Use of a three-dimensional virtual environment to teach drug-receptor interactions

Impact of Virtual Reality on Pharmacology Education: A Pilot Study

Introduction Virtual reality (VR) is a powerful tool in health professional education. It has been successfully implemented in various domains of education with positive learning outcomes. The three-dimensional (3D) visualization offered by VR can potentially be applied to learn complex pharmacology topics. This study aims to investigate whether VR technology can improve the learning of complex pharmacological concepts. Methods A VR learning module on cardiovascular drugs was developed using Kern's six-step framework. 32 medical students participated in the pilot study. Their pharmacology knowledge was assessed using pre- and post-intervention tests. Additionally, feedback from the participants were collected through a post-intervention survey that assessed learner satisfaction, ease of use, perceived usefulness, quality of visual elements, intention to use, and comfort level during the VR experience. Results Participants scored significantly higher in the post-intervention test than in the pre-intervention test (p <0.05). A majority of the participants (90%) were satisfied with the VR module, finding it easy to use, and time efficient. A minority of participants (15%) preferred a traditional learning format while some participants (20%) experienced discomfort in VR. Conclusion Our findings suggest that VR enhances pharmacology knowledge in medical students and is well-received as an innovative educational tool. By providing immersive 3D visualization of complex drug actions, VR has the potential to transform pharmacology education into an engaging and effective learning experience.

An idea to explore: Augmented reality and LEGO® brick modeling in the biochemistry and cell biology classroom-two tactile ways to teach biomolecular structure-Function

We present here two accessible ways for enhanced understanding of complex biological structures and their function in undergraduate Biology and Biochemistry classrooms. These methods can be applied for in-class instruction as well as for remote lessons, as they are cheap, easily available and easy to implement. LEGO® bricks and MERGE CUBE based augmented reality can be applied to make three-dimensional representation for any structure available on PDB. We envisage these techniques to be useful for students when visualizing simple stereochemical problems or complex pathway interactions.

Development and use of augmented reality models to teach medicinal chemistry

BACKGROUND AND PURPOSE

Students in the doctor of pharmacy curriculum have varied backgrounds in their chemical training and also their ability to make mental conversions from two-dimensional chemical representations, on lecture slides or textbook images, to three-dimensional cognitive understanding. In order to bridge the gap, augmented reality (AR) models were developed to provide an alternative learning medium for the students. AR was selected to take advantage of the ubiquitous presence of smartphones, without incurring the expense of Virtual Reality hardware.

EDUCATIONAL ACTIVITY AND SETTING

AR models were developed and introduced in the classroom in three phases. Student survey responses were used to improve the utility of the models in between phases. Active learning exercises were developed that required both individual and group interactions to complete.

FINDINGS

An optimized AR model creation workflow was developed that allowed each AR model to be created and posted in about 30 min. Depending on the phase of the study, 69% to 88% of the students found the AR models easy to use and 58% to 83% wanted to see more AR models used in future lectures. A majority (76%) of the students viewed the AR models on their smartphones.

SUMMARY

Augmented reality modules were created for use in medicinal chemistry courses in the pharmacy curriculum. Models were introduced in phases and included iterative improvements based on student feedback. The AR exercises provided active learning opportunities and were well received. The majority of students would like additional AR modules used in the course.

“MedChemVR”: A Virtual Reality Game to Enhance Medicinal Chemistry Education

Medicinal chemistry (MC) is an indispensable component of the pharmacy curriculum. The pharmacists’ unique knowledge of a medicine’s chemistry enhances their understanding of the pharmacological activity, manufacturing, storage, use, supply, and handling of drugs. However, chemistry is a challenging subject for both teaching and learning. These challenges are typically caused by the inability of students to construct a mental image of the three-dimensional (3D) structure of a drug molecule from its two-dimensional presentations. This study explores a prototype virtual reality (VR) gamification option, as an educational tool developed to aid the learning process and to improve the delivery of the MC subject to students. The developed system is evaluated by a cohort of 41 students. The analysis of the results was encouraging and provided invaluable feedback for the future development of the proposed system.

An immersive journey to the molecular structure of SARS-CoV-2: Virtual reality in COVID-19

The era of the explosion of immersive technologies has bumped head-on with the coronavirus disease 2019 (COVID-19) global pandemic caused by the severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2). The proper understanding of the three-dimensional structures that compose the virus, as well as of those involved in the infection process and in treatments, is expected to contribute to the advance of fundamental and applied research against this pandemic, including basic molecular biology studies and drug design. Virtual reality (VR) is a powerful technology to visualize the biomolecular structures that are currently being identified for SARS-CoV-2 infection, opening possibilities to significant advances in the understanding of the disease-associate mechanisms and thus to boost new therapies and treatments. The present availability of VR for a large variety of practical applications together with the increasingly easiness, quality and economic access of this technology is transforming the way we interact with digital information. Here, we review the software implementations currently available for VR visualization of SARS-CoV-2 molecular structures, covering a range of virtual environments: CAVEs, desktop software, and cell phone applications, all of them combined with head-mounted devices like cardboards, Oculus Rift or the HTC Vive. We aim to impulse and facilitate the use of these emerging technologies in research against COVID-19 trying to increase the knowledge and thus minimizing risks before placing huge amounts of money for the development of potential treatments.

The effects of a virtual learning environment compared with an individual handheld device on pharmacology knowledge acquisition, satisfaction and comfort ratings

BACKGROUND

Virtual reality is reported to improve post-intervention knowledge and skills outcomes of health professionals compared to traditional teaching methods or digital online media. However, providing equitable access to high quality virtual reality resources for large, diverse nursing and midwifery student cohorts within multi-campus settings remains challenging.

OBJECTIVES

This study compared the effect on student learning, satisfaction and comfort following exposure to a three-dimensional pharmacology artefact in a virtual facility (CAVE2™)¹ with viewing of the same artefact using a mobile handheld device with stereoscopic lenses attached.

DESIGN

The study used a pretest-posttest design.

SETTING

School of Nursing and Midwifery in a regional university in Southeast Queensland, Australia.

PARTICIPANTS

Two hundred and forty-nine second year undergraduate nursing and midwifery students.

METHODS

Online multiple choice tests were deployed to measure knowledge acquisition. Self-reported satisfaction scores and comfort ratings were collected using questionnaires.

RESULTS

Participants were not disadvantaged in terms of knowledge acquisition by using either CAVE2™ or the mobile handheld visualisation mode (P = 0.977). Significant differences in favour of the CAVE2™ environment were found in between students' satisfaction scores for clinical reasoning (P = 0.013) and clinical learning (P < 0.001) compared to the handheld mode, and there were no significant differences in their satisfaction with debriefing and reflective practice processes (P = 0.377) related to undertaking visualisation activities. A small number of students using handheld devices with stereoscopic lenses reported greater discomfort in relation to the visualisation that negatively impacted their learning (P = 0.001).

CONCLUSION

Three-dimensional artefacts using mobile devices is promising in terms of cost-effectiveness and accessibility for students with restricted access to on-campus teaching modes.

Extended Reality in Patient Care and Pharmacy Practice: A Viewpoint

The evolution of technology has given practitioners and educators more tools to better treat, manage, and educate both patients and future pharmacists. The objective of this viewpoint publication is to describe the current use of extended reality (XR) in pharmacy and propose ways in which pharmacy practice and education may benefit from incorporation of this technology. While these tools have been used for decades by many other professions, pharmacy is starting to adopt XR in professional and educational practice. XR (virtual reality, mixed reality, and augmented reality) is being used in various aspects of pharmacy care and education, such as pain management, diabetes self-care, cross-checking of prescriptions, treatments for addiction, and (in limited ways) patient and pharmacy education. There is great potential for further integration of XR into pharmacy practice and pharmacy education to ultimately improve patient care and education as well as pharmacy education.

Extended Reality in Patient Care and Pharmacy Practice: A Viewpoint

The evolution of technology has given practitioners and educators more tools to better treat, manage, and educate both patients and future pharmacists. The objective of this viewpoint publication is to describe the current use of extended reality (XR) in pharmacy and propose ways in which pharmacy practice and education may benefit from incorporation of this technology. While these tools have been used for decades by many other professions, pharmacy is starting to adopt XR in professional and educational practice. XR (virtual reality, mixed reality, and augmented reality) is being used in various aspects of pharmacy care and education, such as pain management, diabetes self-care, cross-checking of prescriptions, treatments for addiction, and (in limited ways) patient and pharmacy education. There is great potential for further integration of XR into pharmacy practice and pharmacy education to ultimately improve patient care and education as well as pharmacy education.

Pharmacology through Play: using Lego® to revise core concepts for undergraduates

This article was migrated. The article was marked as recommended. Background: Pharmacology, while critical knowledge for healthcare professionals, is often viewed by students as dry and difficult to understand. We sought to examine the student acceptability of a Lego®-based learning session, in an attempt to improve pharmacology learning. Methods: In line with constructivist theories, students were facilitated to build, in small groups, their own Lego® shape to represent an area of core pharmacology and to use this to explain the concept to other students (e.g. agonist-receptor interactions). The validated Course Experience Questionnaire (CEQ) was used to gauge students' ideas on the session. Multiple choice questions were used before and after the session to evaluate knowledge. Results: Most students were positive regarding the session, finding it enjoyable, relevant for their learning and even recommending it be used to explore more complex areas of pharmacology. In addition, there was a significant increase in the MCQ scores following the session. Conclusions: This study used constructivist theory to develop a novel teaching intervention to create a more student-centred, active learning environment. This effective low-cost method could be applied to other teaching programmes to enhance student learning.

Effectiveness of three-dimensional visualisation on undergraduate nursing and midwifery students' knowledge and achievement in pharmacology: A mixed methods study

BACKGROUND

Historically nursing and midwifery students have reported difficulty understanding the concept-based science underpinning the interactions between drugs and their targets. This knowledge is crucial for the administration and monitoring of the therapeutic and adverse effects of medications. Immersive three-dimensional technology is reported to enhance understanding of complex scientific concepts but the physical effects of motion sickness may limit its use.

OBJECTIVES

This project compared the effectiveness of three-dimensional immersive visualisation technology with two-dimensional visualisation technology as a teaching method to improve student understanding of a pharmacological concept, and to assess levels of student discomfort and satisfaction associated with the experience.

DESIGN

Traditional lecture content and presentation about drug-receptor binding was followed by exposure to either a two- or three-dimensional artifact visualising β-adrenoceptor binding. Two student groups were compared by type of exposure: Group 1 watched the artifact via a three-dimensional immersive facility and Group 2 on a wide, two-dimensional screen.

SETTINGS

School of Nursing and Midwifery in a regional university in Southeast Queensland, Australia.

PARTICIPANTS

Two hundred and two second year undergraduate nursing and midwifery students.

METHODS

The study used mixed methods methodology. Pre- and post- testing of student knowledge was collected using five multiple-choice questions. A post-intervention survey elicited students' self-assessed perceptions of discomfort and satisfaction with the learning experience.

RESULTS

The three-dimensional immersive learning experience was comparable to the two-dimensional experience in terms of satisfaction and comfort but resulted in statistically significant improvements in post-test scores.

CONCLUSIONS

The three-dimensional experience improved understanding when compared to two-dimensional viewing, satisfied students leaning needs, and caused minimal discomfort. The results are encouraging in terms of using three-dimensional technology to enhance student knowledge of pharmacological concepts necessary for competency in medication management.

Virtual Reality in Pharmacy: Opportunities for Clinical, Research, and Educational Applications

Virtual reality (VR) has been widely studied and applied in numerous medical applications.1 In pharmacy, VR can potentially be applied as follows: adjunctively or as a replacement for pharmacotherapy; in drug design and discovery; in pharmacist education; and in patient counseling and behavior modification.1-6 Research applying VR in pharmacy is currently limited; however, interest in these applications is increasing. The majority of studies conducted during the past decade have found VR to be safe and effective, and to promote a high degree of user satisfaction.4 VR technology has become increasingly affordable, flexible, and portable, enabling its use for therapeutic purposes in both inpatient and outpatient environments.4 But despite the compelling features of VR, a number of challenges exist, such as validation of clinical efficacy, cost/accessibility and usability issues, technical capabilities, and acceptance.1-5 This article discusses the potential for the use of VR in pharmacy for clinical, research, and educational applications.

The Past, Present, and Future of Virtual Reality in Pharmacy Education

Objective. To characterize how virtual reality (VR) has been and is being used in pharmacy education, and evaluate the projected utility of VR technology in pharmacy education in the future. Findings. Virtual reality technology has been used in pharmacy education for many years to provide engaging learning experiences. Although these learning experiences were not available in the three-dimensional digital environments provided by current VR, they demonstrated improvements in learning. Recent technological advancements have substantially increased the potential usefulness of VR for pharmacy education by providing immersive educational activities that mimic real world experiences to reinforce didactic and laboratory concepts. Virtual reality training that uses head-mounted displays is just beginning in pharmacy education, but more educational VR programs are becoming available. Further research will be necessary to fully understand the potential impact of VR on pharmacy education. Summary. Virtual reality technology can provide an immersive and interactive learning environment, overcoming many of the early challenges faced by instructors who used virtual activities for pharmacy education. With further technological and software development, VR has the potential to become an integral part of pharmacy education.

Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background

Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice.

Objective

The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction.

Methods

We performed a systematic review of the effectiveness of VR in pre- and postregistration health professions education following the gold standard Cochrane methodology. We searched 7 databases from the year 1990 to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data, and assessed risk of bias, and then, we compared the information in pairs. We contacted authors of the studies for additional information if necessary. All pooled analyses were based on random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate the quality of the body of evidence.

Results

A total of 31 studies (2407 participants) were included. Meta-analysis of 8 studies found that VR slightly improves postintervention knowledge scores when compared with traditional learning (standardized mean difference [SMD]=0.44; 95% CI 0.18-0.69; I²=49%; 603 participants; moderate certainty evidence) or other types of digital education such as online or offline digital education (SMD=0.43; 95% CI 0.07-0.79; I²=78%; 608 participants [8 studies]; low certainty evidence). Another meta-analysis of 4 studies found that VR improves health professionals’ cognitive skills when compared with traditional learning (SMD=1.12; 95% CI 0.81-1.43; I²=0%; 235 participants; large effect size; moderate certainty evidence). Two studies compared the effect of VR with other forms of digital education on skills, favoring the VR group (SMD=0.5; 95% CI 0.32-0.69; I²=0%; 467 participants; moderate effect size; low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. None of the studies reported any patient-related outcomes, behavior change, as well as unintended or adverse effects of VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of evidence primarily because of the risk of bias and/or inconsistency.

Conclusions

We found evidence suggesting that VR improves postintervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.

Molecular Visualization on the Holodeck

Can virtual reality be useful for visualizing and analyzing molecular structures and three-dimensional (3D) microscopy? Uses we are exploring include studies of drug binding to proteins and the effects of mutations, building accurate atomic models in electron microscopy and x-ray density maps, understanding how immune system cells move using 3D light microscopy, and teaching schoolchildren about biomolecules that are the machinery of life. Virtual reality (VR) offers immersive display with a wide field of view and head tracking for better perception of molecular architectures and uses 6-degree-of-freedom hand controllers for simple manipulation of 3D data. Conventional computer displays with trackpad, mouse and keyboard excel at two-dimensional tasks such as writing and studying research literature, uses for which VR technology is at present far inferior. Adding VR to the conventional computing environment could improve 3D capabilities if new user-interface problems can be solved. We have developed three VR applications: ChimeraX for analyzing molecular structures and electron and light microscopy data, AltPDB for collaborative discussions around atomic models, and Molecular Zoo for teaching young students characteristics of biomolecules. Investigations over three decades have produced an extensive literature evaluating the potential of VR in research and education. Consumer VR headsets are now affordable to researchers and educators, allowing direct tests of whether the technology is valuable in these areas. We survey here advantages and disadvantages of VR for molecular biology in the context of affordable and dramatically more powerful VR and graphics hardware than has been available in the past.

A critical narrative review of transfer of basic science knowledge in health professions education

CONTEXT

'Transfer' is the application of a previously learned concept to solve a new problem in another context. Transfer is essential for basic science education because, to be valuable, basic science knowledge must be transferred to clinical problem solving. Therefore, better understanding of interventions that enhance the transfer of basic science knowledge to clinical reasoning is essential. This review systematically identifies interventions described in the health professions education (HPE) literature that document the transfer of basic science knowledge to clinical reasoning, and considers teaching and assessment strategies.

METHODS

A systematic search of the literature was conducted. Articles related to basic science teaching at the undergraduate level in HPE were analysed using a 'transfer out'/'transfer in' conceptual framework. 'Transfer out' refers to the application of knowledge developed in one learning situation to the solving of a new problem. 'Transfer in' refers to the use of previously acquired knowledge to learn from new problems or learning situations.

RESULTS

Of 9803 articles initially identified, 627 studies were retrieved for full text evaluation; 15 were included in the literature review. A total of 93% explored 'transfer out' to clinical reasoning and 7% (one article) explored 'transfer in'. Measures of 'transfer out' fostered by basic science knowledge included diagnostic accuracy over time and in new clinical cases. Basic science knowledge supported learning - 'transfer in' - of new related content and ultimately the 'transfer out' to diagnostic reasoning. Successful teaching strategies included the making of connections between basic and clinical sciences, the use of commonsense analogies, and the study of multiple clinical problems in multiple contexts. Performance on recall tests did not reflect the transfer of basic science knowledge to clinical reasoning.

CONCLUSIONS

Transfer of basic science knowledge to clinical reasoning is an essential component of HPE that requires further development for implementation and scholarship.

A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study

Background

Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students’ preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals.

Objective

The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: “What are professionals’ perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?”

Methods

The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with the game.

Results

Overall, the results were positive in all dimensions of the game that were assessed as means ranged from 3.2 to 3.99 out of 5, with user engagement receiving the highest score (mean 3.99, SD 0.87). Users’ perceived difficulty level received the lowest score (mean 3.20, SD 0.65), a finding which agrees with the analysis of log files that showed a rather low success rate (20.6%). Even though professionals saw the educational value and usefulness of the tool for pre-hospital emergency training (mean 3.83, SD 1.05), they identified confusing features and provided input for improving them.

Conclusions

Overall, the results of the professional feedback-informed evaluation of the game provide a strong indication of its potential as an educational tool for emergency training. Professionals’ input will serve to improve the game. Further research will aim to validate VETM, in a randomized pre-test, post-test control group study to examine possible learning gains in participants’ problem-solving skills in treating a patient’s symptoms in an emergency situation.