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REVIEW ARTICLE
Year : 2023 | Volume
: 50
| Issue : 1 | Page : 23-27
Virtual reality in medical institutions: Innovative tool to strengthen the process of delivery of medical education
Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2
1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
Correspondence Address:
Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jss.jss_159_21
The process of medical education delivery has evolved constantly considering the rapid progress in the field of medical sciences, and the varied roles expected of a health-care professional. The current review has been done to explore the role of virtual reality in medical education, and to identify the potential challenges and the suggestions that can aid in the successful introduction of the same in the undergraduate teaching period. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 23 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include virtual reality and medical education in the title alone only. Virtual reality is a kind of dynamic and adaptive learning and has been associated with multiple benefits that extend much beyond what is being offered by conventional teaching. Regardless of the multiple benefits, we must realize that it should be used to keep the intended learning outcomes in mind, so as to ensure that it can be integrated into the curriculum effectively. In conclusion, the tool of virtual reality has all the potential to transform medical education delivery in the coming days. Since virtual reality advocates principles of adult learning and gives them a platform to apply their knowledge to practice and subsequently improve on, it is quite necessary that all the medical colleges look to introduce the same within their setup and integrate it with conventional learning.
Keywords: Medical education, skills, virtual reality
The process of medical education delivery has evolved constantly, considering the rapid progress in the field of medical sciences, changes in the expectations of the general population, reforms in the healthcare atmosphere, and the varied roles expected of a health-care professional.[1] In the process of producing a competent medical graduate, we aim to provide experiential and self-directed learning, so that the medical student gives utmost priority to patient safety and the quality of care offered to the patients. Considering the vast amount of information available in the current world, the priority is not about retaining the facts, but the way in which it is used, interpreted, and applied to the overall patient care.[1],[2] The current review has been done to explore the role of virtual reality in medical education, and to identify the potential challenges and the suggestions that can aid in the successful introduction of the same in the undergraduate teaching period.
MethodsAn extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on research skills among medical students published in the period 2004–2021 were included in the review. A total of 26 studies similar to the current study objectives were identified initially, of which three were excluded due to the unavailability of the complete version of the articles. Overall, 23 articles were selected based upon their suitability with the current review objectives and analyzed. Keywords used in the search include virtual reality and medical education in the title alone only (viz., virtual reality [ti] AND medical education [ti]). The articles published in only the English language were included in the review [Figure 1]. The collected information is presented under the following subheadings, namely Virtual reality, Conventional teaching versus Virtual reality, Merits of virtual reality in medical education, Potential challenges and recommended solutions, Lessons from the field, Implications for practice, and Implications for research.
Virtual RealityVirtual reality refers to the use of software applications to generate an immersive simulated learning experience, wherein the users (in the current case – medical students) wear a head-mounted display, which enables them to engage with the virtual environment and the characters in such a way that it gives a feeling of being real.[1],[2] In recent years, significant advancement has been reported in the field of virtual reality, with useful applications in various sectors (viz., automobile, architecture, engineering, medicine, etc.). Such a wide application with encouraging results can be attributed to the very fact that virtual reality offers a standardized, repeatable, and controllable environment for the users.[1],[2],[3]
Virtual reality has been employed in both medical and nursing streams and helps students to learn from their experience in the virtual world.[3],[4] The delivery of standardized experience under controlled settings can prove to be extremely useful for facilitating learning among medical students. The virtual environment can be present in a virtual ward, wherein the students can interact with patients, or colleagues, or even with the caregivers, very much similar to the interactions that can happen in real settings. In other words, such a learning experience prepares medical students to take action during the authentic clinical experience.[1],[2],[3],[4] Furthermore, virtual reality has been employed in the demonstration of 3D anatomy, simulation of surgical procedures, teaching empathy to medical students, treatment of phobia or anxiety disorders, rehabilitation of patients, etc.[3],[4],[5],[6],[7]
Conventional Teaching versus Virtual RealityThe conventional mode of teaching is often lecture centered and has key attributes of memorization and attendance. In addition, we cannot ignore that hands-on practical training is a crucial aspect of conventional teaching.[2],[4] Nevertheless, this method of teaching has its own limitations, such as being monotonous, lack of standardization across the nation, inability to target all types of learners, constraints pertaining to assessment, and absence of feasible practices which can aid the students to acquire practical skills.[8],[9],[10] Steps like promotion of e-learning or employment of technology or implementation of problem-based learning, communication skills training, and simulation-based learning have been adopted to make conventional training more interactive and effective, keeping in mind the principles of adult learning.[6],[7],[8],[9]
Virtual reality is a kind of simulation wherein computer-created graphics are employed to produce a realistic world depending on the commands of users. However, considering the possibility of real-time interactivity, this technology aids in changing the input, which then brings about a change in the virtual environment.[10],[11],[12] Such kinds of exposure eliminate the possibility of being monotonous and ensure both theoretical and practical learning for different types of learners.[8],[9],[10] Virtual reality plays a significant role in the strengthening of surgical skills and improving the overall competence in different specialties.[6] The findings of a meta-analysis demonstrated that students who are trained with virtual reality had better pass rates, improvement in the acquisition of complex skills, and specialized knowledge, in comparison to the students who were trained using the conventional teaching methods.[13]
Merits of Virtual Reality in Medical EducationVirtual reality is a kind of dynamic and adaptive learning and has been associated with multiple benefits that extend much beyond what is being offered by conventional teaching.[7],[8],[9] Exposure to virtual reality can help medical students to refine their history taking skills, patient examination skills, improve their abilities to make an evidence based decision for ordering appropriate investigations, aid them in reaching a potential diagnosis and even acquire the skills to effectively treat the patients.[14],[16] The learning can be further enhanced by the inclusion of other human factors (viz. family members or team members), or clinical parameters of patients that are revised to make the overall experience enriching and similar to real life scenarios.[15],[17]
Further, the patients can be made to look restless and confused, that acts as a stressful factor for the trainee students and thereby prepare them for augmenting their performance in stressful circumstances. In short, medical students learn the skill of critical thinking, clinical reasoning, problem-solving, and decision-making, which are quite essential for successful clinical practice.[3],[4],[5],[6] Further, virtual reality plays an important role in improving the satisfaction of students as they not only gain knowledge but even acquire useful skills.[13],[14],[15] Moreover, due to the immediate feedback received on the technical or nontechnical skills, or owing to the debriefing received after the session, the probability of deep learning significantly enhances. In addition, the involved students can share their learning experiences with one another and the feedback received, so that the process of learning continues even after virtual learning.[16],[17],[18],[19]
Virtual reality in medical education ensures access to clinical experience, and as these devices are available in the market, thus they can be easily set up and used subsequently without being detrimental to the patients or students.[12],[14] Further, as students can learn even in the absence of teachers, they learn at their pace at their time of convenience. In other words, the learning does not remain confined to specific settings but can be merged into daily routine, in the form of simulation-based education. Moreover, as all the learning experiences can be done a multiple time via virtual reality, it helps the student to practice the same till they become better in their performance.[3],[4],[5],[6],[7]
From the medical college perspective, virtual reality enables the delivery of simulation at a minimal cost with limited resources. Further, as the role of teachers is limited, they can focus more on other learning attributes, which do not fit within the scope of virtual reality.[5],[6],[7],[8] At the same time, the potential scope for gamification and enjoyable learning ensures the active engagement of the students. In the long run, students become more confident in not only completing the assigned task but also comprehending the process of the learning experience.[18],[19],[20] Finally, as these can be used in any geographical location, the use of virtual reality removes the equation of physical presence at the place of learning or assessment.[2],[3],[4],[21]
Potential Challenges and Recommended SolutionsThe above discussion clearly suggests that virtual reality is linked with numerous benefits for medical students, faculty members, and administrators. However, we must realize that it should be used to keep the intended learning outcomes in mind, so as to ensure that it can be integrated into the curriculum effectively.[13],[14],[15] For instance, virtual reality cannot be employed in all settings, like the ideal way to teach palpation of the abdomen is via direct contact with the patient and there is no need to introduce virtual reality in this case. On a similar note, we need not introduce virtual reality for breaking the bad news, as the most authentic exposure which a student will get is when s/he is interacting with humans instead of a virtual patient.[15],[22]
In addition, there are a number of other potential challenges that need to be considered before introducing virtual reality in any medical institution [Table 1]. At the same time, with systematic planning and support from different stakeholders, these challenges can be effectively addressed, and the effectiveness of the same can be significantly enhanced.[20],[21],[22],[23] The ground reality is that virtual reality should not be looked upon as the replacement of a medical teacher. Similarly, physical simulation cannot substitute clinical training, as both have their pros and cons. Virtual reality is definitely a technique that has immense potential in the current era and in the times to come. Nevertheless, we have to be smart enough to decide about the competencies that can be taught via conventional teaching and the competencies that require the introduction of virtual reality.[19],[20],[21],[22] If we are able to make this call, not only we will be able to produce a health workforce ready for future developments but also minimize the cost related to virtual reality and reduce the workload on faculty members.[11],[13]
Illustrations from Academic FieldAs already mentioned, virtual reality has found immense applications in both medical and nursing streams, and that too in both undergraduate and postgraduate education worldwide. These applications range from performing a cardiac examination on a virtual patient, or learning suturing or cardiopulmonary resuscitation skills, or observing the pupillary response to light, etc. At the University of Northampton, virtual reality has been employed for nursing students to enable them to learn various skills (viz., soft skills, clinical skills, etc.) in small groups. The virtual environment is simultaneously projected on a screen to help other students also to experience the same and thus envisage peer learning. The students are given immediate feedback, and upon the end of the session, there will be a debriefing session as well, and thus, the learning becomes long term.[1]
At the University of Oxford, virtual reality has been implemented for training both medical students and doctors. Apart from using it for teaching, the university has been using virtual reality during the times of recruitment of faculty members as a proxy indicator to ascertain their competence levels.[1] Moreover, the utility of virtual reality has been explored in conducting objective structured clinical examinations, as it will significantly minimize the efforts and the cost involved. We must acknowledge that the employment of virtual reality during faculty recruitment or during assessments can significantly aid in saving time, eliminate the need for space constraints, and the need for the mandatory presence of experts.
Implications for PracticeConsidering the widespread utility of virtual reality in the field of medicine, all medical colleges should look forward to implementing the same within their settings.[5],[6],[7] This will essentially require faculty development programs to train them about different applications and the ways, in which they can be used to develop skills among students. This has to be followed by a department-level meeting, wherein the entire team of faculty members decides on the competencies that will need a virtual reality for training or assessment.[12],[14] The pros and cons of the same should also be discussed in depth and then batch-wise students can be exposed to the same. It is very essential that the administration should support the entire process.[2],[3]
Implications for ResearchAs virtual reality is still finding its feet in most of the developing nations, especially with regard to medical education delivery, there is ample amount of scope for conducting research work.[9],[10],[11],[12],[13],[14],[15],[16],[17],[18] The research activity can start itself with carrying out a needs assessment among medical students about introducing virtual reality as a part of the curriculum. At the same time, even the readiness of faculty members to adopt another tool for teaching-learning can be ascertained and the potential barriers can be identified.[20],[21],[22] Further, once virtual reality has been implemented, it is always a good strategy to explore the experiences of different stakeholders. It will be ideal to carry out a qualitative study, wherein the opinion of medical students as well as faculty members can be identified pertaining to what they liked and what needs further modification. Based on the given suggestions, subsequent modifications can be brought about.
ConclusionThe tool of virtual reality has all the potential to transform medical education delivery in the coming days. Since virtual reality advocates principles of adult learning and gives them a platform to apply their knowledge to practice and subsequently improve upon, it is quite necessary that all the medical colleges look to introduce the same within their setup and integrate it with conventional learning.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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