Using Virtual Reality within Behavior Analysis Practice

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

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

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

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.

Behavior analysis is the underclass of psychology. It is under-funded, under-taught, and underappreciated. A lot is happening that is positive, but just beneath the surface, there are grave dangers lurking that could significantly worsen our already poor status. I prefer to believe that most of these dangers are things we can control by our own behavior (itself a rather behavioral idea), and I offer this list of dangers in that spirit. As someone once said: if you always do what you always did, you'll always get what you always got. Behavior analysts need to appreciate the following six dangers and adapt to them. LOSS OF MISSION Behavior analysis was initially strategically committed to the field of animal learning, but from the beginning its ultimate purpose was an understanding of complex human behavior: importance of a science of behavior derives largely from the possibility of an eventual extension to human affairs (Skinner, Behavior of Organisms, 1938, p. 441). In the early decades that was merely a promise, but the arrival of applied behavior analysis turned it into a program. Over the years, however, both basic and applied behavior analysis have narrowed and that original vision is being lost. Applied behavior analysis is gradually becoming a subfield of developmental disabilities, as a glance at a recent issue of JABA will confirm. The depth of the risk this creates is covered over by methodological rigor and applied impact within that narrow domain. Basic behavior analysis clings largely to narrow and precise questions of self-stimulatory interest in the animal laboratory, even while animal laboratories are being closed one by one, and areas of research within behavior analysis are being opened up that require human research. The depth of the problem is covered over by the productivity of a few major behavioral laboratories and the emergence of a handful of international labs, where protection from political winds have allowed the old seeds to grow a few new sprouts. In some ways, all of the other dangers I list can be traced back to the following core concern. Behavior analysis was always a carom shot. Instead of approaching human complexity directly, it tried to develop conceptual tools based on simple behaviors in simple contexts with small non-human animals, and then to apply these to an analysis of virtually every form of complex human behavior. It was a bold and even slightly preposterous idea, and yet it was one that worked far beyond what anyone had a right to expect. Now, however, we seem to be on the verge of forgetting what the mission was in the first place. Many basic behavior analysts have begun to believe that basic behavior analysis is a subfield of animal learning or (perhaps worse) behavioral biology. Where are the experimental analyses of emotion, friendship, sexuality, health, reasoning, humor, intelligence, and so on? Interpretation is not enough--we need an experimental analysis of such behaviors. Without the basic account, applied behavior analysts either ignore these areas or build common sense approaches to them. TOOL POLISHING No field so enjoys principles as does behavior analysis. Principles of behavior are ways of speaking about the prediction and influence of the historically and currently situated actions of organisms that are precise, broadly applicable, and coherent in terms of the larger fabric of science. Principles are the intellectual tools of analysis. They are not, however, ends in themselves. Sometimes behavior analysts are like the watchmakers who decided to make a set of extremely fine tools before actually making some complicated new watches. Forgetting what the tools were for, the talented watchmakers did not build the watches and display them in a glass cabinet, but instead put the tools themselves in that cabinet, taking them out only to polish them and to show how they work. Basic behavior analysts are especially prone to this error. …

The aim of this study was to validate a novel medical virtual reality (VR) platform used for medical image segmentation and contouring in radiation oncology and 3D anatomical modeling and simulation for planning medical interventions, including surgery. The first step of the validation was to verify quantitatively and qualitatively that the VR platform can produce substantially equivalent 3D anatomical models, image contours, and measurements to those generated with existing commercial platforms. To achieve this, a total of eight image sets and 18 structures were segmented using both VR and reference commercial platforms. The image sets were chosen to cover a broad range of scanner manufacturers, modalities, and voxel dimensions. The second step consisted of evaluating whether the VR platform could provide efficiency improvements for target delineation in radiation oncology planning. To assess this, the image sets for five pediatric patients with resected standard-risk medulloblastoma were used to contour target volumes in support of treatment planning of craniospinal irradiation, requiring complete inclusion of the entire cerebral-spinal volume. Structures generated in the VR and the commercial platforms were found to have a high degree of similarity, with dicesimilarity coefficient ranging from 0.963 to 0.985 for high-resolution images and 0.920 to 0.990 for lower resolution images. Volume, cross-sectional area, and length measurements were also found to be in agreement with reference values derived from a commercial system, with length measurements having a maximum difference of 0.22mm, angle measurements having a maximum difference of 0.04°, and cross-sectional area measurements having a maximum difference of 0.16 mm2. The VR platform was also found to yield significant efficiency improvements, reducing the time required to delineate complex cranial and spinal target volumes by an average of 50% or 29min.

Introduction/Main Objectives: This study delves into how technology acceptance (i.e., perceived ease of use and perceived usefulness) and immersive engagement determinants (i.e., perceived enjoyment, interactivity, and telepresence) influence the satisfaction and purchasing intentions of today's youth, specifically focusing on the moderating role of trust within the context of virtual reality (VR) platforms. Background Problems: The current literature has a limited understanding of users' adoption patterns of VR apps, the impact of VR on consumer behaviour, and the lack of knowledge among young consumers regarding the VR platform. Novelty: Previous studies did not consider trust as a moderator in the relationship between satisfaction and behavioural intention when using VR platforms. Moreover, the current research has extended multiple variables to explain user satisfaction and intention based on TAM. Research Methods: The research used a quantitative methodology based on survey data collected from young consumers in Sarawak, one of the Borneo region's states, who use VR platforms. A two-stage Partial Least Squares Structural Equation Modelling (PLS-SEM) analysis was conducted using WarpPLS 8.0 software. Finding/Results: The finding indicated that satisfaction was positively correlated with perceived usefulness, perceived enjoyment, and telepresence. Besides, satisfaction was positively related to the intention to purchase. Conclusion: This study can guide practitioners in decision-making and serve as a reference for scholars conducting related research in the Borneo region.

This study sought to develop a method that supports a more evidence-based approach to evaluating multiple design options in virtual reality (VR), combining subjective insights gathered using traditional approaches and objective feedback gathered using the VR platform. Additionally, this study sought to understand how objective data garnered from the VR platform could be used to compliment traditional evaluation strategies. VR can be a viable research platform for supporting evidence-based design practices. Prior studies have predominately utilized experiential user feedback. While able to provide valuable subjective insights, these approaches are less effective in making objective comparisons between multiple designs alternatives. A repeated measures study was conducted with nursing faculty. User feedback was captured through surveys, interviews, and the VR platform. The survey, interview, and the objective VR data converged in terms of identifying the highest performing design option. Survey data showed that Room 2 performed best in terms of perceived physical access to supplies, unobstructed movement, and availability of space to accommodate additional equipment. VR data showed that participants in Room 2 had significantly higher visibility to both patient and care partners throughout their simulated interaction. Simulation-based evaluations in VR that use a combination of users' subjective insights and objective data obtained from VR can be an effective tool for helping designers evaluate multiple design options. The use of scenario-based simulations provided a structured and clinically relevant approach to comparing three preoperative rooms, supporting a more robust assessment of users' physical response to a simulated healthcare environment.

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

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.

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.

IntroductionThe increasing integration of Artificial Intelligence (AI) and Virtual Reality (VR) in healthcare education offers innovative ways to enhance collaborative learning and improve patient safety. This narrative review examines the synergistic impact of AI-powered virtual reality (VR) simulations, such as those used in surgical training and patient communication, on knowledge acquisition, clinical skill development, and collaborative competencies among healthcare students. It also explores long-term knowledge retention, ethical considerations within virtual scenarios, and the psychological impact of high-stakes simulations on learner resilience.MethodsThis review is distinguished by its exhaustive literature search, which spanned PubMed, CINAHL, Scopus, Google Scholar, and other pertinent databases, to identify studies published between 2005 and 2024. The distinct focus on AI and VR interventions in healthcare education, particularly those with outcomes related to interdisciplinary learning or patient safety, distinguishes this review. Data were thematically analyzed across domains, including adaptive learning, technical skill development, teamwork, patient safety, and ethics.ResultsThe findings of this review carry significant practical implications. Five key themes emerged: adaptive learning (n = 17), immersive skill development (n = 10), teamwork enhancement (n = 10), patient safety (n = 18), and ethical considerations (n = 21). These themes underscore the potential of AI and VR in healthcare education. AI-driven adaptive systems enabled personalized VR training, enhancing engagement and knowledge retention. Real-time AI feedback during simulations improved decision-making in safe, controlled environments. Interdisciplinary team simulations enhanced communication and collaboration, which are crucial for effective clinical care. Ethical modules embedded in VR scenarios promoted moral reasoning. Several studies also reported increased learner confidence in performing clinical procedures following VR training, suggesting enhanced preparedness for practice.ConclusionThe integration of AI and VR holds the potential to revolutionize healthcare education, fostering personalized, immersive, and ethically informed learning. These technologies enhance technical proficiency and equip students with the complex demands of modern clinical practice. Strategic implementation can contribute to error reduction, improved patient outcomes, and a culture of safety. However, the journey is not over. Continued research is crucial for assessing the long-term outcomes and cost-effectiveness of these educational innovations, as well as for keeping pace with the rapidly evolving field of AI and VR in healthcare education.

Accurate acetabular cup and femoral stem component orientation are critical for optimising patient outcomes, reducing complications and increasing component longevity following total hip replacement (THR). This study aimed to determine the accuracy of a novel virtual reality (VR) platform in assessing component orientation in a simulated THR model. The VR platform (HTC Vive Pro® system hardware) was compared against the validated Vicon® optical motion capture (MoCap) system. An acetabular cup and femoral stem were manually implanted across a range of orientations into pelvic and femur sawbones, respectively. Simultaneous readings of the acetabular cup operative anteversion (OA) and inclination (OI) and femoral stem alignment (FSA) and neck anteversion (FNA) were obtained from the VR and MoCap systems. Statistical analysis was performed using Pearson product-moment correlation coefficient (PPMCC) (Pearson's r) and linear regression (R2). A total of 55 readings were obtained for the acetabular cup and 68 for the femoral stem model. The mean average differences in OA, OI, FSA and FNA between the systems were 3.44°, -0.01°, 0.01° and -0.04°, respectively. Strong positive correlations were demonstrated between both systems in OA, OI, FSA and FNA, with Pearson's r = 0.92, 0.94, 0.99 and 0.99, and adjusted R2 = 0.82, 0.9, 0.98 and 0.98, respectively. The novel VR platform is highly accurate and reliable in determining both acetabular cup and femoral stem component orientations in simulated THR models. This adaptable and cost-effective digital tracking platform may be modified for use in a range of simulated surgical training and educational purposes, particularly in orthopaedic surgery.

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.

Background Learning and applying anatomy are essential but are studied and done through 2D tools and imaging techniques. This study aims to verify the usefulness of an additional 3D technique and ensure an improvement in the visualization of anatomical structures and pathological findings. Objective The study aims to examine the usefulness of virtual reality (VR) technology as an additional tool in medical diagnostics. Groups of students, residents, and specialists in surgery, radiology, and internal medicine evaluated magnetic resonance imaging (MRI) by answering a multiple-choice questionnaire. Subsequently, a virtual 3D display was used for processing. The questionnaire focused on topographical conditions and the transfer of academic knowledge into clinical application. The main objective was to determine anatomical understanding in a comparison between sectional image (2D) presentation and additional VR (3D) presentation, measured through correctly answered questions and processing time. The system usability scale (SUS) was integrated as another criterion for VR usability. Methods The cross-over study assessed 63 participants regarding their knowledge of liver anatomy and pathologies based on an interindividual comparison. Group formation according to the respective level of medical training was as follows: students (n=35), residents (n=15), and specialists (n=13). Participants answered 25 multiple-choice questions first using sectional imaging (MRI) in a 2D environment (computer screen) and afterward with the respective segmented 3D model visualized in a VR simulation. The main criteria for the analyses were the number of correctly answered questions and processing time. A customized SUS was used to analyze VR usability. Missing data analysis showed that there were no accounted missing data. Results The rate of correct answers improved significantly with the additional use of VR (F1,59=314.376; P&lt;.001). Using MRI, a significant difference was observed between students and residents (P=.04) and between students and specialists (P&lt;.001). In the VR condition, no significant differences between groups were found. In the MRI condition, significant differences in processing time were observed between students and specialists (P=.02) and between residents and specialists (P=.04). No differences existed between students and residents. With VR, processing time decreased significantly in all groups (F1,59=280.700; P&lt;.001). Significant differences between students and specialists (P=.02) and between students and residents (P=.004) remained. No notable differences between residents and specialists (P=.72) were found. The SUS showed a subjectively simplified answerability of the questions with additional use of VR. The usefulness and benefits for an additional use of VR were stated. Conclusions The additional use of VR suggests statistically significant improvements across all groups. VR seems to enable students and residents to participate in diagnostics and create treatment plans at an early stage. Transferred to clinical practice, this may lead to improvement in diagnostics and interventions. The lack of randomization and a potential learning effect are the main limitations to be addressed in future studies.