A Data-driven Approach to Identify Feedback Elements for Effective VR Training

Virtual Reality (VR) technology has become an increasingly popular tool in various training applications. It can provide trainees with a controlled environment to practice scenarios that may be too dangerous or expensive to replicate in real life. Yet, while VR training provides many benefits, it is essential to ensure that it is used appropriately and consider the potential risks associated with such technology, namely cybersickness. If not taken into account, cybersickness can seriously threaten the usability of VR training applications, preventing them from reaching their full potential. Similarly, poor usability can have negative impacts on users’ well-being. This paper provides an overview of the usability and cybersickness characteristics of VR training. Then, it looks into seven human factors (HF) dimensions impacting cybersickness and provides recommendations to mitigate its effects on VR users. Finally, it shows the importance of considering both usability and cybersickness aspects to achieve safe and effective training in VR. To this end, two VR applications are compared, one used for learning assembly operations and the other to learn aircraft operating procedures. Their usability issues and degree of cybersickness are then discussed using the HF dimensions.

There is limited data assessing simulation and virtual reality training as a standardized tool in medical education. This feasibility study aimed to evaluate the effectiveness of virtual reality training and a student-led simulation module in preparing medical students to perform a lumbar puncture. Twenty-five medical students completed a pre-intervention survey, and a baseline video recorded lumbar puncture procedure on a task trainer. Students were randomly distributed into the virtual reality group, or the curriculum's standard student-led procedural instruction group. Participants were then given 45min to practice the lumbar puncture procedure. After the intervention, all participants were video recorded again as they performed a post-intervention lumbar puncture and completed a post-intervention survey. Pre- and post-intervention videos were scored using a critical action checklist in conjunction with time needed to complete the procedure to evaluate proficiency. At baseline, there were no major statistically significant differences between groups. Assessing overall post-intervention performance, both groups showed improvement in aggregate score (p < 0.001) and time required to complete (p = 0.002) the lumbar puncture. Following interventions, the student-led group improved over the virtual reality group in a variety of metrics. The student-led group increased their aggregate score by 3.49 and decreased their time to completion by 34s over the VR group when controlling for baseline measures. Both virtual reality and student-led simulation training were useful training modalities, with hands-on simulation showing better results versus virtual reality training in this setting. The online version contains supplementary material available at 10.1007/s40670-020-01141-6.

The goal for a virtual reality (VR) training system is to enable trainees to acquire all the knowledge they need to perform effectively in a real environment. Such a system should provide an experience so authentic that no further real-world training is necessary, meaning that it is sufficient to train in VR. We evaluate the impact of a haptic thermal stimulus, which is of paramount importance to decision making, on trainees performance and knowledge acquisition. A thermal device was created to deliver the stimulus. As a proof of concept, a procedure from firefighter training is selected, in which sensing the temperature of a door with one's hand is essential. The sample consisted of 48 subjects divided among three experimental scenarios: one in which a virtual thermometer is used (visual stimulus), another in which the temperature is felt with the hand (thermal stimulus) and a third in which both methods are used (visual + thermal stimuli). For the performance evaluation, we measured the total time taken, the numbers of correctly executed procedures and identified neutral planes, the deviation from the target height, and the responses to a knowledge transfer questionnaire. Presence, cybersickness, and usability are measured to evaluate the impact of the haptic thermal stimulus. Considering the thermal stimulus condition as the baseline, we conclude that the significantly different results in the performance among the conditions indicate that the better performance in the visual-only condition is not representative of the real-life performance. Consequently, VR training applications need to deliver the correct stimuli for decision making.

BackgroundIt appears that active video games (AVGs) and training apps that allow for physical activity (PA) in immersive virtual reality (VR) may be useful for sports, health-enhancing PA, and physical education (PE). Therefore, research is needed to identify their potential.ObjectiveThe study aimed to evaluate the intensity and attractiveness of exercise during table tennis (TT) training in VR in arcade and simulation modes and to assess the potential for using such exercises in health-enhancing PA, sport, and PE.MethodsThe research used the Racket Fury: Table Tennis VR. Exercise intensity during TT training in VR was evaluated by heart rate (HR) monitoring and rating of perceived exertion (RPE 6–20). The effectiveness of short-term TT training in VR was estimated based on the user’s performance in playing against an opponent with artificial intelligence (AI), satisfaction with playing TT was measured using the Physical Activity Enjoyment Scale (PACES), and the potential usefulness of the tested app in PA, sport, and PE was assessed based on a questionnaire for participating PE teachers (30 participants).ResultsPA intensity during TT training in VR expressed as a percentage of maximum heart rate (HRmax) was moderate but was significantly (p < 0.001; d=-0.830) higher in the easier arcade mode (69.50 ± 12.58%HRmax) than in the simulation mode (64.10 ± 9.67%HRmax). Despite the greater fatigue of respondents, user satisfaction was significantly higher in arcade mode. Users’ performance when playing with AI was significantly better after 20 min of training in VR than before training. PE teachers recognize the great potential of the app.ConclusionsThe application tested is characterized by a beneficial PA intensity, with its level depending on the game mode. Facilitating strokes during a game of virtual TT promotes increased intensity of exercise and increased enjoyment of the PA. Short-term TT training in VR improves playing skills in a virtual environment. PE teachers spoke highly of the app and recognized the potential for using VR technology in PA, sports, and school PE.

Standard surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time-consuming, costly, and of variable effectiveness. Training using a virtual reality simulator is an option to supplement standard training. Virtual reality training improves the technical skills of surgical trainees such as decreased time for suturing and improved accuracy. The clinical impact of virtual reality training is not known. To assess the benefits (increased surgical proficiency and improved patient outcomes) and harms (potentially worse patient outcomes) of supplementary virtual reality training of surgical trainees with limited laparoscopic experience. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index Expanded until July 2012. We included all randomised clinical trials comparing virtual reality training versus other forms of training including box-trainer training, no training, or standard laparoscopic training in surgical trainees with little laparoscopic experience. We also planned to include trials comparing different methods of virtual reality training. We included only trials that assessed the outcomes in people undergoing laparoscopic surgery. Two authors independently identified trials and collected data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager 5 analysis. For each outcome we calculated the mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals based on intention-to-treat analysis. We included eight trials covering 109 surgical trainees with limited laparoscopic experience. Of the eight trials, six compared virtual reality versus no supplementary training. One trial compared virtual reality training versus box-trainer training and versus no supplementary training, and one trial compared virtual reality training versus box-trainer training. There were no trials that compared different forms of virtual reality training. All the trials were at high risk of bias. Operating time and operative performance were the only outcomes reported in the trials. The remaining outcomes such as mortality, morbidity, quality of life (the primary outcomes of this review) and hospital stay (a secondary outcome) were not reported. Virtual reality training versus no supplementary training: The operating time was significantly shorter in the virtual reality group than in the no supplementary training group (3 trials; 49 participants; MD -11.76 minutes; 95% CI -15.23 to -8.30). Two trials that could not be included in the meta-analysis also showed a reduction in operating time (statistically significant in one trial). The numerical values for operating time were not reported in these two trials. The operative performance was significantly better in the virtual reality group than the no supplementary training group using the fixed-effect model (2 trials; 33 participants; SMD 1.65; 95% CI 0.72 to 2.58). The results became non-significant when the random-effects model was used (2 trials; 33 participants; SMD 2.14; 95% CI -1.29 to 5.57). One trial could not be included in the meta-analysis as it did not report the numerical values. The authors stated that the operative performance of virtual reality group was significantly better than the control group. Virtual reality training versus box-trainer training: The only trial that reported operating time did not report the numerical values. In this trial, the operating time in the virtual reality group was significantly shorter than in the box-trainer group. Of the two trials that reported operative performance, only one trial reported the numerical values. The operative performance was significantly better in the virtual reality group than in the box-trainer group (1 trial; 19 participants; SMD 1.46; 95% CI 0.42 to 2.50). In the other trial that did not report the numerical values, the authors stated that the operative performance in the virtual reality group was significantly better than the box-trainer group. Virtual reality training appears to decrease the operating time and improve the operative performance of surgical trainees with limited laparoscopic experience when compared with no training or with box-trainer training. However, the impact of this decreased operating time and improvement in operative performance on patients and healthcare funders in terms of improved outcomes or decreased costs is not known. Further well-designed trials at low risk of bias and random errors are necessary. Such trials should assess the impact of virtual reality training on clinical outcomes.

Virtual reality (VR) research has gone through rapid advances and the technology has established itself as a valuable training tool in many domains. While research in the field of emergency response, and more specifically in the field of firefighting, is still catching up, the future potential of VR technology for training is promising. This paper uses the SWOT framework to analyse the strengths, weaknesses, opportunities, and threats immersive VR technology faces in the field of firefighter training. While using VR for training is cost-effective, safe to use and provides the ability to prepare trainees with a large variety of high fidelity training environments, the lack in specialization of the applications for the fire-service sector and issues with technology acceptance and limitations need to be addressed. Looking to current research, there are promising findings that might be directly transferable, creating affective, and multi-sensory experiences for more effective mental and physical training of firefighters in the future. More research is needed to establish methods of skills transfer from VR to real life scenarios and to evaluate the potential risk of frequent training in engaging and physiologically stimulating virtual environments.

The usability of virtual reality (VR) training applications is crucial for their success, but examining the usability in the early development stages remains challenging. A realistic and plausible solution would be revisiting and reconciling Heuristics Evaluation (HE) methods among the most widely used usability inspection methods in the human-computer interaction (HCI) domain. While research on studying and using HE methods is growing within the VR domain, few studies have considered the novel VR environment challenges new requirements for fitting HE methods to the context and applying them effectively. To this end, we conducted a user study with 14 evaluators using the standard HE methods to complete two HE sessions for a VR training application. We identified five critical challenges that evaluators encountered in the HE process by observing and interviewing them. Based on our findings, we discuss the importance of considering an easy-to-use heuristic set, how we can facilitate the HE procedures in the VR context, and the opportunities for developing HE-supporting tools.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Introduction: Previous studies evaluating the effect of virtual reality (VR) training on operating room performance have only analyzed the latter portion of the laparoscopic cholecystectomy (LC), while including many residents beyond their second year of training. The aim of this study was to better understand the impact of VR training on subjects with limited laparoscopic surgical experience during completion of an entire laparoscopic cholecystectomy. Methods: Twelve surgical residents (PGY 1 & 2) were randomized to either standard training (n = 6) or VR training (n = 6). In the VR training group subjects were required to reach expert established performance criterion levels on the manipulation diathermy task of the Minimally Invasive Surgical Trainer (MIST-VR). All subjects then performed a video-recorded LC under the supervision of a surgeon blinded to training status. Recordings were assessed by two blinded surgeon investigators using scores based on expert-defined errors with inter-rater reliability >0.9. Results: VR trained subjects completed the full LC 20% faster than controls (39 min. vs. 31 min.), made half as many errors while exposing cystic structures (5.3 vs 10), and one-third fewer errors in dissecting the gallbladder (5.5 vs. 8.2). Overall, controls made 40% more errors (11.7 vs 19.7, p Conclusions: Criterion based VR training to expert performance levels for junior surgical residents results in fewer intra-operative errors and greater performance consistency during the entire laparoscopic cholecystectomy procedure.

Virtual reality technology is an emerging technology that possibly can address the problems encountered in training (elderly) people to handle a mobility device. The objective of this review was to study different virtual reality training applications as well as their clinical implication for patients with mobility problems. Computerized literature searches were performed using the MEDLINE, Cochrane, CIRRIE and REHABDATA databases. This resulted in eight peer reviewed journal articles. The included studies could be divided into three categories, on the basis of their study objective. Five studies were related to training driving skills, two to physical exercise training and one to leisure activity. This review suggests that virtual reality is a potentially useful means to improve the use of a mobility device, in training one's driving skills, for keeping up the physical condition and also in a way of leisure time activity. Although this field of research appears to be in its early stages, the included studies pointed out a promising transfer of training in a virtual environment to the real-life use of mobility devices.

Beyond its applications in other settings, virtual reality (VR) technology has gained attention in medical education, offering immersive learning experiences. Previous research has demonstrated its potential as an educational tool in medical settings, highlighting enhanced educational outcomes, skill acquisition and retention, standardized training experiences, and the promotion of active learning. However, there is still a dearth of research exploring various aspects of VR user experiences, with most studies focusing on its effect on skill acquisition. Limited qualitative research further hinders an in-depth understanding of user experiences, restricting a comprehensive overview of VR's potential in medical education. This study explored subjective experiences with VR simulation training and its perceived benefits and challenges among medical students in the United Kingdom, using the 5 domains of the Immersive Technology Evaluation Measure (ITEM). In July 2024, 15- to 20-minute in-person interviews were conducted with 11 medical students who had completed the immersive VR training consisting of the assessment and treatment of a virtual patient. Guided by the 5 domains of the ITEM as preconceived themes, a deductive thematic analysis was used to explore individual experiences with the training, embedded within narrative responses. Findings aligned with the 5 a priori ITEM domains of system usability, immersion, motivation, cognitive load, and debriefing. Within these predefined domains, new subthemes emerged that enhanced the understanding of user experience. Participants reported usability barriers involving accessibility, technical issues, and limited variability in scenarios. Immersion was generally strong due to realistic environments, although reduced interactivity constrained authenticity. Motivation was reflected in active engagement and a greater sense of preparedness for clinical practice. Cognitive load was associated with divided attention, physical effects, and a need for clearer guidance and familiarization. Ultimately, participants valued debriefing sessions as valuable opportunities for reflection and reinforcing knowledge. VR training fosters immersion and motivation, but its effectiveness depends on balancing technical usability with cognitive demands. Future integration should prioritize design variability and structured debriefing to optimize learning outcomes. Refinement of immersive VR training in clinical education is also warranted, alongside further research in broader contexts and longitudinal use.

Due to limited space and resources, it can be difficult to train students on audiological procedures adequately. In the present study, we compared audiology training outcomes between a traditional approach and a recently developed immersive virtual reality (VR) approach in audiology students. Twenty-nine first-year audiology students participated in the study; 14 received traditional training (“TT group”), and 15 received the VR training (“VRT group”). Pre- and post-training evaluation included a 20-item test developed by an audiology educator. Post-training satisfaction and self-confidence were evaluated using Likert scales. Mean post-training test scores improved by 6.9±9.8 percentage points in the TT group and by 21.1±7.8 points in the VRT group; the improvement in scores was significant for both groups. After completing the traditional training, the TT group was subsequently trained with the VR system, after which mean scores further improved by 7.5 points; there was no significant difference in post-VR training scores between the TT and VRT groups. After training, the TT and VRT groups completed satisfaction and self-confidence questionnaires. Satisfaction and self-confidence ratings were significantly higher for the VR training group, compared to the traditional training group. Satisfaction ratings were “good” (4 on Likert scale) for 74% of the TT group and 100% of the VRT group. Self-confidence ratings were “good” for 71% of the TT group and 92% of the VRT group. These results suggest that a VR training approach may be an effective alternative or supplement to traditional training for audiology students.

The objective of this paper is to describe the current status, advantages, and disadvantages of Virtual Reality simulators as tools for training and assessment of laparoscopic skills. This is a review of publications about Virtual Reality simulators in laparoscopic training and assessment. Information was obtained through author’s experience and by search of MEDLINE using the keywords Virtual Reality simulation, training, assessment and laparoscopic surgery. The references cited in these studies were reviewed to find out whether any other trials fitted the selection criteria. There are several validated Virtual Reality systems that allow the transfer of skills from the virtual environment to the operating room and objective assessment of operative skills in laparoscopic surgery. In conclusion, Virtual Reality simulators are valid and objective tools in surgical education. Several systems are currently considered sufficiently validated and ready to be implemented in comprehensive educational curricula in minimally invasive surgery.

Objectives This study is aimed at exploring the effects of virtual reality (VR) training on postural control, measured by anticipatory and compensatory postural adjustments (APAs and CPAs, respectively), in patients with chronic nonspecific low back pain (CNLBP) and the potential neuromuscular mechanism of VR training. Methods Thirty-four patients were recruited and randomly assigned to the VR group (n = 11), the motor control exercise group (MCE, n = 12) and the control group (CG, n = 11). The VR group received VR training using Kinect Xbox 360 systems and magnetic therapy. Besides magnetic therapy, the participants in the MCE group performed real-time ultrasound-guided abdominal drawing-in maneuver (ADIM) and four-point kneeling exercise. The CG only received magnetic therapy. Surface muscle electromyography (sEMG) was used to record the muscle activities of transverse abdominis (TrA), multifidus (MF), lateral gastrocnemius (LG), and tibialis anterior (TA) during ball-hitting tasks. The muscle activation time and integrals of the electromyography activities (IEMGs) during the APA and CPA stages were calculated and used in the data analysis. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) scores were also recorded. Results A significant interaction effect of time × group was observed on the activation time of TrA (p = 0.018) and MF (p = 0.037). The post-intervention activation time of the TrA was earlier in the VR group (p = 0.029). In contrast, the post-intervention activation time of the MF was significantly delayed in the VR group (p = 0.001). The IEMGs of TrA (p = 0.002) and TA (p = 0.007) during CPA1 significantly decreased only in the VR group after the intervention. The VAS scores of three group participants showed significant decreases after intervention (p < 0.001). Conclusions Patients with CNLBP showed reciprocal muscle activation patterns of the TrA and MF muscles after VR training. VR training may be a potential intervention for enhancing the APAs of the patients with CNLBP.

Virtual reality (VR) offers the potential to provide a lifelike, safe, and interactive environment where healthcare providers can practice and refresh their skills. The Neonatal Resuscitation Program (NRP) is an evidence-based and standardized approach for training healthcare providers on the resuscitation of the newborn where VR can be applied. Here we describe a development study for a VR-NRP simulation. This contribution is relevant for researchers and developers in the health sector interested in the integration of VR and other extended reality (XR) technologies in medical education and training. For the implementation of the VR simulation, we used the Unity game engine, a VR-capable laptop, and an HTC Vive Pro Head-Mounted Display. We focused on the skill of positive pressure ventilation (PPV) using a bag and mask as the main scenario for the simulation since this is a foundational skill in NRP. To validate the prototype, we compared the VR-NRP simulation with 360° immersive VR videos in a crossover study involving 30 health-care providers and students, collecting various data through questionnaires and skill assessments by NRP instructors. We described in detail the creation process by which a highly realistic VR simulation was produced reflecting the visual elements and sounds of a Neonatal Intensive Care Unit in a hospital setting. In the crossover study, we found both VR technologies were positively viewed by healthcare professionals and performed very similarly. However, the VR simulation provided a significantly increased feeling of presence. Participants found the VR simulation more useful and reported higher confidence in NRP skills such as proper mask placement and newborn response evaluation, reflecting improved experiential learning outcomes. This research represents a step forward in understanding how VR technologies can be developed and applied for effective, immersive medical training, increasing the availability of NRP refresher sessions, and providing insights into similar applications.