The next hot topic under review from BMERG’s Fiona Holmes is Virtual Reality. In her blog she explores the different types of VR and shares and how her team is trialling the technique to enhance education practice and experience for student learners.
Photo by Bermix Studio on Unsplash
Virtual reality (VR) is not new, but it’s new to me, and I was curious to learn more about VR simulation in the context of medical education: What exactly is it? What has it been used for successfully? What are its limitations?
So, what is VR?
VR is an artificial reality with which a user/student can interact. The main difference between the types of VR is the extent of ‘immersability’ and interaction within the VR.
Fully immersive VR
This is the ultimate VR experience within a virtual environment, disconnected from real life.
It involves wearing a VR head mounted display (HMD) and may also involve other equipment such as haptic (real feel) data gloves, voice recognition and sound software. It puts the healthcare learner completely inside the experience complete with a virtual surgical team, equipment, and patient. Like being in a real-life computer game.
Fully immersive VR has been used particularly effectively in surgical training programmes to practice procedures (decreases injury, increases speed and improves overall outcomes) and manage cases and has been shown to enhance experiential learning and acquisition of cognitive, psychomotor, and affective skills.
Immersive VR can incorporate virtual worlds that can involve multiple participants in different locations. They have been used for training in the management of stressful emergency or major incident situations and can hone attention, decision making, critical thinking, clinical reasoning, multi-tasking and communication skills. However, so far, fully immersive VR hasn’t been used widely in medical education mainly due to the high upfront costs.
Semi-immersive VR
This doesn’t fully enclose the user/student in the virtual environment although interaction can involve using headsets or motion controllers connected to a computer which displays e.g., medical simulations. Augmented reality fits into this category and involves overlaying images onto the real world and it has been used to visualise anatomy and practice surgical procedures on physical models.
Non-immersive VR
Some suggest this isn’t really VR, and although it is a lower tech, provides a more accessible (cost and ease of use) method of providing an interactive environment for clinical educational experiences. Simulations of medical procedures or clinical scenarios (which can be standardised to current protocols) on a computer can be interacted with using a keyboard or mouse. Some applications incorporate gamification which can enhance engagement.
How we are going to trial VR in our programme
I co-ordinate the Clinical Perfusion Science programme at Bristol, where our students are training to be perfusionists, the professionals who operate the heart-lung bypass machine during cardiac surgery. Alongside teaching and learning of relevant theory they hone their practical clinical skills on the job, based in hospitals throughout the United Kingdom and Ireland, becoming independent practitioners over a period of about 2 years.
While in Bristol they do some low-fidelity practicals, and some simulations (situations that replicate real-life clinical perfusion scenarios using a high-fidelity ‘beating heart’ manikin and cardiopulmonary bypass pump followed by feedback and debriefing). There is no doubt that simulation is an essential and effective part of clinical education and it’s always our students’ favourite part of their study blocks. They really value the freedom to practice with their peers and ask questions in a safe environment, but there simply isn’t enough time, space, or resources to fit in as much as we or they would like.
While VR cannot substitute for in person simulations and certainly not the real clinical experience of a multidisciplinary potentially high stress environment of a cardiac surgery operating theatre, we want another way to bring in more clinically relevant and practical teaching to their education. Ideally it would allow standardised and repeatable, with everyone able to have a go multiple times, safe, controlled, flexible, scalable learning at a distance. Clinical experiences could be shared between our students in hospitals across the world.
Due to the accessibility and ease of use of non-immersive VR, we have chosen to trial this type of VR to meet some of our training objectives using the VirCPB system, a gamified online cardiopulmonary bypass training program. VirCPB is relatively easy to set up, affordable, and it doesn’t require the students to have anything more than a laptop to access a virtual cardiac theatre via a link.
We will use it as a formative learning tool, an adjunct to our in-person simulation sessions. Practice makes perfect and students can engage multiple times, flexibly, autonomously as well as collaboratively. It will be combined with feedback and debriefing to develop technical and non-technical skills. We and the students can monitor their performance and improvement. We hope it will provide a standardised and objective way to potentially assess competency.
We are going to start with a product trial to evaluate the benefits of VR in a study led by Jody Stafford, Honorary Lecturer, Bristol Medical School. We believe that students will benefit from this experience and hope we can incorporate it into our programme more permanently – watch this space!
Read more:
If this blog has sparked your interest, here are a couple of examples of papers about VR techniques in medicine: