Medical Students' Experiences With Virtual Reality Simulation Training: Qualitative Study.

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

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.

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.

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.

This study evaluates the effectiveness of an immersive training system using virtual reality (VR) on basketball performance metrics among physical culture students. The use of VR in sports training has gained attention for its potential to enhance both physical skills and cognitive functions. Objective: The objective was to compare the effects of immersive VR training against traditional training methods on shooting accuracy, reaction times, and cognitive load. Sixty university students were divided into control and experimental groups, participating in respective training regimes. Methodology: the study employed a VR setup to conduct the training sessions, and quantitative data were analyzed using One Way ANOVA. This analysis revealed significant improvements in shooting accuracy and reaction times in the VR-trained group, with p-values well below 0.05. Results: The results, however, indicated no significant differences in cognitive load between the groups. These outcomes suggest that while VR can enhance certain physical skills, its impact on cognitive aspects of performance is not clearly established. Discussion: The discussion highlights that, compared to previous studies, this research confirms the benefits of VR in physical training but raises questions about its cognitive effects, which have been inconsistent across different studies. Conclusions: This study confirms VR's effectiveness in enhancing specific athletic skills and underscores the need for further research into its cognitive impacts. The findings advocate for incorporating VR technologies into sports training programs, highlighting the importance of continuous innovation and comprehensive evaluation in diverse training environments.

There has been limited literature on immersive virtual reality (VR) simulation in orthopaedic education. The purpose of this multicenter, blinded, randomized controlled trial was to determine the validity and efficacy of immersive VR training in orthopaedic resident education. Nineteen senior orthopaedic residents (resident group) and 7 consultant shoulder arthroplasty surgeons (expert group) participated in the trial comparing immersive VR with traditional learning using a technical journal article as a control. The examined task focused on achieving optimal glenoid exposure. Participants completed demographic questionnaires, knowledge tests, and a glenoid exposure on fresh-frozen cadavers while being examined by blinded shoulder arthroplasty surgeons. Training superiority was determined by the outcome measures of the Objective Structured Assessment of Technical Skills (OSATS) score, a developed laboratory metric, verbal answers, and time to task completion. Immersive VR had greater realism and was superior in teaching glenoid exposure than the control (p = 0.01). The expert group outperformed the resident group on knowledge testing (p = 0.04). The immersive VR group completed the learning activity and knowledge tests significantly faster (p < 0.001) at a mean time (and standard deviation) of 11 ± 3 minutes than the control group at 20 ± 4 minutes, performing 3 to 5 VR repeats for a reduction in learning time of 570%. The immersive VR group completed the glenoid exposure significantly faster (p = 0.04) at a mean time of 14 ± 7 minutes than the control group at 21 ± 6 minutes, with superior OSATS instrument handling scores (p = 0.03). The immersive VR group scored equivalently in surprise verbal scores (p = 0.85) and written knowledge scores (p = 1.0). Immersive VR demonstrated substantially improved translational technical and nontechnical skills acquisition over traditional learning in senior orthopaedic residents. Additionally, the results demonstrate the face, content, construct, and transfer validity for immersive VR. This adequately powered, randomized controlled trial demonstrated how an immersive VR system can efficiently (570%) teach a complex surgical procedure and also demonstrate improved translational skill and knowledge acquisition when compared with a traditional learning method.

Virtual reality (VR) is a rapidly growing concept in the field of medical education, offering significant potential for innovation. Assessing how VR is used in ophthalmology to teach medical students, residents, and attendings will help identify areas where VR can be further developed. Moreover, analyzing the strengths and limitations of VR in medical education, surgical training, and patient education within ophthalmology will provide valuable insights into its impact on the field.This scoping review aimed to (1) map the current applications of VR across ophthalmology education, (2) analyze the effectiveness of VR interventions for different learner groups, (3) identify gaps in current VR implementation, and (4) assess the quality of evidence supporting VR use in ophthalmology education.A literature review was performed by scanning databases including PubMed, IEEE Xplore®, and Education Resources Information Center (ERIC). Relevant articles published from 2015 to 2023 were identified through the databases. Inclusion and exclusion criteria were formed for the articles to be further analyzed for eligibility. Articles were further categorized based on their VR application and target learners.Most studies targeted the education of ophthalmology residents, highlighting a gap in VR use among students, other healthcare personnel, and patients. Future research should focus on expanding VR applications to these underrepresented groups. The rapid growth of VR in other areas of medical education suggests similar potential to enhance ophthalmology knowledge and skills across a more comprehensive audience. Research in the application of VR in ophthalmology education should extend beyond surgical training for residents to maximize its potential in improving patient care. For example, studies could explore how VR training improves the ophthalmic diagnostic skills of medical students, evaluate whether VR-based patient education enhances understanding of ophthalmic conditions and leads to improved patient outcomes, and whether VR training for opticians aids in the early detection of specific conditions like diabetic retinopathy. This review is limited by excluding grey literature, which may limit the material analyzed and overlook insights from non-peer-reviewed sources.

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.

The effectiveness of virtual reality (VR) simulation training for improving robotic surgical skills is not firmly established. This systematic review and meta-analysis aimed to evaluate the impact of VR simulator training on surgeons' robotic surgical performance in the operating room (OR). To synthesize evidence regarding the association between VR-based robotic surgery training and subsequent technical performance inside the OR. A comprehensive literature search was conducted in PubMed, Scopus, Embase, and CINAHL databases, adhering to PRISMA 2020 guidelines. Studies evaluating VR simulator training for robotic surgeons with subsequent performance assessment in the OR were included. Risk of bias assessment was performed using the Medical Education Research Study Quality Instrument and the modified Newcastle-Ottawa Scale for Education (NOS-E), along with funding source appraisal. A total of 294 records were screened, resulting in 13 studies (281 participants) included in the systematic review, and 4 studies (72 participants) suitable for meta-analysis. Metaanalysis was conducted using a random-effects model to pool correlation coefficients between preand post-training performance. Of the included studies, nine reported positive evidence, three found no evidence, and one found negative evidence regarding VR training's role. The meta-analysis of before-after studies revealed a significant positive correlation ( r = 0.717, P < 0.05) between simulation performance and intraoperative outcomes. The small number of studies included in the meta-analysis and methodological heterogeneity may limit generalisability of results. VR simulator training is associated with improved robotic surgical performance in the OR. Incorporation of VR simulation into robotic surgical curricula is likely beneficial for skill acquisition and operative readiness.

Over the past decade Virtual reality (VR) technology has become more readily available. Although VR still suffers from inducing simulation sickness and having cumbersome controllers, industrial companies have embraced the technology as an alternative to overly complex and expensive simulators. A primary pedagogical consideration for effective VR training is feedback. While research has proven the positive training impact of feedback over having no feedback, very few studies explore techniques to help pinpoint the exact training outcomes that require feedback in a VR training simulator. This study illustrates how collecting human interaction metrics data from a VR fire extinguisher training application without a feedback mechanism can identify the areas where feedback for effective training is most required. We conducted a descriptive comparison study with 36 participants. We collected and analysed the participants’ VR interaction data across nine validated metrics and compared the results to their practical fire extinguishing evaluation on the same metrics. Our results show that the interaction data from the VR application presents curious behaviour regarding the distance participants kept between themselves and the fire, and their regard for wind direction when approaching the fire. The same elements surfaced in the practical evaluation. We conclude that collecting and analysing metrics from a VR training application is a suitable technique for identifying training aspects or outcomes that require a feedback mechanism.

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.

BackgroundTraining in invasive procedures like pericardiocentesis is a critical component of medical education but poses significant challenges due to its complexity and infrequent clinical application. Pericardiocentesis is an invasive procedure used to remove excess pericardial fluid from the pericardial sac, typically performed to relieve cardiac tamponade. It requires precise anatomical knowledge, ultrasound guidance, and dexterous needle placement to minimize complications. Simulation-based training, particularly with innovative technologies such as 3D printing and virtual reality (VR), offers accessible and cost-effective solutions. This study compared the effectiveness of 3D-printed mannequins and VR simulations in pericardiocentesis training, focusing on learning outcomes, stress responses, and cognitive load.MethodsThirty-five final-year medical students participated in this quasi-experimental study, receiving training with both models in separate sessions under the supervision of two experienced instructors. Learning outcomes were evaluated using the objective structured clinical examination (OSCE), while stress responses were assessed via heart rate variability (HRV), a measure of fluctuations in heart rate that reflect stress levels. Perceived cognitive load was measured with the NASA Task Load Index (NASA-TLX). Wilcoxon signed-rank and Friedman tests were used for statistical analysis.ResultsThe 3D-printed mannequin outperformed VR in tasks requiring fine motor skills, such as material handling and drainage placement (Z = − 2.56, p < 0.05; Z = − 2.34, p < 0.05). VR training, however, was associated with lower mental demand and effort (Z = − 2.147, p < 0.05; Z = − 2.356, p < 0.05). Biometric analysis indicated higher stress levels during mannequin-based training (SD1/SD2, chi-square = 14.157, p < 0.01), reflecting its closer replication of real-life clinical conditions.ConclusionsBoth 3D-printed mannequins and VR simulations serve as effective tools for pericardiocentesis training, each offering unique advantages. The 3D-printed mannequin supports tactile skill acquisition, while VR enhances cognitive engagement in a low-stress environment. A hybrid approach—beginning with VR and progressing to 3D-printed models—maximizes training outcomes, particularly in resource-limited settings, where affordable simulation tools can improve access to medical education.

BackgroundExtended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence.ObjectiveOur aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education.MethodsWe conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.ResultsOf the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (100%), and AR (73%). Knowledge was the most common outcome reported in studies on screen-based VR (80%) and VR serious games (58%). Less common outcomes included participants’ attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement or self-efficacy beliefs, emotional state, competency developed, and patient outcomes. At least one form of validity evidence was found in approximately half of the studies on VR simulators (55%), VR patient simulations (56%), VR serious games (58%), and AR (55%) and in a quarter of the studies on screen-based VR (27%). Most studies used assessment methods that were implemented in a nondigital format, such as paper-based written exercises or in-person assessments where examiners observed performance (72%).ConclusionsRCTs on VR and AR in medical education report a restricted range of outcomes, mostly skills and knowledge. The studies largely report immediate postintervention outcome data and use assessment methods that are in a nondigital format. Future RCTs should include a broader set of outcomes, report on the validity evidence of the measurement instruments used, and explore the use of assessments that are implemented digitally.

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

The potential of virtual reality (VR) in medical education in Kazakhstan proved substantial, offering innovative learning methods and creating secure, interactive training environments that facilitated the acquisition of both theoretical knowledge and practical skills. This study aimed to evaluate the application and effectiveness of virtual reality in medical education through a survey conducted with 53 students and 20 teachers. To assess the perceptions and satisfaction with VR in medical education, a survey was conducted utilizing a scale from 1 to 10. Findings from the survey revealed that students perceived significant advantages in using virtual reality to grasp complex medical concepts and hone clinical skills. They appreciated the opportunity to apply theoretical knowledge in practice, the availability of high-quality content across various disciplines, and the safe learning conditions provided. Teachers recognized virtual reality as a valuable educational tool but highlighted some challenges, including insufficient training and limited access to equipment. Addressing these obstacles is crucial for the successful integration of virtual reality into training programs, thereby unlocking its full potential and enhancing educational outcomes.