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Project Proposal by Kevin Song

Supervisor: Dr. Greg Malin

December 2023

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Virtual Reality (VR) is a computer-generated environment that simulates a realistic experience, often through the use of immersive technologies such as headsets or goggles.

"VR has a unique power, more than any other technology that has ever existed, to make users believe they are in a different environment. This allows them to learn from experience as they would do in real life. This ability to deliver experiences on demand is where the power of VR lies" (Pottle, 2019).

Common types of VR include:

1. 360-video

A passive experience viewing 360-degree videos

2. Interactive VR

A totally immersive, dynamic, adaptive and interactive world

3. VR conferencing

A 3D representation of a real-life meeting

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Rationale: why use VR in medical education?

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Rationale: why use VR in medical education?

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There are a vast range of benefits for VR simulation in medical education. Outside of the 5 pointed listed in the above figure, VR also provides:

Accessibility to clinical experiences

Flexibility of access allowing for integration into daily practice

Repeatable scenarios

Potential to generate large amounts of performance data

Future potential of global distribution (Pottle, 2019)

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Proposed levels of Bloom's Taxonomy satisfied through different applications of VR in medical education (Yang et al., 2017).

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There are a variety of learning theories to support the use of VR in medical education. Most revolve around VR's capability to deliver a realistic and immersive environment in the context of simulation, while others focus around procedural training.

Key theories include:

1. Behaviorism:

Definition: Stimulus produces behaviours that can be reinforced or weakened through conditioning. Consequently, knowledge is seen as a repertoire of behaviours.

In simulation, feedback is used to train new behaviours, and can permit over-learning to make those behaviours automatic (Ker & Bradley, 2010).

2. Constructivism

Definition: New knowledge is actively constructed by participating in a situation rather than passively absorbing.

VR facilitates constructivist learning by immersing students in a realistic, interactive environment and can further support development in social situations (Marougkas et al., 2023).

3. Experiential learning

Definition: Learning is most effective following a four-process cycle of concrete experience -> reflective observation -> abstract conceptualization -> active experimentation.

VR allows for an immersive environment where learners can actively engage in activities with room for exploration, experimentation, and reflection (Marougkas et al., 2023).

4. Gamification

Definition: Application of game-like properties to non-game situations.

VR has huge potential to be used in gamification with so many pre-existing VR video games. It will be especially useful in creating "serious games" -games that are interactive, challenging, and fun to play while supplying the user with skills, knowledge, or attitudes useful in reality (Chan et al., 2017).

Furthermore, Marougkas et al. summarized many more learning theories connected to VR based on prior literature. They found links to constructivism (and social constructivism), experiential learning, gamification of learning, John Dewey’s theory of learning by doing, flow theory, Cognitive Theory of Multimedia Learning, and cognitive load theory (Marougkas et al., 2023).

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List of articles to highlight the growing evidence to support VR use in medical education (Shah & Bennett, 2023).

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VR has been a hot topic in medical education following the COVID-19 pandemic as virtual care and education became a focus.

Two studies used 360-video VR as educational tools. Sultan et al. found that 4th year medical students received higher MCQE and OSCE scores following 360-video sessions compared to a typical interactive lecture. Meanwhile, Pieterse et al. used 360-videos to help reduce stress and anxiety in students transitioning from pre-clerkship to clerkship, with a majority of students finding VR to be enjoyable, realistic and informative.

Lastly, Sukumar et al. designed a novel virtual rounds curriculum for students undergoing their internal medicine clerkship rotation where students rounded on patients through VR videoconferencing. Again, a majority of students found the experience educative and useful (Sukumar et al., 2021).

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List of challenges facing VR use in medical education ranked in descending significance based upon an industry survey (Kolo et al., 2017). 

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Despite the advantages and immense potential, VR still has many limitation (see figure above). It should be recognized as a tool used to accomplish a defined set of learning outcomes, with integration into a program's curriculum.

"Key to the conversations that institutions have about VR is the acknowledgement that VR should not replace the expert educator. In much the same way that physical simulation should not replace clinical training, VR is just a technology to deliver a learning technique, in this case simulation. There are certain learning objectives that are best taught through physical simulation, there are others that are best taught through VR. Educators need to decide which objective they are looking to improve and determine the most appropriate method of delivery. With this approach, clinicians, universities and healthcare institutions can increase simulation delivery at reduced cost, while taking the burden off faculty and ensuring training quality." (Pottle, 2019).

Fortunately, many of the limitations such as lack of funding, research, and even user side effects (nausea, headache, etc.) will see improvement as the field of VR gains more traction and the technology continues to improve.

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Please see the slideshow detailing steps for a proposed pilot project introducing VR into the UGME. An example of a project using VR for anatomy education is included at the end of the slideshow.

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Developed by UBC

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ICE VR: Immersive Clinical Experiences #virtualreality #vr #ubcmedicine

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A completed application available on the Oculus app store

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VR scenarios used by Cleveland Clinic to teach cardiac surgery residents.

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A Virtual Reality Glimpse of OR Emergency Training

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ACLS Virtual Reality Simulation | Medical Training for Clinicians

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Chan, T., Gottlieb, M., Sherbino, J., Boysen-Osborn, M., Papananou, D., & Yarris, L. (2017). Education Theory Made Practical: Volume 1.

Ker, J., & Bradley, P. (2010). Simulation in Medical Education. In Understanding Medical Education (pp. 164–180). https://doi.org/https://doi.org/10.1002/9781444320282.ch12

Kolo, K., Katin, P., & Lane, H. (2017, June 10). Key Challenges to Adoption of VR/AR for Healthcare. VR/AR Association.

Marougkas, A., Troussas, C., Krouska, A., & Sgouropoulou, C. (2023). Virtual Reality in Education: A Review of Learning Theories, Approaches and Methodologies for the Last Decade. Electronics, 12(13), 2832. https://doi.org/10.3390/electronics12132832

Pieterse, A. D., Hierck, B. P., de Jong, P. G. M., Ginn, T. F., Hamoen, E. C., & Reinders, M. E. J. (2023). User experiences of medical students with 360-degree virtual reality applications to prepare them for the clerkships. Virtual Reality, 27(2), 1381–1389. https://doi.org/10.1007/s10055-022-00731-6

Pottle, J. (2019). Virtual reality and the transformation of medical education. Future Healthcare Journal, 6(3), 181–185. https://doi.org/10.7861/fhj.2019-0036

Shah, M., & Bennett, J. (2023). Educational Benefits of Using Virtual Reality Simulations. Elsevier Education: White Paper.

Sukumar, S., Zakaria, A., Lai, C. J., Sakumoto, M., Khanna, R., & Choi, N. (2021). Designing and Implementing a Novel Virtual Rounds Curriculum for Medical Students’ Internal Medicine Clerkship During the COVID-19 Pandemic. MedEdPORTAL. https://doi.org/10.15766/mep_2374-8265.11106

Yang, X., Cheng, P.-Y., & Yang, X. (2017). The Impact of Three Types of Virtual Reality Scene on Learning. 2017 International Conference of Educational Innovation through Technology (EITT), 322–324. https://doi.org/10.1109/EITT.2017.83