Developing Virtual Reality Simulations for Office-Based Medical Emergencies

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

Can virtual reality simulation be used for advanced bariatric surgical training?

To investigate the effect on final-product performance of a distributed, virtual reality (VR) simulation training program on cadaveric dissection performance and learning curves compared with standard VR simulation training during a temporal bone course. Educational interventional cohort study. The national Danish temporal bone courses of 2016 and 2017. Postgraduate year 2 to 5 residents in otorhinolaryngology. Nine participants volunteered for additional VR simulation training (intervention) before the temporal bone course, with training blocks distributed (i.e., separated). The remaining 28 participants received standard VR simulation training during the temporal bone course (control). VR simulation and cadaveric dissection final-product performances were analyzed by blinded raters using a 26-item modified Welling Scale. Distributed VR simulation training before the temporal bone course (intervention) significantly increased dissection final-product performance by 25% compared with standard VR simulation training during the course (control) (mean scores 12.8 points versus 10.3 points, p < 0.01). Distributed and repeated VR simulation practice markedly decreased drilling time. Guidance by the simulator-integrated tutor-function significantly increased final-product performance by 2.3 points compared with nontutored procedures but at the cost of increased drilling time. Skills acquired in a VR simulation environment translate to cadaveric dissection skills and repeated and distributed VR simulation can be used to further increase performance compared with standard VR simulation training during a temporal bone course. Further dissemination of inexpensive VR simulators would allow all future temporal bone course participants to train locally before attending future centralized courses.

Development of three-dimensional visualisation technology of the aerodynamic environment in a greenhouse using CFD and VR technology, Part 2: Development of an educational VR simulator

Simulation is a key component of surgical training, enabling trainees to develop their skills in a safe environment. With simulators broadly grouped into physical models and virtual-reality (VR) simulators, it is important to evaluate the comparative effectiveness of the simulator types in terms of validity as well as cost. The review aims to compare the benefits and drawbacks of novel VR and physical simulators within the broader themes of endourology, laparoscopic and robotic operations, and other urological procedures. Key benefits of bench models include their comparatively lower cost, easy access and provision of haptic feedback, whereas VR simulators are generally self-sufficient, reusable and enable skills of haemostasis to be practised. The advent of perfused 3D printed simulators across a range of urological procedures may replace cadavers as the traditional gold-standard simulation modality. Although possessing differing strengths and downsides, VR and physical simulators when used together can have an additive effect due to skill transferability across the platforms. Further comparative studies are required to directly quantify the differences between physical models and VR simulators in terms of performance metrics and cost-effectiveness. There is lack of validated VR simulators for open and reconstructive procedures.

Minimally invasive laparoscopic surgery requires intensive training due to challenges such as loss of haptic feedback and depth perception. Traditional training methods include box trainers (BT), which offer realistic haptic feedback but lack objective performance assessment, and virtual reality (VR) simulators, which provide automated feedback but lack haptic feedback. This review, conducted at the Barts Cancer Institute, Queen Mary University, examines the learning outcomes of VRsimulators with haptic feedback compared to BT. A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from December 2023 to April 2024. Research databases, such as PubMed, EMBASE, CINAHL, and Web of Science, were searched for randomized controlled trials (RCTs) comparing VR simulators with haptic feedback to BT in training medical students. Seven RCTs met the inclusion criteria, and four were included in the meta-analysis. The primary outcomes were learning curves and learning effectswhile secondary outcomes included skill transfer to a surgical environment. The review analysed data from 125 participants across the studies. Results indicated that BTs demonstrated a superior learning curve, with participants achieving proficiency faster than those using VR. Both simulators showed significant learning effects; however, BTs resulted in greater improvements across more performance parameters. Regarding skill transfer to surgical environments, there was no significant difference between the two groups, suggesting both approaches effectively support surgical skill transfer. Overall, BT has a more effective learning curve and marginally better performance in skill acquisition. While VR with haptic feedback offers enhanced realism, it does not fully replicate the natural haptic feedback provided by BT. Further studies are needed to improve VR haptic feedback and its integration into training programs to enhance learning outcomes.

Temporal bone surgery requires excellent surgical skills and simulation-based training can aid novices' skills acquisition. However, simulation-based training is challenged by early stagnation of performance after few performances. Structured self-assessment during practice might enhance learning by inducing reflection and engagement in the learning task. In this study, structured self-assessment was introduced during virtual reality (VR) simulation of mastoidectomy to investigate the effects on subsequent performance during cadaveric dissection. A prospective educational study with comparison with historical controls (reference cohort). At a temporal bone dissection course, eighteen participants performed structured self-assessment during 3h of VR simulation mastoidectomy training before proceeding to cadaver dissection (intervention cohort). At a previous course, eighteen participants received identical VR simulation training but without the structured self-assessment (reference cohort). Final products from VR simulation and cadaveric dissection were recorded and assessed by two blinded raters using a 19-point modified Welling Scale. The intervention cohort completed fewer procedures (average 4.2) during VR simulation training than the reference cohort (average 5.7). Nevertheless, the intervention cohort achieved a significantly higher average performance score both in VR simulation (11.1 points, 95% CI [10.6-11.5]) and subsequent cadaveric dissection (11.8 points, 95% CI [10.7-12.8]) compared with the reference cohort, who scored 9.1 points (95% CI [8.7-9.5]) during VR simulation and 5.8 points (95% CI [4.8-6.8]) during cadaveric dissection. Structured self-assessment is a valuable learning support during self-directed VR simulation training of mastoidectomy and the positive effect on performance transfers to subsequent cadaveric dissection performance.

BackgroundThis study compared scenario-based generative artificial intelligence (GenAI) patient simulation with immersive 360° virtual reality (VR) simulation in terms of perceived clinical competence, cultural awareness, AI readiness, and simulation effectiveness among nursing students.MethodsThis cross-over randomised controlled study design was conducted from June 2024 to August 2024. Forty-four undergraduate nursing students from years 1–3 were randomised to receive either GenAI patient simulation (Group B) or 360° VR simulation (Group A) with a one-week washout period. Five self-reported questionnaires were used to measure clinical competency: the Clinical Competence Questionnaire (CCQ), Cultural Awareness Scale (CAS), Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS), Simulation Effectiveness Tool – Modified Questionnaire (SET-M), and a demographic questionnaire.ResultsBoth interventions significantly improved clinical competence, cultural awareness, and AI readiness. When administered first, GenAI patient simulation demonstrated greater initial effects on clinical competence and AI readiness compared to the 360° VR simulation, though both groups achieved similar improvements by study completion. At T1, Group B (receiving GenAI) demonstrated significantly larger improvements in CCQ total score [47.68 (95% CI: 36.68, 58.68), p < 0.001] compared to Group A (receiving 360° VR) [24.95 (95% CI: 13.96, 35.95), p < 0.001], with significant between-group difference [16.59 (95% CI: 2.77, 30.41), p = 0.020]. At T2 (post-crossover), both groups maintained significant improvements. For MAIRS-MS (measured at baseline and following each group’s GenAI exposure), Group B showed improvement from baseline to T1 [30.18 (95% CI: 23.35, 37.01), p < 0.001] while Group A showed improvement from baseline to T2 [16.64 (95% CI: 9.80, 23.47), p < 0.001], with significant between-group difference [12.09 (95% CI: 4.43, 19.75), p = 0.003]. Both groups experienced changes in CAS scores, though between-group differences were not statistically significant. For SET-M, most participants (75%) felt debriefing contributed to their learning, and 68.2% reported increased confidence in nursing assessment skills.ConclusionsThe findings provide preliminary evidence of its effectiveness in enhancing perceived clinical outcomes among nursing students. Both 360° VR simulation and GenAI patient simulation may serve as effective teaching tools; however, GenAI patient simulation appeared to demonstrate a greater initial effect on clinical competence and AI readiness, although both interventions proved effective across all measured domains.Clinical trial registration/numberNot applicable.

A global health issue, sexual assault affects individuals of all ages, genders, and socioeconomic status. Forensic nurses, particularly sexual assault nurse examiners (SANE), deliver trauma-informed, patient-centered health care. Providing care to persons who experience sexual violence requires mastery of numerous psychomotor skills, many of which are not taught in nursing school. To facilitate knowledge and skill development, simulation-based learning was incorporated into an adult sexual assault simulation course designed for new SANEs. A virtual reality (VR) simulation was developed over three years with a multi-disciplinary team to assist Registered Nurses (RNs) who were novice SANEs to master technical skills necessary to perform the sexual assault examination. Through a head mounted display, learners were immersed in the virtual environment, working their way through modules that taught technical skills. This novel approach was created through a unique collaboration of students, content experts, and faculty, providing a consistent platform to examine a vulnerable population without re-traumatizing the victim. The VR simulation may be used to train new nurses and refine skills of more experienced nurses in sexual assault examination. Keywords: Virtual Reality Simulation, Sexual Assault Nurse Examiner, Sexual Assault, Forensics

Objective To minimize loss of life, mass casualty response requires swift identification, efficient triage categorization, and rapid hemorrhage control. Current training methods remain suboptimal. Our objective was to train first responders to triage a mass casualty incident using Virtual Reality (VR) simulation and obtain their impressions of the training’s quality and effectiveness. Methods We trained subjects in SALT Triage then had them respond to a terrorist bombing of a subway station using a fully immersive VR simulation. We gathered learner reactions to their VR experience and post-encounter debriefing with a custom electronic survey. Results Nearly 400 subjects experienced the VR encounter and completed evaluation surveys. Most participants (95%) recommended the experience for other first responders and rated the simulation (95%) and virtual patients (91%) as realistic. Ninety-four percent of participants rated the VR simulator as “excellent” or “good.” We observed no differences between those who owned a personal VR system and those who did not. Conclusions Our VR simulator (go.osu.edu/firstresponder) is an automated, customizable, fully immersive virtual reality system for training and assessing personnel in the proper response to a mass casualty incident. Participants perceived the encounter as effective for training, regardless of their prior experience with virtual reality.

Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme

Pain and discomfort are perceptible during many medical procedures. In the past, drugs have been the conventional means to alleviate pain, but in many instances, medications by themselves do not provide optimal results. Current advances are being made to control pain by integrating both the science of pain medications and the science of the human mind. Various psychological techniques, including distraction by virtual reality environments and the playing of video games, are being employed to treat pain. In virtual reality environments, an image is provided for the patient in a realistic, immersive manner devoid of distractions. This technology allows users to interact at many levels with the virtual environment, using many of their senses, and encourages them to become immersed in the virtual world they are experiencing. When immersion is high, much of the user's attention is focused on the virtual environment, leaving little attention left to focus on other things, such as pain. In this way virtual reality provides an effective medium for reproducing and/or enhancing the distractive qualities of guided imagery for the majority of the population who cannot visualize successfully.

An experimental comparison on the effectiveness of various levels of simulator fidelity on ab initio pilot training

Immersive virtual reality (VR) simulations are increasingly being used in diverse educational and training contexts to supplement traditional learning methods. The high versatility of virtual laboratories allows students to take advantage of many benefits, like experiencing dangerous reactions, time-consuming protocols, or expensive equipment without the necessity of a real science laboratory. However, little research is currently available to support the efficacy and efficiency of this new learning tool. In this context, the main objective of this study was to assess the influence of biotechnology training by using immersive VR technologies on the student’s motivational and learning outcomes as compared with learning with conventional methods only. To this aim we tested two diverse strategies, respectively VR simulations were used in place of or in addition to the teacher’s introductory lesson of a hands-on laboratory experience. Aligned questionaries were administered before and after the proposed activities to assess theoretical knowledge, self-efficacy, interest in biotechnology, and engagement of the participants. We found that when the introductory lesson to a biotechnology hands-on laboratory is replaced with an equivalent immersive VR simulation, the student’s learning outcomes are lower with respect to the traditional approach. On the contrary, when VR simulations are integrated as an additional tool to the existing learning methods, higher learning outcomes were observed demonstrating a deeper understanding of the learning contents. Furthermore, our study showed that learning with immersive VR simulations motivates students more than the traditional methods, thus, using this new technology in addition to the existing educational methods in biotechnology could be considered as a win-win strategy to raise the attention of the students while increasing the learning outcomes.

Introduction Currently there is little evidence on the role of virtual reality (VR) simulators for orthopaedic trauma simulation due to lack of validated commercially available platforms. We determined face validity and acceptability of the only VR haptic-enabled DHS fixation simulator as a potential training tool. Methods 52 medical students (naive to both DHS fixation and VR simulation) were voluntarily recruited and electronically randomised to two groups. Group 1 (training) performed five attempts whilst Group 2 (control) performed one attempt. After a week, both groups repeated the same number of attempts. Participants then filled in an eight-item questionnaire using a seven-point Likert scale (1–7). The mean score and Mann-Whitney U-test for significance (p Results No significant difference was found between both cohorts in all questionnaire responses, thus data was pooled and analysed as a unified cohort. Participants agreed that visual appearance of the external surgical field was realistic (mean score 4.8 [68.6%]) and that the haptic feedback was realistic (mean score 5.7 [81.4%]). The simulator was moderately accepted as an unthreatening learning environment (mean score 6.4 [91.4%]), subjects recognised the VR DHS simulator as a useful training tool (mean score 6.3 [90.0%]) and would recommend this modality to colleagues (mean score 6.3 [90%]). Moreover, participants strongly agreed that they enjoyed using the simulator (mean score 6.5 [92.9%]), that they would like to practise on a simulator before operating on a patient (mean score 6.5 [92.9%]) and they would like to train further on the simulator (mean score 6.5 [92.9%]). Conclusions The simulator was well received and participants moderately agreed that the VR DHS simulator would be a useful training tool and would recommend it to their colleagues. There was an overwhelming and unanimous demand among medical students and future surgeons for VR simulation technology in formal orthopaedic training. References Blyth P, Anderson IA, Stott NS. Virtual reality simulators in orthopaedic surgery: what do the surgeons think? J Surg Res 2006;131(1):133–9; discussion 140–2. Froelich JM, Milbrandt JC, Novicoff WM, et al . Surgical simulators and hip fractures: a role in residency training? J Surg Educ 2011;68(4):298–302.