TY - JOUR AU - Hiley, Katherine AU - Bi-Mohammad, Zanib AU - Taylor, Luke AU - Burgess-Dawson, Rebecca AU - Patterson, Dominic AU - Puttick-Whiteman, Devon AU - Gay, Christopher AU - Hiscoe, Janette AU - Munsch, Chris AU - Richardson, Sally AU - Knowles-Lee, Mark AU - Beecham, Celia AU - Ralph, Neil AU - Chatterjee, Arunangsu AU - Mathew, Ryan AU - Mushtaq, Faisal PY - 2025/4/2 TI - Extended Reality?Enhanced Mental Health Consultation Training: Quantitative Evaluation Study JO - JMIR Med Educ SP - e64619 VL - 11 KW - mental health KW - training KW - consultation KW - extended reality KW - virtual reality KW - augmented reality N2 - Background: The use of extended reality (XR) technologies in health care can potentially address some of the significant resource and time constraints related to delivering training for health care professionals. While substantial progress in realizing this potential has been made across several domains, including surgery, anatomy, and rehabilitation, the implementation of XR in mental health training, where nuanced humanistic interactions are central, has lagged. Objective: Given the growing societal and health care service need for trained mental health and care workers, coupled with the heterogeneity of exposure during training and the shortage of placement opportunities, we explored the feasibility and utility of a novel XR tool for mental health consultation training. Specifically, we set out to evaluate a training simulation created through collaboration among software developers, clinicians, and learning technologists, in which users interact with a virtual patient, ?Stacey,? through a virtual reality or augmented reality head-mounted display. The tool was designed to provide trainee health care professionals with an immersive experience of a consultation with a patient presenting with perinatal mental health symptoms. Users verbally interacted with the patient, and a human instructor selected responses from a repository of prerecorded voice-acted clips. Methods: In a pilot experiment, we confirmed the face validity and usability of this platform for perinatal and primary care training with subject-matter experts. In our follow-up experiment, we delivered personalized 1-hour training sessions to 123 participants, comprising mental health nursing trainees, general practitioner doctors in training, and students in psychology and medicine. This phase involved a comprehensive evaluation focusing on usability, validity, and both cognitive and affective learning outcomes. Results: We found significant enhancements in learning metrics across all participant groups. Notably, there was a marked increase in understanding (P<.001) and motivation (P<.001), coupled with decreased anxiety related to mental health consultations (P<.001). There were also significant improvements to considerations toward careers in perinatal mental health (P<.001). Conclusions: Our findings show, for the first time, that XR can be used to provide an effective, standardized, and reproducible tool for trainees to develop their mental health consultation skills. We suggest that XR could provide a solution to overcoming the current resource challenges associated with equipping current and future health care professionals, which are likely to be exacerbated by workforce expansion plans. UR - https://mededu.jmir.org/2025/1/e64619 UR - http://dx.doi.org/10.2196/64619 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64619 ER - TY - JOUR AU - Huang, Kuo-Ting AU - Ma, Zexin AU - Yao, Lan PY - 2025/3/31 TI - Media-Induced and Psychological Factors That Foster Empathy Through Virtual Reality in Nursing Education: 2×2 Between-Subjects Experimental Study JO - JMIR Med Educ SP - e59083 VL - 11 KW - nursing education KW - narrative transportation KW - presence KW - virtual reality KW - game-based learning KW - affective empathy N2 - Background: Virtual reality (VR) has emerged as a promising tool in medical education, particularly for fostering critical skills such as empathy. However, how VR, combined with perspective-taking, influences affective empathy in nursing education remains underexplored. Objective: This study investigates the influence of VR and perspective-taking on affective empathy in nursing education, focusing on 4 psychological factors: perceived self-location, narrative transportation, emotional engagement, and affective empathy. Methods: A 2×2 between-subjects design was used, involving 69 nursing undergraduates from two Midwest universities. The participants engaged with a narrative-focused video game, That Dragon, Cancer, in either VR or non-VR conditions and from the perspective of either parents or clinicians. Results: VR significantly enhanced perceived self-location (P=.01), while adopting a clinician?s perspective amplified emotional engagement (P=.03). However, VR did not significantly influence narrative transportation (P=.35). An interaction effect was found between the platform and player?s perspective on narrative transportation (P=.04). Several indirect effects of media elements on affective empathy were observed via other psychological factors, though the direct effect of VR on affective empathy was not significant (P=.84). Conclusions: These findings underscore the potential of VR in medical education, suggesting that perspective-taking should be carefully considered when designing immersive learning experiences. The study advocates for broader integration of VR technologies into medical curricula to enhance instruction quality and patient-centered care. UR - https://mededu.jmir.org/2025/1/e59083 UR - http://dx.doi.org/10.2196/59083 ID - info:doi/10.2196/59083 ER - TY - JOUR AU - Martín-Valero, Rocío AU - Vega-Morales Sr, Alejandro AU - Martín-Vega, Javier Francisco AU - Rodriguez-Huguet, Manuel AU - Rodríguez-Martínez, Carmen Maria AU - Vinolo-Gil, Jesus Maria PY - 2025/3/27 TI - Effectiveness of Augmented Reality in the Teaching of Health University Students: Quasi-Experimental Study JO - JMIR Serious Games SP - e54312 VL - 13 KW - augmented reality KW - qualifications KW - usability KW - university KW - teaching KW - education KW - implementation KW - academic performance KW - quasi-experimental design KW - control group KW - applications KW - experimental group N2 - Background: The exponential growth of new technologies has resulted in the need for updating the field of education. From the educational point of view, there are some studies that have promoted the implementation of new technologies. These facts have raised the need to implement augmented reality in the university environment, especially among students of health sciences. The use of augmented reality can mean a new approach to teaching by teachers and better learning by students. Objective: We aimed to analyze the degree of usability of two augmented reality applications and to compare the academic performance between the control group and the experimental group at the Universities of Cádiz and Málaga. The students at the University of Málaga used the Zapworks augmented reality software, while those at the University of Cádiz used the Aumentaty augmented reality software for their respective experimental groups. The secondary objective was to measure the relationships between all the studied variables. Methods: This was a quasi-experimental design with a posttest as the only evaluation measure. We followed the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement and the ethical and legal aspects of the Principles of the Declaration of Helsinki. An intervention was carried out using two augmented reality applications on the subject of General Procedures in Physiotherapy II at the Universities of Málaga and Cádiz. Results: A total of 199 participants took part in the study. Demographic variables, ratings, and usability were assessed, followed by statistical analysis, with the results and their interpretation being described in the study. Significant differences (P<.001) were found in the ratings at both the universities. In addition, significant differences (P<.001) were found between the experimental group and the control group. Regarding the degree of usability in the univariate analysis, no significant differences were found (P=.049). A multiple regression analysis of the rating and usability was performed. The rating showed significant differences, with a beta of 1.4 (P<.001), and usability was also significant (P=.03) in favor of the Aumentaty group. Conclusions: Significant differences were observed in those who used augmented reality compared to the control group, with higher values observed in the University of Cádiz. There are no correlations between the variables of usability and qualifications. Trial Registration: ClinicalTrials.gov NCT05798468; https://clinicaltrials.gov/study/NCT05798468 UR - https://games.jmir.org/2025/1/e54312 UR - http://dx.doi.org/10.2196/54312 ID - info:doi/10.2196/54312 ER - TY - JOUR AU - Ba, Hongjun AU - Zhang, Lili AU - He, Xiufang AU - Li, Shujuan PY - 2025/3/26 TI - Knowledge Mapping and Global Trends in Simulation in Medical Education: Bibliometric and Visual Analysis JO - JMIR Med Educ SP - e71844 VL - 11 KW - medical education KW - simulation-based teaching KW - bibliometrics KW - visualization analysis KW - knowledge mapping N2 - Background: With the increasing recognition of the importance of simulation-based teaching in medical education, research in this field has developed rapidly. To comprehensively understand the research dynamics and trends in this area, we conducted an analysis of knowledge mapping and global trends. Objective: This study aims to reveal the research hotspots and development trends in the field of simulation-based teaching in medical education from 2004 to 2024 through bibliometric and visualization analyses. Methods: Using CiteSpace and VOSviewer, we conducted bibliometric and visualization analyses of 6743 articles related to simulation-based teaching in medical education, published in core journals from 2004 to 2024. The analysis included publication trends, contributions by countries and institutions, author contributions, keyword co-occurrence and clustering, and keyword bursts. Results: From 2004 to 2008, the number of articles published annually did not exceed 100. However, starting from 2009, the number increased year by year, reaching a peak of 850 articles in 2024, indicating rapid development in this research field. The United States, Canada, the United Kingdom, Australia, and China published the most articles. Harvard University emerged as a research hub with 1799 collaborative links, although the overall collaboration density was low. Among the 6743 core journal articles, a total of 858 authors were involved, with Lars Konge and Adam Dubrowski being the most prolific. However, collaboration density was low, and the collaboration network was relatively dispersed. A total of 812 common keywords were identified, forming 4189 links. The keywords ?medical education,? ?education,? and ?simulation? had the highest frequency of occurrence. Cluster analysis indicated that ?cardiopulmonary resuscitation? and ?surgical education? were major research hotspots. From 2004 to 2024, a total of 20 burst keywords were identified, among which ?patient simulation,? ?randomized controlled trial,? ?clinical competence,? and ?deliberate practice? had high burst strength. In recent years, ?application of simulation in medical education,? ?3D printing,? ?augmented reality,? and ?simulation training? have become research frontiers. Conclusions: Research on the application of simulation-based teaching in medical education has become a hotspot, with expanding research areas and hotspots. Future research should strengthen interinstitutional collaboration and focus on the application of emerging technologies in simulation-based teaching. UR - https://mededu.jmir.org/2025/1/e71844 UR - http://dx.doi.org/10.2196/71844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/71844 ER - TY - JOUR AU - Karunaratne, Dilroshini AU - Whittock, Jessica AU - Moore, Amber AU - Dasigan, Krishna AU - Chevolleau, Jasmine AU - Bartholomew, Brent AU - Kelly, Nikki AU - Cohen, E. Charlotte PY - 2025/3/19 TI - Exploring the Use of an Augmented Reality Device Learning Tool for Multidisciplinary Staff Training on Domestic Abuse and Sexual Violence: Postintervention Qualitative Evaluation JO - JMIR Form Res SP - e60075 VL - 9 KW - augmented reality KW - virtual reality KW - medical technology KW - domestic abuse KW - sexual violence KW - medical education KW - training KW - domestic violence KW - violence KW - assault KW - victim KW - survivor-centered KW - staff KW - community stakeholders KW - social care KW - innovation N2 - Background: Legislative policies published by National Health Service, England and the UK Government focus on prioritizing the creation of a stronger system. These frameworks emphasize on the improvement of health care staff?s ability to identify and refer domestic abuse (DA) survivors as key areas for supporting workforce development. Health care staff are often the first professional contact of survivors of DA, and insufficient staff training is a key barrier to survivors being identified and directed to support. The Microsoft HoloLens2 is a mixed-reality headset that allows virtual objects (holograms) to be integrated into the real world. Mixed-reality headsets are being increasingly used within medical education and have the advantage of independent operation, reducing the staffing requirements for teaching. The HoloLens2 can be used to project HoloPatients (HPs), which resemble clinically unwell patients, into the classroom. Two of these HPs have been specifically designed to portray survivors of DA and sexual violence (SV). Objective: This study explored potential uses of the HP in DA and SV training as a potential survivor-centered educational initiative that could be used as an adjunct to existing training for health care professionals and community sector workers. Methods: Frontline staff and community stakeholders from the national health service, DA, and law enforcement sectors were invited on 3 separate occasions (n=14, 12, 22) to a HoloLens2 demonstration that displayed 9 HPs. The patient voice was to be outlined by personalized scripts, co-created alongside sector charities, ensuring survivor engagement and participation. Participants were given the opportunity to wear the headset and familiarize themselves with the technology during the sessions. A post-intervention evaluation research model was used to explore the feasibility and functionality of the HP as an educational tool. Results: Thematic analysis described the HP as a ?realistic,? ?adjustable? tool that ?creates a safe learning environment.? Participants suggested it could be useful in ?pre-exposure preparation? by ?improving communication? and allowing different approaches to be trialed in a safe environment. The use of survivor scripts was described as a useful tool to ?bring the survivor into the learning space? in a safe way. Participants identified the HP as a suitable tool for workers inside and outside health care, including social sectors such as law enforcement (32%). Conclusions: The HP acts as a low-risk, adaptable tool for trainees to develop skills in a safe environment. This study demonstrates that professionals perceived the HoloLens as an innovative means to amplify the lived experience voice. Further research will evaluate this additional impact on trainees? confidence and responses to survivors disclosing DA and SV within different disciplines to drive improved outcomes. Trial Registration: Permission to conduct this study granted by the Research Innovation and Quality Improvement Team at Chelsea and Westminster NHS Foundation Trust UR - https://formative.jmir.org/2025/1/e60075 UR - http://dx.doi.org/10.2196/60075 ID - info:doi/10.2196/60075 ER - TY - JOUR AU - Talan, Jordan AU - Forster, Molly AU - Joseph, Leian AU - Pradhan, Deepak PY - 2025/3/12 TI - Exploring the Role of Immersive Virtual Reality Simulation in Health Professions Education: Thematic Analysis JO - JMIR Med Educ SP - e62803 VL - 11 KW - virtual reality KW - medical education KW - virtual reality simulation KW - extended reality KW - simulation KW - VR KW - health professions education KW - health education KW - thematic analysis KW - evolving technology KW - qualitative study KW - qualitative KW - semistructured interviews KW - educational experiences KW - theoretical framework N2 - Background: Although technology is rapidly advancing in immersive virtual reality (VR) simulation, there is a paucity of literature to guide its implementation into health professions education, and there are no described best practices for the development of this evolving technology. Objective: We conducted a qualitative study using semistructured interviews with early adopters of immersive VR simulation technology to investigate use and motivations behind using this technology in educational practice, and to identify the educational needs that this technology can address. Methods: We conducted 16 interviews with VR early adopters. Data were analyzed via directed content analysis through the lens of the Unified Theory of Acceptance and Use of Technology. Results: The main themes that emerged included focus on cognitive skills, access to education, resource investment, and balancing immersion. These findings help to clarify the intended role of VR simulation in health professions education. Based on our data, we synthesized a set of research questions that may help define best practices for future VR development and implementation. Conclusions: Immersive VR simulation technology primarily serves to teach cognitive skills, expand access to educational experiences, act as a collaborative repository of widely relevant and diverse simulation scenarios, and foster learning through deep immersion. By applying the Unified Theory of Acceptance and Use of Technology theoretical framework to the context of VR simulation, we not only collected validation evidence for this established theory, but also proposed several modifications to better explain use behavior in this specific setting. UR - https://mededu.jmir.org/2025/1/e62803 UR - http://dx.doi.org/10.2196/62803 ID - info:doi/10.2196/62803 ER - TY - JOUR AU - Fleet, Andrew AU - Kaustov, Lilia AU - Belfiore, BR Elio AU - Kapralos, Bill AU - Matava, Clyde AU - Wiegelmann, Julian AU - Giacobbe, Peter AU - Alam, Fahad PY - 2025/3/11 TI - Current Clinical and Educational Uses of Immersive Reality in Anesthesia: Narrative Review JO - J Med Internet Res SP - e62785 VL - 27 KW - virtual reality KW - augmented reality KW - mixed reality KW - anesthesia KW - immersive reality KW - medical education KW - artificial intelligence N2 - Background: The concept of immersive reality (IR), an umbrella term that encompasses virtual reality, augmented reality, and mixed reality, has been established within the health care realm as a potentially valuable tool with numerous applications in both medical education and patient care. Objective: This review aimed to introduce anesthesiologists to the emerging and rapidly evolving literature on IR, its use in anesthesia education, and its transferability into the clinical context. Methods: A review of the relevant literature was conducted using the PubMed database from inception to July 5, 2023. Additional references were identified from the reference lists of selected papers. Results: A total of 51 papers related to the use of IR in anesthesia medical education (including both technical and nontechnical skills) and 63 papers related to applications in clinical practice (eg, preprocedure planning, patient education, and pain management) were included. We present evidence supporting the use of IR in the training and clinical practice of modern anesthesiologists. Conclusions: IR is useful for a variety of applications in anesthesia medical education and has potential advantages over existing simulation approaches. Similarly, IR has demonstrated potential improvements in patient care across several clinical contexts relevant to practicing anesthesiologists. However, many applications remain in the early stages of development, and robust trials are urgently needed to confirm clinical or educational effectiveness and to assess mechanisms, educational validity, and cost-effectiveness. UR - https://www.jmir.org/2025/1/e62785 UR - http://dx.doi.org/10.2196/62785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62785 ER - TY - JOUR AU - Galvin, Charlotte AU - Watt, Jonathan AU - Ghatnekar, Payal AU - Peres, Nicholas AU - Rees-Lee, Jacqueline PY - 2025/2/27 TI - A Local Training Program to Increase Awareness of Emerging Extended Reality Technologies Among Health Care Professionals: Development Study JO - JMIR XR Spatial Comput SP - e57361 VL - 2 KW - health care XR KW - extended reality in health care KW - XR KW - virtual reality in health care KW - VR KW - digital awareness training KW - digital deep dive KW - digital literacy KW - emerging health care technology KW - digital future KW - extended reality KW - virtual reality N2 - Background: Demands on health care services can greatly outweigh capacity. Multifactorial causative factors present great challenges, forcing the National Health Service (NHS) to increase efficiency and adaptivity. Concurrently, digital advancements are excelling and long-term plans for NHS sustainability are focusing on the use of technological interventions to benefit patients. As a result, integration of extended reality (XR) technology has become an important focus of health care research. However, models of how the digital literacy of health care workforces can be developed and how frontline staff can be actively involved in the design and development of creative digital interventions are lacking. Such programs are essential to allow the development and upscaling of digital innovation within the NHS for the benefit of the patients. Such a program has been developed in the Digital Futures research lab at Torbay and South Devon NHS Foundation Trust, representing one of the first immersive digital technologies research spaces embedded within the NHS. A ?Digital Deep Dive? training program has been developed, allowing local health care workers to recognize the possibilities of digital health care technologies and supporting them in the evolution of ideas for potential bespoke digital solutions appropriate to their own patient groups and care pathways. Objective: This paper aims to explain the development of this unique XR Deep Dive program and present the evaluation that informed future directions for its ongoing development. Methods: The Deep Dive sessions were designed according to relevant pedagogic principles, including experiential, active, and contextual learning theories. Voluntary pilot sessions were held for local clinical teams comprised of junior doctors, consultants, nurses, and allied health professionals. Self-selection sampling was used. Participants completed an anonymous postsession feedback form, which was used to conduct a service evaluation. Data were analyzed using descriptive statistics (quantitative) and thematic analysis (qualitative). Results: In total, 21 completed questionnaires were analyzed. Overall, the sessions were positively received: all participants reported increased awareness of the potential for digital health care innovation postsession and most found it useful and relevant to their clinical careers. Participants valued the sessions being grounded in a context relevant to local practice with opportunities to interact with the technology through the lens of use cases. Conclusions: We have developed a unique training initiative providing contextually relevant XR technology awareness training for health care professionals locally. Despite the growing pace of digital health care innovation, we recognized a knowledge gap in our local workforce regarding the potential of XR technologies within health care. We responded by developing a training program grounded in the concept of digital co-creation?working with staff and service users to develop bespoke solutions integrated within patient pathways. The results from this paper will help to inform future directions for developing digital awareness training in our trust and have implications for wider NHS digital literacy training. UR - https://xr.jmir.org/2025/1/e57361 UR - http://dx.doi.org/10.2196/57361 ID - info:doi/10.2196/57361 ER - TY - JOUR AU - Sarkar, Korak AU - Bhimarasetty, Vishal AU - Rahim, Abdul AU - Curtis, Colin AU - Hughes, Kimberly PY - 2025/2/21 TI - Assessing the Feasibility and Utility of Patient-Specific 3D Advanced Visualization Modeling in Cerebrovascular Disease: Retrospective Analysis and Prospective Survey Pilot Study JO - JMIR Form Res SP - e51939 VL - 9 KW - cerebrovascular disease KW - advanced visualization KW - 3D modeling KW - cerebrovascular KW - intracerebral arteriovenous malformations KW - artery KW - vein KW - vessel KW - medical extended reality KW - 3D printing KW - medical simulation KW - virtual reality KW - augmented reality KW - usability KW - survey KW - stroke KW - brain KW - cerebral N2 - Background: The prevalence, clinical burden, and health care costs (>US $100 billion) associated with cerebrovascular disease (CVD) will increase significantly as the US population grows and ages over the next 25 years. Existing 2D imaging modalities have inherent limitations in visualizing complex CVD, which may be mitigated with the use of patient-specific 3D advanced visualization (AV) technologies. There remain gaps in knowledge, however, regarding how and with what impact these technologies are being used in CVD. Objective: The aim of this study was to characterize the clinical attributes and reported utility associated with the use of 3D AV modeling in CVDs, specifically intracerebral arteriovenous malformations. Methods: This pilot study employs a combination of retrospective analysis and prospective surveys to describe the utilization and utility of patient-specific AV models at a single high-volume certified comprehensive stroke center. Results: From July 2017 to February 2023, 25 AV models were created for 4 different clinicians. The average patient age was 37.4 years; 44% (11/25) of the patients were African Americans, 52% (13/25) were on public insurance, and 56% (14/25) were associated with a neurovascular procedure. In this study, 18 clinicians with diverse experience responded to AV model surveys, with a 92.2% (166/180) completion rate. There was an average reported utility of 8.0 on a 0-10 scale, with higher scores reflecting increased utility. Compared to 2D viewing, AV models allowed staff to appreciate novel abnormal anatomy, and therefore, they would have changed their therapeutic approach in 45% (23/51) of the cases. Conclusions: AV models were used in complex CVDs associated with young, publicly insured individuals requiring resource-intensive interventions. There was strong and diverse clinician engagement with overall report of substantial utility of AV models. Staff clinicians frequently reported novel anatomical and therapeutic insights based on AV models compared to traditional 2D viewing. This study establishes the infrastructure for future larger randomized studies that can be repeated for CVDs or other disease states and incorporate assessments of other AV modalities such as 3D printing and medical extended reality. UR - https://formative.jmir.org/2025/1/e51939 UR - http://dx.doi.org/10.2196/51939 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51939 ER - TY - JOUR AU - Kitapcioglu, Dilek AU - Aksoy, Emin Mehmet AU - Ozkan, Ekin Arun AU - Usseli, Tuba AU - Cabuk Colak, Dilan AU - Torun, Tugrul PY - 2025/2/14 TI - Enhancing Immersion in Virtual Reality?Based Advanced Life Support Training: Randomized Controlled Trial JO - JMIR Serious Games SP - e68272 VL - 13 KW - artificial intelligence KW - voice recognition KW - serious gaming KW - immersion KW - virtual reality N2 - Background: Serious game?based training modules are pivotal for simulation-based health care training. With advancements in artificial intelligence (AI) and natural language processing, voice command interfaces offer an intuitive alternative to traditional virtual reality (VR) controllers in VR applications. Objective: This study aims to compare AI-supported voice command interfaces and traditional VR controllers in terms of user performance, exam scores, presence, and confidence in advanced cardiac life support (ACLS) training. Methods: A total of 62 volunteer students from Acibadem Mehmet Ali Aydinlar University Vocational School for Anesthesiology, aged 20-22 years, participated in the study. All the participants completed a pretest consisting of 10 multiple-choice questions about ACLS. Following the pretest, participants were randomly divided into 2 groups: the voice command group (n=31) and the VR controller group (n=31). The voice command group members completed the VR-based ACLS serious game in training mode twice, using an AI-supported voice command as the game interface. The VR controller group members also completed the VR-based ACLS serious game in training mode twice, but they used VR controllers as the game interface. The participants completed a survey to assess their level of presence and confidence during gameplay. Following the survey, participants completed the exam module of the VR-based serious gaming module. At the final stage of the study, participants completed a posttest, which had the same content as the pretest. VR-based exam scores of the voice command and VR controller groups were compared using a 2-tailed, independent-samples t test, and linear regression analysis was conducted to examine the effect of presence and confidence rating. Results: Both groups showed an improvement in performance from pretest to posttest, with no significant difference in the magnitude of improvement between the 2 groups (P=.83). When comparing presence ratings, there was no significant difference between the voice command group (mean 5.18, SD 0.83) and VR controller group (mean 5.42, SD 0.75; P=.25). However, when comparing VR-based exam scores, the VR controller group (mean 80.47, SD 13.12) significantly outperformed the voice command group (mean 66.70, SD 21.65; P=.005), despite both groups having similar time allocations for the exam (voice command group: mean 18.59, SD 5.28 minutes and VR controller group: mean 17.3, SD 4.83 minutes). Confidence levels were similar between the groups (voice command group: mean 3.79, SD 0.77 and VR controller group: mean 3.60, SD 0.72), but the voice command group displayed a significant overconfidence bias (voice command group: mean 0.09, SD 0.24 and VR controller group: mean ?0.09, SD 0.18; P=.002). Conclusions: VR-based ACLS training demonstrated effectiveness; however, the use of voice commands did not result in improved performance. Further research should explore ways to optimize AI?s role in education through VR. Trial Registration: ClinicalTrials.gov NCT06458452; https://clinicaltrials.gov/ct2/show/NCT06458452 UR - https://games.jmir.org/2025/1/e68272 UR - http://dx.doi.org/10.2196/68272 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68272 ER - TY - JOUR AU - Koivisto, Jaana-Maija AU - Kämäräinen, Sanna AU - Mattsson, Katri AU - Jumisko-Pyykkö, Satu AU - Ikonen, Riikka AU - Haavisto, Elina PY - 2025/2/13 TI - Exploring Nursing Students? Experiences of Empathy and User Experiences in an Immersive Virtual Reality Simulation Game: Cross-Sectional Study JO - JMIR Serious Games SP - e62688 VL - 13 KW - education KW - nursing KW - learning KW - empathy KW - virtual reality KW - simulation KW - user experience KW - cross sectional N2 - Background: Empathy is associated with better clinical outcomes and patient-care experiences, and it has been demonstrated that training can improve nursing students? empathy. The use of virtual reality (VR) as an experiential learning strategy may increase the empathetic behavior of caregivers. Although much research exists on the use of VR in education, there is still little research on learning empathy in nursing education through immersive VR games that include a head-mounted display and hand controllers. In addition, it is important to study both learning and user experiences in nursing education that utilizes VR technology. Objective: This study aims to explore nursing students? experiences of empathy and user experiences in an immersive VR simulation game. Methods: A cross-sectional design was used. A total of 52 graduating nursing students from 3 universities of applied sciences in Finland participated in the study. The immersive VR simulation game employed in the study was played with a head-mounted display and hand controllers. The instruments used were the Basic Empathy Scale in Adults (BES-A) before the VR simulation gaming session and the Comprehensive State Empathy Scale (CSES) and AttrakDiff 2.0 Scale after the session. Results: The students? overall level of empathy experienced in the immersive VR simulation game was favorable (CSES; mean 2.9, SD 0.57). Participants who had a higher level of empathy (BES-A) before playing the immersive VR simulation game also experienced slightly more feelings of empathy after playing (CSES). However, the association between the measures was not statistically significant (r=0.187, P=.18). The overall empathy (CSES) experienced in the immersive VR simulation game was positively correlated with its subscales. The use of the VR simulation provided a positive user experience in all 4 factors of the AttrakDiff 2.0 Scale. Overall User Experience and Emotion Sharing correlated negatively (r=?0.248, P=.042), as did Attractiveness and Emotion Sharing (r=?0.327, P=.018). Hedonic Quality Stimulation correlated negatively with Cognitive Empathy (r=?0.279, P=.045). Conclusions: The results of this study indicate that the use of an immersive VR simulation game in nursing education as a means of increasing empathy seems promising and justified. The immersive VR simulation game offered positive user experiences, which further supported the idea of implementing it in education. However, more research is needed on what kinds of VR environments are the most effective in promoting empathy among nursing students. Furthermore, when using VR technology in learning, one should consider that the VR setting must not be too technical but rather simple, straightforward, and predictable. UR - https://games.jmir.org/2025/1/e62688 UR - http://dx.doi.org/10.2196/62688 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62688 ER - TY - JOUR AU - Beverly, A. Elizabeth AU - Miller, Samuel AU - Love, Matthew AU - Love, Carrie PY - 2025/2/12 TI - Feasibility of a Cinematic?Virtual Reality Program Educating Health Professional Students About the Complexity of Geriatric Care: Pilot Pre-Post Study JO - JMIR Aging SP - e64633 VL - 8 KW - virtual reality KW - VR KW - aging KW - geriatric syndromes KW - diabetes KW - elder abuse and neglect KW - gerontology KW - geriatrics KW - older KW - elderly KW - education KW - student KW - cinematic KW - video KW - head mounted KW - feasibility KW - experience KW - attitude KW - opinion KW - perception KW - elder abuse KW - chronic conditions KW - older adult care KW - health intervention KW - randomized controlled trial N2 - Background: The US population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of health care professionals for this aging population, we need to provide training that captures the complexity of geriatric care. Objective: This pilot study aimed to assess the feasibility of the cinematic?virtual reality (cine-VR) training in the complexity of geriatric care. We measured changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy before and after participating in the training program. Methods: We conducted a single-arm, pretest-posttest pilot study to assess the feasibility of a cine-VR training and measure changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy. Health professional students from a large university in the Midwest were invited to participate in 1 of 4 cine-VR trainings. Participants completed 3 surveys before and after the cine-VR training. We performed paired t tests to examine changes in these constructs before and after the training. Results: A total of 65 health professional students participated in and completed the full cine-VR training for 100% retention. Participants did not report any technological difficulties or adverse effects from wearing the head-mounted displays or viewing the 360-degree video. Out of the 65 participants, 48 completed the pre- and postassessments. We observed an increase in awareness of discrimination towards people with disability (t47=?3.97; P<.001). In addition, we observed significant improvements in self-efficacy to identify and manage elder abuse and neglect (t47=?3.36; P=.002). Finally, we observed an increase in participants? empathy (t47=?2.33; P=.02). Conclusions: We demonstrated that our cine-VR training program was feasible and acceptable to health professional students at our Midwestern university. Findings suggest that the cine-VR training increased awareness of discrimination towards people with disabilities, improved self-efficacy to identify and manage elder abuse and neglect, and increased empathy. Future research using a randomized controlled trial design with a larger, more diverse sample and a proper control condition is needed to confirm the effectiveness of our cine-VR training. UR - https://aging.jmir.org/2025/1/e64633 UR - http://dx.doi.org/10.2196/64633 ID - info:doi/10.2196/64633 ER - TY - JOUR AU - Chang, Wen AU - Lin, Chun-Chih AU - Crilly, Julia AU - Lee, Hui-Ling AU - Chen, Li-Chin AU - Han, Chin-Yen PY - 2025/2/11 TI - Virtual Reality Simulation for Undergraduate Nursing Students for Care of Patients With Infectious Diseases: Mixed Methods Study JO - JMIR Med Educ SP - e64780 VL - 11 KW - virtual reality KW - infection control KW - learning motivation KW - learning attitudes KW - nursing education N2 - Background: Virtual reality simulation (VRS) teaching offers nursing students a safe, immersive learning environment with immediate feedback, enhancing learning outcomes. Before the COVID-19 pandemic, nursing students had limited training and opportunities to care for patients in isolation units with infectious diseases. However, the pandemic highlighted the ongoing global priority of providing care for patients with infectious diseases. Objective: This study aims to (1) examine the effectiveness of VRS in preparing nursing students to care for patients with infectious diseases by assessing its impact on their theoretical knowledge, learning motivation, and attitudes; and (2) evaluate their experiences with VRS. Methods: This 2-phased mixed methods study recruited third-year undergraduate nursing students enrolled in the Integrated Emergency and Critical Care course at a university in Taiwan. Phase 1 used a quasi-experimental design to address objective 1 by comparing the learning outcomes of students in the VRS teaching program (experimental group) with those in the traditional teaching program (control group). Tools included an infection control written test, the Instructional Materials Motivation Survey, and a learning attitude questionnaire. The experimental group participated in a VRS lesson titled ?Caring for a Patient with COVID-19 in the Negative Pressure Unit? as part of the infection control unit. In phase 2, semistructured interviews were conducted to address objective 2, exploring students? learning experiences. Results: A total of 107 students participated in phase 1, and 18 students participated in phase 2. Both the VRS and control groups showed significant improvements in theoretical knowledge scores (for the VRS group t46=?7.47; P<.001, for the control group t59=?4.04; P<.001). However, compared with the control group, the VRS group achieved significantly higher theoretical knowledge scores (t98.13=2.70; P=.008) and greater learning attention (t105=2.30; P=.02) at T1. Additionally, the VRS group demonstrated a statistically significant higher regression coefficient for learning confidence compared with the control group (?=.29; P=.03). The students? learning experiences in the VRS group were categorized into 4 themes: Applying Professional Knowledge to Patient Care, Enhancing Infection Control Skills, Demonstrating Patient Care Confidence, and Engaging in Real Clinical Cases. The core theme identified was Strengthening Clinical Patient Care Competencies. Conclusions: The findings suggest that VRS teaching significantly enhanced undergraduate nursing students? infection control knowledge, learning attention, and confidence. Qualitative insights reinforced the quantitative results, highlighting the holistic benefits of VRS teaching in nursing education, including improved learning outcomes. The positive impact on student motivation and attitudes indicates a potentially transformative approach to nursing education, particularly in the post?COVID-19 era, where digital and remote learning tools play an increasingly vital role. UR - https://mededu.jmir.org/2025/1/e64780 UR - http://dx.doi.org/10.2196/64780 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64780 ER - TY - JOUR AU - Baetzner, Sabine Anke AU - Hill, Yannick AU - Roszipal, Benjamin AU - Gerwann, Solčne AU - Beutel, Matthias AU - Birrenbach, Tanja AU - Karlseder, Markus AU - Mohr, Stefan AU - Salg, Alexander Gabriel AU - Schrom-Feiertag, Helmut AU - Frenkel, Ottilie Marie AU - Wrzus, Cornelia PY - 2025/1/27 TI - Mass Casualty Incident Training in Immersive Virtual Reality: Quasi-Experimental Evaluation of Multimethod Performance Indicators JO - J Med Internet Res SP - e63241 VL - 27 KW - prehospital decision-making KW - disaster medicine KW - emergency medicine KW - mass casualty incident KW - medical education KW - eye tracking KW - emergency simulation KW - virtual reality N2 - Background: Immersive virtual reality (iVR) has emerged as a training method to prepare medical first responders (MFRs) for mass casualty incidents (MCIs) and disasters in a resource-efficient, flexible, and safe manner. However, systematic evaluations and validations of potential performance indicators for virtual MCI training are still lacking. Objective: This study aimed to investigate whether different performance indicators based on visual attention, triage performance, and information transmission can be effectively extended to MCI training in iVR by testing if they can discriminate between different levels of expertise. Furthermore, the study examined the extent to which such objective indicators correlate with subjective performance assessments. Methods: A total of 76 participants (mean age 25.54, SD 6.01 y; 45/76, 59% male) with different medical expertise (MFRs: paramedics and emergency physicians; non-MFRs: medical students, in-hospital nurses, and other physicians) participated in 5 virtual MCI scenarios of varying complexity in a randomized order. Tasks involved assessing the situation, triaging virtual patients, and transmitting relevant information to a control center. Performance indicators included eye-tracking?based visual attention, triage accuracy, triage speed, information transmission efficiency, and self-assessment of performance. Expertise was determined based on the occupational group (39/76, 51% MFRs vs 37/76, 49% non-MFRs) and a knowledge test with patient vignettes. Results: Triage accuracy (d=0.48), triage speed (d=0.42), and information transmission efficiency (d=1.13) differentiated significantly between MFRs and non-MFRs. In addition, higher triage accuracy was significantly associated with higher triage knowledge test scores (Spearman ?=0.40). Visual attention was not significantly associated with expertise. Furthermore, subjective performance was not correlated with any other performance indicator. Conclusions: iVR-based MCI scenarios proved to be a valuable tool for assessing the performance of MFRs. The results suggest that iVR could be integrated into current MCI training curricula to provide frequent, objective, and potentially (partly) automated performance assessments in a controlled environment. In particular, performance indicators, such as triage accuracy, triage speed, and information transmission efficiency, capture multiple aspects of performance and are recommended for integration. While the examined visual attention indicators did not function as valid performance indicators in this study, future research could further explore visual attention in MCI training and examine other indicators, such as holistic gaze patterns. Overall, the results underscore the importance of integrating objective indicators to enhance trainers? feedback and provide trainees with guidance on evaluating and reflecting on their own performance. UR - https://www.jmir.org/2025/1/e63241 UR - http://dx.doi.org/10.2196/63241 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63241 ER - TY - JOUR AU - Conen, Robin AU - Mueller, Steffen AU - Tibubos, Nanette Ana PY - 2025/1/20 TI - Integration of Conventional and Virtual Reality Approaches in Augmented Reality for Theory-Based Psychoeducational Intervention Design for Chronic Low Back Pain: Scoping Review JO - Interact J Med Res SP - e59611 VL - 14 KW - augmented reality KW - virtual reality KW - chronic low back pain KW - education KW - pain management KW - intervention N2 - Background: Psychoeducation positively influences the psychological components of chronic low back pain (CLBP) in conventional treatments. The digitalization of health care has led to the discussion of virtual reality (VR) interventions. However, CLBP treatments in VR have some limitations due to full immersion. In comparison, augmented reality (AR) supplements the real world with virtual elements involving one?s own body sensory perception and can combine conventional and VR approaches. Objective: The aim of this study was to review the state of research on the treatment of CLBP through psychoeducation, including immersive technologies, and to formulate suggestions for psychoeducation in AR for CLBP. Methods: A scoping review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in August 2024 by using Livivo ZB MED, PubMed, Web of Science, American Psychological Association PsycINFO (PsycArticle), and PsyArXiv Preprints databases. A qualitative content analysis of the included studies was conducted based on 4 deductively extracted categories. Results: We included 12 studies published between 2019 and 2024 referring to conventional and VR-based psychoeducation for CLBP treatment, but no study referred to AR. In these studies, educational programs were combined with physiotherapy, encompassing content on pain biology, psychological education, coping strategies, and relaxation techniques. The key outcomes were pain intensity, kinesiophobia, pain catastrophizing, degree of disability, quality of life, well-being, self-efficacy, depression, attrition rate, and user experience. Passive, active, and gamified strategies were used to promote intrinsic motivation from a psychological point of view. Regarding user experience from a software development perspective, user friendliness, operational support, and application challenges were recommended. Conclusions: For the development of a framework for an AR-based psychoeducational intervention for CLBP, the combination of theories of acceptance and use of technologies with insights from health psychological behavior change theories appears to be of great importance. An example of a theory-based design of a psychoeducation intervention in AR for CLBP is proposed and discussed. UR - https://www.i-jmr.org/2025/1/e59611 UR - http://dx.doi.org/10.2196/59611 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59611 ER - TY - JOUR AU - Teng, Peng AU - Xu, Youran AU - Qian, Kaoliang AU - Lu, Ming AU - Hu, Jun PY - 2025/1/17 TI - Case-Based Virtual Reality Simulation for Severe Pelvic Trauma Clinical Skill Training in Medical Students: Design and Pilot Study JO - JMIR Med Educ SP - e59850 VL - 11 KW - case-based learning KW - virtual reality KW - pelvic fracture KW - severe pelvic trauma KW - hemodynamic instability KW - clinical skill training KW - VR KW - pelvic trauma KW - medical student KW - pilot study KW - orthopedic surgery KW - theoretical teaching KW - acceptability N2 - Background: Teaching severe pelvic trauma poses a significant challenge in orthopedic surgery education due to the necessity of both clinical reasoning and procedural operational skills for mastery. Traditional methods of instruction, including theoretical teaching and mannequin practice, face limitations due to the complexity, the unpredictability of treatment scenarios, the scarcity of typical cases, and the abstract nature of traditional teaching, all of which impede students? knowledge acquisition. Objective: This study aims to introduce a novel experimental teaching methodology for severe pelvic trauma, integrating virtual reality (VR) technology as a potent adjunct to existing teaching practices. It evaluates the acceptability, perceived ease of use, and perceived usefulness among users and investigates its impact on knowledge, skills, and confidence in managing severe pelvic trauma before and after engaging with the software. Methods: A self-designed questionnaire was distributed to 40 students, and qualitative interviews were conducted with 10 teachers to assess the applicability and acceptability. A 1-group pretest-posttest design was used to evaluate learning outcomes across various domains, including diagnosis and treatment, preliminary diagnosis, disease treatment sequencing, emergency management of hemorrhagic shock, and external fixation of pelvic fractures. Results: A total of 40 students underwent training, with 95% (n=38) affirming that the software effectively simulated real-patient scenarios. All participants (n=40, 100%) reported that completing the simulation necessitated making the same decisions as doctors in real life and found the VR simulation interesting and useful. Teacher interviews revealed that 90% (9/10) recognized the VR simulation?s ability to replicate complex clinical cases, resulting in enhanced training effectiveness. Notably, there was a significant improvement in the overall scores for managing hemorrhagic shock (t39=37.6; 95% CI 43.6-48.6; P<.001) and performing external fixation of pelvic fractures (t39=24.1; 95% CI 53.4-63.3; P<.001) from pre- to postsimulation. Conclusions: The introduced case-based VR simulation of skill-training methodology positively influences medical students? clinical reasoning, operative skills, and self-confidence. It offers an efficient strategy for conserving resources while providing quality education for both educators and learners. UR - https://mededu.jmir.org/2025/1/e59850 UR - http://dx.doi.org/10.2196/59850 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59850 ER - TY - JOUR AU - Zhang, Dandan AU - Fu, MuLi AU - Zhang, Jianzhong AU - Li, Yuxuan AU - Chen, Li AU - Chen, Yong-Jun AU - Zhong, Zhefeng AU - Zhang, Yin-Ping PY - 2025/1/17 TI - Evaluating Whether Nonimmersion Virtual Reality Simulation Training Improves Nursing Competency in Isolation Wards: Randomized Controlled Trial JO - J Med Internet Res SP - e63131 VL - 27 KW - virtual reality simulation KW - isolation ward KW - preparedness KW - pandemic KW - nurse N2 - Background: During infectious disease outbreaks such as the COVID-19 pandemic, nurses are crucial in patient care and public health safety; however, they face challenges such as inadequate training and high stress in isolation wards. Virtual reality (VR) technology offers innovative training solutions to enhance nurses? clinical skills and preparedness. However, extensive studies on its effectiveness in isolation ward environments are still limited. Objective: This study aims to develop a nonimmersive VR (NIVR) simulation training program for isolation wards and further validate its feasibility and training effectiveness in aiding nurses in adapting to isolation ward settings. Methods: This study was a prospective, parallel, open-label, randomized controlled trial. A total of 90 nurses from 3 hospitals in China were randomly assigned to either the control or intervention group, with 45 (50%) individuals in each group. Both groups received training on isolation ward layout and nursing procedures. The control group underwent a 4-hour conventional training session consisting of 2 hours of face-to-face lectures and 2 hours of ward visits. The intervention group received a 4-hour NIVR simulation training session. Subsequently, both groups completed approximately 4 hours of emergency drills and assessments. Results: After the intervention, there were no significant differences in theoretical test or performance assessment scores between the 2 groups (t88=?0.30, P=.75; Cohen d=?0.06; z score=0.00, P>.99), using a 2-tailed t test. However, the intervention group completed 6 tasks faster than the control group (t88=5.10, P<.001; Cohen d=1.08), with an average reduction of about 3 minutes (control group: mean 43.91, SD 2.99 min; intervention group: mean 40.77, SD 2.85 min). Notably, they completed task 3 (patient reception inward) and task 6 (exiting the isolation area) significantly quicker (t88=3.22, P=.002; Cohen d=0.68; t88=3.03, P=.003; Cohen d=0.64, respectively), with no significant differences for the other tasks. Conclusions: This study highlights the potential of NIVR simulation training for nurses working in isolation wards. Although NIVR simulation training does not significantly surpass traditional methods in imparting theoretical knowledge, it does reduce task completion time for specific activities. Its capacity for safe, repetitive practice and realistic scenario simulation makes NIVR a valuable tool in medical education. Further research and optimization of VR simulation training programs are recommended to enhance nurses? practical skills and pandemic preparedness. Trial Registration: Chinese Clinical Trial Registry ChiCTR240083155; https://www.chictr.org.cn/hvshowproject.html?id=250356&v=1.0 UR - https://www.jmir.org/2025/1/e63131 UR - http://dx.doi.org/10.2196/63131 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63131 ER - TY - JOUR AU - Kim, Minha AU - Son, Hi Meong AU - Moon, Suhyeon AU - Cha, Chul Won AU - Jo, Joon Ik AU - Yoon, Hee PY - 2025/1/16 TI - A Mixed Reality?Based Telesupervised Ultrasound Education Platform on 5G Network Compared to Direct Supervision: Prospective Randomized Pilot Trial JO - JMIR Serious Games SP - e63448 VL - 13 KW - ultrasonography KW - telemedicine KW - medical education KW - distance learning KW - fifth-generation network KW - mixed reality KW - ultrasound education KW - hospital KW - randomized pilot trial KW - pilot study KW - doctor KW - telesupervision KW - head-mounted display KW - primary outcomes KW - user experience KW - self-confidence KW - image quality KW - educational intervention KW - training experience KW - South Korea KW - telehealth N2 - Background: Ultrasound education is transitioning from in-person training to remote methods using mixed reality (MR) and 5G networks. Previous studies are mainly experimental, lacking randomized controlled trials in direct training scenarios. Objective: This study aimed to compare an MR-based telesupervised ultrasound education platform on private 5G networks with traditional in-person training for novice doctors. Methods: Conducted at a tertiary academic hospital from November to December 2023, the prospective unblinded randomized controlled pilot study assigned doctors without prior abdominal ultrasound education experience to either the telesupervision group (TG; n=20) or direct supervision group (DG; n=20). Participants received a 15-minute video lecture, conducted ultrasound on a phantom, and had 18 images scored by 2 blinded experts. Additionally, the TG received 5 minutes of training on the basic operation of a head-mounted display. Communication between doctors in the TG and supervisors was facilitated through a head-mounted display, whereas those in the DG interacted directly with supervisors. Primary outcomes were image quality scores, while secondary outcomes included procedure time, number of supervisor interventions, user experience using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), System Usability Scale (SUS), and self-confidence through pre- and postsurveys. Results: Image quality scores and procedure times showed no significant differences between the groups (TG: 66.8 [SD 10.3] vs DG: 66.8 [SD 10.4], P=.84; TG: 23.8 [SD 8.0] min vs DG: 24.0 [SD 8.1] min, P=.95, respectively). However, the TG engaged in more educational interventions (TG: 4.0 [SD 2.5] vs DG: 0.8 [SD 1.1], P<.001), reflecting a more interactive training environment. TG participants reported lower NASA-TLX scores for mental demand (43.8 [SD 24.8] vs 60.6 [SD 22.4], P=.03), effort (43.1 [SD 22.9] vs 67.9 [SD 17], P<.001), and frustration (26.9 [SD 20.3] vs 45.2 [SD 27.8], P=.02), indicating a reduced cognitive load compared to the DG. The mean SUS score was also higher in the TG (66.6 [SD 9.1] vs 60.2 [SD 10.4], P=.046), suggesting better usability. Both groups showed significant improvements in confidence, with the TG showing notably greater improvement in abdominal ultrasound proficiency (pre-education TG: 1.6 [SD 0.9] vs DG: 1.7 [SD 0.9], P=.73; post-education TG: 3.8 [SD 0.9] vs DG: 2.8 [SD 1.0], P=.006). Conclusions: Although no significant differences in image quality scores were observed between groups, considerable differences in positive educational interactions, workload, and usability were evident. These findings emphasize the platform?s potential to enhance the ultrasound training experience, suggesting more interactive and efficient learning. Trial Registration: ClinicalTrials.gov NCT06171828; https://clinicaltrials.gov/study/NCT06171828 UR - https://games.jmir.org/2025/1/e63448 UR - http://dx.doi.org/10.2196/63448 ID - info:doi/10.2196/63448 ER - TY - JOUR AU - Mühling, Tobias AU - Schreiner, Verena AU - Appel, Marc AU - Leutritz, Tobias AU - König, Sarah PY - 2025/1/10 TI - Comparing Virtual Reality?Based and Traditional Physical Objective Structured Clinical Examination (OSCE) Stations for Clinical Competency Assessments: Randomized Controlled Trial JO - J Med Internet Res SP - e55066 VL - 27 KW - virtual reality KW - VR KW - objective structured clinical examination KW - OSCE KW - medical education KW - technological proficiency KW - assessment KW - clinical competence KW - item characteristics KW - discrimination power KW - acceptance KW - technical feasibility KW - effectiveness KW - comparative study KW - physical stations KW - medical students KW - standardized patients KW - cost-effectiveness N2 - Background: Objective structured clinical examinations (OSCEs) are a widely recognized and accepted method to assess clinical competencies but are often resource-intensive. Objective: This study aimed to evaluate the feasibility and effectiveness of a virtual reality (VR)?based station (VRS) compared with a traditional physical station (PHS) in an already established curricular OSCE. Methods: Fifth-year medical students participated in an OSCE consisting of 10 stations. One of the stations, emergency medicine, was offered in 2 modalities: VRS and PHS. Students were randomly assigned to 1 of the 2 modalities. We used 2 distinct scenarios to prevent content leakage among participants. Student performance and item characteristics were analyzed, comparing the VRS with PHS as well as with 5 other case-based stations. Student perceptions of the VRS were collected through a quantitative and qualitative postexamination online survey, which included a 5-point Likert scale ranging from 1 (minimum) to 5 (maximum), to evaluate the acceptance and usability of the VR system. Organizational and technical feasibility as well as cost-effectiveness were also evaluated. Results: Following randomization and exclusions of invalid data sets, 57 and 66 participants were assessed for the VRS and PHS, respectively. The feasibility evaluation demonstrated smooth implementation of both VR scenarios (septic and anaphylactic shock) with 93% (53/57) of students using the VR technology without issues. The difficulty levels of the VRS scenarios (septic shock: P=.67; anaphylactic shock: P=.58) were comparable to the average difficulty of all stations (P=.68) and fell within the reference range (0.4-0.8). In contrast, VRS demonstrated above-average values for item discrimination (septic shock: r'=0.40; anaphylactic shock: r'=0.33; overall r'=0.30; with values >0.3 considered good) and discrimination index (septic shock: D=0.25; anaphylactic shock: D=0.26; overall D=0.16, with 0.2-0.3 considered mediocre and <0.2 considered poor). Apart from some hesitancy toward its broader application in future practical assessments (mean 3.07, SD 1.37 for VRS vs mean 3.65, SD 1.18 for PHS; P=.03), there were no other differences in perceptions between VRS and PHS. Thematic analysis highlighted the realistic portrayal of medical emergencies and fair assessment conditions provided by the VRS. Regarding cost-effectiveness, initial development of the VRS can be offset by long-term savings in recurring expenses like standardized patients and consumables. Conclusions: Integration of the VRS into the current OSCE framework proved feasible both technically and organizationally, even within the strict constraints of short examination phases and schedules. The VRS was accepted and positively received by students across various levels of technological proficiency, including those with no prior VR experience. Notably, the VRS demonstrated comparable or even superior item characteristics, particularly in terms of discrimination power. Although challenges remain, such as technical reliability and some acceptance concerns, VR remains promising in applications of clinical competence assessment. UR - https://www.jmir.org/2025/1/e55066 UR - http://dx.doi.org/10.2196/55066 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55066 ER - TY - JOUR AU - Zechner, Olivia AU - Schrom-Feiertag, Helmut AU - Wespi, Rafael AU - Pretolesi, Daniele AU - Nguyen, Quynh AU - Tscheligi, Manfred PY - 2024/12/24 TI - Enhancing Mixed Reality Simulation Training Technology With Real-Time Performance Visualization: Mixed Methods Study With Medical First Responders JO - JMIR XR Spatial Comput SP - e57655 VL - 1 KW - mixed reality KW - immersive technologies KW - simulation training KW - simulation KW - paramedic KW - medical first responders KW - human performance KW - stress KW - stress monitoring KW - human-centered design N2 - Background: Mixed reality (MR) simulation training is emerging in paramedical education as a way to practice responding to stress-intensive scenarios like mass casualty incidents in a safe and controlled environment. Current training platforms, however, lack real-time stress and human performance monitoring tools. Objective: The study aims to enhance MR training for medical first responders through real-time evaluation of performance and stress levels, leveraging biosignal monitoring and advanced analytics to allow instructors to tailor feedback and maintain optimal challenge and safety levels. Methods: The study includes a structured, multiphase approach including initial requirement gathering (structured interviews and cocreation workshops), an online design survey, iterative prototype development, and a field trial (including training observations and interviews). Data were collected from 5 end user consortium members across Europe. Quantitative data from checklists were analyzed using frequencies and percentages to understand feature usage and event occurrences. Qualitative data from semistructured interviews and cocreation workshops were transcribed, coded, and subjected to thematic analysis to identify patterns and insights into the usability and effectiveness of the enhanced features in the MR training. Results: The study identified a number of requirements that medical first responders have for an MR training system, including requirements not included in currently available solutions. A total of 80 performance metrics were initially identified and refined to a set of 54 metrics, which were categorized into key performance indicator groups such as scene safety, triage performance, and communication. Requirements for smart wearables to monitor stress levels are provided and highlight the importance of a user-centered design process to provide users with effective tools that fit their needs. Stress visualization preferences are described in the form of a dashboard as well as in virtual environments surrounding the avatar. Using an iterative design process and user feedback, a training system was developed, integrating real-time performance tracking and stress monitoring. The field trial provided insights into the practical use of these features during a real training exercise, showed interaction preferences between trainer and trainees, and highlighted further improvement opportunities. Conclusions: This research enhances MR training for paramedics by integrating real-time performance metrics and stress indicators based on a human-centered design approach that aligns with end user needs, thereby laying the foundation for developing more effective and immersive training solutions for high-stress professions. UR - https://xr.jmir.org/2024/1/e57655 UR - http://dx.doi.org/10.2196/57655 ID - info:doi/10.2196/57655 ER - TY - JOUR AU - Wang, Y. Ellen AU - Qian, Daniel AU - Zhang, Lijin AU - Li, S-K Brian AU - Ko, Brian AU - Khoury, Michael AU - Renavikar, Meghana AU - Ganesan, Avani AU - Caruso, J. Thomas PY - 2024/12/23 TI - Acceptance of Virtual Reality in Trainees Using a Technology Acceptance Model: Survey Study JO - JMIR Med Educ SP - e60767 VL - 10 KW - virtual reality KW - technology assessment KW - graduate medical education trainees KW - medical education KW - technology adoption KW - Technology Acceptance Model KW - factor analysis KW - VR KW - TAM KW - United Theory of Acceptance and Use of Technology KW - UTAUT N2 - Background: Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of health care settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. The behavioral intentions of GME trainees with regard to VR as an anxiolytic tool have not been characterized through a theoretical framework of technology adoption. Objective: The primary aim of this study was to apply a hybrid Technology Acceptance Model (TAM) and a United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM-UTAUT. Methods: Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence the adoption of new technologies. Results: In total, 202 of 1540 GME trainees participated. Only 198 participants were included in the final analysis (12.9% participation rate). Perceptions of usefulness, ease of use, and enjoyment; social influence; and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated a good fit. All domain measurements demonstrated acceptable reliability. Conclusions: This TAM-UTAUT demonstrated validity and reliability for predicting the behavioral intentions of GME trainees to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model?s reliability within specialties in different geographic locations. UR - https://mededu.jmir.org/2024/1/e60767 UR - http://dx.doi.org/10.2196/60767 ID - info:doi/10.2196/60767 ER - TY - JOUR AU - Ogundiya, Oluwadamilola AU - Rahman, Jasmine Thahmina AU - Valnarov-Boulter, Ioan AU - Young, Michael Tim PY - 2024/12/19 TI - Looking Back on Digital Medical Education Over the Last 25 Years and Looking to the Future: Narrative Review JO - J Med Internet Res SP - e60312 VL - 26 KW - digital health KW - digital medical education KW - health education KW - medical education KW - mobile phone KW - artificial intelligence KW - AI N2 - Background: The last 25 years have seen enormous progression in digital technologies across the whole of the health service, including health education. The rapid evolution and use of web-based and digital techniques have been significantly transforming this field since the beginning of the new millennium. These advancements continue to progress swiftly, even more so after the COVID-19 pandemic. Objective: This narrative review aims to outline and discuss the developments that have taken place in digital medical education across the defined time frame. In addition, evidence for potential opportunities and challenges facing digital medical education in the near future was collated for analysis. Methods: Literature reviews were conducted using PubMed, Web of Science Core Collection, Scopus, Google Scholar, and Embase. The participants and learners in this study included medical students, physicians in training or continuing professional development, nurses, paramedics, and patients. Results: Evidence of the significant steps in the development of digital medical education in the past 25 years was presented and analyzed in terms of application, impact, and implications for the future. The results were grouped into the following themes for discussion: learning management systems; telemedicine (in digital medical education); mobile health; big data analytics; the metaverse, augmented reality, and virtual reality; the COVID-19 pandemic; artificial intelligence; and ethics and cybersecurity. Conclusions: Major changes and developments in digital medical education have occurred from around the start of the new millennium. Key steps in this journey include technical developments in teleconferencing and learning management systems, along with a marked increase in mobile device use for accessing learning over this time. While the pace of evolution in digital medical education accelerated during the COVID-19 pandemic, further rapid progress has continued since the resolution of the pandemic. Many of these changes are currently being widely used in health education and other fields, such as augmented reality, virtual reality, and artificial intelligence, providing significant future potential. The opportunities these technologies offer must be balanced against the associated challenges in areas such as cybersecurity, the integrity of web-based assessments, ethics, and issues of digital privacy to ensure that digital medical education continues to thrive in the future. UR - https://www.jmir.org/2024/1/e60312 UR - http://dx.doi.org/10.2196/60312 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60312 ER - TY - JOUR AU - Ng, Hydra Hei-Yin AU - Wu, W. Changwei AU - Hsu, Hao-Che AU - Huang, Chih-Mao AU - Hsu, Ai-Ling AU - Chao, Yi-Ping AU - Jung, Tzyy-Ping AU - Chuang, Chun-Hsiang PY - 2024/12/6 TI - Neurological Evidence of Diverse Self-Help Breathing Training With Virtual Reality and Biofeedback Assistance: Extensive Exploration Study of Electroencephalography Markers JO - JMIR Form Res SP - e55478 VL - 8 KW - biofeedback KW - virtual reality KW - breathing training KW - EEG KW - electroencephalography KW - effective connectivity N2 - Background: Recent advancements in virtual reality (VR) and biofeedback (BF) technologies have opened new avenues for breathing training. Breathing training has been suggested as an effective means for mental disorders, but it is difficult to master the technique at the beginning. VR-BF technologies address the problem of breathing, and visualizing breathing may facilitate the learning of breathing training. This study explores the integration of VR and BF to enhance user engagement in self-help breathing training, which is a multifaceted approach encompassing mindful breathing, guided breathing, and breath counting techniques. Objective: We identified 3 common breathing training techniques in previous studies, namely mindful breathing, guided breathing, and breath counting. Despite the availability of diverse breathing training methods, their varying effectiveness and underlying neurological mechanisms remain insufficiently understood. We investigated using electroencephalography (EEG) indices across multiple breathing training modalities to address this gap. Methods: Our automated VR-based breathing training environment incorporated real-time EEG, heart rate, and breath signal BF. We examined 4 distinct breathing training conditions (resting, mindful breathing, guided breathing, and breath counting) in a cross-sectional experiment involving 51 healthy young adults, who were recruited through online forum advertisements and billboard posters. In an experimental session, participants practiced resting state and each breathing training technique for 6 minutes. We then compared the neurological differences across the 4 conditions in terms of EEG band power and EEG effective connectivity outflow and inflow with repeated measures ANOVA and paired t tests. Results: The analyses included the data of 51 participants. Notably, EEG band power across the theta, alpha, low-beta, high-beta, and gamma bands varied significantly over the entire scalp (t ?1.96, P values <.05). Outflow analysis identified condition-specific variations in the delta, alpha, and gamma bands (P values <.05), while inflow analysis revealed significant differences across all frequency bands (P values <.05). Connectivity flow analysis highlighted the predominant influence of the right frontal, central, and parietal brain regions in the neurological mechanisms underlying the breathing training techniques. Conclusions: This study provides neurological evidence supporting the effectiveness of self-help breathing training through the combined use of VR and BF technologies. Our findings suggest the involvement of internal-external attention focus and the dorsal attention network in different breathing training conditions. There is a huge potential for the use of breathing training with VR-BF techniques in terms of clinical settings, the new living style since COVID-19, and the commercial value of introducing VR-BF breathing training into consumer-level digital products. Furthermore, we propose avenues for future research with an emphasis on the exploration of applications and the gamification potential in combined VR and BF breathing training. Trial Registration: ClinicalTrials.gov NCT06656741; https://clinicaltrials.gov/study/NCT06656741 UR - https://formative.jmir.org/2024/1/e55478 UR - http://dx.doi.org/10.2196/55478 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55478 ER - TY - JOUR AU - Jiang, Nan AU - Zhang, Yuelun AU - Liang, Siyu AU - Lyu, Xiaohong AU - Chen, Shi AU - Huang, Xiaoming AU - Pan, Hui PY - 2024/12/5 TI - Effectiveness of Virtual Simulations Versus Mannequins and Real Persons in Medical and Nursing Education: Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e56195 VL - 26 KW - artificial intelligence KW - clinical virtual simulation KW - medical education KW - meta-analysis KW - nursing education KW - virtual patient KW - virtual reality N2 - Background: Virtual simulation (VS) is a developing education approach with the recreation of reality using digital technology. The teaching effectiveness of VSs compared to mannequins and real persons (RPs) has never been investigated in medical and nursing education. Objective: This study aims to compare VSs and mannequins or RPs in improving the following clinical competencies: knowledge, procedural skills, clinical reasoning, and communication skills. Methods: Following Cochrane methodology, a meta-analysis was conducted on the effectiveness of VSs in pre- and postregistration medical or nursing participants. The Cochrane Library, PubMed, Embase, and Educational Resource Information Centre databases were searched to identify English-written randomized controlled trials up to August 2024. Two authors independently selected studies, extracted data, and assessed the risk of bias. All pooled estimates were based on random-effects models and assessed by trial sequential analyses. Leave-one-out, subgroup, and univariate meta-regression analyses were performed to explore sources of heterogeneity. Results: A total of 27 studies with 1480 participants were included. Overall, there were no significant differences between VSs and mannequins or RPs in improving knowledge (standard mean difference [SMD]=0.08; 95% CI ?0.30 to 0.47; I2=67%; P=.002), procedural skills (SMD=?0.12; 95% CI ?0.47 to 0.23; I2=75%; P<.001), clinical reasoning (SMD=0.29; 95% CI ?0.26 to 0.85; I2=88%; P<.001), and communication skills (SMD=?0.02; 95% CI: ?0.62 to 0.58; I2=86%; P<.001). Trial sequential analysis for clinical reasoning indicated an insufficient sample size for a definitive judgment. For procedural skills, subgroup analyses showed that VSs were less effective among nursing participants (SMD=?0.55; 95% CI ?1.07 to ?0.03; I2=69%; P=.04). Univariate meta-regression detected a positive effect of publication year (?=.09; P=.02) on communication skill scores. Conclusions: Given favorable cost-utility plus high flexibility regarding time and space, VSs are viable alternatives to traditional face-to-face learning modalities. The comparative effectiveness of VSs deserves to be followed up with the emergence of new technology. In addition, further investigation of VSs with different design features will provide novel insights to drive education reform. Trial Registration: PROSPERO CRD42023466622; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=466622 UR - https://www.jmir.org/2024/1/e56195 UR - http://dx.doi.org/10.2196/56195 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56195 ER - TY - JOUR AU - Preibisch, Joshua AU - Tabriz, Navid AU - Kaluschke, Maximilian AU - Weyhe, Dirk AU - Uslar, Verena PY - 2024/11/27 TI - Virtual Reality in Clinical Teaching and Diagnostics for Liver Surgery: Prospective Cohort Study JO - JMIR XR Spatial Comput SP - e60383 VL - 1 KW - VR KW - virtual reality KW - multiple-choice test KW - anatomy KW - patient-specific 3D visualization KW - MRI-based segmentation KW - liver KW - cohort study KW - visualization KW - tool KW - medical diagnostic KW - questionnaire KW - usability KW - diagnostics KW - surgery KW - 3D KW - MRI KW - magnetic resonance imaging N2 - 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<.001). Using MRI, a significant difference was observed between students and residents (P=.04) and between students and specialists (P<.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<.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. Trial Registration: German Register of Clinical Studies DRKS00030024; https://drks.de/search/de/trial/DRKS00030024 UR - https://xr.jmir.org/2024/1/e60383 UR - http://dx.doi.org/10.2196/60383 ID - info:doi/10.2196/60383 ER - TY - JOUR AU - Mřrk, Gry AU - Bonsaksen, Tore AU - Larsen, Sřnnik Ole AU - Kunnikoff, Martin Hans AU - Lie, Stangeland Silje PY - 2024/11/19 TI - Virtual Reality Simulation in Undergraduate Health Care Education Programs: Usability Study JO - JMIR Med Educ SP - e56844 VL - 10 KW - 360° videos KW - health professions education KW - virtual reality KW - usability study KW - undergraduates KW - university KW - students KW - simulation N2 - Background: Virtual reality (VR) is increasingly being used in higher education for clinical skills training and role-playing among health care students. Using 360° videos in VR headsets, followed by peer debrief and group discussions, may strengthen students? social and emotional learning. Objective: This study aimed to explore student-perceived usability of VR simulation in three health care education programs in Norway. Methods: Students from one university participated in a VR simulation program. Of these, students in social education (n=74), nursing (n=45), and occupational therapy (n=27) completed a questionnaire asking about their perceptions of the usability of the VR simulation and the related learning activities. Differences between groups of students were examined with Pearson chi-square tests and with 1-way ANOVA. Qualitative content analysis was used to analyze data from open-ended questions. Results: The nursing students were most satisfied with the usability of the VR simulation, while the occupational therapy students were least satisfied. The nursing students had more often prior experience from using VR technology (60%), while occupational therapy students less often had prior experience (37%). Nevertheless, high mean scores indicated that the students experienced the VR simulation and the related learning activities as very useful. The results also showed that by using realistic scenarios in VR simulation, health care students can be prepared for complex clinical situations in a safe environment. Also, group debriefing sessions are a vital part of the learning process that enhance active involvement with peers. Conclusions: VR simulation has promise and potential as a pedagogical tool in health care education, especially for training soft skills relevant for clinical practice, such as communication, decision-making, time management, and critical thinking. UR - https://mededu.jmir.org/2024/1/e56844 UR - http://dx.doi.org/10.2196/56844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56844 ER - TY - JOUR AU - Hanke, Laura AU - Schulte, Richard AU - Boedecker, Christian AU - Huettl, Florentine AU - Saalfeld, Patrick AU - Chheang, Vuthea AU - Wessels, Marlene AU - von Castell, Christoph AU - Hecht, Heiko AU - Hansen, Christian AU - Lang, Hauke AU - Huber, Tobias PY - 2024/11/5 TI - Influence of Distraction Factors on Performance in Laparoscopic Surgery in Immersive Virtual Reality: Study Protocol of a Cross-Over Trial in Medical Students and Residents?DisLapVR JO - JMIR Res Protoc SP - e59014 VL - 13 KW - immersive virtual reality KW - distractions in surgery KW - KW - laparoscopy KW - medical training KW - medical students KW - surgical education KW - surgical training KW - VR KW - cognitive load KW - multitasking KW - stress resilience N2 - Background: Working in an operating room (OR) is physically and mentally challenging: the operation itself demands the surgeon's full attention, while time and cost efficiency constraints, daily planning, and emergency care interfere with the procedure. Thus, multitasking becomes an integral surgical competence. This study aims to examine the effect of disruptions during surgery in a highly immersive virtual reality (IVR) operation environment combined with a virtual reality (VR) laparoscopy simulator. Objective: This study aims to identify distractions in the OR and their importance in the clinical setting. Methods: An IVR environment was created using a high-resolution, stereoscopic 360° video of the OR. Different distractions were identified, classified as auditory, visual, or audio-visual, and recorded accordingly. The surrounding was combined with a VR laparoscopic simulator. Participants?medical students and surgical residents?received proficiency-based training in basic laparoscopic skills and were blinded to the aim of the experiment. Following a cross-over design, each participant received a unique order of virtual distraction factors while performing tasks on the laparoscopic simulator. During the experiment, subjective passing of time, stress, heart rate, and visually induced motion sickness are recorded. After the experiment, validated questionnaires for usability, immersion, and stress were completed, as well as subjective evaluation of the distractions. The questionnaires used included the system usability scale, Self-Assessment Manikin score, National Aeronautics and Space Administration Task Load Index, and the immersion rating scale as described by Nichols. Performance in the laparoscopic tasks in relation to distractions will be evaluated by the Wilcoxon test and ANOVA for continuous variables. Subgroup analyses in regard to age, gender, and expertise (medical students vs surgical residents) are planned. Results: The described trial started in August 2022 and is ongoing. By July 2024, a total of 30 medical students and 9 surgeons have completed the study. Conclusions: We present a study protocol aiming to identify the impact of different disruptions in OR during laparoscopic training in IVR. Hence, it may lead to an improved awareness of distractions and facilitate accommodations toward an improved work environment. Prior research leads to the hypothesis that the performance of a more experienced surgeon is less impacted by distractions than the performance of inexperienced surgeons and medical students. Furthermore, we investigate which type of distraction has the largest impact on performance. With this knowledge, specific multitasking training can be devised, which may be particularly useful in medical education, for which VR might play a leading role. Additionally, workplace surroundings in the OR can be optimized with this knowledge. Trial Registration: German Registry for Clinical Trials DRKS00030033; https://drks.de/search/en/trial/DRKS00030033 International Registered Report Identifier (IRRID): DERR1-10.2196/59014 UR - https://www.researchprotocols.org/2024/1/e59014 UR - http://dx.doi.org/10.2196/59014 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59014 ER - TY - JOUR AU - Kitapcioglu, Dilek AU - Aksoy, Emin Mehmet AU - Ozkan, Ekin Arun AU - Usseli, Tuba PY - 2024/8/7 TI - Comparing Learning Outcomes of Machine-Guided Virtual Reality?Based Training With Educator-Guided Training in a Metaverse Environment: Randomized Controlled Trial JO - JMIR Serious Games SP - e58654 VL - 12 KW - metaverse KW - serious gaming KW - virtual reality KW - educator guidance KW - educator KW - learning KW - machine guided KW - VR KW - guided training KW - randomized controlled trial KW - mixed reality KW - training KW - training module KW - module KW - correlation KW - gaming KW - gaming module KW - serious game KW - game KW - games N2 - Background: Virtual reality (VR) modules are commonly used for health care training, such as adult advanced cardiac life support (ACLS), due to immersion and engagement. The metaverse differs from current VR serious gaming by enabling shared social connections, while current VR modules focus on computer-based content without social interaction. Educators in the metaverse can foster communication and collaboration during training sessions. Objective: This study aimed to compare learning outcomes of VR-based, machine-guided training with educator-guided, VR-based training in the metaverse environment. Methods: A total of 62 volunteered students from Acibadem Mehmet Ali Aydinlar University Vocational School for Anesthesiology were randomly divided into 2 groups of 31 participants each: one group received VR-based training with machine guidance (MG), and the other received VR-based training with educator guidance (EG) in the metaverse. The members of both groups undertook VR-based basic training for ACLS. Afterward, the MG group was trained with a VR-based advanced training module, which provides training with full MG, whereas the EG group attended the VR-based, educator-guided training in the metaverse. The primary outcome of the study was determined by the exam score of the VR-based training module. Descriptive statistics defined continuous variables such as VR exam scores and time spent on machine- or educator-guided training. The correlation between training time and VR exam scores was assessed with the Spearman rank correlation, and nonnormally distributed variables were compared using the Mann-Whitney U test. Statistical significance was set at P<.05, with analyses executed by MedCalc Statistical Software (version 12.7.7). Results: Comparing the VR test scores between the MG and EG groups revealed no statistically significant difference. The VR test scores for the EG group had a median of 86 (range 11-100). In contrast, the MG group scores had a median of 66 (range 13-100; P=.08). Regarding the correlation between the duration of machine-guided or educator-guided training and VR-based exam scores, for the MG group, =0.569 and P=.005 were obtained. For the EG group, this correlation was found to be =0.298 and P=.10. While this correlation is statistically significant for the MG group, it is not significant for the EG group. The post hoc power analysis (80%), considering the correlation between the time spent on training and exam scores, supported this finding. Conclusions: The results of this study suggest that a well-designed, VR-based serious gaming module with MG could provide comparable learning outcomes to VR training in the metaverse with EG for adult ACLS training. Future research with a larger sample size could explore whether social interaction with educators in a metaverse environment offers added benefits for learners. Trial Registration: ClinicalTrials.gov NCT06288087; https://clinicaltrials.gov/study/NCT06288087 UR - https://games.jmir.org/2024/1/e58654 UR - http://dx.doi.org/10.2196/58654 UR - http://www.ncbi.nlm.nih.gov/pubmed/39110497 ID - info:doi/10.2196/58654 ER - TY - JOUR AU - Sendra-Portero, Francisco AU - Lorenzo-Álvarez, Rocío AU - Rudolphi-Solero, Teodoro AU - Ruiz-Gómez, José Miguel PY - 2024/8/6 TI - The Second Life Metaverse and Its Usefulness in Medical Education After a Quarter of a Century JO - J Med Internet Res SP - e59005 VL - 26 KW - medical education KW - medical students KW - postgraduate KW - computer simulation KW - virtual worlds KW - metaverse UR - https://www.jmir.org/2024/1/e59005 UR - http://dx.doi.org/10.2196/59005 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59005 ER - TY - JOUR AU - Lonati, Caterina AU - Wellhausen, Marie AU - Pennig, Stefan AU - Röhrßen, Thomas AU - Kircelli, Fatih AU - Arendt, Svenja AU - Tschulena, Ulrich PY - 2024/8/6 TI - The Use of a Novel Virtual Reality Training Tool for Peritoneal Dialysis: Qualitative Assessment Among Health Care Professionals JO - JMIR Med Educ SP - e46220 VL - 10 KW - peritoneal dialysis KW - virtual reality KW - patient education KW - patient training KW - chronic kidney disease KW - nursing KW - qualitative assessment N2 - Background: Effective peritoneal dialysis (PD) training is essential for performing dialysis at home and reducing the risk of peritonitis and other PD-related infections. Virtual reality (VR) is an innovative learning tool that is able to combine theoretical information, interactivity, and behavioral instructions while offering a playful learning environment. To improve patient training for PD, Fresenius Medical Care launched the stay?safe MyTraining VR, a novel educational program based on the use of a VR headset and a handheld controller. Objective: This qualitative assessment aims to investigate opinions toward the new tool among the health care professionals (HCPs) who were responsible for implementing the VR application. Methods: We recruited nursing staff and nephrologists who have gained practical experience with the stay?safe MyTraining VR within pilot dialysis centers. Predetermined open-ended questions were administered during individual and group video interviews. Results: We interviewed 7 HCPs who have 2 to 20 years of experience in PD training. The number of patients trained with the stay?safe MyTraining VR ranged from 2 to 5 for each professional. The stay?safe MyTraining VR was well accepted and perceived as a valuable supplementary tool for PD training. From the respondents? perspective, the technology improved patients? learning experience by facilitating the internalization of both medical information and procedural skills. HCPs highlighted that the opportunity offered by VR to reiterate training activities in a positive and safe learning environment, according to each patient?s needs, can facilitate error correction and implement a standardized training curriculum. However, VR had limited use in the final phase of the patient PD training program, where learners need to get familiar with the handling of the materials. Moreover, the traditional PD training was still considered essential to manage the emotional and motivational aspects and address any patient-specific application-oriented questions. In addition to its use within PD training, VR was perceived as a useful tool to support the decision-making process of patients and train other HCPs. Moreover, VR introduction was associated with increased efficiency and productivity of HCPs because it enabled them to perform other activities while the patient was practicing with the device. As for patients? acceptance of the new tool, interviewees reported positive feedback, including that of older adults. Limited use with patients experiencing dementia or severe visual impairment or lacking sensomotoric competence was mentioned. Conclusions: The stay?safe MyTraining VR is suggested to improve training efficiency and efficacy and thus could have a positive impact in the PD training scenario. Our study offers a process proposal that can serve as a guide to the implementation of a VR-based PD training program within other dialysis centers. Dedicated research is needed to assess the operational benefits and the consequences on patient management. UR - https://mededu.jmir.org/2024/1/e46220 UR - http://dx.doi.org/10.2196/46220 UR - http://www.ncbi.nlm.nih.gov/pubmed/39106093 ID - info:doi/10.2196/46220 ER - TY - JOUR AU - Yeo, Ji-Young AU - Nam, Hyeongil AU - Park, Jong-Il AU - Han, Soo-Yeon PY - 2024/7/26 TI - Multidisciplinary Design?Based Multimodal Virtual Reality Simulation in Nursing Education: Mixed Methods Study JO - JMIR Med Educ SP - e53106 VL - 10 KW - multidisciplinary KW - multimodal KW - nursing KW - simulation KW - virtual reality KW - VR KW - education KW - allied health KW - educational KW - simulations KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - feasibility KW - nurse KW - nurses KW - qualitative KW - interview KW - interviews KW - development KW - develop KW - teaching KW - educator KW - educators KW - user test KW - user testing KW - module KW - modules KW - usability KW - satisfaction N2 - Background: The COVID-19 pandemic underscored the necessity for innovative educational methods in nursing. Our study takes a unique approach using a multidisciplinary simulation design, which offers a systematic and comprehensive strategy for developing virtual reality (VR) simulations in nursing education. Objective: The aim of this study is to develop VR simulation content for a pediatric nursing module based on a multidisciplinary simulation design and to evaluate its feasibility for nursing education. Methods: This study used a 1-group, posttest-only design. VR content for pediatric nursing practice was developed by integrating the technological characteristics of a multimodal VR system with the learning elements of traditional nursing simulation, combining various disciplines, including education, engineering, and nursing. A user test was conducted with 12 nursing graduates (preservice nurses) followed by post hoc surveys (assessing presence, VR systems, VR sickness, and simulation satisfaction) and in-depth, one-on-one interviews. Results: User tests showed mean scores of 4.01 (SD 1.43) for presence, 4.91 (SD 0.81) for the VR system, 0.64 (SD 0.35) for VR sickness, and 5.00 (SD 1.00) for simulation satisfaction. In-depth interviews revealed that the main strengths of the immersive VR simulation for pediatric pneumonia nursing were effective visualization and direct experience through hands-on manipulation; the drawback was keyword-based voice interaction. To improve VR simulation quality, participants suggested increasing the number of nursing techniques and refining them in more detail. Conclusions: This VR simulation content for a pediatric nursing practice using a multidisciplinary educational design model was confirmed to have positive educational potential. Further research is needed to confirm the specific learning effects of immersive nursing content based on multidisciplinary design models. UR - https://mededu.jmir.org/2024/1/e53106 UR - http://dx.doi.org/10.2196/53106 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53106 ER - TY - JOUR AU - Park, Subin AU - Shin, Ju Hui AU - Kwak, Hyoeun AU - Lee, Joo Hyun PY - 2024/7/24 TI - Effects of Immersive Technology?Based Education for Undergraduate Nursing Students: Systematic Review and Meta-Analysis Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach JO - J Med Internet Res SP - e57566 VL - 26 KW - nursing education KW - nursing students KW - immersive technology KW - systematic review KW - meta-analysis KW - virtual reality KW - augmented reality KW - extended reality KW - simulation-based learning KW - medical education N2 - Background: The adoption of immersive technology in simulation-based nursing education has grown significantly, offering a solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diverse reports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology in nursing education to inform future educational programs. Objective: This systematic review aimed to identify the contents of immersive technology?based education for undergraduate nursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods. Methods: A literature search was performed using 4 databases: PubMed, CINAHL, Embase, and Web of Science; the latest search was completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursing students; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or nonrandomized studies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality, or extended reality. Quality assessment was conducted using Cochrane Risk-of-Bias Tool version 2 for RCTs and the Risk-of-Bias Assessment Tool for Nonrandomized Studies. The main outcomes of the included studies were classified according to the New World Kirkpatrick Model (NWKM), ranging from level 1 (reaction) to level 4 (results). Meta-analysis was conducted using RevMan 5.4 software, and subgroup analysis was conducted due to heterogeneity of the results of the meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was adopted for assessing certainty and synthesizing results of the relevant literature. Results: A total of 23 studies were included, with participant numbers ranging from 33 to 289. Of these, 19 (82.6%) studies adopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home health care; 4 (17.4%) studies used AR technologies; and 15 (65.2%) studies involved virtual patients in their scenarios. Based on the NWKM, the main outcome variables were classified as level 1 (usability and satisfaction), level 2 (knowledge, motivation, confidence, performance, attitude, and self-efficacy), and level 3 (clinical reasoning); level 4 outcomes were not found in the selected studies. Results of the subgroup analysis showed that immersive technology?based nursing education is more effective than traditional education in knowledge attainment (standard mean difference [SMD]=0.59, 95% CI 0.28-0.90, P<.001, I2=49%). Additionally, there were significant difference differences between the experimental and control group in confidence (SMD=0.70, 95% CI 0.05-1.35, P=.03, I2=82%) and self-efficacy (SMD=0.86, 95% CI 0.42-1.30, P<.001, I2=63%). Conclusions: These findings support the effectiveness of immersive technology?based education for undergraduate nursing students, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies be conducted to evaluate the effects of immersive technology?based nursing education on NWKM level 4. UR - https://www.jmir.org/2024/1/e57566 UR - http://dx.doi.org/10.2196/57566 UR - http://www.ncbi.nlm.nih.gov/pubmed/38978483 ID - info:doi/10.2196/57566 ER - TY - JOUR AU - Polecho?ski, Jacek AU - Przepiórzy?ski, Alan AU - Polecho?ski, Piotr AU - Tomik, Rajmund PY - 2024/7/16 TI - Effect of Elastic Resistance on Exercise Intensity and User Satisfaction While Playing the Active Video Game BoxVR in Immersive Virtual Reality: Empirical Study JO - JMIR Serious Games SP - e58411 VL - 12 KW - virtual reality KW - VR KW - game KW - gaming KW - immersive KW - immersion KW - health-related physical activity KW - physical activity KW - exercise KW - active video games KW - attractiveness KW - enjoyment scale KW - enjoyment KW - serious games KW - elastic resistance KW - resistance N2 - Background: One of the main contemporary forms of physical activity (PA) involves exercises and games in an immersive virtual reality (VR) environment, which allows the user to practice various forms of PA in a small space. Unfortunately, most of the currently available VR games and workout applications are mostly based on upper body movements, especially the arms, which do not guarantee sufficiently high exercise intensity and health benefits. Therefore, it is worth seeking solutions to help increase the exercise load during PA in VR. Objective: The main aim of this study was to evaluate the effect of elastic arm resistance in the form of latex resistance bands of different elasticity levels on the intensity of students? PA while playing the BoxVR game. We further assessed the satisfaction of this form of exercise and its associations with PA intensity. Methods: A total of 21 healthy and physically fit men (mean age 22.5, SD 2.0 years) were included in the study. The tests consisted of 3 10-minute games. One game was run with no load and the other two were run with 1.5-meter latex resistance bands (low and high resistance). The order of the tests was randomized and the participants rested for 20 minutes after each exercise. Exercise intensity was estimated using objective (heart rate monitoring) and subjective (Borg scale) methods. The Physical Activity Enjoyment Scale was used to assess satisfaction with the PA. The effect of elastic resistance on exercise intensity and user enjoyment was estimated using ANOVA for repeated measures. Results: The ANOVA results indicated that incorporation of elastic resistance caused a significant change (F2,40=20.235, P<.001; ?˛p=0.503) in the intensity of PA in VR, which was low while playing without resistance and then increased to a moderate level with additional resistance. The use of elastic bands also changed participants? perceptions of the enjoyment of exercise in VR (F2,40=9.259, P<.001; ?˛p=0.316). The students rated their satisfaction with PA in VR on a 7-point scale highly and similarly when exercising without an upper limb load (mean 6.19, SD 0.61) and with slight elastic resistance (mean 6.17, SD 0.66), whereas their satisfaction declined significantly (mean 5.66, SD 0.94) when incorporating a higher load. Conclusions: The intensity of PA among students playing the BoxVR game is at a relatively low level. With the added resistance of elastic bands attached to the upper limbs, the intensity of the exercise increased to a moderate level, as recommended for obtaining health benefits. Participants rated the enjoyment of PA in VR highly. The use of slight elastic resistance did not negatively affect satisfaction with the BoxVR game, although user satisfaction declined with a higher load. Further research should be undertaken to increase the effectiveness of exercise in VR so that regular users can enjoy the health benefits. UR - https://games.jmir.org/2024/1/e58411 UR - http://dx.doi.org/10.2196/58411 ID - info:doi/10.2196/58411 ER - TY - JOUR AU - Chan, Kitty AU - Kor, Kin Patrick Pui AU - Liu, Wa Justina Yat AU - Cheung, Kin AU - Lai, Timothy AU - Kwan, Cho Rick Yiu PY - 2024/7/10 TI - The Use of Immersive Virtual Reality Training for Developing Nontechnical Skills Among Nursing Students: Multimethods Study JO - Asian Pac Isl Nurs J SP - e58818 VL - 8 KW - education KW - educational KW - hospital KW - hospitals KW - nontechnical skills KW - nurse KW - nurses KW - nursing education KW - nursing KW - satisfaction KW - self-confidence KW - simulation KW - simulations KW - virtual reality KW - VR KW - immersive N2 - Background: Immersive virtual reality (IVR) is a niche technology rising in popularity in nursing education. Although there is an abundance of evidence to demonstrate the effect of virtual reality (VR) on desired learning outcomes, this evidence is limited to technical or procedural skills or managing a single patient with clinical problems. Nontechnical skills (NTS), such as communication, decision-making, teamwork, situation awareness, and managerial skills, have not been explored using IVR technology. Objective: This study aimed to (1) investigate the potential efficacy of the IVR system virtual reality hospital (VR-Hospital, or VR-Hosp), a single-user game we developed, on nursing students? NTS, sense of presence in the virtual clinical environment, and satisfaction and self-confidence in learning; (2) identify variables that predict NTS; and (3) explore students? experience in using VR-Hosp. Methods: A multimethods design with a quantitative and qualitative approach was adopted. Participants were provided with VR-Hosp with 3 scenarios in training. VR-Hosp adopted a multibed, multipatient, multitask approach and was embedded with various clinical situations. Learning outcomes were measured after the training, followed by group interviews. Results: In total, 202 students joined the study. Results revealed high levels of satisfaction and self-confidence in learning. Significant achievement in NTS was perceived by the students. The levels of satisfaction and self-confidence in learning and the involvement and sensory fidelity domains in the sense of presence were positive predictors of NTS. Conclusions: The promising results offer a basis for designing IVR activities for nursing education. Further investigations are imperative to determine the impact of IVR technology on learning outcomes in clinical practice. UR - https://apinj.jmir.org/2024/1/e58818 UR - http://dx.doi.org/10.2196/58818 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58818 ER - TY - JOUR AU - Steindorff, Jenny-Victoria AU - Redlich, Lisa-Marie AU - Paulicke, Denny AU - Jahn, Patrick PY - 2024/7/8 TI - Use and Design of Virtual Reality?Supported Learning Scenarios in the Vocational Qualification of Nursing Professionals: Scoping Review JO - JMIR Serious Games SP - e53356 VL - 12 KW - scoping review KW - generalist nursing education KW - digital teaching formats KW - virtual reality application KW - co-creation N2 - Background: Numerous reviews advocate using virtual reality (VR) in educational contexts. This medium allows learners to test experiences in realistic environments. Virtually supported scenarios offer a safe and motivating way to explore, practice, and consolidate nursing skills in rare and critical nursing tasks. This is also cited as one of the reasons why VR can significantly increase the knowledge acquisition of nursing students. Nevertheless, studies are limited in their significance owing to the chosen design. Despite great interest, this results in a low level of confidence in VR as a curricular teaching method for nursing education. Therefore, defining concrete design and didactic-methodological parameters that support teachers in the use and implementation of VR is more relevant. Objective: This scoping review aims to provide an overview of significant design aspects for VR scenario conception and its transfer to generalist nursing education to generate value for the development of teaching scenarios and their sustainable implementation in teaching. Methods: A comprehensive literature search was performed using the MEDLINE (via PubMed) and CINAHL databases, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist was applied. The search was conducted from May to July 2022, using a specific search principle corresponding to the focus and the growing study corpus. A previously defined ?population, concept, and context? scheme was employed as the basis for the double-blind review of all relevant international German and English publications released up to May 1, 2022. Results: In accordance with the predefined selection procedure, 22 publications were identified. The identified aspects aided in the development of design, didactic, and research recommendations. The intuitive operation of realistically designed VR scenarios, which are standardized, reliable, and modifiable, as well as clear instructions and specific multimodal feedback functions were described positively. The same applied to the linear structure of the sequences with graduated demands and high image quality for increased immersion with low sensory overload. Changes in perspectives, multiuser options, dialogs, and recording functions can contribute to an interactive care practice. On the research side, it is advisable to define VR terminologies. In addition to considering larger samples, varying settings, and financial issues, it is recommended to conduct long-term studies on knowledge acquisition or improved patient outcomes. Conclusions: VR scenarios offer high potential in the context of nursing education if teachers and learners develop them co-creatively according to design features and implement them by means of a well-conceived concept. VR enables trainees to develop practical skills continuously in a standardized way. In addition, its deployment supports the sensitization of trainees to digital nursing technologies and the expansion of their digital skills in a practical setting. Furthermore, it allows sustainability issues to be addressed. UR - https://games.jmir.org/2024/1/e53356 UR - http://dx.doi.org/10.2196/53356 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53356 ER - TY - JOUR AU - Yoo, Suyoung AU - Heo, Sejin AU - Song, Soojin AU - Park, Aeyoung AU - Cho, Hyunchung AU - Kim, Yuna AU - Cha, Chul Won AU - Kim, Kyeongsug AU - Son, Hi Meong PY - 2024/5/23 TI - Adoption of Augmented Reality in Educational Programs for Nurses in Intensive Care Units of Tertiary Academic Hospitals: Mixed Methods Study JO - JMIR Serious Games SP - e54188 VL - 12 KW - augmented reality KW - AR KW - clinical skills education KW - nurse education KW - technology-based education KW - education KW - nurse KW - nursing KW - allied health KW - technology-enhanced learning KW - interview KW - training KW - usability KW - acceptability KW - educational KW - teaching KW - ICU KW - intensive care unit KW - self-guided KW - self-directed KW - hands-on KW - adoption KW - TAM KW - Technology Acceptance Model KW - skill KW - acquisition N2 - Background: In the wake of challenges brought by the COVID-19 pandemic to conventional medical education, the demand for innovative teaching methods has surged. Nurse training, with its focus on hands-on practice and self-directed learning, encountered significant hurdles with conventional approaches. Augmented reality (AR) offers a potential solution to addressing this issue. Objective: The aim of this study was to develop, introduce, and evaluate an AR-based educational program designed for nurses, focusing on its potential to facilitate hands-on practice and self-directed learning. Methods: An AR-based educational program for nursing was developed anchored by the Kern six-step framework. First, we identified challenges in conventional teaching methods through interviews and literature reviews. Interviews highlighted the need for hands-on practice and on-site self-directed learning with feedback from a remote site. The training goals of the platform were established by expert trainers and researchers, focusing on the utilization of a ventilator and extracorporeal membrane oxygenation system. Intensive care nurses were enrolled to evaluate AR education. We then assessed usability and acceptability of the AR training using the System Usability Scale and Technology Acceptance Model with intensive care nurses who agreed to test the new platform. Additionally, selected participants provided deeper insights through semistructured interviews. Results: This study highlights feasibility and key considerations for implementing an AR-based educational program for intensive care unit nurses, focusing on training objectives of the platform. Implemented over 2 months using Microsoft Dynamics 365 Guides and HoloLens 2, 28 participants were trained. Feedback gathered through interviews with the trainers and trainees indicated a positive reception. In particular, the trainees mentioned finding AR particularly useful for hands-on learning, appreciating its realism and the ability for repetitive practice. However, some challenges such as difficulty in adapting to the new technology were expressed. Overall, AR exhibits potential as a supplementary tool in nurse education. Conclusions: To our knowledge, this is the first study to substitute conventional methods with AR in this specific area of critical care nursing. These results indicate the multiple principal factors to take into consideration when adopting AR education in hospitals. AR is effective in promoting self-directed learning and hands-on practice, with participants displaying active engagement and enhanced skill acquisition. Trial Registration: ClinicalTrials.gov NCT05629663; https://clinicaltrials.gov/study/NCT05629663. UR - https://games.jmir.org/2024/1/e54188 UR - http://dx.doi.org/10.2196/54188 UR - http://www.ncbi.nlm.nih.gov/pubmed/38780998 ID - info:doi/10.2196/54188 ER - TY - JOUR AU - Shetty, Shishir AU - Bhat, Supriya AU - Al Bayatti, Saad AU - Al Kawas, Sausan AU - Talaat, Wael AU - El-Kishawi, Mohamed AU - Al Rawi, Natheer AU - Narasimhan, Sangeetha AU - Al-Daghestani, Hiba AU - Madi, Medhini AU - Shetty, Raghavendra PY - 2024/5/8 TI - The Scope of Virtual Reality Simulators in Radiology Education: Systematic Literature Review JO - JMIR Med Educ SP - e52953 VL - 10 KW - virtual reality KW - simulators KW - radiology education KW - medical imaging KW - radiology KW - education KW - systematic review KW - literature review KW - imaging KW - meta analysis KW - student KW - students KW - VR KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses N2 - Background: In recent years, virtual reality (VR) has gained significant importance in medical education. Radiology education also has seen the induction of VR technology. However, there is no comprehensive review in this specific area. This review aims to fill this knowledge gap. Objective: This systematic literature review aims to explore the scope of VR use in radiology education. Methods: A literature search was carried out using PubMed, Scopus, ScienceDirect, and Google Scholar for articles relating to the use of VR in radiology education, published from database inception to September 1, 2023. The identified articles were then subjected to a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)?defined study selection process. Results: The database search identified 2503 nonduplicate articles. After PRISMA screening, 17 were included in the review for analysis, of which 3 (18%) were randomized controlled trials, 7 (41%) were randomized experimental trials, and 7 (41%) were cross-sectional studies. Of the 10 randomized trials, 3 (30%) had a low risk of bias, 5 (50%) showed some concerns, and 2 (20%) had a high risk of bias. Among the 7 cross-sectional studies, 2 (29%) scored ?good? in the overall quality and the remaining 5 (71%) scored ?fair.? VR was found to be significantly more effective than traditional methods of teaching in improving the radiographic and radiologic skills of students. The use of VR systems was found to improve the students? skills in overall proficiency, patient positioning, equipment knowledge, equipment handling, and radiographic techniques. Student feedback was also reported in the included studies. The students generally provided positive feedback about the utility, ease of use, and satisfaction of VR systems, as well as their perceived positive impact on skill and knowledge acquisition. Conclusions: The evidence from this review shows that the use of VR had significant benefit for students in various aspects of radiology education. However, the variable nature of the studies included in the review reduces the scope for a comprehensive recommendation of VR use in radiology education. UR - https://mededu.jmir.org/2024/1/e52953 UR - http://dx.doi.org/10.2196/52953 ID - info:doi/10.2196/52953 ER - TY - JOUR AU - Yun, Hyun Young AU - Shin, Hoon Dong AU - Choi, Jin Hyung PY - 2024/5/7 TI - Perspectives of Medical Students and Developers Regarding Virtual Reality, Augmented Reality, Mixed Reality, and 3D Printing Technologies: Survey Study JO - JMIR XR Spatial Comput SP - e54230 VL - 1 KW - medical student KW - developer KW - virtual reality KW - augmented reality KW - mixed reality KW - 3D printing KW - perspective KW - survey N2 - Background: Emerging technologies, such as virtual reality (VR), augmented reality (AR), mixed reality (MR), and 3D printing (3DP), have transformative potential in education and health care. However, complete integration has not yet been achieved, and routine use is limited. There may exist gaps in the perspectives of these technologies between users and developers, and improvement may be necessary in developing such technologies. Objective: The purpose of this study was to investigate the gaps in perspectives between medical students and developers in medical education regarding satisfaction and anticipated future use of VR, AR, MR, and 3DP technologies, as well as developers? perspectives on their advantages and current challenges. Methods: This retrospective survey study was conducted during a 4-hour elective course over a period of 4 weeks. In this course, computed tomography scans of congenital heart disease patients, medical image processing software, head-mounted displays, and a virtual table were used. Student pre- and postsurveys and the developer survey included demographic and other characteristics, satisfaction, and anticipated future use of VR, AR, MR, and 3DP technologies. The advantages and current challenges of these technologies were only assessed in the developer survey. Results: The study enrolled 41 participants, including 15 first-year medical students and 26 software and content developers. Students were more satisfied than developers across AR, VR, and 3DP in terms of overall satisfaction (VR and AR: P<.001; 3DP: P=.002), esthetics (VR: all P<.001; AR: vividness, P=.006 and design, P<.001; 3DP: vividness, P=.001 and design, P=.002), and continuous use intention (VR: repetition, P=.04 and continuous use, P=.02). Particularly in VR, satisfaction with reality was higher among students than among developers (real world, P=.006). Developers anticipated future use of MR for educating medical students and residents, individual and collaborative surgical planning, and performing surgery on patients. In contrast, students anticipated future use of VR primarily for student education, 3DP for resident education and individual surgical planning, and AR for collaborative surgical planning and performing surgery on patients. Developers perceived the inherent capabilities of VR, AR, and MR technologies as strengths, with hardware performance identified as a drawback. For 3DP, the possibility of customized product manufacturing was seen as an advantage, while cost was seen as a disadvantage. Conclusions: This study elucidated the different perspectives between medical students and developers regarding 3D technologies, highlighting the discrepancy in potential applications and challenges within the medical field. These findings will guide the integration of 3D technologies in education and health care to fulfill the needs and goals of both medical students and developers. UR - https://xr.jmir.org/2024/1/e54230 UR - http://dx.doi.org/10.2196/54230 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54230 ER - TY - JOUR AU - Fortuna, Karen AU - Bohm, Andrew AU - Lebby, Stephanie AU - Holden, Kisha AU - Agic, Branka AU - Cosco, D. Theodore AU - Walker, Robert PY - 2024/3/1 TI - Examining the Feasibility, Acceptability, and Effectiveness of Remote Training on Community-Based Participatory Research: Single-Arm Pre-Post Pilot Study JO - J Particip Med SP - e48707 VL - 16 KW - community-based participatory research KW - CBPR KW - peer support KW - health literacy KW - remote training KW - community-based KW - user KW - mental health N2 - Background: Over the past decade, a growing body of scientific evidence has demonstrated that community engagement in research leads to more relevant research, enhances the uptake of research findings, and improves clinical outcomes. Despite the increasing need for the integration of community engagement methodologies into the scientific inquiry, doctoral and master's level competencies in the field of psychiatry often lack dedicated training or coursework on community engagement methodologies. Objective: A total of 13 service users, peer support specialists, caregivers of people with mental health challenges, and scientists (with specialties ranging from basic science to implementation science) aged 18 and older participated in remote training on community-based participatory research. Data were collected at baseline, 2 days, and 3 months. Methods: A total of 13 service users, peer support specialists, caregivers of people with mental health challenges, and scientists (with specialties ranging from basic science to implementation science) aged 18 and older participated in remote training on community-based participatory research. Data were collected at baseline, 2 days, and 3 months. Results: The pilot study demonstrated that a 3-month remote training on community-based participatory research (?Partnership Academy?) was deemed feasible and acceptable by service users, peer support specialists, caregivers of people with mental health challenges, and scientists. Improvements were found in research engagement and the quality of partnership. A marked increase in distrust in the medical system was also found. Groups submitted 4 grant applications and published 1 peer-reviewed journal at a 3-month follow-up. Conclusions: This pre- and postpilot study demonstrated it is possible to train groups of service users, peer support specialists, caregivers of people with mental health challenges, and scientists in community-based participatory research. These findings provide preliminary evidence that a 3-month remote training on community-based participatory research (?Partnership Academy?) is feasible, acceptable, and potentially associated with improvements in research engagement as well as the quality of partnership and output, such as manuscripts and grant applications. UR - https://jopm.jmir.org/2024/1/e48707 UR - http://dx.doi.org/10.2196/48707 UR - http://www.ncbi.nlm.nih.gov/pubmed/38427414 ID - info:doi/10.2196/48707 ER - TY - JOUR AU - Hu, Yanjie AU - Yuan, Xingzhu AU - Ye, Peiling AU - Chang, Chengting AU - Hu, Han Yue AU - Zhang, Weihua AU - Li, Ka PY - 2023/11/23 TI - Virtual Reality in Clinical Nursing Practice Over the Past 10 Years: Umbrella Review of Meta-Analyses JO - JMIR Serious Games SP - e52022 VL - 11 KW - virtual reality KW - clinical nursing KW - artificial intelligence KW - AI-assisted medical rehabilitation KW - health promotion KW - umbrella review N2 - Background: Virtual reality (VR) has shown promising levels of effectiveness in nursing education, pain management, and rehabilitation. However, meta-analyses have discussed the effects of VR usage in nursing unilaterally and inconsistently, and the evidence base is diffuse and varied. Objective: We aimed to synthesize the combined evidence from meta-analyses that assessed the effects of nurses using VR technology on nursing education or patient health outcomes. Methods: We conducted an umbrella review by searching for meta-analyses about VR intervention in clinical nursing practice on Web of Science, Embase, Cochrane, and PubMed, and in reference lists. Eligible studies were published in English between December 1, 2012, and September 20, 2023. Meta-analyses of ?2 intervention studies and meta-analyses without 95% CI or heterogeneity data were excluded. Characteristic indicators, population information, VR intervention information, and 95% CIs were extracted. A descriptive analysis of research results was conducted to discern relationships between VR interventions and outcomes. I2 and P values were used to evaluate publication bias. AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2 and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) checklist were used to appraise literature quality. Results: In total, 768 records were identified; 74 meta-analyses were included for review. The most reported VR study conditions were neuronursing (25/74, 34%), pediatric nursing (13/74, 18%), surgical and wound care (11/74, 15%), oncological nursing (11/74, 15%), and older adult nursing (10/74, 14%). Further, 30% (22/74) of meta-analyses reported publication bias, and 15% (11/74) and 8% (6/74) were rated as ?high? based on AMSTAR 2 and the GRADE checklist, respectively. The main outcome indicators among all included meta-analyses were pain (37/214, 17.3%), anxiety (36/214, 16.8%), cognitive function (17/214, 7.9%), balance (16/214, 7.5%), depression (16/214, 7.5%), motor function (12/214, 5.6%), and participation in life (12/214, 5.6%). VR treatment for cognition, pain, anxiety, and depression was effective (all P values were <.05), while the utility of VR for improving motor function, balance, memory, and attention was controversial. Adverse effects included nausea, vomiting, and dizziness (incidence: range 4.76%-50%). The most common VR platforms were Pico VR glasses, head-mounted displays, the Nintendo Wii, and the Xbox Kinect. VR intervention duration ranged from 2 weeks to 12 months (typically ?4 wk). VR session length and frequency ranged from 5 to 100 minutes and from 1 to 10 times per week, respectively. Conclusions: VR in nursing has positive effects?relieving patients? pain, anxiety, and depression and improving cognitive function?despite the included studies? limited quality. However, applying VR in nursing to improve patients? motor function, balance, memory, and attention remains controversial. Nursing researchers need to further explore the effects and standard operation protocols of VR in clinical practice, and more high-quality research on VR in nursing is needed. Trial Registration: PROSPERO CRD42022381382; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=381382 UR - https://games.jmir.org/2023/1/e52022 UR - http://dx.doi.org/10.2196/52022 ID - info:doi/10.2196/52022 ER - TY - JOUR AU - Bui, T. Dung AU - Barnett, Tony AU - Hoang, Ha AU - Chinthammit, Winyu PY - 2023/10/2 TI - Usability of Augmented Reality Technology in Situational Telementorship for Managing Clinical Scenarios: Quasi-Experimental Study JO - JMIR Med Educ SP - e47228 VL - 9 KW - augmented reality KW - mentorship KW - patient simulation KW - patient care management KW - quasi-experimental study KW - telehealth N2 - Background: Telementorship provides a way to maintain the professional skills of isolated rural health care workers. The incorporation of augmented reality (AR) technology into telementoring systems could be used to mentor health care professionals remotely under different clinical situations. Objective: This study aims to evaluate the usability of AR technology in telementorship for managing clinical scenarios in a simulation laboratory. Methods: This study used a quasi-experimental design. Experienced health professionals and novice health practitioners were recruited for the roles of mentors and mentees, respectively, and then trained in the use of the AR setup. In the experiment, each mentee wearing an AR headset was asked to respond to 4 different clinical scenarios: acute coronary syndrome (ACS), acute myocardial infarction (AMI), pneumonia severe reaction to antibiotics (PSRA), and hypoglycemic emergency (HE). Their mentor used a laptop to provide remote guidance, following the treatment protocols developed for each scenario. Rating scales were used to measure the AR?s usability, mentorship effectiveness, and mentees? self-confidence and skill performance. Results: A total of 4 mentors and 15 mentees participated in this study. Mentors and mentees were positive about using the AR technology, despite some technical issues and the time required to become familiar with the technology. The positive experience of telementorship was highlighted (mean 4.8, SD 0.414 for mentees and mean of 4.25, SD 0.5 for mentors on the 5-point Likert scale). Mentees? confidence in managing each of the 4 scenarios improved after telementoring (P=.001 for the ACS, AMI, and PSRA scenarios and P=.002 for the HE scenario). Mentees? individual skill performance rates ranged from 98% in the ACS scenario to 97% in the AMI, PSRA, and HE scenarios. Conclusions: This study provides evidence about the usability of AR technology in telementorship for managing clinical scenarios. The findings suggest the potential for this technology to be used to support health workers in real-world clinical environments and point to new directions of research. UR - https://mededu.jmir.org/2023/1/e47228 UR - http://dx.doi.org/10.2196/47228 UR - http://www.ncbi.nlm.nih.gov/pubmed/37782533 ID - info:doi/10.2196/47228 ER - TY - JOUR AU - Aksoy, Emin Mehmet AU - Özkan, Ekin Arun AU - Kitapcioglu, Dilek AU - Usseli, Tuba PY - 2023/9/28 TI - Comparing the Outcomes of Virtual Reality?Based Serious Gaming and Lecture-Based Training for Advanced Life Support Training: Randomized Controlled Trial JO - JMIR Serious Games SP - e46964 VL - 11 KW - Advanced Cardiac Life Support KW - virtual reality KW - serious game KW - randomized controlled trial KW - Advanced Life Support N2 - Background: Simulation-based Advanced Cardiac Life Support (ACLS) or Advanced Life Support (ALS) training for health care professionals is important worldwide for saving lives. Virtual reality (VR)?based serious gaming can be an alternative modality to be used as a part of simulation-based ALS training. Objective: The aim of this study is to investigate whether a VR-based ALS serious game module can replace classroom-based ALS lectures, the latter being part of existing conventional ALS training protocols in addition to skills training. Methods: Participants were students from Acibadem Mehmet Ali Aydinlar University?s Vocational School for Anesthesiology (N=29) randomly divided into 2 groups with 15 (conventional training group) and 14 (VR-based training group) participants each. Participants in the conventional training group had to complete the pretest consisting of multiple-choice questions at the beginning of the study. Afterward, they took part in an interactive classroom-based ALS lecture. The next step involved skills training with task trainers to teach them compression skills. Following this, the conventional training group was divided into Code Blue teams, each consisting of 5 participants for the simulation session. Two independent instructors evaluated video recordings in terms of technical and nontechnical skills. The score acquired from the manikin-based simulation session was considered the main performance indicator in this study to measure the learning outcome. A similar workflow was used for the VR-based training group, but this group was trained with the VR-based ALS serious game module instead of the theoretical lecture. The final stage of the study involved completing the posttest consisting of multiple-choice questions. A preference survey was conducted among the study participants. Mann-Whitney U and Wilcoxon signed-rank tests were used to analyze the 2 groups? performances in this study. Results: The improvement in posttest results compared with pretest results was significant in the conventional training group (P=.002). Hands-on technical scores of the conventional training group were higher than those of the VR-based training group during manikin-based simulation, but total scores, including those for technical and crisis resource management skills, acquired from the manikin-based simulation session did not reveal any significant difference between the 2 groups. The results of the VR preference survey revealed that the majority of the participants prefer VR-based serious game?based training instead of classroom lectures. Conclusions: Although hands-on technical scores of the conventional training group during the manikin-based simulation session were higher than those of the VR-based training group, both groups? total performance scores, including those for technical and crisis resource management skills, did not differ significantly. The preference survey reveals that the majority of the participants would prefer a VR-based ALS serious gaming module instead of lecture-based training. Further studies are required to reveal the learning outcome of VR-based ALS serious gaming. Trial Registration: ClinicalTrials.gov NCT05798910; https://clinicaltrials.gov/study/NCT05798910 UR - https://games.jmir.org/2023/1/e46964 UR - http://dx.doi.org/10.2196/46964 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768719 ID - info:doi/10.2196/46964 ER - TY - JOUR AU - Helle, Nikolina AU - Vikman, Dubland Miriam AU - Dahl-Michelsen, Tone AU - Lie, Stangeland Silje PY - 2023/9/20 TI - Health Care and Social Work Students? Experiences With a Virtual Reality Simulation Learning Activity: Qualitative Study JO - JMIR Med Educ SP - e49372 VL - 9 KW - virtual reality KW - virtual reality simulation KW - learning KW - experiences KW - health care and social work KW - higher education KW - health care KW - social work N2 - Background: Virtual reality is used to an increasing extent in various fields and is now making inroads into health and social education. Virtual reality simulation can provide a safe and controlled environment for students to practice and master skills that are transferable to real-world situations without putting patients, clients, or themselves at risk of any harm. Virtual reality simulation using 360° videos represents a novel approach to simulation in health care and social work education, and this inspired our interest in exploring students? experiences with such a learning activity. Objective: The aim of this study was to explore occupational therapy, social education, nursing, and social work students? experiences with virtual reality simulation as a learning activity in an interdisciplinary subject. Methods: The data were collected through 6 semistructured focus groups with 28 students. We conducted the focus groups after the students from the 4 education programs had participated in the virtual reality simulation at 3 campuses at a specialized university in Norway. Each focus group interview was facilitated by 1 moderator and 1 facilitator, a combination of experienced researchers and novices. We followed a qualitative design using the 6-step thematic analysis described by Braun and Clarke. Results: The analysis revealed 3 overall themes for students? experiences with the virtual reality simulation. The first theme, 360° videos provide observations for individual learning, illustrates how learning can take place through the students? experiences with sensory inputs and observations from the 360° videos. Students experienced that the video enabled them to individually reflect and achieve learning from what was considered a clinically relevant video. The second theme, 360° videos activate emotional learning, demonstrates how the students experienced emotional engagement when watching the 360° videos. The degree of realism provided in the video was considered as important for the students? learning. The last theme, Debrief sessions enhance comprehensive learning, pinpoints how the students experienced learning through reflective discussions with other students after watching the 360° videos. Students claimed this process to be a vital part of the learning activity. Conclusions: Virtual reality simulation represents a promising learning activity to enhance the professional learning of health care and social work students. It offers opportunities for individualized learning through observations, and it also engages students emotionally in the learning process. The combination of 360° videos and group discussions in virtual reality appears promising to enhance professional learning outcomes and competence, which may contribute to improved health care and social work services. UR - https://mededu.jmir.org/2023/1/e49372 UR - http://dx.doi.org/10.2196/49372 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728988 ID - info:doi/10.2196/49372 ER - TY - JOUR AU - Naef, C. Aileen AU - Jeitziner, Marie-Madlen AU - Jakob, M. Stephan AU - Müri, M. René AU - Nef, Tobias PY - 2023/9/14 TI - Creating Custom Immersive 360-Degree Videos for Use in Clinical and Nonclinical Settings: Tutorial JO - JMIR Med Educ SP - e42154 VL - 9 KW - 360-degree video KW - head-mounted display KW - healthcare KW - relaxing content KW - technology KW - video content KW - video production KW - virtual reality KW - VR UR - https://mededu.jmir.org/2023/1/e42154 UR - http://dx.doi.org/10.2196/42154 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707883 ID - info:doi/10.2196/42154 ER - TY - JOUR AU - Lau, Tiang Siew AU - Siah, Jiat Rosalind Chiew AU - Dzakirin Bin Rusli, Khairul AU - Loh, Liang Wen AU - Yap, Gwee John Yin AU - Ang, Emily AU - Lim, Ping Fui AU - Liaw, Ying Sok PY - 2023/8/30 TI - Design and Evaluation of Using Head-Mounted Virtual Reality for Learning Clinical Procedures: Mixed Methods Study JO - JMIR Serious Games SP - e46398 VL - 11 KW - user experience KW - acceptability KW - usability KW - virtual patient KW - clinical procedure KW - immersive KW - nursing student KW - virtual reality KW - education KW - performance N2 - Background: The capacity of health care professionals to perform clinical procedures safely and competently is crucial as it will directly impact patients? outcomes. Given the ability of head-mounted virtual reality to simulate the authentic clinical environment, this platform should be suitable for nurses to refine their clinical skills for knowledge and skills acquisition. However, research on head-mounted virtual reality in learning clinical procedures is limited. Objective: The objectives of this study were (1) to describe the design of a head-mounted virtual reality system and evaluate it for education on clinical procedures for nursing students and (2) to explore the experience of nursing students using head-mounted virtual reality for learning clinical procedures and the usability of the system. Methods: This usability study used a mixed method approach. The stages included developing 3D models of the necessary instruments and materials used in intravenous therapy and subcutaneous injection procedures performed by nurses, followed by developing the procedures using the Unreal Engine (Epic Games). Questionnaires on the perception of continuance intention and the System Usability Scale were used along with open-ended questions. Results: Twenty-nine nursing students took part in this questionnaire study after experiencing the immersive virtual reality (IVR) intervention. Participants reported largely favorable game perception and learning experience. Mean perception scores ranged from 3.21 to 4.38 of a maximum score of 5, while the mean system usability score was 53.53 of 100. The majority found that the IVR experience was engaging, and they were immersed in the game. The challenges encountered included unfamiliarity with the new learning format; technological constraints, such as using hand controllers; and physical discomfort. Conclusions: The conception of IVR for learning clinical procedures through deliberate practice to enhance nurses? knowledge and skills is promising. However, refinement of the prototypes is required to improve user experience and learning. Future research can explore other ways to use IVR for better education and health care purposes. UR - https://games.jmir.org/2023/1/e46398 UR - http://dx.doi.org/10.2196/46398 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647108 ID - info:doi/10.2196/46398 ER - TY - JOUR AU - Hong, Chengang AU - Wang, Liping PY - 2023/8/21 TI - Virtual Reality Technology in Nursing Professional Skills Training: Bibliometric Analysis JO - JMIR Serious Games SP - e44766 VL - 11 KW - virtual reality KW - VR KW - nursing professional skills KW - bibliometric analysis KW - visual content analysis KW - extended reality KW - XR KW - augmented reality KW - AR KW - mixed reality N2 - Background: Nursing professional skills training has undergone significant transformation due to the exponential growth of computer and medical technology. The innovative use of virtual reality (VR) in nursing education has emerged as a cutting-edge technical support technique that has gained attention as a highly effective method for improving nurse training quality. Objective: This study aims to review the current status of VR technology in nursing professional skills training, research hotspots, and emerging trends in the last 15 years. Methods: The Web of Science Core Collection database was used to search for literature on VR technology in nursing professional skills training covering the period from 2006 to 2022. Biblioshiny (K-Synth Srl) was used to import and convert the records to Bibliometrix (K-Synth Srl) for analysis, and R (R Core Team) was used for descriptive bibliometric analysis. VOSviewer (Leiden University) was used to cluster co-occurring keywords, and Scimago Graphica (version 1.0.16; Scimago Lab) was used to generate a geographical visualization of published countries and regions. Results: A total of 1073 papers were analyzed, indicating a surge in research on the application of VR in nursing professional skills training in recent years, as evidenced by a positive trend in annual publication of relevant literature. The majority of studies were from the United States (n=340) and Canada (n=107), and Margaret Verkuyl was the most prolific author, leading the way with 9 publications. Furthermore, ?Computerized Virtual Patients in Health Professions Education: a Systematic Review and Meta-Analysis? was the most frequently cited reference. Keywords such as education, simulation, skills, students, and care were most commonly used by researchers. Conclusions: The bibliometric analysis provides a comprehensive overview of the use of VR in nursing professional skills training, indicating that VR-based training is an effective means of improving the skills and competencies of nursing students and professionals alike. The COVID-19 pandemic has reinforced the importance of developing VR-based distance education, despite challenges such as integrating virtual and real-world training and mitigating safety risks. UR - https://games.jmir.org/2023/1/e44766 UR - http://dx.doi.org/10.2196/44766 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603389 ID - info:doi/10.2196/44766 ER - TY - JOUR AU - Toohey, Shannon AU - Wray, Alisa AU - Hunter, John AU - Saadat, Soheil AU - Boysen-Osborn, Megan AU - Smart, Jonathan AU - Wiechmann, Warren AU - Pressman, D. Sarah PY - 2023/8/18 TI - Authors? Response to the Validity of Cortisol and Galvanic Skin Responses for Measuring Student Stress During Training JO - JMIR Med Educ SP - e50902 VL - 9 KW - augmented reality KW - AR KW - salivary cortisol KW - galvanic skin conductance KW - medical simulation KW - medical education UR - https://mededu.jmir.org/2023/1/e50902 UR - http://dx.doi.org/10.2196/50902 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594800 ID - info:doi/10.2196/50902 ER - TY - JOUR AU - Sonawane, Urvi AU - Kasetti, Pragna PY - 2023/8/18 TI - How Valid Are Cortisol and Galvanic Skin Responses in Measuring Student Stress During Training? Comment on the Psychological Effects of Simulation Training JO - JMIR Med Educ SP - e45340 VL - 9 KW - augmented reality KW - AR KW - salivary cortisol KW - galvanic skin conductance KW - medical simulation KW - medical education UR - https://mededu.jmir.org/2023/1/e45340 UR - http://dx.doi.org/10.2196/45340 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594784 ID - info:doi/10.2196/45340 ER - TY - JOUR AU - Liaw, Ying Sok AU - Tan, Zhi Jian AU - Bin Rusli, Dzakirin Khairul AU - Ratan, Rabindra AU - Zhou, Wentao AU - Lim, Siriwan AU - Lau, Ching Tang AU - Seah, Betsy AU - Chua, Ling Wei PY - 2023/7/26 TI - Artificial Intelligence Versus Human-Controlled Doctor in Virtual Reality Simulation for Sepsis Team Training: Randomized Controlled Study JO - J Med Internet Res SP - e47748 VL - 25 KW - artificial intelligence KW - interprofessional education KW - interprofessional communication KW - sepsis care KW - team training KW - virtual reality KW - simulation KW - AI KW - health care education KW - nursing student KW - nursing education KW - medical education N2 - Background: Interprofessional communication is needed to enhance the early recognition and management of patients with sepsis. Preparing medical and nursing students using virtual reality simulation has been shown to be an effective learning approach for sepsis team training. However, its scalability is constrained by unequal cohort sizes between medical and nursing students. An artificial intelligence (AI) medical team member can be implemented in a virtual reality simulation to engage nursing students in sepsis team training. Objective: This study aimed to evaluate the effectiveness of an AI-powered doctor versus a human-controlled doctor in training nursing students for sepsis care and interprofessional communication. Methods: A randomized controlled trial study was conducted with 64 nursing students who were randomly assigned to undertake sepsis team training with an AI-powered doctor (AI-powered group) or with medical students using virtual reality simulation (human-controlled group). Participants from both groups were tested on their sepsis and communication performance through simulation-based assessments (posttest). Participants? sepsis knowledge and self-efficacy in interprofessional communication were also evaluated before and after the study interventions. Results: A total of 32 nursing students from each group completed the simulation-based assessment, sepsis and communication knowledge test, and self-efficacy questionnaire. Compared with the baseline scores, both the AI-powered and human-controlled groups demonstrated significant improvements in communication knowledge (P=.001) and self-efficacy in interprofessional communication (P<.001) in posttest scores. For sepsis care knowledge, a significant improvement in sepsis care knowledge from the baseline was observed in the AI-powered group (P<.001) but not in the human-controlled group (P=.16). Although no significant differences were found in sepsis care performance between the groups (AI-powered group: mean 13.63, SD 4.23, vs human-controlled group: mean 12.75, SD 3.85, P=.39), the AI-powered group (mean 9.06, SD 1.78) had statistically significantly higher sepsis posttest knowledge scores (P=.009) than the human-controlled group (mean 7.75, SD 2.08). No significant differences were found in interprofessional communication performance between the 2 groups (AI-powered group: mean 29.34, SD 8.37, vs human-controlled group: mean 27.06, SD 5.69, P=.21). However, the human-controlled group (mean 69.6, SD 14.4) reported a significantly higher level of self-efficacy in interprofessional communication (P=.008) than the AI-powered group (mean 60.1, SD 13.3). Conclusions: Our study suggested that AI-powered doctors are not inferior to human-controlled virtual reality simulations with respect to sepsis care and interprofessional communication performance, which supports the viability of implementing AI-powered doctors to achieve scalability in sepsis team training. Our findings also suggested that future innovations should focus on the sociability of AI-powered doctors to enhance users? interprofessional communication training. Perhaps in the nearer term, future studies should examine how to best blend AI-powered training with human-controlled virtual reality simulation to optimize clinical performance in sepsis care and interprofessional communication. Trial Registration: ClinicalTrials.gov NCT05953441; https://clinicaltrials.gov/study/NCT05953441 UR - https://www.jmir.org/2023/1/e47748 UR - http://dx.doi.org/10.2196/47748 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494112 ID - info:doi/10.2196/47748 ER - TY - JOUR AU - Loeb, Daniel AU - Shoemaker, Jamie AU - Parsons, Allison AU - Schumacher, Daniel AU - Zackoff, Matthew PY - 2023/6/30 TI - How Augmenting Reality Changes the Reality of Simulation: Ethnographic Analysis JO - JMIR Med Educ SP - e45538 VL - 9 KW - simulation KW - augmented reality KW - computerized mannequin KW - video review N2 - Background: Simulation-based medical education (SBME) provides key medical training for providers to safely and ethically practice high-risk events. Augmented reality (AR)?enhanced simulation projects digital images of realistic examination findings into a participant?s field of view, which allows nuanced physical examination findings such as respiratory distress and skin perfusion to be prominently displayed. It is unknown how AR compares to traditional mannequin (TM)?based simulation with regard to influencing participant attention and behavior. Objective: The purpose of this study is to use video-based focused ethnography?a problem-focused, context-specific descriptive form of research whereby the research group collectively analyzes and interprets a subject of interest?to compare and categorize provider attention and behavior during TM and AR and provide suggestions for educators looking to delineate these 2 modalities. Methods: Twenty recorded interprofessional simulations (10 TM, 10 AR) featuring a decompensating child were evaluated through video-based focused ethnography. A generative question was posed: ?How do the attention and behavior of participants vary based on the simulation modality?? Iterative data collection, analysis, and pattern explanation were performed by a review team spanning critical care, simulation, and qualitative expertise. Results: The attention and behavior of providers during TM and AR simulation clustered into three core themes: (1) focus and attention, (2) suspension of disbelief, and (3) communication. Participants focused on the mannequin during AR, especially when presented with changing physical examination findings, whereas in TM, participants focused disproportionately on the cardiorespiratory monitor. When participants could not trust what they were seeing or feeling in either modality, the illusion of realism was lost. In AR, this manifested as being unable to physically touch a digital mannequin, and in TM, participants were often unsure if they could trust their physical examination findings. Finally, communication differed, with calmer and clearer communication during TM, while AR communication was more chaotic. Conclusions: The primary differences clustered around focus and attention, suspension of disbelief, and communication. Our findings provide an alternative methodology to categorize simulation, shifting focus from simulation modality and fidelity to participant behavior and experience. This alternative categorization suggests that TM simulation may be superior for practical skill acquisition and the introduction of communication strategies for novice learners. Meanwhile, AR simulation offers the opportunity for advanced training in clinical assessment. Further, AR could be a more appropriate platform for assessing communication and leadership by more experienced clinicians due to the generated environment being more representative of decompensation events. Further research will explore the attention and behavior of providers in virtual reality?based simulations and real-life resuscitations. Ultimately, these profiles will inform the development of an evidence-based guide for educators looking to optimize simulation-based medical education by pairing learning objectives with the ideal simulation modality. UR - https://mededu.jmir.org/2023/1/e45538 UR - http://dx.doi.org/10.2196/45538 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389920 ID - info:doi/10.2196/45538 ER - TY - JOUR AU - Dinh, Alana AU - Tseng, Emily AU - Yin, Lukas Andrew AU - Estrin, Deborah AU - Greenwald, Peter AU - Fortenko, Alexander PY - 2023/3/28 TI - Perceptions About Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers JO - JMIR Form Res SP - e45211 VL - 7 KW - augmented reality KW - telemedicine KW - telehealth KW - emergency medicine KW - education KW - mobile phone N2 - Background: Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR?s implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. Objective: This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. Methods: Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR?s potential in remote health care. Interviews were transcribed and analyzed via thematic coding. Results: Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR?s adoption. Conclusions: AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine. UR - https://formative.jmir.org/2023/1/e45211 UR - http://dx.doi.org/10.2196/45211 UR - http://www.ncbi.nlm.nih.gov/pubmed/36976628 ID - info:doi/10.2196/45211 ER - TY - JOUR AU - Lie, Stangeland Silje AU - Rřykenes, Kari AU - Sćheim, Aleksandra AU - Groven, Synne Karen PY - 2023/3/20 TI - Developing a Virtual Reality Educational Tool to Stimulate Emotions for Learning: Focus Group Study JO - JMIR Form Res SP - e41829 VL - 7 KW - virtual reality KW - 360° video KW - learning KW - experiences KW - emotions KW - health care and social work higher education N2 - Background: By watching 360° videos in virtual reality headsets, students may experience being immersed in the portrayed situation. There is a paucity of empirical studies on the application of immersive 360° videos watched in virtual reality headsets for students in health care and social work education and the pedagogical theory guiding the development of such educational tools. This led to our interest in exploring how a virtual reality educational tool involving 360° videos can stimulate emotions and how this can be used as a pedagogical tool in these educational programs. Objective: The aim of this study was to explore the experiences of faculty members and students regarding a prototype 360° video watched in virtual reality headsets during the development phase of an educational project. We addressed the following research questions: How does the virtual reality prototype stimulate emotions? How can virtual reality be used in higher education for health care and social work students? Methods: We used a qualitative design and collected data through focus group interviews with project participants. The data were analyzed using qualitative content analysis. Results: Our analysis identified 2 main themes in participants? experiences with the virtual reality prototype. The first theme highlights that when participants experienced watching the 360° video in a virtual reality headset, it stimulated their emotions as an authentic professional experience would. The second theme, contextualization of virtual reality, highlights participants? perceptions of how the virtual reality experience should be incorporated into a safe educational context. Conclusions: Our findings suggest that 360° videos with human actors who use eye contact with the camera can trigger emotions in the viewer and therefore serve as a pedagogic tool that can create authentic professional experiences for students. The participants expressed the view that the virtual reality educational tool could be used to prepare students for real-life practice in health care and social work. However, they underlined that 360° videos in virtual reality need to be contextualized in educational programs to create a safe environment for learning and to ensure follow-up on the emotions such experiences can trigger in students. Our results highlight the perceived importance of allowing students to reflect on the virtual reality experience in a safe setting and of follow-up by faculty members. In-person follow-up with students can be resource intensive for programs with large numbers of students and makes it challenging to offer repeated training, something that has been identified as one of the benefits of virtual reality. UR - https://formative.jmir.org/2023/1/e41829 UR - http://dx.doi.org/10.2196/41829 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939819 ID - info:doi/10.2196/41829 ER - TY - JOUR AU - Liu, Wa Justina Yat AU - Yin, Yue-Heng AU - Kor, Kin Patrick Pui AU - Cheung, Ki Daphne Sze AU - Zhao, Yan Ivy AU - Wang, Shanshan AU - Su, Jing Jing AU - Christensen, Martin AU - Tyrovolas, Stefanos AU - Leung, M. Angela Y. PY - 2023/3/6 TI - The Effects of Immersive Virtual Reality Applications on Enhancing the Learning Outcomes of Undergraduate Health Care Students: Systematic Review With Meta-synthesis JO - J Med Internet Res SP - e39989 VL - 25 KW - immersive virtual reality KW - virtual reality KW - effects KW - undergraduate health care education KW - systematic review KW - meta-synthesis N2 - Background: Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students? competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. Objective: This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. Methods: MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students? learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P<.05 was used to test for statistical significance using SPSS (version 28; IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. Results: A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15; 95% CI 16.3%-67.7%; P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90%; P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. Conclusions: This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger sample size and robust study design are required to evaluate the effects of IVR teaching. Trial Registration: International prospective register of systematic reviews (PROSPERO) CRD42022313706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=313706 UR - https://www.jmir.org/2023/1/e39989 UR - http://dx.doi.org/10.2196/39989 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877550 ID - info:doi/10.2196/39989 ER - TY - JOUR AU - Mahling, Moritz AU - Wunderlich, Robert AU - Steiner, Daniel AU - Gorgati, Eleonora AU - Festl-Wietek, Teresa AU - Herrmann-Werner, Anne PY - 2023/3/3 TI - Virtual Reality for Emergency Medicine Training in Medical School: Prospective, Large-Cohort Implementation Study JO - J Med Internet Res SP - e43649 VL - 25 KW - emergency medicine KW - resuscitation KW - virtual reality KW - simulation KW - undergraduate medical education KW - Germany KW - medical education KW - virtual training KW - digital learning KW - medical student N2 - Background: Virtual reality (VR)?based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. Objective: The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. Methods: The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. Results: A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. Conclusions: In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine. UR - https://www.jmir.org/2023/1/e43649 UR - http://dx.doi.org/10.2196/43649 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867440 ID - info:doi/10.2196/43649 ER - TY - JOUR AU - Gupta, Sanchit AU - Wilcocks, Kyle AU - Matava, Clyde AU - Wiegelmann, Julian AU - Kaustov, Lilia AU - Alam, Fahad PY - 2023/2/14 TI - Creating a Successful Virtual Reality?Based Medical Simulation Environment: Tutorial JO - JMIR Med Educ SP - e41090 VL - 9 KW - virtual reality KW - innovation KW - digital health KW - simulation KW - medical education KW - medical training KW - tutorial KW - how-to KW - curriculum UR - https://mededu.jmir.org/2023/1/e41090 UR - http://dx.doi.org/10.2196/41090 UR - http://www.ncbi.nlm.nih.gov/pubmed/36787169 ID - info:doi/10.2196/41090 ER - TY - JOUR AU - Lie, Stangeland Silje AU - Helle, Nikolina AU - Sletteland, Vahl Nina AU - Vikman, Dubland Miriam AU - Bonsaksen, Tore PY - 2023/1/24 TI - Implementation of Virtual Reality in Health Professions Education: Scoping Review JO - JMIR Med Educ SP - e41589 VL - 9 KW - implementation KW - virtual reality KW - higher education KW - medical education KW - health professions education KW - continuing education KW - scoping review KW - health professional KW - technology N2 - Background: Virtual reality has been gaining ground in health professions education and may offer students a platform to experience and master situations without endangering patients or themselves. When implemented effectively, virtual reality technologies may enable highly engaging learning activities and interactive simulations. However, implementation processes present challenges, and the key to successful implementation is identifying barriers and facilitators as well as finding strategies to address them. Objective: This scoping review aimed to identify the literature on virtual reality implementation in health professions education, identify barriers to and facilitators of implementation, and highlight gaps in the literature in this area. Methods: The scoping review was conducted based on the Joanna Briggs Institute Evidence Synthesis methodologies. Electronic searches were conducted in the Academic Search Elite, Education Source, and CINAHL databases on January 5, 2022, in Google Scholar on February 2 and November 18, 2022, and in PubMed database on November 18, 2022. We conducted hand searches of key items, reference tracking, and citation tracking and searches on government webpages on February 2, 2022. At least 2 reviewers screened the identified literature. Eligible studies were considered based on predefined inclusion criteria. The results of the identified items were analyzed and synthesized using qualitative content analysis. Results: We included 7 papers and identified 7 categories related to facilitators of and barriers to implementation?collaborative participation, availability, expenses, guidelines, technology, careful design and evaluation, and training?and developed a model that links the categories to the 4 constructs from Carl May?s general theory of implementation. All the included reports provided recommendations for implementation, including recommendations for careful design and evaluation, training of faculty and students, and faculty presence during use. Conclusions: Virtual reality implementation in health professions education appears to be a new and underexplored research field. This scoping review has several limitations, including definitions and search words, language, and that we did not assess the included papers? quality. Important implications from our findings are that ensuring faculty?s and students? competence in using virtual reality technology is necessary for the implementation processes. Collaborative participation by including end users in the development process is another factor that may ensure successful implementation in higher education contexts. To ensure stakeholders? motivation and potential to use virtual reality, faculty and students could be invited to participate in the development process to ensure that the educational content is valued. Moreover, technological challenges and usability issues should be resolved before implementation to ensure that pedagogical content is the focus. This accentuates the importance of piloting, sufficient time resources, basic testing, and sharing of experiences before implementation. International Registered Report Identifier (IRRID): RR2-10.2196/37222 UR - https://mededu.jmir.org/2023/1/e41589 UR - http://dx.doi.org/10.2196/41589 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692934 ID - info:doi/10.2196/41589 ER - TY - JOUR AU - Hsieh, Pei-Lun AU - Wang, Yu-Rung AU - Huang, Tien-Chi PY - 2023/1/4 TI - Exploring Key Factors Influencing Nursing Students? Cognitive Load and Willingness to Serve Older Adults: Cross-sectional Descriptive Correlational Study JO - JMIR Serious Games SP - e43203 VL - 11 KW - immersive virtual reality learning KW - VR learning KW - mental effort KW - mental load KW - service willingness KW - older adult KW - virtual reality KW - nursing student KW - professional education KW - digital learning KW - older adult population N2 - Background: Virtual learning environments (VLEs) use a virtual environment to support learning activities. VLEs are commonly used to overcome the temporal and spatial restrictions of learning activities held in conventional face-to-face classrooms. In VLEs, students can participate in learning activities using the internet, and teachers can provide assistive learning tools during the process. Objective: The purpose of this study was to investigate the relationships among nursing students? mental load, cognitive load, and affective learning outcomes in terms of their willingness to serve older adults in an interaction-based educational virtual reality (VR) learning environment. Methods: This study used a cross-sectional method. A total of 130 students participated in interaction-based VR learning and completed related questionnaires. Descriptive and inferential statistics and stepwise regression for data analysis were used. Results: The research results revealed that in the dimension of willingness to use VR learning materials, perceived usefulness received the highest score (mean 4.42, SD 0.45). In the dimension of nursing ability, students scored the highest in information management and application ability to care for case patients (mean 4.35, SD 0.54). Correlation analysis revealed that cognitive load during learning and willingness to serve older adults were negatively correlated, whereas willingness to use VR learning materials was positively correlated with nursing ability and willingness to serve older adults. Analyzing the regression coefficients of predictor variables revealed that willingness to use VR learning materials (?=.23; t2=2.89, P=.005) and cognitive load during learning (?=?.35; t2=?.4.30, P<.001) were predictive factors of nursing students? willingness to serve older adults. Conclusions: This study demonstrated that students? willingness to use VR learning materials and their cognitive load during learning affected their willingness to care for older adults. Therefore, the components of mental or cognitive load generate inconsistent predictive effects on affective variables and willingness to serve older adults. UR - https://games.jmir.org/2023/1/e43203 UR - http://dx.doi.org/10.2196/43203 UR - http://www.ncbi.nlm.nih.gov/pubmed/36333104 ID - info:doi/10.2196/43203 ER - TY - JOUR AU - Pang, Mengwei AU - Zhao, Xiaohan AU - Lu, Daiyu AU - Dong, Yihan AU - Jiang, Lin AU - Li, Jie AU - Ji, Ping PY - 2022/9/12 TI - Preliminary User Evaluation of a New Dental Technology Virtual Simulation System: Development and Validation Study JO - JMIR Serious Games SP - e36079 VL - 10 IS - 3 KW - virtual simulation KW - dental technology KW - OSCE KW - virtual reality KW - dentistry KW - dental technician KW - framework KW - certified dental technician KW - development KW - validation KW - serious game KW - dental KW - technology N2 - Background: With the advancements in the dental health care industry, the demand for dental technicians has increased. Dental technicians should be thoroughly assessed and trained in practical skills and pass professional certification examinations to ensure that they are competent to work closely with dentists. Unfortunately, such training courses and tests are in short supply worldwide. The use of virtual simulation technology can help solve these problems. Objective: This study presents a new strategic framework design for a certified dental technician practical examination called as the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT), which is based on the Objective Structured Clinical Examination (OSCE). We present the development and validation of the OMEDT system, a new virtual simulated training system, to meet the demands of the OMEDT framework. The combination of OMEDT and the OMEDT system can solve the complex problems encountered in the certified dental technician practical examination with excellent efficiency, high quality, and low cost. Methods: The OMEDT framework design was constructed according to the OSCE guide and the Chinese vocational skill standards for dental technicians. To develop the OMEDT system, we organized a new framework based on the virtual learning network platform, the haptic feedback system, and the real-time dental training and evaluation system. The effectiveness evaluation of the OMEDT system was divided into 2 phases: in the first phase, 36 students were recruited to use the test module to finish the task and their performance data were collected and analyzed; and in the second phase, a questionnaire was administered to 30 students who used the system for their studies and graduation exams. Results: The OMEDT and the corresponding skill training virtual simulation OMEDT system were developed, and preliminary user evaluation was performed to assess their effectiveness and usefulness. The OMEDT system was found to improve students? practical skills by training with the evaluation results. In addition, several key research topics were explored, including the effects of positive feedback of the knowledge of results on the improvement of the students? skill level and the common sense transformation of educators in the virtual simulation technology environment. Conclusions: The development of OMEDT and the OMEDT system has been completed and their effectiveness has been verified. UR - https://games.jmir.org/2022/3/e36079 UR - http://dx.doi.org/10.2196/36079 UR - http://www.ncbi.nlm.nih.gov/pubmed/36094803 ID - info:doi/10.2196/36079 ER - TY - JOUR AU - Ezenwa, Nkolika Beatrice AU - Umoren, Rachel AU - Fajolu, Bamikeolu Iretiola AU - Hippe, S. Daniel AU - Bucher, Sherri AU - Purkayastha, Saptarshi AU - Okwako, Felicitas AU - Esamai, Fabian AU - Feltner, B. John AU - Olawuyi, Olubukola AU - Mmboga, Annet AU - Nafula, Concepta Mary AU - Paton, Chris AU - Ezeaka, Chinyere Veronica PY - 2022/9/12 TI - Using Mobile Virtual Reality Simulation to Prepare for In-Person Helping Babies Breathe Training: Secondary Analysis of a Randomized Controlled Trial (the eHBB/mHBS Trial) JO - JMIR Med Educ SP - e37297 VL - 8 IS - 3 KW - virtual reality KW - mobile learning KW - Helping Babies Breathe KW - neonatal resuscitation KW - mobile Helping Babies Survive powered by District Health Information Software 2 KW - neonatal mortality KW - digital education KW - health care education KW - health care worker KW - medical education KW - digital intervention N2 - Background: Neonatal mortality accounts for approximately 46% of global under-5 child mortality. The widespread access to mobile devices in low- and middle-income countries has enabled innovations, such as mobile virtual reality (VR), to be leveraged in simulation education for health care workers. Objective: This study explores the feasibility and educational efficacy of using mobile VR for the precourse preparation of health care professionals in neonatal resuscitation training. Methods: Health care professionals in obstetrics and newborn care units at 20 secondary and tertiary health care facilities in Lagos, Nigeria, and Busia, Western Kenya, who had not received training in Helping Babies Breathe (HBB) within the past 1 year were randomized to access the electronic HBB VR simulation and digitized HBB Provider?s Guide (VR group) or the digitized HBB Provider?s Guide only (control group). A sample size of 91 participants per group was calculated based on the main study protocol that was previously published. Participants were directed to use the electronic HBB VR simulation and digitized HBB Provider?s Guide or the digitized HBB Provider?s Guide alone for a minimum of 20 minutes. HBB knowledge and skills assessments were then conducted, which were immediately followed by a standard, in-person HBB training course that was led by study staff and used standard HBB evaluation tools and the Neonatalie Live manikin (Laerdal Medical). Results: A total of 179 nurses and midwives participated (VR group: n=91; control group: n=88). The overall performance scores on the knowledge check (P=.29), bag and mask ventilation skills check (P=.34), and Objective Structured Clinical Examination A checklist (P=.43) were similar between groups, with low overall pass rates (6/178, 3.4% of participants). During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86%; control group: 57/88, 65%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75%, IQR 9%-98%) than in the control group (62%, IQR 13%-97%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8%; control group: 16/88, 18%; P=.045) and the washing hands step (VR group: 20/90, 22%; control group: 32/88, 36%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries. UR - https://mededu.jmir.org/2022/3/e37297 UR - http://dx.doi.org/10.2196/37297 UR - http://www.ncbi.nlm.nih.gov/pubmed/36094807 ID - info:doi/10.2196/37297 ER - TY - JOUR AU - Toohey, Shannon AU - Wray, Alisa AU - Hunter, John AU - Waldrop, Ian AU - Saadat, Soheil AU - Boysen-Osborn, Megan AU - Sudario, Gabriel AU - Smart, Jonathan AU - Wiechmann, Warren AU - Pressman, D. Sarah PY - 2022/8/1 TI - Comparing the Psychological Effects of Manikin-Based and Augmented Reality?Based Simulation Training: Within-Subjects Crossover Study JO - JMIR Med Educ SP - e36447 VL - 8 IS - 3 KW - augmented reality KW - AR KW - salivary cortisol KW - galvanic skin conductance KW - medical simulation KW - medical education N2 - Background: Patient simulators are an increasingly important part of medical training. They have been shown to be effective in teaching procedural skills, medical knowledge, and clinical decision-making. Recently, virtual and augmented reality simulators are being produced, but there is no research on whether these more realistic experiences cause problematic and greater stress responses as compared to standard manikin simulators. Objective: The purpose of this research is to examine the psychological and physiological effects of augmented reality (AR) in medical simulation training as compared to traditional manikin simulations. Methods: A within-subjects experimental design was used to assess the responses of medical students (N=89) as they completed simulated (using either manikin or AR) pediatric resuscitations. Baseline measures of psychological well-being, salivary cortisol, and galvanic skin response (GSR) were taken before the simulations began. Continuous GSR assessments throughout and after the simulations were captured along with follow-up measures of emotion and cortisol. Participants also wrote freely about their experience with each simulation, and narratives were coded for emotional word use. Results: Of the total 86 medical students who participated, 37 (43%) were male and 49 (57%) were female, with a mean age of 25.2 (SD 2.09, range 22-30) years and 24.7 (SD 2.08, range 23-36) years, respectively. GSR was higher in the manikin group adjusted for day, sex, and medications taken by the participants (AR-manikin: ?0.11, 95% CI ?0.18 to ?0.03; P=.009). The difference in negative affect between simulation types was not statistically significant (AR-manikin: 0.41, 95% CI ?0.72 to 1.53; P=.48). There was no statistically significant difference between simulation types in self-reported stress (AR-manikin: 0.53, 95% CI ?2.35 to 3.42; P=.71) or simulation stress (AR-manikin: ?2.17, 95% CI ?6.94 to 2.59; P=.37). The difference in percentage of positive emotion words used to describe the experience was not statistically significant between simulation types, which were adjusted for day of experiment, sex of the participants, and total number of words used (AR-manikin: ?4.0, 95% CI ?0.91 to 0.10; P=.12). There was no statistically significant difference between simulation types in terms of the percentage of negative emotion words used to describe the experience (AR-manikin: ?0.33, 95% CI ?1.12 to 0.46; P=.41), simulation sickness (AR-manikin: 0.17, 95% CI ?0.29 to 0.62; P=.47), or salivary cortisol (AR-manikin: 0.04, 95% CI ?0.05 to 0.13; P=.41). Finally, preexisting levels of posttraumatic stress disorder, perceived stress, and reported depression were not tied to physiological responses to AR. Conclusions: AR simulators elicited similar stress responses to currently used manikin-based simulators, and we did not find any evidence of AR simulators causing excessive stress to participants. Therefore, AR simulators are a promising tool to be used in medical training, which can provide more emotionally realistic scenarios without the risk of additional harm. UR - https://mededu.jmir.org/2022/3/e36447 UR - http://dx.doi.org/10.2196/36447 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916706 ID - info:doi/10.2196/36447 ER - TY - JOUR AU - Heo, Sejin AU - Moon, Suhyeon AU - Kim, Minha AU - Park, Minsu AU - Cha, Chul Won AU - Son, Hi Meong PY - 2022/7/22 TI - An Augmented Reality?Based Guide for Mechanical Ventilator Setup: Prospective Randomized Pilot Trial JO - JMIR Serious Games SP - e38433 VL - 10 IS - 3 KW - augmented reality KW - mechanical ventilation education KW - medical education KW - critical care KW - medical training KW - virtual reality KW - virtual education KW - nurse KW - nursing education KW - nursing KW - health care professional KW - learning platform KW - digital learning KW - digital health N2 - Background: Recently, the demand for mechanical ventilation (MV) has increased with the COVID-19 pandemic; however, the conventional approaches to MV training are resource intensive and require on-site training. Consequently, the need for independent learning platforms with remote assistance in institutions without resources has surged. Objective: This study aimed to determine the feasibility and effectiveness of an augmented reality (AR)?based self-learning platform for novices to set up a ventilator without on-site assistance. Methods: This prospective randomized controlled pilot study was conducted at Samsung Medical Center, Korea, from January to February 2022. Nurses with no prior experience of MV or AR were enrolled. We randomized the participants into 2 groups: manual and AR groups. Participants in the manual group used a printed manual and made a phone call for assistance, whereas participants in the AR group were guided by AR-based instructions and requested assistance with the head-mounted display. We compared the overall score of the procedure, required level of assistance, and user experience between the groups. Results: In total, 30 participants completed the entire procedure with or without remote assistance. Fewer participants requested assistance in the AR group compared to the manual group (7/15, 47.7% vs 14/15, 93.3%; P=.02). The number of steps that required assistance was also lower in the AR group compared to the manual group (n=13 vs n=33; P=.004). The AR group had a higher rating in predeveloped questions for confidence (median 3, IQR 2.50-4.00 vs median 2, IQR 2.00-3.00; P=.01), suitability of method (median 4, IQR 4.00-5.00 vs median 3, IQR 3.00-3.50; P=.01), and whether they intended to recommend AR systems to others (median 4, IQR 3.00-5.00 vs median 3, IQR 2.00-3.00; P=.002). Conclusions: AR-based instructions to set up a mechanical ventilator were feasible for novices who had no prior experience with MV or AR. Additionally, participants in the AR group required less assistance compared with those in the manual group, resulting in higher confidence after training. Trial Registration: ClinicalTrials.gov NCT05446896; https://beta.clinicaltrials.gov/study/NCT05446896 UR - https://games.jmir.org/2022/3/e38433 UR - http://dx.doi.org/10.2196/38433 UR - http://www.ncbi.nlm.nih.gov/pubmed/35867382 ID - info:doi/10.2196/38433 ER - TY - JOUR AU - Baashar, Yahia AU - Alkawsi, Gamal AU - Ahmad, Wan Wan Nooraishya AU - Alhussian, Hitham AU - Alwadain, Ayed AU - Capretz, Fernando Luiz AU - Babiker, Areej AU - Alghail, Adnan PY - 2022/7/5 TI - Effectiveness of Using Augmented Reality for Training in the Medical Professions: Meta-analysis JO - JMIR Serious Games SP - e32715 VL - 10 IS - 3 KW - augmented reality KW - medical KW - training KW - virtual KW - meta-analysis N2 - Background: Augmented reality (AR) is an interactive technology that uses persuasive digital data and real-world surroundings to expand the user's reality, wherein objects are produced by various computer applications. It constitutes a novel advancement in medical care, education, and training. Objective: The aim of this work was to assess how effective AR is in training medical students when compared to other educational methods in terms of skills, knowledge, confidence, performance time, and satisfaction. Methods: We performed a meta-analysis on the effectiveness of AR in medical training that was constructed by using the Cochrane methodology. A web-based literature search was performed by using the Cochrane Library, Web of Science, PubMed, and Embase databases to find studies that recorded the effect of AR in medical training up to April 2021. The quality of the selected studies was assessed by following the Cochrane criteria for risk of bias evaluations. Results: In total, 13 studies with a total of 654 participants were included in the meta-analysis. The findings showed that using AR in training can improve participants' performance time (I2=99.9%; P<.001), confidence (I2=97.7%; P=.02), and satisfaction (I2=99.8%; P=.006) more than what occurs under control conditions. Further, AR did not have any effect on the participants? knowledge (I2=99.4%; P=.90) and skills (I2=97.5%; P=.10). The meta-regression plot shows that there has been an increase in the number of articles discussing AR over the years and that there is no publication bias in the studies used for the meta-analysis. Conclusions: The findings of this work suggest that AR can effectively improve performance time, satisfaction, and confidence in medical training but is not very effective in areas such as knowledge and skill. Therefore, more AR technologies should be implemented in the field of medical training and education. However, to confirm these findings, more meticulous research with more participants is needed. UR - https://games.jmir.org/2022/3/e32715 UR - http://dx.doi.org/10.2196/32715 UR - http://www.ncbi.nlm.nih.gov/pubmed/35787488 ID - info:doi/10.2196/32715 ER - TY - JOUR AU - Chidambaram, Swathi AU - Palumbo, Chiara Maria AU - Stifano, Vito AU - McKenna, John AU - Redaelli, Alberto AU - Olivi, Alessandro AU - Apuzzo, Michael AU - Pannullo, Susan PY - 2022/6/1 TI - The Potential for Using Extended Reality Technology in Interdisciplinary Case Discussions and Case Planning in Stereotactic Radiosurgery: Proof-of-Concept Usability Study JO - JMIR Neurotech SP - e36960 VL - 1 IS - 1 KW - mixed reality KW - augmented reality KW - extended reality KW - HoloLens KW - interdisciplinary teams KW - virtual reality KW - brain tumour KW - tumor KW - radiosurgery KW - surgery N2 - Background: Extended reality (XR) is a term that captures a variety of techniques, such as augmented reality (AR) and mixed reality (MR), which allow users to interact with virtual models in real time. This technology has an emerging role in several applications within neurosurgery. XR can be useful in enhancing how radiosurgical cases are planned. Multidisciplinary team (MDT) review is an essential part of the radiosurgery case planning process; during case discussions, patient images are reviewed, usually in 2D or 3D modifications. The current commercially available platforms for this review need improvement. Objective: We describe a novel visualization application, titled ?NeuroVis? by our development team, which uses an XR Microsoft HoloLens headset to provide an interactive 3D visualization of a patient?s neuroanatomy in stereotactic surgery (SRS) case planning discussions. Methods: We present examples of 6 common radiosurgery indications to demonstrate the utility of NeuroVis to solve common visualization hurdles in MDTs. Results: The utility of NeuroVis is demonstrated through 6 common brain tumor SRS cases as a proof-of-concept illustration of the utility of NeuroVis to enhance radiosurgery case discussion by improving visualization of the standard neuroimaging used in radiosurgery treatment planning by MDTs. Conclusions: The NeuroVis application provides several interactive features that produce an enhanced ability to place participating members of an interdisciplinary treatment team on the same visualization plane. This technology, by facilitating team discussions and case review, has the potential to improve the efficiency, efficacy, and safety of radiosurgery treatment planning and, as a result, to optimize patient care. UR - https://neuro.jmir.org/2022/1/e36960 UR - http://dx.doi.org/10.2196/36960 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/36960 ER - TY - JOUR AU - Beverly, Elizabeth AU - Rigot, Brooke AU - Love, Carrie AU - Love, Matt PY - 2022/4/29 TI - Perspectives of 360-Degree Cinematic Virtual Reality: Interview Study Among Health Care Professionals JO - JMIR Med Educ SP - e32657 VL - 8 IS - 2 KW - virtual reality KW - qualitative KW - medical education KW - health care KW - digital learning KW - learning platform KW - health care providers N2 - Background: The global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters. Objective: The aim of this study was to explore health care professionals? experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience. Methods: We conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. Results: We conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67%, women; n=22, 92%, White; and n=4, 17%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character?s frustrations and disappointments; perceived ease of use of cine-VR: 96% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them. Conclusions: Participants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals. UR - https://mededu.jmir.org/2022/2/e32657 UR - http://dx.doi.org/10.2196/32657 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486427 ID - info:doi/10.2196/32657 ER - TY - JOUR AU - Tudor Car, Lorainne AU - Kyaw, Myint Bhone AU - Teo, Andrew AU - Fox, Erlikh Tatiana AU - Vimalesvaran, Sunitha AU - Apfelbacher, Christian AU - Kemp, Sandra AU - Chavannes, Niels PY - 2022/4/13 TI - Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review JO - JMIR Serious Games SP - e29594 VL - 10 IS - 2 KW - virtual reality KW - augmented reality KW - mixed reality KW - outcomes KW - extended reality KW - digital education KW - randomized controlled trials KW - medical education KW - measurement instruments N2 - Background: Extended 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. Objective: Our 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. Methods: We 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. Results: Of 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%). Conclusions: RCTs 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. UR - https://games.jmir.org/2022/2/e29594 UR - http://dx.doi.org/10.2196/29594 UR - http://www.ncbi.nlm.nih.gov/pubmed/35416789 ID - info:doi/10.2196/29594 ER - TY - JOUR AU - Ricci, Serena AU - Calandrino, Andrea AU - Borgonovo, Giacomo AU - Chirico, Marco AU - Casadio, Maura PY - 2022/3/23 TI - Viewpoint: Virtual and Augmented Reality in Basic and Advanced Life Support Training JO - JMIR Serious Games SP - e28595 VL - 10 IS - 1 KW - basic and advanced life support KW - first aid KW - cardiopulmonary resuscitation KW - emergency KW - training KW - simulation training KW - medical simulation KW - healthcare simulation KW - virtual reality KW - augmented reality UR - https://games.jmir.org/2022/1/e28595 UR - http://dx.doi.org/10.2196/28595 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319477 ID - info:doi/10.2196/28595 ER - TY - JOUR AU - Li, Yaning AU - Ye, Hongqiang AU - Wu, Siyu AU - Zhao, Xiaohan AU - Liu, Yunsong AU - Lv, Longwei AU - Zhang, Ping AU - Zhang, Xiao AU - Zhou, Yongsheng PY - 2022/3/9 TI - Mixed Reality and Haptic?Based Dental Simulator for Tooth Preparation: Research, Development, and Preliminary Evaluation JO - JMIR Serious Games SP - e30653 VL - 10 IS - 1 KW - dental education KW - simulator KW - mixed reality KW - tooth preparation N2 - Background: Virtual reality (VR) dental simulators are currently used in preclinical skills training. However, with the development of extended reality technologies, the use of mixed reality (MR) has shown significant advantages over VR. Objective: This study aimed to describe the research and development of a newly developed MR and haptic?based dental simulator for tooth preparation and to conduct a preliminary evaluation of its face validity. Methods: A prototype of the MR dental simulator for tooth preparation was developed by integrating a head-mounted display (HMD), special force feedback handles, a foot pedal, computer hardware, and software program. We recruited 34 participants and divided them into the Novice group (n=17) and Skilled group (n=17) based on their clinical experience. All participants prepared a maxillary right central incisor for an all-ceramic crown in the dental simulator, completed a questionnaire afterward about their simulation experience, and evaluated hardware and software aspects of the dental simulator. Results: Of the participants, 74% (25/34) were satisfied with the overall experience of using the Unidental MR Simulator. Approximately 90% (31/34, 91%) agreed that it could stimulate their interest in learning, and 82% (28/34) were willing to use it for skills training in the future. Differences between the 2 study groups in their experience with the HMD (resolution: P=.95; wearing comfort: P=.10), dental instruments (P=.95), force feedback of the tooth (P=.08), simulation of the tooth preparation process (P=.79), overall experience with the simulation (P=.47), and attitude toward the simulator (improves skills: P=.47; suitable for learning: P=.36; willing to use: P=.89; inspiring for learning: P=.63) were not significant. The Novice group was more satisfied with the simulator?s ease of use (P=.04). There were significant positive correlations between the overall experience with the simulation and the HMD?s resolution (P=.03) and simulation of the preparation process (P=.001). Conclusions: The newly developed Unidental MR Simulator for tooth preparation has good face validity. It can achieve a higher degree of resemblance to the real clinical treatment environment by improving the positional adjustment of the simulated patients, for a better training experience in dental skills. UR - https://games.jmir.org/2022/1/e30653 UR - http://dx.doi.org/10.2196/30653 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262501 ID - info:doi/10.2196/30653 ER - TY - JOUR AU - Gasteiger, Norina AU - van der Veer, N. Sabine AU - Wilson, Paul AU - Dowding, Dawn PY - 2022/2/14 TI - How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis JO - JMIR Serious Games SP - e31644 VL - 10 IS - 1 KW - realist synthesis KW - realist review KW - review KW - virtual reality KW - augmented reality KW - simulation KW - training KW - health KW - health personnel KW - education KW - mobile phone N2 - Background: Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation. Objective: The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance. Methods: We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration. Results: Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration. Conclusions: Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations. UR - https://games.jmir.org/2022/1/e31644 UR - http://dx.doi.org/10.2196/31644 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156931 ID - info:doi/10.2196/31644 ER - TY - JOUR AU - Jiang, Haowen AU - Vimalesvaran, Sunitha AU - Wang, King Jeremy AU - Lim, Boon Kee AU - Mogali, Reddy Sreenivasulu AU - Car, Tudor Lorainne PY - 2022/2/2 TI - Virtual Reality in Medical Students? Education: Scoping Review JO - JMIR Med Educ SP - e34860 VL - 8 IS - 1 KW - virtual reality KW - medical education KW - medical students KW - virtual worlds KW - digital health education N2 - Background: Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education. Objective: The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research. Methods: We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR. Conclusions: Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-046986 UR - https://mededu.jmir.org/2022/1/e34860 UR - http://dx.doi.org/10.2196/34860 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107421 ID - info:doi/10.2196/34860 ER - TY - JOUR AU - Ryan, V. Grace AU - Callaghan, Shauna AU - Rafferty, Anthony AU - Higgins, F. Mary AU - Mangina, Eleni AU - McAuliffe, Fionnuala PY - 2022/2/1 TI - Learning Outcomes of Immersive Technologies in Health Care Student Education: Systematic Review of the Literature JO - J Med Internet Res SP - e30082 VL - 24 IS - 2 KW - Virtual Reality KW - Augmented Reality KW - Mixed Reality KW - Learning Outcomes KW - Medical Education KW - Nursing Education KW - Midwifery Education KW - Systematic Review N2 - Background: There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care students. Objective: The aim of this review is to assess the learning outcomes of immersive technologies compared with traditional learning modalities with regard to knowledge and the participants? learning experience in medical, midwifery, and nursing preclinical university education. Methods: A systematic review was conducted according to the Cochrane Collaboration guidelines. Randomized controlled trials comparing traditional learning methods with virtual, augmented, or mixed reality for the education of medicine, nursing, or midwifery students were evaluated. The identified studies were screened by 2 authors independently. Disagreements were discussed with a third reviewer. The quality of evidence was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) in April 2020. Results: Of 15,627 studies, 29 (0.19%) randomized controlled trials (N=2722 students) were included and evaluated using the MERSQI tool. Knowledge gain was found to be equal when immersive technologies were compared with traditional learning modalities; however, the learning experience increased with immersive technologies. The mean MERSQI score was 12.64 (SD 1.6), the median was 12.50, and the mode was 13.50. Immersive technology was predominantly used to teach clinical skills (15/29, 52%), and virtual reality (22/29, 76%) was the most commonly used form of immersive technology. Knowledge was the primary outcome in 97% (28/29) of studies. Approximately 66% (19/29) of studies used validated instruments and scales to assess secondary learning outcomes, including satisfaction, self-efficacy, engagement, and perceptions of the learning experience. Of the 29 studies, 19 (66%) included medical students (1706/2722, 62.67%), 8 (28%) included nursing students (727/2722, 26.71%), and 2 (7%) included both medical and nursing students (289/2722, 10.62%). There were no studies involving midwifery students. The studies were based on the following disciplines: anatomy, basic clinical skills and history-taking skills, neurology, respiratory medicine, acute medicine, dermatology, communication skills, internal medicine, and emergency medicine. Conclusions: Virtual, augmented, and mixed reality play an important role in the education of preclinical medical and nursing university students. When compared with traditional educational modalities, the learning gain is equal with immersive technologies. Learning outcomes such as student satisfaction, self-efficacy, and engagement all increase with the use of immersive technology, suggesting that it is an optimal tool for education. UR - https://www.jmir.org/2022/2/e30082 UR - http://dx.doi.org/10.2196/30082 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103607 ID - info:doi/10.2196/30082 ER - TY - JOUR AU - Jung, Younhyun PY - 2022/1/28 TI - Virtual Reality Simulation for Disaster Preparedness Training in Hospitals: Integrated Review JO - J Med Internet Res SP - e30600 VL - 24 IS - 1 KW - virtual reality KW - in-hospital disaster preparedness training KW - mass casualty incidents KW - hospitals N2 - Background: A critical component of disaster preparedness in hospitals is experiential education and training of health care professionals. A live drill is a well-established, effective training approach, but cost restraints and logistic constraints make clinical implementation challenging, and training opportunities with live drills may be severely limited. Virtual reality simulation (VRS) technology may offer a viable training alternative with its inherent features of reproducibility, just-in-time training, and repeatability. Objective: This integrated review examines the scientific evidence pertaining to the effectiveness of VRS and its practical usefulness in training health care professionals for in-hospital disaster preparedness. Methods: A well-known 4-stage methodology was used for the integrated review process. It consisted of problem identification, a literature search and inclusion criteria determination, 2-stage validation and analysis of searched studies, and presentation of findings. A search of diverse publication repositories was performed. They included Web of Science (WOS), PubMed (PMD), and Embase (EMB). Results: The integrated review process resulted in 12 studies being included. Principle findings identified 3 major capabilities of VRS: (1) to realistically simulate the clinical environment and medical practices related to different disaster scenarios, (2) to develop learning effects on increased confidence and enhanced knowledge acquisition, and (3) to enable cost-effective implementation of training programs. Conclusions: The findings from the integrated review suggested that VRS could be a competitive, cost-effective adjunct to existing training approaches. Although the findings demonstrated the applicability of VRS to different training scenarios, these do not entirely cover all disaster scenarios that could happen in hospitals. This integrated review expects that the recent advances of VR technologies can be 1 of the catalysts to enable the wider adoption of VRS training on challenging clinical scenarios that require sophisticated modeling and environment depiction. UR - https://www.jmir.org/2022/1/e30600 UR - http://dx.doi.org/10.2196/30600 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089144 ID - info:doi/10.2196/30600 ER - TY - JOUR AU - Chao, Yi-Ping AU - Chuang, Hai-Hua AU - Hsin, Li-Jen AU - Kang, Chung-Jan AU - Fang, Tuan-Jen AU - Li, Hsueh-Yu AU - Huang, Chung-Guei AU - Kuo, J. Terry B. AU - Yang, H. Cheryl C. AU - Shyu, Hsin-Yih AU - Wang, Shu-Ling AU - Shyu, Liang-Yu AU - Lee, Li-Ang PY - 2021/11/22 TI - Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e13124 VL - 9 IS - 4 KW - cognitive load KW - heart rate variability KW - video learning KW - learning outcome KW - secondary-task reaction time KW - virtual reality N2 - Background: Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. Objective: The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. Methods: This pilot system?design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. Results: All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ?3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ?3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ?3.6 seconds was not related to a Milestone level of ?3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ?1.43 seemed to be inversely associated with a hedonic stimulation score of ?2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. Conclusions: Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners? needs and prompted learning through the different video modules. Trial Registration: ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 UR - https://games.jmir.org/2021/4/e13124 UR - http://dx.doi.org/10.2196/13124 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813485 ID - info:doi/10.2196/13124 ER - TY - JOUR AU - Chiang, Chih-Huei AU - Huang, Chiu-Mieh AU - Sheu, Jiunn-Jye AU - Liao, Jung-Yu AU - Hsu, Hsiao-Pei AU - Wang, Shih-Wen AU - Guo, Jong-Long PY - 2021/11/2 TI - Examining the Effectiveness of 3D Virtual Reality Training on Problem-solving, Self-efficacy, and Teamwork Among Inexperienced Volunteers Helping With Drug Use Prevention: Randomized Controlled Trial JO - J Med Internet Res SP - e29862 VL - 23 IS - 11 KW - 3D virtual reality KW - volunteers KW - problem-solving KW - self-efficacy KW - teamwork N2 - Background: Illegal drug usage among adolescents is a critical health problem. The Taiwanese government provides an accompanying volunteer program to prevent students who experiment with drugs from reusing them. An appropriate training program can improve volunteers? abilities to assist students using drugs. Problem-solving, self-efficacy, and teamwork are critical abilities for inexperienced volunteers who help with drug use prevention. By interacting with the animation or 3D virtual reality (VR) in the virtual scene, learners can immerse themselves in the virtual environment to learn, and 3D VR can increase learning opportunities and reduce the cost of human and material resources. Objective: The aim of this study was to examine the effectiveness of spherical video-based virtual reality (SVVR) training in improving problem-solving, self-efficacy, and teamwork among volunteers who helped prevent adolescents from using illegal drugs. Methods: This study used a randomized controlled design with a total of 68 participants in the experimental (n=35) and control (n=33) groups. The participants in the experimental group received the SVVR training program and their counterparts in the control group did not receive any training. Results: Generalized estimating equation analyses indicated that the experimental group showed significant posttraining improvements in problem-solving and self-efficacy but not teamwork when compared with the control group. Conclusions: The results of this study revealed that SVVR could improve participants? problem-solving skills and self-efficacy for assisting students in not using illegal drugs. However, future studies are suggested to develop effective SVVR to assist inexperienced volunteers in enhancing their teamwork abilities. We believed that introducing the training program to more sites can enhance volunteer training so that volunteers can have a better companionship effect when helping students quit drugs. Trial Registration: ClinicalTrials.gov NCT05072431; https://clinicaltrials.gov/ct2/show/NCT05072431 UR - https://www.jmir.org/2021/11/e29862 UR - http://dx.doi.org/10.2196/29862 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726606 ID - info:doi/10.2196/29862 ER - TY - JOUR AU - Toto, L. Regina AU - Vorel, S. Ethan AU - Tay, E. Khoon-Yen AU - Good, L. Grace AU - Berdinka, M. Jesse AU - Peled, Adam AU - Leary, Marion AU - Chang, P. Todd AU - Weiss, K. Anna AU - Balamuth, B. Frances PY - 2021/10/6 TI - Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial JO - JMIR Med Educ SP - e29899 VL - 7 IS - 4 KW - augmented reality KW - simulation KW - septic shock KW - children KW - pediatrics KW - simulation-based education KW - application KW - fluid administration N2 - Background: Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education. Objective: In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps. Methods: We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants? time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups. Results: We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient?s perfusion. Conclusions: We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants? awareness of abnormal perfusion. UR - https://mededu.jmir.org/2021/4/e29899 UR - http://dx.doi.org/10.2196/29899 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612836 ID - info:doi/10.2196/29899 ER - TY - JOUR AU - Pan, Myat AU - San, Myat PY - 2021/10/4 TI - Innovation and Inequality: A Medical Student Perspective. Comment on "The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic" JO - JMIR Med Educ SP - e26790 VL - 7 IS - 4 KW - medical education KW - technology KW - coronavirus KW - medical students KW - COVID-19 KW - pandemic KW - online lecture KW - virtual reality KW - education UR - https://mededu.jmir.org/2021/4/e26790 UR - http://dx.doi.org/10.2196/26790 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081609 ID - info:doi/10.2196/26790 ER - TY - JOUR AU - Liu, Songxiang AU - Xie, Mao AU - Zhang, Zhicai AU - Wu, Xinghuo AU - Gao, Fei AU - Lu, Lin AU - Zhang, Jiayao AU - Xie, Yi AU - Yang, Fan AU - Ye, Zhewei PY - 2021/9/10 TI - A 3D Hologram With Mixed Reality Techniques to Improve Understanding of Pulmonary Lesions Caused by COVID-19: Randomized Controlled Trial JO - J Med Internet Res SP - e24081 VL - 23 IS - 9 KW - COVID-19 KW - mixed reality KW - hologram KW - pulmonary KW - lesion KW - diagnostic KW - imaging N2 - Background: The COVID-19 outbreak has now become a pandemic and has had a serious adverse impact on global public health. The effect of COVID-19 on the lungs can be determined through 2D computed tomography (CT) imaging, which requires a high level of spatial imagination on the part of the medical provider. Objective: The purpose of this study is to determine whether viewing a 3D hologram with mixed reality techniques can improve medical professionals? understanding of the pulmonary lesions caused by COVID-19. Methods: The study involved 60 participants, including 20 radiologists, 20 surgeons, and 20 medical students. Each of the three groups was randomly divided into two groups, either the 2D CT group (n=30; mean age 29 years [range 19-38 years]; males=20) or the 3D holographic group (n=30; mean age 30 years [range 20=38 years]; males=20). The two groups completed the same task, which involved identifying lung lesions caused by COVID-19 for 6 cases using a 2D CT or 3D hologram. Finally, an independent radiology professor rated the participants' performance (out of 100). All participants in two groups completed a Likert scale questionnaire regarding the educational utility and efficiency of 3D holograms. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed by all participants. Results: The mean task score of the 3D hologram group (mean 91.98, SD 2.45) was significantly higher than that of the 2D CT group (mean 74.09, SD 7.59; P<.001). With the help of 3D holograms, surgeons and medical students achieved the same score as radiologists and made obvious progress in identifying pulmonary lesions caused by COVID-19. The Likert scale questionnaire results showed that the 3D hologram group had superior results compared to the 2D CT group (teaching: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; understanding and communicating: 2D CT group median 1, IQR 1-1 versus 3D group median 5, IQR 5-5; P<.001; increasing interest: 2D CT group median 2, IQR 2-2 versus 3D group median 5, IQR 5-5; P<.001; lowering the learning curve: 2D CT group median 2, IQR 1-2 versus 3D group median 4, IQR 4-5; P<.001; spatial awareness: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; learning: 2D CT group median 3, IQR 2-3 versus 3D group median 5, IQR 5-5; P<.001). The 3D group scored significantly lower than the 2D CT group for the ?mental,? ?temporal,? ?performance,? and ?frustration? subscales on the NASA-TLX. Conclusions: A 3D hologram with mixed reality techniques can be used to help medical professionals, especially medical students and newly hired doctors, better identify pulmonary lesions caused by COVID-19. It can be used in medical education to improve spatial awareness, increase interest, improve understandability, and lower the learning curve. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100045845; http://www.chictr.org.cn/showprojen.aspx?proj=125761 UR - https://www.jmir.org/2021/9/e24081 UR - http://dx.doi.org/10.2196/24081 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061760 ID - info:doi/10.2196/24081 ER - TY - JOUR AU - Liu, Fang AU - Weng, Huiting AU - Xu, Rong AU - Li, Xia AU - Zhang, Zhe AU - Zhao, Kuaile AU - Zhou, Zhiguang AU - Wang, Qin PY - 2021/9/9 TI - Nursing Interns? Attitudes Toward, Preferences for, and Use of Diabetes Virtual Simulation Teaching Applications in China: National Web-Based Survey JO - JMIR Mhealth Uhealth SP - e29498 VL - 9 IS - 9 KW - nursing interns KW - virtual simulation KW - China KW - nursing education KW - diabetes N2 - Background: Diabetes has placed heavy social and economic burdens on society and families worldwide. Insufficient knowledge and training of frontline medical staff, such as nurses, interns, and residents, may lead to an increase in acute and chronic complications among patients with diabetes. However, interns have insufficient knowledge about diabetes management. The factors that affect interns? current level of diabetes-related knowledge are still unclear. Therefore, understanding the behavioral intentions of interns is essential to supporting the development and promotion of the use of virtual simulation teaching applications. Objective: This study aimed to identify the determinants of nursing interns? intentions to use simulation-based education applications. Methods: From December 1, 2020, to February 28, 2021, the web-based survey tool Sojump (Changsha Xingxin Information Technology Co) was used to survey nursing interns in hospitals across China. Two survey links were sent to 37 partner schools in 23 major cities in China, and they were disseminated through participants? WeChat networks. Multiple regression analysis was used to determine the association between demographic information and basic disease information and the use of the application for treating adult patients. Results: Overall, 883 nursing interns from 23 provinces in China responded to the survey. Among them, the virtual simulation utilization rate was 35.6% (314/883) and the awareness rate was 10.2% (90/883). In addition, among the interns, only 10.2% (90/883) correctly understood the concept of virtual simulation, and most of them (793/883, 89.8%) believed that scenario-simulation training or the use of models for teaching are all the same. Multiple regression analysis showed that the educational level, independent learning ability, and professional identity of the interns were related to use of the application (P<.05). Skills and knowledge that the interns most wanted to acquire included the treatment of hypoglycemia (626/883, 70.9%), functional test simulation (610/883, 69.1%), and blood glucose monitoring technology (485/883, 54.9%). A total of 60.5% (534/883) of the interns wanted to acquire clinical thinking skills, while 16.0% (141/883) wanted to acquire operational skills. Nursing trainees believed that the greatest obstacles to virtual simulation included limited time (280/883, 31.7%), the degree of simulation (129/883, 14.6%), the demand for satisfaction (108/883, 12.2%), and test scores (66/883, 7.5%). Conclusions: The understanding and usage rate of diabetes virtual simulation teaching applications by Chinese nursing interns is very low. However, they have high requirements regarding this teaching method. Conducting high-quality randomized controlled trials and designing applications that are suitable for the needs of different nurse trainees will increase students? interest in learning and help improve diabetes knowledge among nursing interns. UR - https://mhealth.jmir.org/2021/9/e29498 UR - http://dx.doi.org/10.2196/29498 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499047 ID - info:doi/10.2196/29498 ER - TY - JOUR AU - Perron, Elizabeth Janaya AU - Coffey, Jonathon Michael AU - Lovell-Simons, Andrew AU - Dominguez, Luis AU - King, E. Mark AU - Ooi, Y. Chee PY - 2021/7/29 TI - Resuscitating Cardiopulmonary Resuscitation Training in a Virtual Reality: Prospective Interventional Study JO - J Med Internet Res SP - e22920 VL - 23 IS - 7 KW - pediatrics KW - cardiopulmonary resuscitation KW - virtual reality KW - medical education N2 - Background: Simulation-based technologies are emerging to enhance medical education in the digital era. However, there is limited data for the use of virtual reality simulation in pediatric medical education. We developed Virtual Doc as a highly immersive virtual reality simulation to teach pediatric cardiopulmonary resuscitation skills to medical students. Objective: The primary objectives of this study were to evaluate participant satisfaction and perceived educational efficacy of Virtual Doc. The secondary aim of this study was to assess the game play features of Virtual Doc. Methods: We conducted a prospective closed beta-testing study at the University of New South Wales (Sydney, Australia) in 2018. All medical students from the 6-year undergraduate program were eligible to participate and were recruited through voluntary convenience sampling. Participants attended a 1-hour testing session and attempted at least one full resuscitation case using the virtual reality simulator. Following this, participants were asked to complete an anonymous postsession questionnaire. Responses were analyzed using descriptive statistics. Results: A total of 26 participants were recruited, consented to participate in this study, and attended a 1-hour in-person closed beta-testing session, and 88% (23/26) of participants completed the anonymous questionnaire and were included in this study. Regarding participant satisfaction, Virtual Doc was enjoyed by 91% (21/23) of participants, with 74% (17/23) intending to recommend the simulation to a colleague and 66% (15/23) intending to recommend the simulation to a friend. In assessment of the perceived educational value of Virtual Doc, 70% (16/23) of participants agreed they had an improved understanding of cardiopulmonary resuscitation, and 78% (18/23) agreed that Virtual Doc will help prepare for and deal with real-life clinical scenarios. Furthermore, 91% (21/23) of participants agreed with the development of additional Virtual Doc cases as beneficial for learning. An evaluation of the game play features as our secondary objective revealed that 70% (16/23) of participants agreed with ease in understanding how to use Virtual Doc, and 74% (17/23) found the game play elements useful in understanding cardiopulmonary resuscitation. One-third (7/23, 30%) found it easy to work with the interactive elements. In addition, 74% (17/23) were interested in interacting with other students within the simulation. Conclusions: Our study demonstrates a positive response regarding trainee satisfaction and perceived educational efficacy of Virtual Doc. The simulation was widely accepted by the majority of users and may have the potential to improve educational learning objectives. UR - https://www.jmir.org/2021/7/e22920 UR - http://dx.doi.org/10.2196/22920 UR - http://www.ncbi.nlm.nih.gov/pubmed/34326040 ID - info:doi/10.2196/22920 ER - TY - JOUR AU - Ong, Triton AU - Wilczewski, Hattie AU - Paige, R. Samantha AU - Soni, Hiral AU - Welch, M. Brandon AU - Bunnell, E. Brian PY - 2021/7/26 TI - Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint JO - JMIR Serious Games SP - e26520 VL - 9 IS - 3 KW - extended reality KW - virtual reality KW - augmented reality KW - mixed reality KW - telehealth KW - telemedicine KW - COVID-19 KW - telepresence UR - https://games.jmir.org/2021/3/e26520 UR - http://dx.doi.org/10.2196/26520 UR - http://www.ncbi.nlm.nih.gov/pubmed/34227992 ID - info:doi/10.2196/26520 ER - TY - JOUR AU - Nathan, Arjun AU - Fricker, Monty AU - Patel, Sonam AU - Georgi, Maria AU - Hang, Kien Man AU - Asif, Aqua AU - Sinha, Amil AU - Mullins, William AU - Shea, Jessie AU - Hanna, Nancy AU - Lamb, Benjamin AU - Kelly, John AU - Sridhar, Ashwin AU - Collins, Justin PY - 2021/7/22 TI - Virtual Interactive Surgical Skills Classroom: Protocol for a Parallel-Group, Noninferiority, Adjudicator-Blinded, Randomized Controlled Trial (VIRTUAL) JO - JMIR Res Protoc SP - e28671 VL - 10 IS - 7 KW - digital education KW - digital health KW - education KW - surgery KW - surgical skills KW - surgical training KW - surgical KW - suturing KW - telemedicine KW - virtual classroom KW - virtual training N2 - Background: Traditional face-to-face training (FFT) for basic surgical skills is inaccessible and resource-intensive. Noninteractive computer-based learning is more economical but less educationally beneficial. Virtual classroom training (VCT) is a novel method that permits distanced interactive expert instruction. VCT may optimize resources and increase accessibility. Objective: We aim to investigate whether VCT is superior to computer-based learning and noninferior to FFT in improving proficiency in basic surgical skills. Methods: This is a protocol for a parallel-group, noninferiority, randomized controlled trial. A sample of 72 undergraduates will be recruited from 5 medical schools in London. Participants will be stratified by subjective and objective suturing experience level and allocated to 3 intervention groups at a 1:1:1 ratio. VCT will be delivered using the BARCO weConnect software, and FFT will be provided by expert instructors. Optimal student-to-teacher ratios of 12:1 for VCT and 4:1 for FFT will be maintained. The assessed task will be interrupted suturing with hand-tied knots. Results: The primary outcome will be the postintervention Objective Structured Assessment of Technical Skills score, adjudicated by 2 experts blinded to the study and adjusted for baseline proficiency. The noninferiority margin (?) will be defined using historical data. Conclusions: This study will serve as a comprehensive appraisal of the suitability of virtual basic surgical skills classroom training as an alternative to FFT. Our findings will assist the development and implementation of further resource-efficient, accessible, virtual basic surgical skills training programs during the COVID-19 pandemic and in the future. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN12448098; https://www.isrctn.com/ISRCTN12448098 International Registered Report Identifier (IRRID): PRR1-10.2196/28671 UR - https://www.researchprotocols.org/2021/7/e28671 UR - http://dx.doi.org/10.2196/28671 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292162 ID - info:doi/10.2196/28671 ER - TY - JOUR AU - Mok, Tsz-Ngai AU - Chen, Junyuan AU - Pan, Jinghua AU - Ming, Wai-Kit AU - He, Qiyu AU - Sin, Tat-Hang AU - Deng, Jialin AU - Li, Jieruo AU - Zha, Zhengang PY - 2021/7/12 TI - Use of a Virtual Reality Simulator for Tendon Repair Training: Randomized Controlled Trial JO - JMIR Serious Games SP - e27544 VL - 9 IS - 3 KW - virtual reality simulators KW - tendon suture KW - medical education N2 - Background: Virtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality. Objective: The aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field. Methods: In this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the ?Kessler tendon repair with 2 interrupted tendon repair knots? (KS) method and the ?Bunnell tendon repair with figure 8 tendon repair? (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale. Results: Of the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001). Conclusions: Our study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180 UR - https://games.jmir.org/2021/3/e27544 UR - http://dx.doi.org/10.2196/27544 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255649 ID - info:doi/10.2196/27544 ER - TY - JOUR AU - Barteit, Sandra AU - Lanfermann, Lucia AU - Bärnighausen, Till AU - Neuhann, Florian AU - Beiersmann, Claudia PY - 2021/7/8 TI - Augmented, Mixed, and Virtual Reality-Based Head-Mounted Devices for Medical Education: Systematic Review JO - JMIR Serious Games SP - e29080 VL - 9 IS - 3 KW - virtual reality KW - augmented reality KW - global health KW - income-limited countries KW - medical education N2 - Background: Augmented reality (AR), mixed reality (MR), and virtual reality (VR), realized as head-mounted devices (HMDs), may open up new ways of teaching medical content for low-resource settings. The advantages are that HMDs enable repeated practice without adverse effects on the patient in various medical disciplines; may introduce new ways to learn complex medical content; and may alleviate financial, ethical, and supervisory constraints on the use of traditional medical learning materials, like cadavers and other skills lab equipment. Objective: We examine the effectiveness of AR, MR, and VR HMDs for medical education, whereby we aim to incorporate a global health perspective comprising low- and middle-income countries (LMICs). Methods: We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and Cochrane guidelines. Seven medical databases (PubMed, Cochrane Library, Web of Science, Science Direct, PsycINFO, Education Resources Information Centre, and Google Scholar) were searched for peer-reviewed publications from January 1, 2014, to May 31, 2019. An extensive search was carried out to examine relevant literature guided by three concepts of extended reality (XR), which comprises the concepts of AR, MR, and VR, and the concepts of medicine and education. It included health professionals who took part in an HMD intervention that was compared to another teaching or learning method and evaluated with regard to its effectiveness. Quality and risk of bias were assessed with the Medical Education Research Study Quality Instrument, the Newcastle-Ottawa Scale-Education, and A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions. We extracted relevant data and aggregated the data according to the main outcomes of this review (knowledge, skills, and XR HMD). Results: A total of 27 studies comprising 956 study participants were included. The participants included all types of health care professionals, especially medical students (n=573, 59.9%) and residents (n=289, 30.2%). AR and VR implemented with HMDs were most often used for training in the fields of surgery (n=13, 48%) and anatomy (n=4, 15%). A range of study designs were used, and quantitative methods were clearly dominant (n=21, 78%). Training with AR- and VR-based HMDs was perceived as salient, motivating, and engaging. In the majority of studies (n=17, 63%), HMD-based interventions were found to be effective. A small number of included studies (n=4, 15%) indicated that HMDs were effective for certain aspects of medical skills and knowledge learning and training, while other studies suggested that HMDs were only viable as an additional teaching tool (n=4, 15%). Only 2 (7%) studies found no effectiveness in the use of HMDs. Conclusions: The majority of included studies suggested that XR-based HMDs have beneficial effects for medical education, whereby only a minority of studies were from LMICs. Nevertheless, as most studies showed at least noninferior results when compared to conventional teaching and training, the results of this review suggest applicability and potential effectiveness in LMICs. Overall, users demonstrated greater enthusiasm and enjoyment in learning with XR-based HMDs. It has to be noted that many HMD-based interventions were small-scale and conducted as short-term pilots. To generate relevant evidence in the future, it is key to rigorously evaluate XR-based HMDs with AR and VR implementations, particularly in LMICs, to better understand the strengths and shortcomings of HMDs for medical education. UR - https://games.jmir.org/2021/3/e29080 UR - http://dx.doi.org/10.2196/29080 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255668 ID - info:doi/10.2196/29080 ER - TY - JOUR AU - Klemm, Philipp AU - Kleyer, Arnd AU - Tascilar, Koray AU - Schuster, Louis AU - Meinderink, Timo AU - Steiger, Florian AU - Lange, Uwe AU - Müller-Ladner, Ulf AU - Knitza, Johannes AU - Sewerin, Philipp AU - Mucke, Johanna AU - Pfeil, Alexander AU - Schett, Georg AU - Hartmann, Fabian AU - Hueber, J. Axel AU - Simon, David PY - 2021/5/11 TI - A Virtual Reality?Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study JO - JMIR Serious Games SP - e23835 VL - 9 IS - 2 KW - feasibility KW - virtual reality KW - inflammatory arthritis KW - psoriatic arthritis KW - rheumatoid arthritis N2 - Background: Inflammatory arthritides (IA) such as rheumatoid arthritis or psoriatic arthritis are disorders that can be difficult to comprehend for health professionals and students in terms of the heterogeneity of clinical symptoms and pathologies. New didactic approaches using innovative technologies such as virtual reality (VR) apps could be helpful to demonstrate disease manifestations as well as joint pathologies in a more comprehensive manner. However, the potential of using a VR education concept in IA has not yet been evaluated. Objective: We evaluated the feasibility of a VR app to educate health care professionals and medical students about IA. Methods: We developed a VR app using data from IA patients as well as 2D and 3D-visualized pathological joints from X-ray and computed tomography?generated images. This VR app (Rheumality) allows the user to interact with representative arthritic joint and bone pathologies of patients with IA. In a consensus meeting, an online questionnaire was designed to collect basic demographic data (age, sex); profession of the participants; and their feedback on the general impression, knowledge gain, and potential areas of application of the VR app. The VR app was subsequently tested and evaluated by health care professionals (physicians, researchers, and other professionals) and medical students at predefined events (two annual rheumatology conferences and academic teaching seminars at two sites in Germany). To explore associations between categorical variables, the ?2 or Fisher test was used as appropriate. Two-sided P values ?.05 were regarded as significant. Results: A total of 125 individuals participated in this study. Among them, 56% of the participants identified as female, 43% identified as male, and 1% identified as nonbinary; 59% of the participants were 18-30 years of age, 18% were 31-40 years old, 10% were 41-50 years old, 8% were 51-60 years old, and 5% were 61-70 years old. The participants (N=125) rated the VR app as excellent, with a mean rating of 9.0 (SD 1.2) out of 10, and many participants would recommend use of the app, with a mean recommendation score of 3.2 (SD 1.1) out of 4. A large majority (120/125, 96.0%) stated that the presentation of pathological bone formation improves understanding of the disease. We did not find any association between participant characteristics and evaluation of the VR experience or recommendation scores. Conclusions: The data show that IA-targeting innovative teaching approaches based on VR technology are feasible. UR - https://games.jmir.org/2021/2/e23835 UR - http://dx.doi.org/10.2196/23835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973858 ID - info:doi/10.2196/23835 ER - TY - JOUR AU - Li, Yaning AU - Ye, Hongqiang AU - Ye, Fan AU - Liu, Yunsong AU - Lv, Longwei AU - Zhang, Ping AU - Zhang, Xiao AU - Zhou, Yongsheng PY - 2021/4/8 TI - The Current Situation and Future Prospects of Simulators in Dental Education JO - J Med Internet Res SP - e23635 VL - 23 IS - 4 KW - dental simulator KW - dental education KW - virtual reality UR - https://www.jmir.org/2021/4/e23635 UR - http://dx.doi.org/10.2196/23635 UR - http://www.ncbi.nlm.nih.gov/pubmed/33830059 ID - info:doi/10.2196/23635 ER - TY - JOUR AU - Beverly, Ann Elizabeth AU - Love, Carrie AU - Love, Matthew AU - Williams, Eric AU - Bowditch, John PY - 2021/1/27 TI - Using Virtual Reality to Improve Health Care Providers? Cultural Self-Efficacy and Diabetes Attitudes: Pilot Questionnaire Study JO - JMIR Diabetes SP - e23708 VL - 6 IS - 1 KW - virtual reality KW - diabetes attitudes KW - cultural self-efficacy KW - health care providers KW - VR KW - diabetes KW - training N2 - Background: In southeastern Appalachian Ohio, the prevalence of diabetes is 19.9%, nearly double that of the national average of 10.5%. Here, people with diabetes are more likely to have a delayed diagnosis, limited access to health care, and lower health literacy. Despite the high rates of diabetes in the region, the availability of endocrinologists and certified diabetes care and education specialists is limited. Therefore, innovative strategies to address the growing diabetes care demands are needed. One approach is to train the primary care workforce in new and emerging therapies for type 2 diabetes to meet the increasing demands and complexity of diabetes care. Objective: The aim of this study was to assess the effectiveness of a virtual reality training program designed to improve cultural self-efficacy and diabetes attitudes. Methods: Health care providers and administrators were recruited from large health care systems, private practices, university-owned hospitals or clinics, Federally Qualified Health Centers, local health departments, and AmeriCorps. Providers and administrators participated in a 3-hour virtual reality training program consisting of 360-degree videos produced in a professional, cinematic manner; this technique is called virtual reality cinema (cine-VR). Questionnaires measuring cultural self-efficacy, diabetes attitudes, and presence in cine-VR were administered to providers and administrators before and after the program. Results: A total of 69 participants completed the study. The mean age of the sample was 42.2 years (SD 13.7), 86% (59/69) identified as female, 83% (57/69) identified as White, 86% (59/69) identified as providers, and 25% (17/69) identified as nurses. Following the training program, we observed positive improvements in all three of the cultural self-efficacy subscales: Cognitive (mean change ?1.29; t65=?9.309; P<.001), Practical (mean change ?1.85; t65=?9.319; P<.001), and Affective (mean change ?0.75; t65=?7.067; P<.001). We observed the largest magnitude of change with the subscale, with a Cohen d of 1.16 indicating a very large effect. In addition, we observed positive improvements in all five of the diabetes attitude subscales: Need for special training (mean change ?0.21; t67=?6.154; P<.001), Seriousness of type 2 diabetes (mean change ?0.34; t67=?8.114; P<.001), Value of tight glucose control (mean change ?0.13; t67=?3.029; P=.001), Psychosocial impact of diabetes (mean change ?0.33; t67=?6.610; P<.001), and Attitude toward patient autonomy (mean change ?0.17; t67=?3.889; P<.001). We observed the largest magnitude of change with the Psychosocial impact of diabetes subscale, with a Cohen d of 0.87 indicating a large effect. We observed only one significant correlation between presence in cine-VR (ie, Interface Quality) and a positive change score (ie, Affective self-efficacy) (r=.285; P=.03). Conclusions: Our findings support the notion that cine-VR education is an innovative approach to improve cultural self-efficacy and diabetes attitudes among health care providers and administrators. The long-term impact of cine-VR education on cultural self-efficacy and diabetes attitudes needs to be determined. UR - http://diabetes.jmir.org/2021/1/e23708/ UR - http://dx.doi.org/10.2196/23708 UR - http://www.ncbi.nlm.nih.gov/pubmed/33502335 ID - info:doi/10.2196/23708 ER - TY - JOUR AU - Chen, Feng-Qin AU - Leng, Yu-Fei AU - Ge, Jian-Feng AU - Wang, Dan-Wen AU - Li, Cheng AU - Chen, Bin AU - Sun, Zhi-Ling PY - 2020/9/15 TI - Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis JO - J Med Internet Res SP - e18290 VL - 22 IS - 9 KW - virtual reality KW - nursing education KW - meta-analysis N2 - Background: Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes. Objective: The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time. Methods: We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Results: A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, P<.001, I2=47%). However, there was no difference between VR and the control conditions in skills (SMD=0.01, 95% CI ?0.24 to 0.26, P=.93, I2=37%), satisfaction (SMD=0.01, 95% CI ?0.79 to 0.80, P=.99, I2=86%), confidence (SMD=0.00, 95% CI ?0.28 to 0.27, P=.99, I2=0%), and performance time (SMD=?0.55, 95% CI ?2.04 to 0.94, P=.47, I2=97%). Conclusions: The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results. UR - http://www.jmir.org/2020/9/e18290/ UR - http://dx.doi.org/10.2196/18290 UR - http://www.ncbi.nlm.nih.gov/pubmed/32930664 ID - info:doi/10.2196/18290 ER - TY - JOUR AU - Antoniou, E. Panagiotis AU - Arfaras, George AU - Pandria, Niki AU - Athanasiou, Alkinoos AU - Ntakakis, George AU - Babatsikos, Emmanouil AU - Nigdelis, Vasilis AU - Bamidis, Panagiotis PY - 2020/9/2 TI - Biosensor Real-Time Affective Analytics in Virtual and Mixed Reality Medical Education Serious Games: Cohort Study JO - JMIR Serious Games SP - e17823 VL - 8 IS - 3 KW - virtual patients KW - affective learning KW - electroencephalography KW - medical education KW - virtual reality KW - wearable sensors KW - serious medical games N2 - Background: The role of emotion is crucial to the learning process, as it is linked to motivation, interest, and attention. Affective states are expressed in the brain and in overall biological activity. Biosignals, like heart rate (HR), electrodermal activity (EDA), and electroencephalography (EEG) are physiological expressions affected by emotional state. Analyzing these biosignal recordings can point to a person?s emotional state. Contemporary medical education has progressed extensively towards diverse learning resources using virtual reality (VR) and mixed reality (MR) applications. Objective: This paper aims to study the efficacy of wearable biosensors for affect detection in a learning process involving a serious game in the Microsoft HoloLens VR/MR platform. Methods: A wearable array of sensors recording HR, EDA, and EEG signals was deployed during 2 educational activities conducted by 11 participants of diverse educational level (undergraduate, postgraduate, and specialist neurosurgeon doctors). The first scenario was a conventional virtual patient case used for establishing the personal biosignal baselines for the participant. The second was a case in a VR/MR environment regarding neuroanatomy. The affective measures that we recorded were EEG (theta/beta ratio and alpha rhythm), HR, and EDA. Results: Results were recorded and aggregated across all 3 groups. Average EEG ratios of the virtual patient (VP) versus the MR serious game cases were recorded at 3.49 (SD 0.82) versus 3.23 (SD 0.94) for students, 2.59 (SD 0.96) versus 2.90 (SD 1.78) for neurosurgeons, and 2.33 (SD 0.26) versus 2.56 (SD 0.62) for postgraduate medical students. Average alpha rhythm of the VP versus the MR serious game cases were recorded at 7.77 (SD 1.62) ?V versus 8.42 (SD 2.56) ?V for students, 7.03 (SD 2.19) ?V versus 7.15 (SD 1.86) ?V for neurosurgeons, and 11.84 (SD 6.15) ?V versus 9.55 (SD 3.12) ?V for postgraduate medical students. Average HR of the VP versus the MR serious game cases were recorded at 87 (SD 13) versus 86 (SD 12) bpm for students, 81 (SD 7) versus 83 (SD 7) bpm for neurosurgeons, and 81 (SD 7) versus 77 (SD 6) bpm for postgraduate medical students. Average EDA of the VP versus the MR serious game cases were recorded at 1.198 (SD 1.467) ?S versus 4.097 (SD 2.79) ?S for students, 1.890 (SD 2.269) ?S versus 5.407 (SD 5.391) ?S for neurosurgeons, and 0.739 (SD 0.509) ?S versus 2.498 (SD 1.72) ?S for postgraduate medical students. The variations of these metrics have been correlated with existing theoretical interpretations regarding educationally relevant affective analytics, such as engagement and educational focus. Conclusions: These results demonstrate that this novel sensor configuration can lead to credible affective state detection and can be used in platforms like intelligent tutoring systems for providing real-time, evidence-based, affective learning analytics using VR/MR-deployed medical education resources. UR - http://games.jmir.org/2020/3/e17823/ UR - http://dx.doi.org/10.2196/17823 UR - http://www.ncbi.nlm.nih.gov/pubmed/32876575 ID - info:doi/10.2196/17823 ER - TY - JOUR AU - Muangpoon, Theerapat AU - Haghighi Osgouei, Reza AU - Escobar-Castillejos, David AU - Kontovounisios, Christos AU - Bello, Fernando PY - 2020/8/13 TI - Augmented Reality System for Digital Rectal Examination Training and Assessment: System Validation JO - J Med Internet Res SP - e18637 VL - 22 IS - 8 KW - Augmented Reality KW - Digital Rectal Examination (DRE) KW - Magnetic Tracker KW - Pressure Sensor KW - Medical Education KW - Usability N2 - Background: Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients. Objective: This paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers. Methods: The system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system. Results: The system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group. Conclusions: The proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal organs. The initial user study proved its applicability and usefulness. UR - https://www.jmir.org/2020/8/e18637 UR - http://dx.doi.org/10.2196/18637 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788146 ID - info:doi/10.2196/18637 ER - TY - JOUR AU - Remtulla, Ridhaa PY - 2020/7/17 TI - The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic JO - JMIR Med Educ SP - e20190 VL - 6 IS - 2 KW - medical education KW - technology KW - coronavirus KW - medical students KW - COVID-19 KW - pandemic KW - online lecture KW - virtual reality UR - http://mededu.jmir.org/2020/2/e20190/ UR - http://dx.doi.org/10.2196/20190 UR - http://www.ncbi.nlm.nih.gov/pubmed/32634107 ID - info:doi/10.2196/20190 ER - TY - JOUR AU - Alvarez-Lopez, Fernando AU - Maina, Fabián Marcelo AU - Saigí-Rubió, Francesc PY - 2020/7/14 TI - Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study JO - J Med Internet Res SP - e17491 VL - 22 IS - 7 KW - simulation training KW - minimally invasive surgery KW - user-computer interface KW - operating rooms KW - medical education KW - computer-assisted surgery N2 - Background: Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access. Objective: This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence. Methods: For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed. Results: A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study?s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67). Conclusions: The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained. UR - http://www.jmir.org/2020/7/e17491/ UR - http://dx.doi.org/10.2196/17491 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673217 ID - info:doi/10.2196/17491 ER - TY - JOUR AU - Hilt, D. Alexander AU - Mamaqi Kapllani, Kevin AU - Hierck, P. Beerend AU - Kemp, C. Anne AU - Albayrak, Armagan AU - Melles, Marijke AU - Schalij, J. Martin AU - Scherptong, C. Roderick W. PY - 2020/6/23 TI - Perspectives of Patients and Professionals on Information and Education After Myocardial Infarction With Insight for Mixed Reality Implementation: Cross-Sectional Interview Study JO - JMIR Hum Factors SP - e17147 VL - 7 IS - 2 KW - human factors KW - myocardial infarction KW - mixed reality KW - patient education KW - patient experience KW - PROM N2 - Background: Patient education is crucial in the secondary prevention of cardiovascular disease. Novel technologies such as augmented reality or mixed reality expand the possibilities for providing visual support in this process. Mixed reality creates interactive digital three-dimensional (3D) projections overlaying virtual objects on the real-world environment. While augmented reality only overlays objects, mixed reality not just overlays but anchors virtual objects to the real world. However, research on this technology in the patient domain is scarce. Objective: The aim of this study was to understand how patients perceive information provided after myocardial infarction and examine if mixed reality can be supportive in this process. Methods: In total, 12 patients that experienced myocardial infarction and 6 health care professionals were enrolled in the study. Clinical, demographic, and qualitative data were obtained through semistructured interviews, with a main focus on patient experiences within the hospital and the knowledge they gained about their disease. These data were then used to map a susceptible timeframe to identify how mixed reality can contribute to patient information and education. Results: Knowledge transfer after myocardial infarction was perceived by patients as too extensive, not personal, and inconsistent. Notably, knowledge on anatomy and medication was minimal and was not recognized as crucial by patients, whereas professionals stated the opposite. Patient journey analysis indicated the following four critical phases of knowledge transfer: at hospital discharge, at the first outpatient visit, during rehabilitation, and during all follow-up outpatient visits. Important patient goals were understanding the event in relation to daily life and its implications on resuming daily life. During follow-up, understanding physical limitations and coping with the condition and medication side effects in daily life emerged as the most important patient goals. The professionals? goals were to improve recovery, enhance medication adherence, and offer coping support. Conclusions: There is a remarkable difference between patients? and professionals? goals regarding information and education after myocardial infarction. Mixed reality may be a practical tool to unite perspectives of patients and professionals on the disease in a more even manner, and thus optimize knowledge transfer after myocardial infarction. Improving medication knowledge seems to be a feasible target for mixed reality. However, further research is needed to create durable methods for education on medication through mixed reality interventions. UR - http://humanfactors.jmir.org/2020/2/e17147/ UR - http://dx.doi.org/10.2196/17147 UR - http://www.ncbi.nlm.nih.gov/pubmed/32573464 ID - info:doi/10.2196/17147 ER - TY - JOUR AU - Babini, H. Mohammad AU - Kulish, V. Vladimir AU - Namazi, Hamidreza PY - 2020/6/1 TI - Physiological State and Learning Ability of Students in Normal and Virtual Reality Conditions: Complexity-Based Analysis JO - J Med Internet Res SP - e17945 VL - 22 IS - 6 KW - virtual reality KW - learning ability KW - brain KW - facial muscle KW - fractal theory N2 - Background: Education and learning are the most important goals of all universities. For this purpose, lecturers use various tools to grab the attention of students and improve their learning ability. Virtual reality refers to the subjective sensory experience of being immersed in a computer-mediated world, and has recently been implemented in learning environments. Objective: The aim of this study was to analyze the effect of a virtual reality condition on students? learning ability and physiological state. Methods: Students were shown 6 sets of videos (3 videos in a two-dimensional condition and 3 videos in a three-dimensional condition), and their learning ability was analyzed based on a subsequent questionnaire. In addition, we analyzed the reaction of the brain and facial muscles of the students during both the two-dimensional and three-dimensional viewing conditions and used fractal theory to investigate their attention to the videos. Results: The learning ability of students was increased in the three-dimensional condition compared to that in the two-dimensional condition. In addition, analysis of physiological signals showed that students paid more attention to the three-dimensional videos. Conclusions: A virtual reality condition has a greater effect on enhancing the learning ability of students. The analytical approach of this study can be further extended to evaluate other physiological signals of subjects in a virtual reality condition. UR - https://www.jmir.org/2020/6/e17945 UR - http://dx.doi.org/10.2196/17945 UR - http://www.ncbi.nlm.nih.gov/pubmed/32478661 ID - info:doi/10.2196/17945 ER - TY - JOUR AU - Ingrassia, Luigi Pier AU - Mormando, Giulia AU - Giudici, Eleonora AU - Strada, Francesco AU - Carfagna, Fabio AU - Lamberti, Fabrizio AU - Bottino, Andrea PY - 2020/5/12 TI - Augmented Reality Learning Environment for Basic Life Support and Defibrillation Training: Usability Study JO - J Med Internet Res SP - e14910 VL - 22 IS - 5 KW - augmented reality KW - cardiopulmonary resuscitation KW - automated external defibrillators N2 - Background: Basic life support (BLS) is crucial in the emergency response system, as sudden cardiac arrest is still a major cause of death worldwide. Unfortunately, only a minority of victims receive cardiopulmonary resuscitation (CPR) from bystanders. In this context, training could be helpful to save more lives, and technology-enhanced BLS simulation is one possible solution. Objective: The aim of this study is to assess the feasibility and acceptability of our augmented reality (AR) prototype as a tool for BLS training. Methods: Holo-BLSD is an AR self-instruction training system, in which a standard CPR manikin is ?augmented? with an interactive virtual environment that reproduces realistic scenarios. Learners can use natural gestures, body movements, and spoken commands to perform their tasks, with virtual 3D objects anchored to the manikin and the environment. During the experience, users were trained to use the device while being guided through an emergency simulation and, at the end, were asked to complete a survey to assess the feasibility and acceptability of the proposed tool (5-point Likert scale; 1=Strongly Disagree, 5=Strongly Agree). Results: The system was rated easy to use (mean 4.00, SD 0.94), and the trainees stated that most people would learn to use it very quickly (mean 4.00, SD 0.89). Voice (mean 4.48, SD 0.87), gaze (mean 4.12, SD 0.97), and gesture interaction (mean 3.84, SD 1.14) were judged positively, although some hand gesture recognition errors reduced the feeling of having the right level of control over the system (mean 3.40, SD 1.04). Conclusions: We found the Holo-BLSD system to be a feasible and acceptable tool for AR BLS training. UR - https://www.jmir.org/2020/5/e14910 UR - http://dx.doi.org/10.2196/14910 UR - http://www.ncbi.nlm.nih.gov/pubmed/32396128 ID - info:doi/10.2196/14910 ER - TY - JOUR AU - Chang, Chen-Wei AU - Yeh, Shih-Ching AU - Li, Mengtong PY - 2020/1/17 TI - The Adoption of a Virtual Reality?Assisted Training System for Mental Rotation: A Partial Least Squares Structural Equation Modeling Approach JO - JMIR Serious Games SP - e14548 VL - 8 IS - 1 KW - virtual reality KW - computer simulation KW - educational technology KW - training programs N2 - Background: Virtual reality (VR) technologies have been developed to assist education and training. Although recent research suggested that the application of VR led to effective learning and training outcomes, investigations concerning the acceptance of these VR systems are needed to better urge learners and trainees to be active adopters. Objective: This study aimed to create a theoretical model to examine how determining factors from relevant theories of technology acceptance can be used to explain the acceptance of a novel VR-assisted mental rotation (MR) training system created by our research team to better understand how to encourage learners to use VR technology to enhance their spatial ability. Methods: Stereo and interactive MR tasks based on Shepard and Metzler?s pencil and paper test for MR ability were created. The participants completed a set of MR tasks using 3D glasses and stereoscopic display and a 6-degree-of-freedom joystick controller. Following task completion, psychometric constructs from theories and previous studies (ie, perceived ease of use, perceived enjoyment, attitude, satisfaction, and behavioral intention to use the system) were used to measure relevant factors influencing behavior intentions. Results: The statistical technique of partial least squares structural equation modeling was applied to analyze the data. The model explained 47.7% of the novel, VR-assisted MR training system?s adoption intention, which suggests that the model has moderate explanatory power. Direct and indirect effects were also interpreted. Conclusions: The findings of this study have both theoretical and practical importance not only for MR training but also for other VR-assisted education. The results can extend current theories from the context of information systems to educational and training technology, specifically for the use of VR-assisted systems and devices. The empirical evidence has practical implications for educators, technology developers, and policy makers regarding MR training. UR - http://games.jmir.org/2020/1/e14548/ UR - http://dx.doi.org/10.2196/14548 UR - http://www.ncbi.nlm.nih.gov/pubmed/31804184 ID - info:doi/10.2196/14548 ER - TY - JOUR AU - Liaw, Ying Sok AU - Tan, Kiat Khoon AU - Wu, Ting Ling AU - Tan, Chee Seng AU - Choo, Hyekyung AU - Yap, John AU - Lim, Mui Sok AU - Wong, Lilian AU - Ignacio, Jeanette PY - 2019/05/28 TI - Finding the Right Blend of Technologically Enhanced Learning Environments: Randomized Controlled Study of the Effect of Instructional Sequences on Interprofessional Learning JO - J Med Internet Res SP - e12537 VL - 21 IS - 5 KW - blended learning KW - constructivism KW - instructional sequence KW - interprofessional learning KW - simulation KW - technologically-enhanced learning KW - virtual reality KW - web-based instruction N2 - Background: With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes. Objective: The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students? learning outcomes on interprofessional competencies. Methods: A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities?Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)?after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students? learning outcomes on interprofessional competencies. Results: A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence ?WI-VR-SE? as their top preference. Conclusions: This study shows that the instructional sequence of a blended learning approach can have a significant impact on students? learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students? learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments. UR - http://www.jmir.org/2019/5/e12537/ UR - http://dx.doi.org/10.2196/12537 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140432 ID - info:doi/10.2196/12537 ER - TY - JOUR AU - Aksoy, Emin PY - 2019/05/01 TI - Comparing the Effects on Learning Outcomes of Tablet-Based and Virtual Reality?Based Serious Gaming Modules for Basic Life Support Training: Randomized Trial JO - JMIR Serious Games SP - e13442 VL - 7 IS - 2 KW - serious gaming KW - virtual reality KW - health care education N2 - Background: Serious gaming is recognized as a training tool due its potential for a risk-free educational environment. There is still limited research about using serious gaming modules for emergency skills training. Objective: The aim of this study is to compare the effects on the knowledge level of participants after using a tablet-based serious game and a virtual reality (VR)?based serious game for Basic Life Support using a pretest/posttest method. Methods: The study was designed as a randomized trial comparing pretest and posttest results. A tablet-based and VR-based serious game with identical content was used for 40 participants. Over half of them (22/40, 55%) were included in the VR group and just under half (18/40, 45%) were in the tablet group. Student t test and Wilcoxon signed rank tests were used to determine the relation between the dependent and independent variables. In order to determine the effect size of the results, the effect size calculator (Cohen d) for t test was used. There is a significant difference between pre- and posttest results in both groups (P=.001; Wilcoxon). Results: Mean posttest results were significantly higher in both groups. The posttest results were significantly higher in the VR group in terms of pre- and posttest changes (P=.021; Student t test). Conclusions: Past research studies have shown that serious gaming presents a favorable additional tool for medical education. The results indicate that both serious gaming modules are effective and that VR-based serious gaming is more efficient in terms of learning outcome than tablet-based gaming. UR - http://games.jmir.org/2019/2/e13442/ UR - http://dx.doi.org/10.2196/13442 UR - http://www.ncbi.nlm.nih.gov/pubmed/31042153 ID - info:doi/10.2196/13442 ER - TY - JOUR AU - Ebner, Florian AU - De Gregorio, Amelie AU - Schochter, Fabienne AU - Bekes, Inga AU - Janni, Wolfgang AU - Lato, Krisztian PY - 2019/05/01 TI - Effect of an Augmented Reality Ultrasound Trainer App on the Motor Skills Needed for a Kidney Ultrasound: Prospective Trial JO - JMIR Serious Games SP - e12713 VL - 7 IS - 2 KW - ultrasound trainer KW - mobile device KW - mobile apps KW - augmented reality KW - kidney KW - sensitivity and specificity KW - ultrasonography KW - education KW - simulation training KW - telemedicine N2 - Background: Medical education is evolving from "learning by doing" to simulation-based hands-on tutorials. Objective: The aim of this prospective 2-armed study was to evaluate a newly developed augmented reality ultrasound app and its effect on educational training and diagnostic accuracy. Methods: We recruited 66 medical students and, using imaging and measuring a kidney as quality indicators, tested them on the time they needed for these tasks. Both groups used textbooks as preparation; in addition, the study group had access to a virtual ultrasound simulation app for mobile devices. Results: There was no significant difference between the study arms regarding age (P=.97), sex (P=.14), and previous ultrasound experience (P=.66). The time needed to complete the kidney measurements also did not differ significantly (P=.26). However, the results of the longitudinal kidney measurements differed significantly between the study and control groups, with larger, more realistic values in the study group (right kidney: study group median 105.3 mm, range 86.1-127.1 mm, control group median 92 mm, range 50.4-112.2 mm; P<.001; left kidney: study group median 100.3 mm, range 81.7-118.6 mm, control group median 85.3 mm, range 48.3-113.4 mm; P<.001). Furthermore, whereas all students of the study group obtained valid measurements, students of the control group did not obtain valid measurements of 1 or both kidneys in 7 cases. Conclusions: The newly developed augmented reality ultrasound simulator mobile app provides a useful add-on for ultrasound education and training. Our results indicate that medical students? use of the mobile app for training purposes improved the quality of kidney measurements. UR - http://games.jmir.org/2019/2/e12713/ UR - http://dx.doi.org/10.2196/12713 UR - http://www.ncbi.nlm.nih.gov/pubmed/31042155 ID - info:doi/10.2196/12713 ER - TY - JOUR AU - Masuoka, Yoshihito AU - Morikawa, Hiroyuki AU - Kawai, Takashi AU - Nakagohri, Toshio PY - 2019/01/14 TI - Use of Smartphone-Based Head-Mounted Display Devices to View a Three-Dimensional Dissection Model in a Virtual Reality Environment: Pilot Questionnaire Study JO - JMIR Med Educ SP - e11921 VL - 5 IS - 1 KW - medical education KW - smartphone KW - virtual reality N2 - Background: Virtual reality (VR) technology has started to gain attention as a form of surgical support in medical settings. Likewise, the widespread use of smartphones has resulted in the development of various medical applications; for example, Google Cardboard, which can be used to build simple head-mounted displays (HMDs). However, because of the absence of observed and reported outcomes of the use of three-dimensional (3D) organ models in relevant environments, we have yet to determine the effects of or issues with the use of such VR technology. Objective: The aim of this paper was to study the issues that arise while observing a 3D model of an organ that is created based on an actual surgical case through the use of a smartphone-based simple HMD. Upon completion, we evaluated and gathered feedback on the performance and usability of the simple observation environment we had created. Methods: We downloaded our data to a smartphone (Galaxy S6; Samsung, Seoul, Korea) and created a simple HMD system using Google Cardboard (Google). A total of 17 medical students performed 2 experiments: an observation conducted by a single observer and another one carried out by multiple observers using a simple HMD. Afterward, they assessed the results by responding to a questionnaire survey. Results: We received a largely favorable response in the evaluation of the dissection model, but also a low score because of visually induced motion sickness and eye fatigue. In an introspective report on simultaneous observations made by multiple observers, positive opinions indicated clear image quality and shared understanding, but displeasure caused by visually induced motion sickness, eye fatigue, and hardware problems was also expressed. Conclusions: We established a simple system that enables multiple persons to observe a 3D model. Although the observation conducted by multiple observers was successful, problems likely arose because of poor smartphone performance. Therefore, smartphone performance improvement may be a key factor in establishing a low-cost and user-friendly 3D observation environment. UR - http://mededu.jmir.org/2019/1/e11921/ UR - http://dx.doi.org/10.2196/11921 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344673 ID - info:doi/10.2196/11921 ER - TY - JOUR AU - Kleinert, Robert AU - Heiermann, Nadine AU - Plum, Sven Patrick AU - Wahba, Roger AU - Chang, De-Hua AU - Maus, Martin AU - Chon, Seung-Hun AU - Hoelscher, H. Arnulf AU - Stippel, Ludger Dirk PY - 2015/11/17 TI - Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education JO - J Med Internet Res SP - e263 VL - 17 IS - 11 KW - medical education KW - simulation KW - virtual patients KW - immersive N2 - Background: Clinical reasoning is based on the declarative and procedural knowledge of workflows in clinical medicine. Educational approaches such as problem-based learning or mannequin simulators support learning of procedural knowledge. Immersive patient simulators (IPSs) go one step further as they allow an illusionary immersion into a synthetic world. Students can freely navigate an avatar through a three-dimensional environment, interact with the virtual surroundings, and treat virtual patients. By playful learning with IPS, medical workflows can be repetitively trained and internalized. As there are only a few university-driven IPS with a profound amount of medical knowledge available, we developed a university-based IPS framework. Our simulator is free to use and combines a high degree of immersion with in-depth medical content. By adding disease-specific content modules, the simulator framework can be expanded depending on the curricular demands. However, these new educational tools compete with the traditional teaching Objective: It was our aim to develop an educational content module that teaches clinical and therapeutic workflows in surgical oncology. Furthermore, we wanted to examine how the use of this module affects student performance. Methods: The new module was based on the declarative and procedural learning targets of the official German medical examination regulations. The module was added to our custom-made IPS named ALICE (Artificial Learning Interface for Clinical Education). ALICE was evaluated on 62 third-year students. Results: Students showed a high degree of motivation when using the simulator as most of them had fun using it. ALICE showed positive impact on clinical reasoning as there was a significant improvement in determining the correct therapy after using the simulator. ALICE positively impacted the rise in declarative knowledge as there was improvement in answering multiple-choice questions before and after simulator use. Conclusions: ALICE has a positive effect on knowledge gain and raises students? motivation. It is a suitable tool for supporting clinical education in the blended learning context. UR - http://www.jmir.org/2015/11/e263/ UR - http://dx.doi.org/10.2196/jmir.5035 UR - http://www.ncbi.nlm.nih.gov/pubmed/26577020 ID - info:doi/10.2196/jmir.5035 ER - TY - JOUR AU - Kleinert, Robert AU - Wahba, Roger AU - Chang, De-Hua AU - Plum, Patrick AU - Hölscher, H. Arnulf AU - Stippel, L. Dirk PY - 2015/04/08 TI - 3D Immersive Patient Simulators and Their Impact on Learning Success: A Thematic Review JO - J Med Internet Res SP - e91 VL - 17 IS - 4 KW - immersive patient simulators KW - Web-based learning KW - validity KW - immersion KW - procedural knowledge N2 - Background: Immersive patient simulators (IPSs) combine the simulation of virtual patients with a three-dimensional (3D) environment and, thus, allow an illusionary immersion into a synthetic world, similar to computer games. Playful learning in a 3D environment is motivating and allows repetitive training and internalization of medical workflows (ie, procedural knowledge) without compromising real patients. The impact of this innovative educational concept on learning success requires review of feasibility and validity. Objective: It was the aim of this paper to conduct a survey of all immersive patient simulators currently available. In addition, we address the question of whether the use of these simulators has an impact on knowledge gain by summarizing the existing validation studies. Methods: A systematic literature search via PubMed was performed using predefined inclusion criteria (ie, virtual worlds, focus on education of medical students, validation testing) to identify all available simulators. Validation testing was defined as the primary end point. Results: There are currently 13 immersive patient simulators available. Of these, 9 are Web-based simulators and represent feasibility studies. None of these simulators are used routinely for student education. The workstation-based simulators are commercially driven and show a higher quality in terms of graphical quality and/or data content. Out of the studies, 1 showed a positive correlation between simulated content and real content (ie, content validity). There was a positive correlation between the outcome of simulator training and alternative training methods (ie, concordance validity), and a positive coherence between measured outcome and future professional attitude and performance (ie, predictive validity). Conclusions: IPSs can promote learning and consolidation of procedural knowledge. The use of immersive patient simulators is still marginal, and technical and educational approaches are heterogeneous. Academic-driven IPSs could possibly enhance the content quality, improve the validity level, and make this educational concept accessible to all medical students. UR - http://www.jmir.org/2015/4/e91/ UR - http://dx.doi.org/10.2196/jmir.3492 UR - http://www.ncbi.nlm.nih.gov/pubmed/25858862 ID - info:doi/10.2196/jmir.3492 ER - TY - JOUR AU - Papadopoulos, Lazaros AU - Pentzou, Afroditi-Evaggelia AU - Louloudiadis, Konstantinos AU - Tsiatsos, Thrasyvoulos-Konstantinos PY - 2013/10/29 TI - Design and Evaluation of a Simulation for Pediatric Dentistry in Virtual Worlds JO - J Med Internet Res SP - e240 VL - 15 IS - 10 KW - virtual patient KW - virtual world KW - pediatric dentistry KW - simulation KW - Second Life KW - OpenSim KW - communication KW - tell-show-do KW - behavior management N2 - Background: Three-dimensional virtual worlds are becoming very popular among educators in the medical field. Virtual clinics and patients are already used for case study and role play in both undergraduate and continuing education levels. Dental education can also take advantage of the virtual world?s pedagogical features in order to give students the opportunity to interact with virtual patients (VPs) and practice in treatment planning. Objective: The objective of this study was to design and evaluate a virtual patient as a supplemental teaching tool for pediatric dentistry. Methods: A child VP, called Erietta, was created by utilizing the programming and building tools that online virtual worlds offer. The case is about an eight-year old girl visiting the dentist with her mother for the first time. Communication techniques such as Tell-Show-Do and parents? interference management were the basic elements of the educational scenario on which the VP was based. An evaluation of the simulation was made by 103 dental students in their fourth year of study. Two groups were formed: an experimental group which was exposed to the simulation (n=52) and a control group which did not receive the simulation (n=51). At the end, both groups were asked to complete a knowledge questionnaire and the results were compared. Results: A statistically significant difference between the two groups was found by applying a t test for independent samples (P<.001), showing a positive learning effect from the VP. The majority of the participants evaluated the aspects of the simulation very positively while 69% (36/52) of the simulation group expressed their preference for using this module as an additional teaching tool. Conclusions: This study demonstrated that a pediatric dentistry VP built in a virtual world offers significant learning potential when used as a supplement to the traditional teaching techniques. UR - http://www.jmir.org/2013/10/e240/ UR - http://dx.doi.org/10.2196/jmir.2651 UR - http://www.ncbi.nlm.nih.gov/pubmed/24168820 ID - info:doi/10.2196/jmir.2651 ER -