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Virtual reality in medical studies

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The use of virtual reality (VR) applications in healthcare has increased significantly in recent years. Technological advances in this field now enable a photorealistic representation of three-dimensional environments in which users can interactively immerse themselves with the help of a headset (glasses with high-resolution displays) and controllers (operating devices for manual interaction). The associated mental activation and deeper understanding of the interrelationships through realistic scenarios promote the anchoring of the content and make VR fundamentally interesting as a learning tool.

Various approaches are also attempting to utilise this potential for medical teaching, with two main areas of application having recently emerged: Firstly, it enables a growing number of learning programmes to display anatomical structures, in some cases down to microscopic detail or in context (e.g. the interaction of muscles and bones). This extends to the three-dimensional visualisation of complex operations in the abdominal cavity, which can be displayed in minute detail in their individual steps [1].

Secondly, VR-based simulations offer learners the opportunity to experience medical scenarios before they actually work in clinical practice. In particular, rare or critical disease processes can be depicted and their treatment practised in a safe environment. Accordingly, several VR-based simulations with different focal points (e.g. resuscitation measures or complex emergency medical case scenarios) have been realised in recent years and some have also been implemented in the curricula of individual faculties [2], [3],[4]. In addition, other programmes are in use with which highly specific medical activities such as post-mortem examinations or brain death diagnostics can be learned [5], [6]. Some of the applications allow several learners to work together on a virtual scenario. In this way, various aspects of teamwork such as communication or leadership skills can also be practised. VR scenarios have also been successfully used to test clinical-practical competences and have shown comparable performance data and even superior test scores [7]. There is ample evidence that VR-based learning environments are highly accepted by students and can increase motivation and self-confidence. The available evidence also already suggests advantages in terms of learning effects when using VR compared to traditional teaching methods. However, the number and quality of randomised controlled studies are still insufficient for a conclusive assessment [8].

Comparability with analogue phenomena

In traditional analogue practical courses, actors or simulation mannequins have mainly been used to date. In addition to the time-consuming organisation and high personnel and material costs, many scenarios cannot be adequately reproduced due to their complexity. As a result, some aspects of practical teaching (such as emergency management or clinical decision-making) have been neglected in previous curricula [9-10].

In contrast to analogue teaching methods, virtual simulations are theoretically available around the clock(permanence) and at different locations(location-independence). The use of VR technology is highly scalable, requires fewer financial resources and reduces the logistical effort for the transport and maintenance of simulators. At the same time, the design options in the scenarios in digital space are almost unlimited(increased changeability). Other strengths of digital technologies, such as the dynamic calculation of physiological parameters or AI-based language models, can also be integrated.

VR-based learning programmes have so far reached their limits when the haptic properties of materials, tools or fabrics play a prominent role. As the current controllers are still largely unsuitable for realistic tactile experiences, additional simulation devices or mannequins are sometimes used in such cases. These are detected by the sensors of the VR headsets and correctly localised in the virtual space.

Another shortcoming, the significance of which is steadily decreasing as the technology develops, is VR sickness (motion or simulator sickness), which can cause temporary symptoms such as dizziness or headaches in a small proportion of users.

Social relevance

VR-based learning and examination environments will enrich practical teaching in the healthcare professions in the future by opening up new, highly relevant content. The additional practice opportunities will give learners more security and self-confidence in dealing with critical situations, among other things. It stands to reason that this will also reduce the frequency of treatment errors among young professionals in the long term. VR-based training programmes with multi-user functionality also focus more strongly on important aspects such as communication and teamwork. Financial resources saved through the preferential use of VR technology over analogue simulators could be used to expand other practice offerings. In the long term, this could significantly increase the attractiveness and quality of medical training.

Sources

  1. Datta, R.R. et al. (2024). Der „Surgical Track“ – innovative Ansätze gegen den Nachwuchsmangel in der Chirurgie. Chirurgie.. https://doi.org/10.1007/s00104-023-02029-y
  2. Issleib, M. et al. (2021). Virtual reality as a teaching method for resuscitation training in undergraduate first year medical students: A randomized controlled trial. In: Scand J Trauma Resusc Emerg Med. 29(1), 27.
  3. Mühling, T.et al. (2023). Virtual reality in medical emergencies training: benefits, perceived stress, and learning success.In: Multimedia Systems 29(4), 2239–2252.
  4. Mahling, M. et al. (2023). Virtual reality for emergency medicine training in medical school: Prospective, large-cohort implementation study. In: J Med Internet Res. 25, e43649.
  5. Biolik, A. et al. (2019). Die virtuelle Leichenschau als interaktive Lehrmethode in der rechtsmedizinischen Ausbildung der Medizinstudierenden an der Martin-Luther-Universität Halle-Wittenberg. 14. Internationales SkillsLab Symposium 2019. Brandenburg (Havel)/Neuruppin, 29.–30.03.2019. DOI: 10.3205/19isls015.
  6. Schulze, H. et al. (2023). Hirntoddiagnostik in Virtual Reality – was denken Studierende darüber?. Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA). Osnabrück, 14.–16.09.2023. doi: 10.3205/23gma227
  7. Mühling, T. et al. (2023). Clinical Competency Assessments: A Comparative Study of Virtual-Reality-Based and Traditional Physical OSCE Stations. JMIR Preprints. 01/12/2023, 55066. DOI: 10.2196/preprints.55066.
  8. Kim H.Y./, Kim E-Y. Effects of Medical Education Program Using Virtual Reality: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2023. doi:10.3390/ijerph20053895.
  9. Fincke F, Prediger S, Schick K, Fürstenberg S, Spychala N, Berberat PO, et al. Entrustable professional activities and facets of competence in a simulated workplace-based assessment for advanced medical students. Med Teach. 2020;42(9):1019–26.
  10. Monrouxe LV, Grundy L, Mann M, John Z, Panagoulas E, Bullock A, et al. How prepared are UK medical graduates for practice? A rapid review of the literature 2009-2014. BMJ Open. 2017;7(1):e013656.