Improved Complex Skill Acquisition by Immersive Virtual Reality Training: A Randomized Controlled Trial.

Up to this date, there have been no reports on immersive virtual reality (IVR) training in thyroid surgery. The purpose of this blinded, randomized controlled trial was to determine the validity and impact of VR training in residents’ education. Nineteen general surgery residents participated in the trial comparing IVR with traditional learning, utilizing a technical textbook as a control. A stratified randomization was used to secure balance in the distribution of residents according to their experience. The examined task pertained to the surgical steps from neck incision up to the placement of the continuous intraoperative neuromonitoring electrode and was evaluated by a blinded Fellow of the European Board of Surgery (FEBS) certified endocrine surgeon. Training superiority was assessed by the outcome measures of Objective Structured Assessment of Technical Skills (OSATS) score, need for the main surgeon to intervene, verbal answers, and time to task completion. Participants completed questionnaires regarding face validity and perceived benefits of the educational process. Immersive VR group completed the task significantly faster (p = 0.012), at a mean time of 27.25 ± 3.8 vs 35.25 ± 6.5 min in the control group, and was superior in OSATS Overall score (p = 0.035), knowledge of instruments (p = 0.015) and flow of operation (p = 0.021) scores. In the dedicated questionnaire, the participants of the IVR group stated greater overall satisfaction of the educational process (p = 0.002), ease of use (p = 0.015), enjoyment (p < 0.001), repetitivity (0.001), and perceived improvement in surgical technique (0.021). The IVR group dedicated more time in training 39 ± 8.9 vs 27.5 ± 7.2 min (p = 0.014), and performed more repetitions of the educative module, 3.5 (2–5) vs 2 (1–3) (p = 0.003) than the control group. IVR training demonstrated improved outcomes in several translational technical skills acquisition over traditional learning, while yielding improved satisfaction and repetitivity for participants. Clinical trials registration number No: NCT06917755.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13304-025-02387-8.

Purpose Immersive Virtual Reality (VR) systems allow for highly repetitive tasks to be performed within a virtual environment that increases practice in home environments. VR can increase access to rehabilitation by reducing access barriers. However, rehabilitation outcomes between immersive VR systems and conventional physical rehabilitation are not well understood. The purpose of this case study was to assess the use of a custom clinically based VR simulation for testing gross hand dexterity with an individual with chronic stroke. Materials and methods The participant performed the box and blocks test (BBT) in an immersive VR environment and a physical environment. Three trials of the BBT were performed with their less-affected and affected hands each in both environments while measuring cortical activity using fNIRS. Rests were given between trials and environment conditions. Results Our results show that there was no statistical difference in the number of blocks moved between the physical and VR BBT for both the affected and less-affected hands. Furthermore, our results also indicate no statistically significant difference between the physical BBT and VR BBT conditions on contralateral motor cortex activation, suggesting that cortical involvement is comparable between physical and VR conditions. Conclusions These results suggest that an immersive VR system may be able to elicit functional and motor cortex activations that are comparable to the conventional physical BBT. Importantly, these findings highlights the potential benefits of VR therapy as a remote therapy intervention and/or to increase the effectiveness and practicality of current in-person rehabilitation programs. Implications for rehabilitation These findings highlight the potential benefits of immersive virtual reality as a remote therapy intervention. Immersive virtual reality use has potential benefits to increase the effectiveness and practicality of current in-person rehabilitation programs.

Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Virtual reality (VR) with its engagement, interaction, and real time feedback could be a solution, with immersive VR systems having preliminary evidence in stroke to be more effective in improving UL outcomes in comparison to non-immersive VR. However, immersive VR research is limited within the realm of MS rehabilitation. Therefore, the main aim of the PhD was to explore immersive VR as an approach for UL rehabilitation for people with MS (pwMS). This was achieved in four stages: 1) a systematic review of the current evidence for VR in UL rehabilitation in MS; 2) predevelopment focus groups to determine requirements for the development of bespoke immersive VR games; 3) software development of bespoke VR games to potentially improve UL function for pwMS; and 4) a feasibility study of the games and immersive VR for pwMS’ UL rehabilitation. The systematic review initially yielded ten articles with varying study design, VR intervention and UL outcome measures used. There were some statistically significant improvements after VR interventions in outcomes such as in nine-hole peg test (NHPT), hand grip strength and active range of motion. There were however conflicting results regarding if VR was more effective than conventional approaches. Whilst the review demonstrated there were positive results for VR improving UL function, most of the studies had small sample sizes and were inadequately powered, and the level of immersion on effectiveness in MS remains unknown. The predevelopment focus groups recruited ten pwMS and eight specialist clinicians to explore their views on immersive VR as an approach to UL rehabilitation and determine requirements to develop VR games for this purpose. PwMS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many pwMS neglected UL exercise and found strategies for adapting to their UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a potential solution, as it was convenient for pwMS to access and could provide a more engaging and disguised approach to exercise. Although, there were shared concerns about cybersickness and disengagement while using VR approaches. Finally, both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and pwMS suggesting more abstract activities. Recommendations were made for the development of VR rehabilitation games which could be personalised and customisable for the varying abilities of pwMS. Using theme-based content analysis and requirement analysis, requirements for the software development of immersive VR games were created and developed using Unity game engine. Three games, “Piano”; “Catch-a-falling-star” and “VR Whack-a-mole” which targeted dexterity and strength for pwMS were developed, with different difficulty levels implemented to adapt to varying ability of pwMS. The final stage of this PhD was a randomised, controlled feasibility study to investigate an intervention of immersive VR involving the three co-produced games for pwMS’ UL rehabilitation. Participants were randomised to either an intervention group consisting of 30 minutes of VR co-produced games, twice/week, for eight weeks, or to a control group of usual care. Participants were recruited from the NHS and third sector organisations. Nineteen pwMS were recruited (intervention n=11, control n=8), with a recruitment rate of 3.2 participants/month. Only minor adverse events were reported (n=9), such as fatigue and UL pain. Adherence was good with 87% (±12%) session completed, and two dropouts were reported in the control group. There were positive trends for improving NHPT and hand grip strength, but there was an observed ceiling effect in the Action Research Arm Test. Participants reported high levels of satisfaction and good usability of the co-produced VR games, as measured by the USE questionnaire. Thematic analysis revealed participants enjoyed the distraction and atmospheres that immersive VR provided, and believed the games were fit for purpose with the majority of participants reporting improvements in their UL function. Participants suggested more variety and progression of exercises for future development. Overall, these studies show that immersive VR has the potential to be beneficial for UL rehabilitation and is feasible and safe for pwMS. Therefore, future work should refine VR games for long-term application and explore the clinical and cost effectiveness of this approach.

Immersive virtual reality can expose humans to novel training and sensory environments, but motor training with virtual reality has not been able to improve motor performance as much as motor training in real-world conditions. An advantage of immersive virtual reality that has not been fully leveraged is that it can introduce transient visual perturbations on top of the visual environment being displayed. The goal of this study was to determine whether transient visual perturbations introduced in immersive virtual reality modify electrocortical activity and behavioral outcomes in human subjects practicing a novel balancing task during walking. We studied three groups of healthy young adults (5 male and 5 female for each) while they learned a balance beam walking task for 30 min under different conditions. Two groups trained while wearing a virtual reality headset, and one of those groups also had half-second visual rotation perturbations lasting ~10% of the training time. The third group trained without virtual reality. We recorded high-density electroencephalography (EEG) and movement kinematics. We hypothesized that virtual reality training with perturbations would increase electrocortical activity and improve balance performance compared with virtual reality training without perturbations. Our results confirmed the hypothesis. Brief visual perturbations induced increased theta spectral power and decreased alpha spectral power in parietal and occipital regions and improved balance performance in posttesting. Our findings indicate that transient visual perturbations during immersive virtual reality training can boost short-term motor learning by inducing a cognitive change, minimizing the negative effects of virtual reality on motor training. NEW & NOTEWORTHY We found that transient visual perturbations in virtual reality during balance training can boost short-term motor learning by inducing a cognitive change, overcoming the negative effects of immersive virtual reality. As a result, subjects training in immersive virtual reality with visual perturbations have equivalent performance improvement as training in real-world conditions. Visual perturbations elicited cortical responses in occipital and parietal regions and may have improved the brain's ability to adapt to variations in sensory input.

BackgroundSimulation‐based training has significantly improved healthcare professionals' skills and patient outcomes. Immersive virtual reality is gaining attention in this field and offers potential educational benefits. However, little is known about how key stakeholders in simulation‐based training and debriefing receive a complex intervention like immersive virtual reality. This study explores the enablers, barriers and applied debriefing strategies involved in using immersive virtual reality in simulation‐based training.MethodsWe purposefully sampled simulation centre directors, course leaders and researchers within debriefing, simulation‐based emergency training and immersive virtual reality. First, they observed and debriefed an online immersive virtual reality‐based emergency training. Then, they participated in an individual semi‐structured interview that was audio recorded and transcribed. We coded and analysed the data based on a reflexive thematic analysis method with a constructionist framing, guided by normalisation process theory as a theoretical lens. All co‐authors informed and validated the identified themes.ResultsWe conducted 10 individual semi‐structured interviews and generated five main themes on factors that supported or impeded the normalisation of immersive virtual reality for simulation‐based training: understanding, engagement, strategies in action, appraisal and psychological safety.DiscussionImmersive virtual reality contains unique challenges and potential for simulation‐based training. Its strengths and limitations should be carefully considered in relation to learning goals, the target group and context. This study explored the advantages and disadvantages of various immersive virtual reality features in relation to different learning objectives and proposed practical strategies for enhancing learning in immersive virtual reality simulation‐based training.

In the recent past, efforts have been made to adopt immersive virtual reality (IVR) systems as a means for design reviews in factory layout planning. While several solutions for this scenario have been developed, their integration into existing planning workflows has not been discussed yet. From our own experience of developing such a solution, we conclude that the use of IVR systems-like CAVEs-is rather disruptive to existing workflows. One major reason for this is that IVR systems are not available everywhere due to their high costs and large physical footprint. As a consequence, planners have to travel to sites offering such systems which is especially prohibitive as planners are usually geographically dispersed. In this paper, we present a concept for integrating IVR systems into the factory planning process by means of a 3D collaborative virtual environment (3DCVE) without disrupting the underlying planning workflow. The goal is to combine non-immersive and IVR systems to facilitate collaborative walkthrough sessions. However, this scenario poses unique challenges to interactive collaborative work that to the best of our knowledge have not been addressed so far. In this regard, we discuss approaches to viewpoint sharing, telepointing and annotation support that are geared towards distributed heterogeneous 3DCVEs.

An immersive type virtual reality (VR) system has been used as one of the visualization techniques for analyzing various complicated phenomena in a computational science. On the other hand, the volume rendering method is widely used for the intuitively understanding of 3-dimensionaly distributed physical quantities. Thus, it is very useful to apply the volume rendering method to the immersive VR system. However, a plane slice sampling method conventionally used in the volume rendering method has a problem that the quality of visualized images deteriorates in the immersive VR system. In this research and development, a sphere slice sampling method is applied to resolve this problem. In this presentation, the comparison between these two methods about the quality of image and the display speed has been performed. Further, the comparison between the hardware volume rendering method and software volume rendering method has been performed.

(1) Background: The development of new technologies means that the use of virtual reality is increasingly being implemented in rehabilitative approaches for adult stroke patients. Objective: To analyze the existing scientific evidence regarding the application of immersive and non-immersive virtual reality in patients following cerebrovascular incidents and their efficacy in achieving dynamic and static balance. (2) Data sources: An electronic search of the databases Medline, Cochrane Library, PEDro, Scopus, and Scielo from January 2010 to December 2020 was carried out using the terms physiotherapy, physical therapy, virtual reality, immersive virtual reality, non-immersive virtual reality, stroke, balance, static balance, and dynamic balance. Selection of studies: Randomized controlled trials in patients older than 18 developed with an adult population (>18 years old) with balance disorders as a consequence of suffering a stroke in the previous six months before therapeutic intervention, including exercises harnessing virtual reality in their interventions and evaluations of balance and published in English or Spanish, were included. A total of two hundred twenty-seven articles were found, ten of which were included for review and of these, nine were included in the subsequent meta-analysis. (3) Data extraction: Two authors selected the studies and extracted their characteristics (participants, interventions, and validation instruments) and results. The methodological quality of the studies was evaluated using the PEDro scale, and the risk of bias was determined using the Cochrane risk-of-bias tool. Data synthesis: Of the selected studies, three did not show significant improvements and seven showed significant improvements in the intervention groups in relation to the variables. (4) Conclusions: Non-immersive virtual reality combined with conventional rehabilitation could be considered as a therapeutic option.

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.

BackgroundMedical and traumatic emergencies can be intimidating and stressful. This is especially true for early-career medical personnel.Training providers to respond effectively to medical emergencies before being confronted with a real scenario is limited by unnatural or high-cost training modalities that fail to realistically replicate the stress and gravity of real-world trauma management. Immersive virtual reality (IVR) may provide a unique training solution. MethodsWe created a working group of 10 active duty or former military emergency medicine physicians and two technical experts. We hosted 10 meetings to facilitate the development process. The program was developed with financial support from the Telemedicine and Advanced Technology Research Center (TATRC), through the primary vendor Exonicus, Inc, with support from Anatomy Next Inc, and Kitware, Inc. Development was completed using an agile project management style, which allowed our team to review progress and provide immediate feedback on previous milestones throughout its completion. The working group completed the resulting four simulation scenarios to evaluate perceived realism and training potential. Finally, testing of the technology platform off the network in a deployed role 3 was conducted.ResultsUpon completion, we created four IVR scenarios based on the highest mortality battlefield injuries: hemorrhage, tension pneumothorax, and airway obstruction. The working group unanimously indicated a high level of realism and potential training usefulness. Throughout this process, there have been a number of lessons learned and we present those here to show what we have created as well as provide guidance to others creating IVR training solutions. ConclusionOur team developed trauma scenarios that, to our knowledge, are the only IVR trauma scenarios to run autonomously without instructor input. Furthermore, we provide a potential template for the creation of future autonomous IVR training programs. This framework may offer a dynamic starting point as more teams seek to leverage the capabilities IVR offers.

Functional near-infrared spectroscopy (fNIRS) allows for a reliable assessment of oxygenated blood flow in relevant brain regions. Recent advancements in immersive virtual reality (VR)-based technology have generated many new possibilities for its application, such as in stroke rehabilitation. In this study, we asked whether there is a difference in oxygenated hemoglobin (HbO2) within brain motor areas during hand/arm movements between immersive and non-immersive VR settings. Ten healthy young participants (24.3 ± 3.7, three females) were tested using a specially developed VR paradigm, called "bus riding", whereby participants used their hand to steer a moving bus. Both immersive and non-immersive conditions stimulated brain regions controlling hand movements, namely motor cortex, but no significant differences in HbO2 could be found between the two conditions in any of the relevant brain regions. These results are to be interpreted with caution, as only ten participants were included in the study.

Mental training of laparoscopic procedures with E-learning has been shown to translate to the operating room. The present study aims to explore whether the use of checklists during E-learning improves transfer of skills to the simulated OR on a Virtual Reality (VR) trainer for Roux-en-Y gastric bypass (RYGB). Laparoscopy naive medical students (n = 80) were randomized in two groups. After an E-learning introduction to RYGB, checklist group rated RYGB videos using the validated Bariatric Objective Structured Assessment of Technical Skills (BOSATS) checklist while group without checklist only observed the videos. Participants then performed RYGB on a VR-trainer twice and were evaluated by a blinded expert rater using BOSATS. A multiple choice (MC) knowledge test on RYGB was performed. Suturing on a cadaveric porcine small bowel was evaluated using objective structured assessment of technical skill (OSATS). Checklist group was better in the knowledge test (A 8.3 ± 1.1 vs. B 7.1 ± 1.3; p ≤ 0.001) and there was a trend towards better VR RYGB performance (BOSATS) on the first try (85.9 ± 10.2 vs. 81.1 ± 11.5; p = 0.058), but not on the second try (92.0 ± 9.7 vs. 89.3 ± 10.5; p = 0.251). Suturing as measured by OSATS was not different (29.5 ± 3.0 vs. 29.0 ± 3.5; p = 0.472). This study presents evidence that the use of a BOSATS checklist during E-learning helps trainees to improve their knowledge acquisition with E-learning. The transfer from mental training to the simulated OR environment seems to be partially enhanced by use of the BOSATS checklist. However, more research is required to investigate potential benefits.

To explore the impact of an immersive virtual reality (VR) training module on infection prevention and control (IPC) knowledge and attitudes of healthcare personnel (HCP) and to demonstrate the use of VR for performance assessment in cleaning and disinfection of portable medical equipment (PME). Quasi-experimental study. Two academic medical centers and three long-term care facilities. HCP in clinical roles were recruited. Pilot sites trained participants on an immersive VR training module on PME cleaning and disinfection. Participants completed the VR module and pre- and post-knowledge and attitude assessment surveys, including a post-survey on the user experience of the VR module. Performance data were collected from the head-mounted displays (HMD) on the duration of the VR session, and participant performance including in-module task completion, hand hygiene compliance, PME disinfection percentage, and in-module quiz performance. Statistical significance and effect size were calculated using paired sample t-tests and Cohen's D for pre- and post-survey results. HMD data were analyzed using descriptive statistics. A total of 60 participants were recruited; 54 were included for analysis, with improvements in knowledge and attitudes post-training. Participant user experience was rated 50.19/55. HMD data demonstrated: 22-minute mean module duration, mean of 2.15/28 tasks not completed, mean of 2.56 missed hand hygiene opportunities, and 54% PME mean disinfection percentage, and varied performance on in-module quizzes. Immersive VR training may be effective in improving HCP knowledge and attitudes in IPC concepts. Performance data collected through VR training can evaluate learner performance and be used to target training for improvement.

The integration of immersive Virtual Reality (VR) and Building Information Modeling (BIM) has many applications within the Architecture, Engineering, and Construction (AEC) industries. In this context VR is often highlighted for its ability to convey scale and details, especially when compared to non-immersive visualizations. However, despite being an active area of research, there is currently a lack of real-world studies exploring immersive VR in a construction-oriented context. In addition, there are still technical challenges and barriers for an efficient integration, such as rendering performance and interoperability issues. This paper addresses these issues by investigating the use of immersive, single- and multi-user VR within the openBIM ecosystem. The contribution is two-fold: (a) an in-depth presentation of algorithms and technical details of a multi-user VR application for immersive visualization of large and complex BIMs and (b) an evaluation of this VR system on several real-world construction projects. In all cases the VR visualization has been directly realized from the design teams IFC-models and the multi-user sessions has been performed both co-located as well as fully remote. The results show that multi-user VR improves communication, understanding, and collaboration, and by letting staff with knowledge and experience from construction production review the project in VR, design errors and constructability issues can be identified and resolved before reaching the actual production stage. Moreover, the use of VR is helpful regarding sequencing and planning, and to identify alternative design solutions.

Effects of immersive virtual reality training on balance, gait and mobility in older adults: A systematic review and meta-analysis