank Test on the 104 matched forms, student-perceived confidence was higher post-teaching intervention (median = 2.75) than pre-intervention (median = 1.50). This difference was statistically significant with large effect size, Z = -8.47, P < 0.001, r = -0.59. Free-text comments focused on non-verbal communication skills teaching, suggesting that these sessions were most beneficial for topics hardest to teach in lecture-based approaches.

CONCLUSION

The teaching aimed to promote patient-centred care and multidisciplinary collaborative practice, encourage student self-reflection and peer-assisted education and provide insight into the needs of patients with dementia. Student feedback indicated that these objectives had been met. This easily replicable teaching method provides a simple means of improving communication skills.