Impact of Virtual and Augmented Reality on Quality of Medical Education During the COVID-19 Pandemic: A Systematic Review

Effectiveness of Virtual and Augmented Reality for Emergency Healthcare Training: A Randomized Controlled Trial

Background: Appropriate clinical training for emergencies is a key factor in the quality of healthcare. Advances in technology facilitate the creation of new forms of training, fostering student interaction and engagement. In this respect, augmented and virtual reality approaches in healthcare training are generating great interest. Objectives: to evaluate the effectiveness of virtual and augmented reality in emergency healthcare training. Methods: A randomized controlled trial was conducted with two intervention groups. Intervention group No. 1 (n = 30) received in-class instruction followed by practice with a cardiopulmonary resuscitation (CPR) manikin and using virtual reality with the Meta Quest model (using the VR applications Heart, Lung, and School of CPR). Intervention group No. 2 (n = 31) received the same in-class training but followed by an augmented reality session. In this intervention, the Heart and Lung AR applications were used on an iPhone 15 ProMax. The control group (n = 32) only received in-class instruction and practice with the CPR manikin. Results: The virtual reality and augmented reality interventions improved learning effectiveness and user satisfaction. These results were statistically significant (p < 0.05) for knowledge post-intervention between groups, VR being the highest. However, the results were not significant for satisfaction. Conclusions: VR procedures can be effective for increasing learning effectiveness in emergency training.

Improving primary healthcare quality in China through training needs analysis

The diagnosis and treatment capability levels of healthcare professionals directly affect the overall quality of medical services. Enhancing these capability levels requires strengthening the professional skill training of healthcare workers, especially those in primary care settings in economically underdeveloped areas. To understand the actual needs for professional skill training among primary healthcare workers, thereby providing data support for targeted training initiatives. An online survey was conducted using convenience sampling and subsequently, snowball sampling from May 10, 2023 to January 31, 2024. The survey included 3811 healthcare workers across China, and 3617 valid questionnaires were recovered. Descriptive analysis was used to compare the professional backgrounds and training needs of healthcare workers at different medical facility levels. Univariate and multivariate logistic regression analyses were employed to explore factors influencing the training of primary healthcare workers. The survey revealed that 70.1% of respondents were female, and 94.2% were from medical facilities below the provincial level, with 43.2% from township-level or lower medical facilities. Significant differences were found in age distribution, work experience, professional titles, educational levels, and training needs among provincial/national, prefectural/county, and township levels (P < 0.05). Busy clinical work schedules were the primary barrier to training participation. Most healthcare workers (78.7%) expected more than four training sessions per year, with the optimal frequency being quarterly. The most anticipated training topics among primary care workers were latest medical guidelines, new technologies/skills, and advanced management concepts, with over 80% interest. Compared with prefectural/county-level facilities, primary care workers at grassroots facilities are more significantly impacted by lower professional titles, lower education levels, weaker medical/technical skills, and insufficient specialized funding (odds ratio > 1, P < 0.001). Training should be tailored to the needs of healthcare workers at different medical facility levels. Particularly for primary care settings, providing special funding support and training in the latest medical guidelines, new technologies/skills, and advanced management concepts are important to improve the composition of titles, education, and professional technicians.

Immersive interfaces for clinical applications: current status and future perspective

Digital immersive technologies have become increasingly prominent in clinical research and practice, including medical communication and technical education, serious games for health, psychotherapy, and interfaces for neurorehabilitation. The worldwide enthusiasm for digital health and digital therapeutics has prompted the development and testing of numerous applications and interaction methods. Nevertheless, the lack of consistency in the approaches and the peculiarity of the constructed environments contribute to an increasing disparity between the eagerness for new immersive designs and the long-term clinical adoption of these technologies. Several challenges emerge in aligning the different priorities of virtual environment designers and clinicians. This article seeks to examine the utilization and mechanics of medical immersive interfaces based on extended reality and highlight specific design challenges. The transfer of skills from virtual to clinical environments is often confounded by perceptual and attractiveness factors. We argue that a multidisciplinary approach to development and testing, along with a comprehensive acknowledgement of the shared mechanisms that underlie immersive training, are essential for the sustainable integration of extended reality into clinical settings. The present review discusses the application of a multilevel sensory framework to extended reality design, with the aim of developing brain-centered immersive interfaces tailored for therapeutic and educational purposes. Such a framework must include broader design questions, such as the integration of digital technologies into psychosocial care models, clinical validation, and related ethical concerns. We propose that efforts to bridge the virtual gap should include mixed methodologies and neurodesign approaches, integrating user behavioral and physiological feedback into iterative design phases.

Augmented and Virtual Reality Applications in Rhinology: A Scoping Review

OBJECTIVES

Virtual reality (VR) and augmented reality (AR) are innovative technologies that have a wide range of potential applications in the health care industry. The aim of this study was to investigate the body of research on AR and VR applications in rhinology by performing a scoping review.

DATA SOURCES

PubMed, Scopus, and Embase.

REVIEW METHODS

According to PRISM-ScR guidelines, a scoping review of literature on the application of AR and/or VR in the context of Rhinology was conducted using PubMed, Scopus, and Embase.

RESULTS

Forty-nine articles from 1996 to 2023 met the criteria for review. Five broad types of AR and/or VR applications were found: preoperative, intraoperative, training/education, feasibility, and technical. The subsequent clinical domains were recognized: craniovertebral surgery, nasal endoscopy, transsphenoidal surgery, skull base surgery, endoscopic sinus surgery, and sinonasal malignancies.

CONCLUSION

AR and VR have comprehensive applications in Rhinology. AR for surgical navigation may have the most emerging potential in skull base surgery and endoscopic sinus surgery. VR can be utilized as an engaging training tool for surgeons and residents and as a distraction analgesia for patients undergoing office-based procedures. Additional research is essential to further understand the tangible effects of these technologies on measurable clinical results. Laryngoscope, 134:4433-4440, 2024.

Live Surgery in Orthopedics: Balancing Educational Benefits and Ethical Challenges in the Modern Surgical Practice

There is a saying that “a picture speaks more than a thousand words.” Similarly, an ongoing video streaming of live surgery can teach you much more than what books can teach. Live surgery in orthopedics offers a unique and dynamic educational experience, providing real-time insights into surgical techniques and decision-making processes. This method has been praised for its potential to enhance learning among residents and practicing surgeons by offering an unfiltered view of operative procedures. However, the integration of live surgery into educational frameworks is not without its challenges. Ethical concerns, patient safety, and the potential for increased stress on the performing surgeon are significant considerations that must be balanced against the educational benefits. Ethical challenges in orthopedic surgery often revolve around the introduction of new technology and maintaining patient safety and confidentiality during live broadcasts [1]. Furthermore, the effectiveness of live surgery as an educational tool must be carefully weighed against these ethical dilemmas and the associated risks [2]. As live surgical broadcasts become more prevalent, it is crucial to establish standardized guidelines to ensure patient safety and uphold ethical standards [3]. This editorial aims to explore the delicate balance between the educational benefits and the ethical challenges inherent in the practice of live surgery within the field of orthopedics.

A comprehensive study on unraveling the advances of immersive technologies (VR/AR/MR/XR) in the healthcare sector during the COVID-19: Challenges and solutions

The current COVID-19 pandemic has affected almost every aspect of life but its impact on the healthcare landscape is conspicuously adverse. However, digital technologies played a significant contribution in coping with the challenges spawned by this pandemic. In this list of applied digital technologies, the role of immersive technologies in battling COVID-19 is notice-worthy. Immersive technologies consisting of virtual reality (VR), augmented reality (AR), mixed reality (MR), extended reality (XR), metaverse, gamification, etc. have shown enormous market growth within the healthcare system, particularly with the emergence of pandemics. These technologies supplemented interactivity, immersive experience, 3D modeling, touching sensory elements, simulation, and feedback mechanisms to tackle the COVID-19 disease in healthcare systems. Keeping in view the applicability and significance of immersive technological advancement, the major aim of this study is to identify and highlight the role of immersive technologies concerning handling COVID-19 in the healthcare setup. The contribution of immersive technologies in the healthcare domain for the different purposes such as medical education, medical training, proctoring, online surgeries, stress management, social distancing, physical fitness, drug manufacturing and designing, and cognitive rehabilitation is highlighted. A comprehensive and in-depth analysis of the collected studies has been performed to understand the current research work and future research directions. A state-of-the-artwork is presented to identify and discuss the various issues involving the adoption of immersive technologies in the healthcare area. Furthermore, the solutions to these emerging challenges and issues have been provided based on an extensive literature study. The results of this study show that immersive technologies have the considerable potential to provide massive support to stakeholders in the healthcare system during current COVID-19 situation and future pandemics.

The Virtual Reality Radiology Workstation: Current Technology and Future Applications

Virtual reality (VR) and augmented reality (AR) technology hold potential across many disciplines in medicine to expand the delivery of education and healthcare. VR-AR applications in radiology, in particular, have gained prominence and have demonstrated advantages in many areas within the field. Recently, VR software has emerged to redesign the physical radiology workstation (ie, reading room) to expand the possibilities of diagnostic interpretation. Given the novelty of this technology, there is limited research investigating the potential applications of a simulated radiology workstation. In this review article, we explore VR-simulated reading room technology in its current form and illustrate the practical applications this technology will bring to future radiologists and learners. We also discuss the limitations and barriers to adopting this technology that must be overcome to truly understand its potential benefits. VR reading room technology offers great potential in radiology, but further research is needed to appreciate its benefits and identify areas for improvement. The findings and insights presented in this review contribute to the ongoing discourse on future technological advancements in radiology and healthcare, offering valuable recommendations for further research and practical implementation.

Enhanced Total Hip Arthroplasty Education Using Augmented Reality: A Survey From a Tertiary Center

BACKGROUND

For total hip arthroplasty (THA), a new technology in the evolution of computer-assisted surgery has emerged in the form of augmented reality (AR). We sought to determine the impact of AR on resident and fellow education after implementation at an academic teaching center.

MATERIALS AND METHODS

The senior author's intraoperative technique allows for the orthopedic trainee to use AR to correct the acetabular component's position after an attempt is made with standard instrumentation. One year after the implementation of this AR method, both resident and fellow trainees were issued an anonymous survey regarding their experience and descriptive statistics were calculated for the results.

RESULTS

Sixteen trainees responded to the survey. One hundred percent felt the use of AR improved their understanding of acetabular component placement and improved their intraoperative experience. Sixty-nine percent reported feeling there was a small increase in operative time but 25% reported no increase in operative time when using AR. Seventy-five percent of trainees felt that patients benefited from the technology and would be in favor of AR if they were having a THA. The majority of those surveyed reported a desire to use AR in their practice if it is available.

CONCLUSION

Computer-assisted surgery has demonstrated variable impacts on orthopedic education. After the implementation of AR at an academic teaching center, all trainees reported it improved their intraoperative experience and their understanding of acetabular component placement. Further studies are needed to determine if AR is able to improve a trainee's component placement. [Orthopedics. 2024;47(4):e157-e160.].

Pressure Ulcer Management Virtual Reality Simulation (PU-VRSim) for Novice Nurses: Mixed Methods Study

BACKGROUND

Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations.

OBJECTIVE

We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences.

METHODS

PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim.

RESULTS

The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management.

CONCLUSIONS

The results revealed that PU-VRSim could improve novice nurses' learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses.

Exploring Augmented Reality Integration in Diagnostic Imaging: Myth or Reality?

This study delves into the transformative potential of integrating augmented reality (AR) within imaging technologies, shedding light on this evolving landscape. Through a comprehensive narrative review, this research uncovers a wealth of literature exploring the intersection between AR and medical imaging, highlighting its growing prominence in healthcare. AR's integration offers a host of potential opportunities to enhance surgical precision, bolster patient engagement, and customize medical interventions. Moreover, when combined with technologies like virtual reality (VR), artificial intelligence (AI), and robotics, AR opens up new avenues for innovation in clinical practice, education, and training. However, amidst these promising prospects lie numerous unanswered questions and areas ripe for exploration. This study emphasizes the need for rigorous research to elucidate the clinical efficacy of AR-integrated interventions, optimize surgical workflows, and address technological challenges. As the healthcare landscape continues to evolve, sustained research efforts are crucial to fully realizing AR's transformative impact in medical imaging. Systematic reviews on AR in healthcare also overlook regulatory and developmental factors, particularly in regard to medical devices. These include compliance with standards, safety regulations, risk management, clinical validation, and developmental processes. Addressing these aspects will provide a comprehensive understanding of the challenges and opportunities in integrating AR into clinical settings, informing stakeholders about crucial regulatory and developmental considerations for successful implementation. Moreover, navigating the regulatory approval process requires substantial financial resources and expertise, presenting barriers to entry for smaller innovators. Collaboration across disciplines and concerted efforts to overcome barriers will be essential in navigating this frontier and harnessing the potential of AR to revolutionize healthcare delivery.

Introducing Virtual Reality in a STEMI Coronary Syndrome Course: Qualitative Evaluation with Nurses and Doctors

In the increasing number of medical education topics taught with virtual reality (VR), the prehospital management of ST-segment elevation myocardial infarction (STEMI) had not been considered. This article proposes an implemented VR system for STEMI training and introduces it in an institutional course addressed to emergency nurses and case manager (CM) doctors. The system comprises three different applications to, respectively, allow (a) the course instructor to control the conditions of the virtual patient, (b) the CM to communicate with the nurse in the virtual field and receive from him/her the patient's parameters and electrocardiogram, and (c) the nurse to interact with the patient in the immersive VR scenario. We enrolled 17 course participants to collect their perceptions and opinions through a semistructured interview. The thematic analysis showed the system was appreciated (n = 17) and described as engaging (n = 4), challenging (n = 5), useful to improve self-confidence (n = 4), innovative (n = 5), and promising for training courses (n = 10). Realism was also appreciated (n = 13), although with some drawbacks (e.g., oversimplification; n = 5). Overall, participants described the course as an opportunity to share opinions (n = 8) and highlight issues (n = 4) and found it useful for novices (n = 5) and, as a refresh, for experienced personnel (n = 6). Some participants suggested improvements in the scenarios' type (n = 5) and variability (n = 5). Although most participants did not report usage difficulties with the VR system (n = 13), many described the need to get familiar with it (n = 13) and the specific gestures it requires (n = 10). Three suffered from cybersickness.

Immersive virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

The purpose of this review was to (1) analyze the effectiveness of immersive virtual reality (iVR) and augmented reality (AR) as teaching/learning resources (collectively called XR-technologies) for gaining anatomy knowledge compared to traditional approaches and (2) gauge students' perceptions of the usefulness of these technologies as learning tools. This meta-analysis, previously registered in PROSPERO (CRD42023423017), followed PRISMA guidelines. A systematic bibliographical search, without time parameters, was conducted through four databases until June 2023. A meta-analytic approach investigated knowledge gains and XR's usefulness for learning. Pooled effect sizes were estimated using Cohen's standardized mean difference (SMD) and 95% confidence intervals (95% CI). A single-group proportional meta-analysis was conducted to quantify the percentage of students who considered XR devices useful for their learning. Twenty-seven experimental studies, reporting data from 2199 health sciences students, were included for analysis. XR-technologies yielded higher knowledge gains than traditional approaches (SMD = 0.40; 95% CI = 0.22 to 0.60), especially when used as supplemental/complementary learning resources (SMD = 0.52; 95% CI = 0.40 to 0.63). Specifically, knowledge performance using XR devices outperformed textbooks and atlases (SMD = 0.32; 95% CI = 0.10 to 0.54) and didactic lectures (SMD = 1.00; 95% CI = 0.57 to 1.42), especially among undergraduate students (SMD = 0.41; 95% CI = 0.20 to 0.62). XR devices were perceived to be more useful for learning than traditional approaches (SMD = 0.54; 95% CI = 0.04 to 1), and 80% of all students who used XR devices reported these devices as useful for learning anatomy. Learners using XR technologies demonstrated increased anatomy knowledge gains and considered these technologies useful for learning anatomy.

The evolution of augmented reality to augment physical therapy: A scoping review

Augmented reality is increasingly used in health care, yet little is known about how AR is being used in physical therapy practice and what clinical outcomes could occur with technology use. In this scoping review, a broad literature review was conducted to gain an understanding of current knowledge of AR use and outcomes in physical therapy practice. A structured literature search of articles published between 2000 to September 2023 that examined the use of AR in a physical therapy context was conducted. Reference lists of articles for full review were searched for additional studies. Data from articles meeting inclusion criteria were extracted and synthesized across studies. 549 articles were identified; 40 articles met criteria for full review. Gait and balance of neurological and older adult populations were most frequently targeted, with more recent studies including orthopedic and other populations. Approximately half were pilot or observational studies and half are experimental. Many studies found within group improvements. Of studies reporting between group differences, AR interventions were more effective in improving function almost half of the time, with 20%, 27% and 28% showing efficacy in disability, balance, and gait outcomes. AR in physical therapy holds promise; however, efficacy outcomes are unclear.

The Impact of COVID-19 on Medical Education: A Lost Generation of Ophthalmologists?

PURPOSE

COVID-19 had a significant impact on undergraduate medical education. There has been extensive analysis on the generic impact on medical education, but the individual impact on specialties, particularly ophthalmology, has not been widely researched. We explored the impact of COVID-19 on the undergraduate ophthalmology experience in the UK, characterising the effect on medical education and considered positive outcomes that could be implemented in future undergraduate curricula.

METHODS

An online-cross sectional study was performed using a 13-item questionnaire in 2023, completed by 101 participants from UK medical schools. This study was conducted through University College London, England.

RESULTS

Statistical and qualitative analysis revealed a significant reduction in clinical exposure during the pandemic with an almost complete shift to online lecture-based teaching. This teaching style has been adapted post-pandemic, which is impacting student confidence in dealing with ophthalmic conditions and deterring them from considering ophthalmology as a career.

CONCLUSIONS

COVID-19 has exacerbated a pre-existing gap in training medical trainees to deal with ophthalmic presentations. With an increase in the proportion of undergraduate medical education taking place online, efforts should be made to ensure students have hands-on, clinical exposure especially in practical placements, such as ophthalmology.

United Kingdom medical student expansion - Can new medical schools seize the initiative?

In June 2023, National Health Service (NHS) England published a Long-Term Workforce Plan 'to put staffing on a sustainable footing and improve patient care.' The plan falls in to three main areas: train, retain and reform. Currently there are around 7,500 medical school places available annually in England, but it is proposed to increase this to 10,000 by 2028 and to 15,000 by 2031. Five new medical schools were approved in the 2018 expansion and others are preparing applications in anticipation of future expansion. In this article, we discuss what factors might shape a new medical school, ensuring it meets the standards required by the UK regulator (General Medical Council) set out in Promoting Excellence and in Outcomes for Graduates.