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Education is the base for a thriving society, and the transfer of knowledge has been a top priority for civilizations since the very beginning. People are constantly looking for ways to make knowledge transfer more easily, more quickly, and more effectively.

In the era of digital devices, we have an opportunity to enable better learning with technology. Virtual Reality (VR) seems to be the natural next step for the evolution of education.

In this article, I'll show how virtual reality can transform the way educational content is delivered.

How we learn today

Before diving into the details of how VR in education will help improve the learning process, it's important to understand why we need to improve the quality of education in the first place. Historically, most technologies designed to aid learning have been aimed at enabling access to information - facts and observations about the world. Before computers, we had a powerful tool that helped us retain facts: books.

In the era of digital technologies, books are being turned into eBooks. Modern search engines make fact-finding really easy - with just a few clicks you can discover answers to many questions.

While knowledge has become more easily available for more people, the current approach to education has two significant problems:

It's based on the same old format - fact retention. Teaching methods are focused on providing facts; however, having access to and consuming a lot of information isn't learning. Being informed isn't the same as being educated.

A lot of people have difficulties comprehending information. Too much information received in a short period of time can easily overwhelm students. As a result, they become bored, disengaged, and usually not sure why they are learning about a topic in the first place.

What makes VR in education beneficial?

Virtual reality can be used to enhance student learning and engagement. VR education can transform the way educational content is delivered; it works on the premise of creating a virtual world - real or imagined - and allows users not only see it but also interact with it. Being immersed in what you're learning motivates you to fully understand it. It'll require less cognitive load to process the information.

Here are just a few properties that makes virtual reality in education so powerful.

Better sense of place

When students read about something, they often want to experience it. With VR, they aren't limited to word descriptions or book illustrations; they can explore the topic and see how things are put together.

Thanks to the feeling of presence VR provides, students can learn about a subject by living it. It's easy to forget that VR experiences aren't real - a body actually believes it's in a new place. This feeling engages the mind in a way that is remarkable.

Rather than reading about Rome, VR headsets let students be transported to Rome. Image by unimersiv

Scale learning experiences

Technologies such as science labs are amazing - they allow students to understand how things work based on practical experience.

A relatively small VR device can even act as a whole science lab.

But such technologies are expensive and almost impossible to scale. They are also limited in the number of things they can do.

Learn by doing

It's a well-known fact that people learn best by doing; however, if you inspect modern education, you'll see how little learning actually happens by doing. Students are focused on reading instructions rather than using them in practice.

VR in education provides an experience anchor to the instruction. With VR education, learners are inspired to discover for themselves. Students have an opportunity to learn by doing rather than passively reading.

A virtual medical lab where there's no danger of things going wrong. Image by ossovr.

Emotional reaction

Visceral reactions to what we are experiencing are fundamental to forming memories. VR in education makes it easy to engage students the whole time, making experiences memorable.

Develop creativity

Having virtual reality in education is useful not only for content consumption, but it's also great for content creation. By giving students powerful tools such as Tilt Brush, you help them boost their creativity.

Visual learning

A lot of people are visual learners - VR is really helpful for this group of learners. Instead of reading about things, students actually see the things they're learning about. Being able to visualize complex functions or mechanisms makes them easier to comprehend.

Users are ready to embrace new technology

The first idea that pops into anyone's mind when they think about VR technology is an entertainment experience. Many designers see VR as an extension of the gaming industry. It's true that VR has historically been dedicated to gaming, but things are changing. According to a recent survey conducted by Greenlight VR, desire for education outweighs desire for gaming content - 63.9 percent vs. 61 percent.

Categories of VR educational experiences

Where can we apply virtual reality in education? The answer is almost everywhere. VR creates an infinite set of possibilities that people can experience. Here are few types of experiences you can create with VR.

Virtual fields trips

VR technology can be used to engage students in topics related to geography, history, or literature by offering a deeply immersive senses of place and time. Simply imagine geography lessons where you can visit any place on the globe - this type of experience is much more enriching than just reading about it.

With VR, they aren't limited to word descriptions or book illustrations; they can explore the topic and see how things are put together.

Google Expeditions is one good example of an app designed to provide such an experience. Expedition is a library of field trips available for regular smartphone users. Each trip is comprised of VR panoramas, and trips vary from the Great Wall of China to Mars. People all over the world can visit places that are virtually impossible to visit in person.

Google piloted this app in hundreds of schools all over the world. The project was extremely successful, with Google taking more than 1 million students in 11 countries on expeditions.

Of course, virtual reality will never replace real field trips and travels, nor should it. But, VR enables experiences to happen that would be otherwise impossible.

High tech training

VR is a good solution for highly technical training fields like the military or the medical industry. For example, the most significant challenge for medical students learning anatomy is understanding the body in three dimensions and how different systems fit together. VR education can help overcome this problem.

One good example is the VR system used by Mendel Grammar School in Opava City, Czech Republic, which helps students in biology classes learn about the anatomy of the eye. The team working on this project employed a Leap Motion controller and specially-adapted Oculus Rift headsets to provide an innovative way of learning anatomy.

Internships

Getting exposure to different careers is an essential part of the learning process. From early childhood, we dream about what we want to be when we grow up, and those dreams are usually inspired by the professionals in our lives. Often, we get this understanding through internships.

I never teach my pupils, I only attempt to provide the conditions in which they can learn.
Albert Einstein

Another benefit of having virtual reality in education is its ability to help broaden students' exposure to careers. It improves people's ability to imagine themselves in others' shoes. Career expeditions show what it's like to work in a field - students can explore a day in someone's career, see what person is studying, and understand what a person likes - or doesn't like - about their job. As a result, the experience becomes familiar to students.

VR lets students explore any profession, like being an astronaut. Image by YouTube.

Group learning

Some of the most important knowledge we gain doesn't come from what we hear from lecturers, but rather from collegiality and debate. VR education gives the opportunity to make learning experiences social by allowing students to communicate with each other. Using avatars and mapped facial expressions, people can come together to discuss, synthesize, and learn from one another.

Distance learning

VR allows us to bridge the gap between educators and learners. With VR, distance learning tools can put educators and students together in the same room with digital representations of themselves - teachers can teleport into the VR world and guide students through their experiences.

Design challenges for VR education experiences

Clearly, the future of virtual reality in education is very exciting and full of potential. We are just at the dawn of this powerful technology and designing for VR is full of challenges that we should be ready to overcome.

5 key properties of good VR learning experiences

VR edu apps should have the following properties:

1. Immersive. Designers should strive to create the feeling that users are in an experience. For example, if you develop a history app, make history come alive for students.

2. Easy to use. Eliminate the need to have special skills to interact with a VR 3D design app.

3. Meaningful. Meaning is really important for students. You can't create a good VR learning experience without a good story. That's why it so important to advance the art of storytelling. Stories quite simply provide the best vehicle for delivering messages that are not only heard and understood, but that also inspire and elicit action.

4. Adaptable. As Albert Einstein once said, "I never teach my pupils, I only attempt to provide the conditions in which they can learn." VR experiences should allow students to explore at their own pace. The app should provide complete control over the level of difficulty. Designers should establish how students learn and then use this knowledge to design VR products that allow effective learning.

5. Measurable. Each educational tool should provide measured impact. Teachers should be able to track the metrics of education so they can measure the resulting knowledge of a subject. When designing experiences for VR education, it's essential to choose appropriate metrics and make it clear what criterium will be used to measure success and failure.

Creating a new role for teachers with VR education

The transition from analog teaching practices to digital ones is going to change what teaching looks like. The role of a teacher will change from content delivery to content facilitation. Teachers will be focused on creating conditions for exploring, rather than providing ready-made knowledge.

Our changing understanding of immersive experiences

It's clear we're in the early stages of VR - and it's going to keep changing. However, technology will continue to push boundaries of how immersive VR can become. We're even going to see advancements in eye tracking and body tracking in coming years. What we consider an immersive experience today will be considered table stakes in the not-too-distant future.

Making VR accessible

VR has a high price point that is a significant barrier for many users. If we analyze the success of Google Expeditions, it's clear that Google was able to reach this many students because the hardware was really accessible. To make VR education accessible to a majority of users, it's important to focus on creating VR experiences for devices users already have and repurpose them into powerful tools for education. A phone we have in our pockets and $20-100 headset devices - such as Google Cardboard or Samsung Gear VR - should be enough to give students good VR experiences.

Open New Horizons with VR Education

Virtual reality in education is on the horizon, and without a doubt, it'll change the world as we know it. Twenty-first century classrooms will be technologically advanced places of learning, with VR technology significantly increasing students' engagement and learning. VR experiences will inspire a whole new generation of young and bright students, ready to innovate and change the world.

At the same time, the next big thing in education no longer relies on technology, but rather on a teacher's decision to push forward and adopt these technologies inside the classroom. The global goal should be to make knowledge available, accessible, and affordable for everyone on the planet. Learn more about the design of other Emerging Technologies here.

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How VR Education Will Change How We Learn & Teach | Adobe XD Ideas

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Education is the base for a thriving society, and the transfer of knowledge has been a top priority for civilizations since the very beginning. People are constantly looking for ways to make knowledge transfer more easily, more quickly, and more effectively. In the era of digital devices, we have an opportunity to enable better learning with technology.

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Virtual reality can benefit and impact students of all ages through every education phase to boost engagement and improve knowledge retention.

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A more in-depth look at how one high school is incorporating VR to promote learning.

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As a first-year resident at Children's Hospital Los Angeles (CHLA), Travus White, MD, stood in a trauma bay, directing a team rushing to save a toddler with a life-threatening allergic reaction. As adrenaline coursed through his body, White scanned nearby carts for treatments. None, when administered, seemed to have any effect.

"What I remember the most was that the respiratory therapist kept saying, 'He's not breathing, he's not breathing, he's not breathing!'" notes White. But he pressed on, using the algorithm he'd learned in training. Soon the patient responded, and White shook off the stress as if waking from a dream.

In fact, the whole scenario had happened in White's mind - thanks to a pair of virtual reality (VR) goggles and software developed with the help of CHLA educators. The patient and emergency staff were merely animations programmed to respond realistically to trainees' split-second decisions.

White is among a growing number of learners at medical schools and teaching hospitals who are training through computer-generated simulations thanks to VR and its cousin, augmented reality (AR). These sophisticated tools allow learners to plunge safely into life-or-death scenarios, peel away layers of human anatomy, walk through a virtual heart, and more. As technologies from the gaming industry improve and costs decline, leaders in academic medicine are increasingly exploring the place of such simulations in medical education.

"The beauty of this is really that you can appreciate in three dimensions what the structures look like."

Gary Steinberg, MD, PhD
Stanford Medical School

Although there is no hard data, an increasing number of medical schools are using or considering these technologies, says Warren Wiechmann, MD, associate dean of clinical science education and educational technology at the University of California (UC), Irvine, School of Medicine.

Wiechmann points to the topic's popularity at the AAMC's Group on Information Resources annual conference in June, where several sessions focused on virtual reality. "The room was packed for all of those sessions," he says.

Early adopters note the varied benefits of AR and VR, including the opportunity for real-life experiences without real-life consequences.

"You don't get that feeling of adrenaline through a written test," says White. "You get it through experiencing it, and I think this is as close to experiencing it in real life as you can get." Todd Chang, MD, MAcM, director of research and scholarship at CHLA, notes that once students get immersed in one of his VR modules, their heart rates rise about 10%.

But the place of these technologies in academic medicine certainly is not yet clear. Among the questions are whether research will support their educational promise.

"Wearing my technologist hat, this is an incredibly exciting time. There are experiences with AR/VR that cannot be easily realized with other methodologies," says Wiechmann. "But my physician side is a little more cautious in thinking that we shouldn't jump headfirst into every new technology that comes out."

Virtual anatomical tours

Computer-generated simulations are usually divided into two categories, virtual reality and augmented reality. They are similar, but different.

Virtual reality is an entirely computer-generated view of a world - that is, purely virtual. Everything the user sees is manufactured, like the CHLA trauma bay scenario White experienced.

Augmented reality, by contrast, superimposes computer-generated images and sounds onto the real world. In medicine, this includes simulated internal organs overlaid on a real manikin. Because the AR experience isn't completely immersive, it doesn't necessarily require goggles: holding up an iPad might suffice to superimpose the image, for example.

Two years ago, faculty at Stanford University School of Medicine began using VR for training in its Neurosurgical Simulation and Virtual Reality Center. There, a platform called Surgical Theater fuses several types of brain scans from a real patient to achieve greater specificity and verisimilitude.

Seated in comfortable, theater-style chairs and wearing VR goggles, users can manipulate and view the organ from multiple perspectives. The experience feels a bit like flying through a detailed and lifelike human brain. "The beauty of this is really that you can appreciate in three dimensions what the structures look like," says Gary Steinberg, MD, PhD, chair of neurosurgery at Stanford.

After the VR experience, students step across the hall to the neurosurgical anatomy lab, where they see and touch the same anatomical structures in a cadaver. The virtual reality warmup prepares students for dissection, says Steinberg, and speeds up learning.

Steinberg raves about virtual reality in medical training. "It's obvious," he believes. "It's intuitive." In fact, Steinberg often prepares for surgery using a VR representation of a patient's imaging.

"If I can rehearse the surgery ahead of time, when I get in there it's not a surprise," he says. "It's as if I've been there before."

The real world, augmented

Augmented reality takes simulations and combines them with real-world tools and interactions.

At the Mayo Clinic Multidisciplinary Simulation Center, instructors use AR for various purposes, including to teach students how to interpret ultrasound imaging. As students look at a standard ultrasound view, AR adds images of underlying tissues, bone structures, blood vessels, muscles, and nerves for a deeper understanding of the ultrasound visualization.

Because the experience is not entirely immersive, students can interact with each other and the instructor while viewing the module, explains Thomas Belda, MS, a Mayo enterprise simulation technology architect. "With augmented reality, the capability is greater for having multiple users experiencing something together [to] interact collaboratively in a clinical scenario during simulation training," he says.

"Wearing my technologist hat, this is an incredibly exciting time. ... But my physician side is a little more cautious in thinking that we shouldn't jump headfirst into every new technology that comes out."

Warren Wiechmann, MD
Associate Dean of Clinical Science Education and Educational Technology
University of California Irvine School of Medicine

At the UC Irvine School of Medicine, faculty recently launched an AR pilot project for fourth-year students and emergency medicine residents. There, a computer app superimposes a hologram of a patient over a manikin to produce a much more lifelike and responsive simulation, says Wiechmann.

With the help of AR, he explains, you can see a manikin have a seizure or turn blue from hypoxia. "[AR] bridges the gap between role-playing and high-fidelity simulation."

Another plus, says Wiechmann, is that unlike more elaborate simulators, the equipment required is relatively inexpensive and portable, "the size of a small suitcase."

What lies ahead?

Despite their enthusiasm, even proponents of AR and VR advise caution, stressing the need to prove the solid value of these tools.

"The best question you always have to answer is why does this matter?" says Wiechmann. "Very rarely do we get to just add something to a curriculum without taking something away. We really want to make sure that if we're going to add something that it really does have good impact."

So far, there's little published research on the effectiveness of VR and AR in medical education.

"Everyone's had really great anecdotal experiences, but our numbers individually are just too small. It's going to force some collaboration [among programs], which will be great for medicine in general."

He'll likely find willing partners.

"The research opportunities are great with this emerging technology," says Belda. "But we have to be very thoughtful. [We have to look at] research constructs to compare it to traditional training. We view this as an opportunity in our future that needs to be taken seriously."

Meanwhile, as prices fall, the capabilities of the technology grow, and developers create new teaching modules, a trend toward greater use of virtual and augmented reality in teaching and training seems almost guaranteed.

"It's really driving the creativity of a lot of the schools," says Wiechmann, "which is a great position for us to be in. Of course, all of that creativity must above all serve our learners and their patients."

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Future or fad? Virtual reality in medical education

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As a first-year resident at Children's Hospital Los Angeles (CHLA), Travus White, MD, stood in a trauma bay, directing a team rushing to save a toddler with a life-threatening allergic reaction. As adrenaline coursed through his body, White scanned nearby carts for treatments. None, when administered, seemed to have any effect.

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Where Medical Device Innovation Meets Expert Insight

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Delivering Surgical Training 5x Faster with VR | Spotlight | Unreal Engine

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3 Instructional Design Strategies For Virtual Reality Learning

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Want to know how to create effective Virtual Reality Learning experiences? Check 3 Instructional Design strategies for Virtual Reality Learning.

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LibGuides: Gill St. Bernard's Upper School Library: Virtual and Augmented Reality in Class

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Designing for virtual reality and the impact on education | Alex Faaborg | TEDxCincinnati

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Augmented reality and virtual reality in the library

As a space for innovative and contemporary learning, the library is a fantastic place for AR and VR. There are so many ways these technologies could be used to raise engagement and to promote literature and literacy. As both AR and VR require specific digital tools, keeping these tools in a central location such as the library makes sense.

Augmented reality

While most AR applications focus on providing pre-created animations or information that overlays reality when viewed through a mobile device, the suggestions below allow students to be part of the creation process. The AR technology is changing rapidly. However, two of the most well-established platforms, Metaverse and HP Reveal, contain desktop studio environments where the experiences are created. The experiences themselves are activated via the apps. The following activities can be conducted using these:

1. Create an interactive orientation activity
Students must find all trigger images and view overlays in order to answer trivia questions. This idea could be adapted for getting students to navigate different parts of the library, or for introducing specific tools or equipment in a teaching area such as home economics or industrial arts.

2. Invite students/parents/the community to view an interactive gallery
Students could create videos of themselves talking about their work. Display the pieces of work - which also act as the trigger images - and provide visitors with advice about which app to download to their smart mobile devices.

3. Encourage parents to interact with library newsletters
Add one or more trigger images to the newsletter that create overlay videos of a recent library event, new resource or positive message.

4. Guide teachers to embed audio or video explanations onto homework tasks
The inclusion of audiovisual explanations means that students can access 24/7 support.

5. Have students create a 'digital story walk' by embedding a narrative into the library or school environment
As characters move around the library or school telling their story, encourage the viewer to travel with them, adding a chapter to each trigger image.

Virtual reality

For virtual reality within the school library, all that is needed is a mobile device (which runs the VR experience), headphones (to be
truly immersed in the 'new' reality) and a VR viewer. The VR viewer can be a high-end model, but terrific experiences can be had
using Google Cardboard. Consider VR as a way to:

1. Develop empathy
Global Nomad Group's Experience of Syria allows students to develop empathy and explore for themselves what life is like for children trapped in a war zone.

2. Add a further layer to literature
Be inspired by the beautiful War of Words, which features a reading of Siegfried Sassoon's poem 'The kiss'. This app demonstrates how VR might engage students in poetry and literature through immersing them in an atmosphere that a simple reading may not provide.

3. Build confidence with public speaking
Apps such as Beyond VR Public Speaking or Virtual Speech can make presentations a less painful experience by offering students the opportunity to practise in front of a virtual audience, in a variety of settings.

AR and VR have the potential to transform learning experiences. As curriculum and digital technology leaders, teacher librarians are well-placed to explore and implement these immersive technologies within the library, the classroom and beyond. To learn more, check out the collection of articles in my Flipboard magazine at http://flip.it/NdZQaU.
Author's note: HP Reveal has announced the closure of the platform. A reminder that this is a changeable space, and we need to embrace a flexible mindset when using these technologies.
Image credits

Main photo by stem.T4L on Unsplash and figure supplied by Kay Oddone.

References

Freeman A, Adams Becker, S, Cummins, M, Davis, A & Hall Giesinger, C 2017, NMC/CoSN Horizon Report (K-12 ed.), The New Media Consortium, Austin, Texas, www.nmc.org/publication/nmccosn-horizon-report-2017-k-12-edition

Milgram, P & Kishino, F 1994, 'A Taxonomy of Mixed Reality Visual Displays', IEICE Transactions on Information and Systems: Special Issue on Networked Reality, no. 12, https://www.researchgate.net/publication/231514051_A_Taxonomy_of_Mixed_Reality_Visual_Displays

Panetta, K 2017, 'Top Trends in the Gartner Hype Cycle for Emerging Technologies', www.gartner.com/smarterwithgartner/top-trends-in-the-gartner-hype-cycle-for-emerging-technologies-2017

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Even better than the real thing? Virtual and augmented reality in the school library

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As a space for innovative and contemporary learning, the library is a fantastic place for AR and VR. There are so many ways these technologies could be used to raise engagement and to promote literature and literacy. As both AR and VR require specific digital tools, keeping these tools in a central location such as the library makes sense.

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A podcast on using AR in the elementary school library

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Augmented Reality in the School Library - Elementary Librarian

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In this podcast, I discuss using augmented reality in the school library with guest Andy Plemmons. Includes recommended apps and simple ways to get started.

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Incorporating virtual reality in the classroom | Mfon Akpan | TEDxTrestleViewPark

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BBC Civilisations AR app for Classroom use

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BBC Civilisations AR app for Classroom use

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This is a demonstration of the making of the app and how it came to be. This also shows that how the AR effects can be used in the classroom and anywhere in the world.
-Emily Grubb

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BBC Civilisations AR | Making of | Nexus Studios

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Jumping into the World of Virtual and Augmented Reality

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Jumping into the World of Virtual and Augmented Reality

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Uses and challenges related to using AR/VR in the school library

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This shows a specific tool called "Zappar" that children have been using in the classroom as an AR tool.  -Emily Grubb

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Augmented Reality for Education - Showcase

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Article: "How VR is Revolutionizing the Way Future Doctors are Learning About Our Bodies"

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Article: "How VR is Revolutionizing the Way Future Doctors are Learning About Our Bodies"

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How VR is Revolutionizing the Way Future Doctors are Learning About Our Bodies | UC San Francisco

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UCSF Adds New Technology as Pilot Project for Its Curriculum

By Mitzi Baker

Wearing virtual reality goggles, Jordan Holler was hard at work taking apart muscles inside of a body.

The first-year medical student at UC San Francisco wasn't touching any real tissues, though. He was using new technology that allowed him to put on a headset and start to "move" anatomy, revealing layers and structures. Then the virtual reality program can be reset to do it over in a new way.

His work is part of new curriculum at UCSF that uses cutting-edge virtual reality technology to bridge hands-on training with cadavers and textbook learning.

"It helps us understand anatomy much better," he said.

The Base of Medical Education

Anatomy forms the foundation for much of what a medical student needs to learn and what a doctor needs to know, but it is often a dreaded memorization ordeal and a challenge to see how all the bones, muscles, nerves and organs fit together.

"Our instructors do an amazing job, but at the same time it is difficult to get an entire three-dimensional picture of what is going on," Holler said.

Cadavers and textbooks have limitations in what they can convey. Virtual reality improves upon learning from a cadaver by its ability to go from the skin layer all the way down to the bones, and back again. Learners can remove every single layer independently and see the different relationships between the muscles and nerves and organs, zooming in to the microscopic level if desired. The process can then be reversed completely back to the skin.

The virtual-reality program used by UCSF medical students allows them to go through the human body layer by layer, deconstructing and reconstructing muscles, organs and bones.

"It's a learning experience almost like putting a puzzle together," said Assistant Professor of Anatomy Derek Harmon, PhD.

Harmon is using the virtual reality software as part of a research pilot with UCSF Professor of Physical Therapy and Anatomy Kimberly Topp, PhD, PT, in collaboration with medical education technology pioneered in the School of Medicine's Technology Enhanced Education (TEE) group.

The instructors and physical therapy student teaching assistants are developing a curriculum for first-year medical students, who will use virtual reality as an optional component in their anatomy curriculum to supplement lectures, traditional two-dimensional textbook and online learning and the cadaver lab. The changes are part of the school's Bridges curriculum, which launched in 2016.

" Virtual reality is exciting for me as an anatomy instructor because it is going to help enhance the students' understanding of the arrangement of the body," said Harmon. "Because the better they know the body, the better physicians they will end up being for the rest of their careers."

Virtual reality anatomy allows the learner wearing a headset - and observers viewing monitors - to interact with a virtual patient that is upright, much as they would with an actual patient in a clinic. The virtual patient can be viewed from the top or bottom, and can be moved around to uncover spatial relationships.

While the 3-D aspect is a huge benefit, Topp pointed out several others.

"Anatomists pride themselves in being able to engage students in their learning to experience the wonder of anatomy," she said. "People are really wowed when using virtual reality. That is how I think it is going to help students remember the anatomy that is so dense in their education."

Future Uses of Virtual Reality

Topp also sees the technology assisting more generally in immersion learning, helping learners get used to an environment that is unfamiliar and frightening.

"It is hard to simulate a realistic trauma experience where nobody is going to get hurt," she said.

A virtual trauma patient allows team members to get used to calming themselves and gaining control over their emotions, thoughts and actions to be useful in the situation.

First-year medical student Carmen Marie Lee uses a virtual-reality set in the UCSF Anatomy Learning Center.

"This is a great way to get students more comfortable with the actual clinical environment that they are headed into," she said, adding that another bonus is the training in communication skills among team members and in immediate decision-making.

Christian Burke, the director of technology innovation with the Office of Medical Education, and the other TEE team members are eagerly planning what else can be done with the technology, including building their own models and using it to simulate surgery, clinical cases and injuries. For example, a discussion of the anatomy of the lower limb might be immediately followed by a virtual reality situation in which a team needs to apply that anatomy to an emergency, such as a traumatic injury. The student is able to practice communication of their knowledge, provide direction for team members, and make clinical decisions in a stressful but safe environment. And then they can do it again in a different virtual clinical environment.

"This has the potential to take us to the next level of experience so we can go from general anatomy learning to an environment where anatomy has been disrupted and the student has to act on it," said Topp. "This technology takes anatomy learning and applies it almost immediately."

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How VR is Revolutionizing the Way Future Doctors are Learning About Our Bodies

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UCSF Adds New Technology as Pilot Project for Its Curriculum By Mitzi Baker Wearing virtual reality goggles, Jordan Holler was hard at work taking apart muscles inside of a body. The first-year medical student at UC San Francisco wasn't touching any real tissues, though.

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Froggipedia Promo Video - Best Augmented Reality App

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 Here is a medical journal discussing the effect of VR teaching in medical groups.

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 Here is a medical journal discussing the effect of VR teaching in medical groups.

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Abstract

Introduction:

Virtual reality is a new method for training different medical groups. Based on this technology, professionals and students of various medical sciences can determine their level of competence for medical treatment before any performance on the patient. Therefore, the aim of this study was to identify the applications of virtual reality technology for training the medical groups.

Methods:

This is a scoping review study conducted in 2016. Articles were retrieved through the search of related keywords in databases such as Pub Med, Scopus, Web of Sciences, Springer, and Google scholar. Then, after applying the entry criteria, 21 papers were selected from a total of 1343. Data extraction was done by a data collection form. The collected data were summarized and reported using content analysis technique according to the study purpose.

Results:

The findings of the study indicated that 11 cases (48%) have used virtual education technology for laparoscopic surgery training. Using virtual reality has improved learning in 17 (74%) studies. A higher accuracy in medical practice by people trained through VR has been reported in 20 (87%) studies.

Conclusion:

The results indicate that the application of virtual reality capabilities plays an important role in improving the performance of different medical groups. According to the results, it can be suggested that virtual reality capabilities should be used to train different medical groups based on their individual and collective needs.

Keywords: Virtual reality , Training , Clinical trials , Technology

Introduction

Virtual reality is a new technology that has been widely used in the health field in recent years and it is applied in a wide range of diseases. In fact, this technology is the simulation of the peripheral world through a computer as well as communication through a receiver ( 1). Virtual reality consists of output tools (vision, hearing, tactile and power transmitter), input devices (mouse, chaser, gloves, etc.), a virtual environment's graphical manufacturing system as well as an information software. In a virtual environment, all the features of activity such as duration, severity and type of feedback can be adopted based on the type of treatment and individuals' ability ( 2, 3). In addition, individuals can see their motor results and correct them if necessary.

One of the most important applications of VR in medical science is in medical education, which has been widely used in the last decade. Many studies have paid attention to various VR applications in medical education ( 4, 5), including the understanding of fracture anatomy by orthopedic residences ( 6), improving the knowledge and skills of clinical residences in the MICU and as an adjunct complement for standard clinical education if internal residences in MICU, as well as general objections regarding the patient safety, ethical concerns and financial constraints for education of medical students have led to a widespread application of non-human and inanimate models for training the laparoscopic skills because simulation-oriented syllabus is very effective in transferring skills to the operating room ( 7- 13).

The American Board of Internal Medicine (ABIM) has announced that it is better for residents to be trained by simulation tools before attempting any interventions on patients because it has been effective in performing invasive hemodynamic monitoring, mechanical ventilation, and standardized educational intervention ( 14).

Stefanidis et al. concluded that suture training using simulator improves the speed and mobility of practitioners in the operation room ( 15). In the same line, Lin et al. found that given the fact that performing bone cut or bone surgery requires high experience and sensitivity, training the simulation of virtual and tactical surgery with feedback can be a safe, repeatable and cost-effective method compared to traditional methods ( 16).

Given the importance of medical education using the virtual reality tools and its role in improving the quality of medical education in various medical specialties, many papers examined this field in recent years. Although Walsh et al. instead of using conventional methods systematically reviewed education of endoscopy using virtual reality, but there was no systematic study regarding its applications ( 17). Therefore, the present study was a systematic review that aimed at identifying the applications of virtual reality in training various medical groups.

Methods

This study is a scoping review which aimed to identify virtual reality applications in training the medical groups in 2016. The research question was identified based on the PCC (Population, Concept and Context) elements. This particular question includes: medical groups that use VR for training (Population); the effect of Virtual Reality in Medicine Groups training (Concept); use of Virtual Reality in medical teaching centers (context).

Consistent with Best Evidence Medical Education (BEME) recommendations, the search was performed on valid databases as well as PubMed, Scopus, ISI Web of Science and Springer. During the search, the restrictions and related keywords were retrieved. To search for related papers, the combination of keywords ( Table 1 ), with the English language and 5-year period restrictions were applied. Also, a search expert helped us to improve the quality of searches.

Table 1

Search strategy

Search Engines and Databases: Pub Med, Springer, ISI Web of Sciences, Scopus, Google Scholar (2012 to 2016)

Limits: Language (only resources with at least an abstract in English)

Date: up to 2016,May, 20

Search strategy: #1 AND #2 AND #3

#1

"VR" OR "virtual reality" OR "computer simulate" OR "Augmented Reality"

#2

"education" OR "training" OR "learning" OR "teaching"

#3

"medicine" OR "medical" OR "medical students" OR "residents" OR "medical groups"

The inclusion criteria were clinical trial and exclusion criteria were commentary non-randomized trials and non-clinical trials. Erratum Review, Commentary, contact with Editor and available Studies were considered. The process of selection of articles was based on the PRISMA chart ( Figure 1 ), and 24 articles were selected out of 1343 retrieved articles. In accordance with BEME, all stages of the selection and evaluation of the quality of the articles were done by two researchers and in the case of disagreement, a third person was available to help.

Considering BEME, to assess the quality of the studies, we excluded Consortium Assessment Tool 2010 (was used) and 3 papers with undesirable quality from the study. Finally, 21 qualified papers of clinical trials were selected.

Consistent with BEME, the required information of the selected papers was collected using a data collection form (including items of the type of study, the year of the study, the sample number, the country where the study was conducted, first author, the most important findings, the proposed solutions and the limitations of each study) and the data were summarized and reported in Tables according to the objectives of the study.

Results

All of 21 clinical trials with inclusion criteria were selected for the current study. 2013 had the largest number of studies ( 9). Studies were conducted in Denmark (4 studies), Canada, the United States and Germany (3 studies for each), England and Australia (2 studies for each), and the Netherlands, Switzerland, Norway, and Austria, (each with 1 study). Using pre-test and post-test was the most common method for data collection.

Based on the other results, the effect of using virtual reality was ranked from 1-4 (very effective, effective, ineffective, and negative); only two studies reported the negative effect on the use of virtual reality in training medical groups. In addition, two studies have reported the ineffectiveness of the use of virtual reality in medical education.

The findings of the present study indicated that the average period of training different medical groups using virtual reality was between six months to one year. In addition, according to the findings of the present study, the application of virtual reality reduced the time required for training medical groups. The secondary results of this study are shown in Table 2 to address the advantages and disadvantages of virtual reality in teaching medical groups.

Table 2

Disadvantages

Advantages

The high cost of the simulators

Decrease in the frequency of training and the ease of training using VR ( 22- 28)

The long nature of some studies in the field of virtual reality

Decrease in the time of surgery in the real environment ( 23, 29, 30)

Additional training using VR without supervision can cause extra stitching, and lead to damages to tissues, and more

Increase in self-confidence in learners using VR compared to other groups ( 32, 23)

The course of studies is very limited; therefore, further studies and more accurate evaluations are necessary

Decrease of harm to those being treated by people who are trained by VR, decrease in mistakes and more successful surgeries ( 29, 33- 35)

Some studies have also pointed to the increase in training time ( 18- 21)

Increase in skills of learners ( 18, 21, 24, 28, 36)

Better learning of anatomical positions ( 27)

Better understanding of the exterior and interior space relationships between the organs ( 27)

Valuable approach for Standard and unified education of medical groups ( 28)

Increase in the skill of surgeon ( 21)

Increase in the safety of the physician and patients ( 21, 33, 34)

Decrease in the costs and increase in the efficiency ( 18, 22, 26, 37)

Overall performance improvement ( 32, 35, 38)

Other secondary results of the current study include suggestions for improving the application of virtual reality that are presented in Table 3 .

Table 3

No.

Proposals

3

The presence of an instructor is very influential (guided- education), and in the absence of such a person there may be distortion and in the training process and the performance can be reduced ( 22, 26)

6

Application of virtual reality is appropriate for midterm training in medical groups and it is not recommended for long-term education ( 17, 24)

8

The use of VR for the training the medical groups should be considered as an additional training and it cannot replace the main method ( 25, 29)

10

Using feedback during the training using virtual reality ( 17, 26, 32, 37, 38)

Discussion

The results indicated that all studies were conducted in developed countries. 95% of the studies that have been studied emphasize the improvement of the skills of trainees (various medical groups) using virtual reality although a few studies noted the ineffectiveness of virtual reality on medical education. Julie Enne et al. proposed the implementation of virtual reality training courses for the acquisition of hysteroscopic skills for clinical professionals who are interested in learning sterilization techniques ( 36).

The application of virtual reality in training different medical groups includes different effects. That is, in some specialties virtual reality is very effective, and in several studies and specialties no positive effects are noted regarding the use of virtual reality compared to the control group. A recent study on gynecology and obstetrics reported the impact of VR application on the enhancement of infant and maternal health ( 35).

A study conducted in 2012 concluded that simulation-based education significantly increased the skills and knowledge of residents in the intensive care unit. It is an invaluable approach for standard medical education ( 28). However, Brydges et al. indicated that "contrary to expectations of researchers, intervention group did not have more advantages over self-regulated learning (SRL), and in fact they spent more time on doing it" ( 20). However, most studies reported the positive impact of the application of virtual reality for training the medical groups. Given that a small number of studies reported the lack of effectiveness of the virtual reality application, further studies are required to be conducted in this area.

In addition, Bongers et al. noted that "this study proposed that multitasking could be taught using virtual reality simulator equipment. But the effectiveness of surgery reduced in trainees with multiple trainings and this level of skill requires more research" ( 18).

The results emphasize a better understanding of the exterior and interior spatial relationships of the organs and development of the anatomical knowledge of students through the application of VR. Yanping et al. emphasized the improvement of the skills of beginners and experienced bone sawing rescuers because the application of surgical simulations helps the trainees to increase their recognition skill of the anatomical positions ( 16). Therefore, virtual reality can be used for training the anatomy courses of different medical groups.

Other results showed that virtual reality should be used as a complementary training along with main training and it can never replace the training in the real environment. A study in the field of software development of virtual reality used for education of nursing emphasized guidance in the objectives of simulation training software and its combination with conventional trainings ( 40). In addition, some studies pointed the effective and positive effects of simulation-oriented syllabus on transferring skills to the operating rooms ( 8- 13).

The results revealed that the presence of an instructor is very influential (guided-training) since his absence may lead to disruption in the learning process and the performance can be reduced ( 22, 26).

One of the issues of conducting this area is the high cost of these studies, such as the high cost of monitors, programming, implementation environment, participants, and so on. A higher number of student were proposed in a study to cover the high cost of using virtual reality ( 39).

Given the importance of continuous monitoring of education, the use of feedback during training is recommended ( 17, 26, 32, 37, 38). Also, the use of virtual reality is suggested for holding retraining courses to increase the quality of the educations.

The results showed that people trained by virtual reality had lower performance errors and higher accuracy compared to those trained by conventional approaches. For example, many studies in the area of education using the simulator indicated that inexperienced residents who learned colonoscopy and endoscopy in the simulator before doing them in real-case (on the patient and in the operating room) did much better and with less errors than other residents who learned it directly in the real environment ( 41- 44).

Conclusion

The application of virtual reality, as a complementary method, plays an important role in improving the performance of different medical groups. Therefore, given the results, it is suggested that it should be used as a complementary educational tool along with main education. Considering that laparoscopic surgery is one of the most important surgical procedures that is taught using virtual reality, individual and general factors affecting its exact implementation should be identified. In addition, given the importance of the issue, it is suggested that more studies should be carried out on the training of medical groups using virtual reality to determine the type and extent of its impact on the performance and efficiency of the students. With respect to the results of the present study, it is suggested that virtual reality should be used in training such skills as laparoscopic surgery, education of orthopedic residents, Gynecology residents, suturing, ultrasound, nursing procedures and paramedical interventions. In addition, it seems necessary to do studies to determine the effectiveness and usefulness of the method and satisfaction of the trainees and patients. Furthermore, considering the needs of trainees, designing virtual reality tools can be an appropriate solution for its effective use for training the medical groups.

Acknowledgement

This study is the result of a research project done through the financial support of Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences with grant No. 95-01-68-12720.

Conflict of Interests: None declared.

References

3. Rizzo A, Kim GJ. A SWOT analysis of the field of virtual reality rehabilitation and therapy. Presence. 2005;14:119-46. [ Google Scholar]

40. Moghaddasi H, Rabiei R, Nazemi E, Bigdeli SH, Ebrahimpour Sadagheyani H. Role of models, approaches and learning theories in the design and production of educational software based on virtual reality techniques and simulation in nursing education: a systematic review. J Urmia Nurs Midwifery Fac. 2016;14(4):300-12. [ Google Scholar]

Articles from Journal of Advances in Medical Education & Professionalism are provided here courtesy of Shiraz University of Medical Sciences

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The Applications of Virtual Reality Technology in Medical Groups Teaching

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Virtual reality is a new method for training different medical groups. Based on this technology, professionals and students of various medical sciences can determine their level of competence for medical treatment before any performance on the patient. ...