Enhancing Medical Education: Exploring the Use of Virtual Reality in Practical Sessions

Authors

Vineetha Menon¹, Ahmad El Ouweini², Sandhya Arun³, Aliaksandr Marozou⁴, Pavel Makarevich⁴, Aliaksandr Lisavets⁴

¹ - College of Pharmacy, Department of Clinical Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.

² - College of Pharmacy, Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates.

³ - Center for Advanced Simulation in Healthcare (CASH) Gulf Medical University, Ajman, United Arab Emirates.

⁴ - Proven solution information technology, Dubai, United Arab Emirates.

The authors (VM, AEO, SA) declare no conflict of interest. AVM, PVM, ASL are employees of the company Proven Solution Information Technology. The study used equipment and software provided by the company Proven Solution Information Technology.

Corresponding Author

Aliaksandr Marozou, MD, Proven Solution Information Technology, Dubai, United Arab Emirates (Email: amorozov@provensolution.com)

Brief Description

This article explores the use of virtual reality (VR) technology in medical education, focusing on its potential in training medical professionals to acquire essential skills, such as taking patient histories and ordering investigations. VR simulations provide a safe, risk-free environment for trainees to practice complex medical procedures, making mistakes and learning from them. The article cites several research studies that show the efficacy of VR in improving clinical outcomes and enhancing medical education. The article then evaluates an innovative VR application developed by Proven Solution, which allows pharmacy students to interact with virtual patients and practice various clinical skills. The study involved 34 pharmacy students who were trained using the VR application to collect patient histories and order investigations. The results of the study were analyzed to determine the effectiveness of VR in training pharmacy students to acquire essential skills.

Introduction

Virtual Reality (VR) is currently changing the way healthcare professionals are trained. VR technology has the potential to provide immersive, realistic, and interactive training simulations, allowing medical professionals to practice complex medical procedures without risk to patients. In addition, specialists can train to work with patients, communicate with them, understand how to make a correct diagnosis, starting from the first contact. The use of VR in medical education has been the subject of numerous research studies, highlighting its efficacy in improving clinical outcomes and enhancing medical education.

One area where VR has proven particularly effective is in surgical training. VR surgical simulations allow trainees to practice surgical procedures in a controlled environment, providing a safe and risk-free space to make mistakes and learn from them. A study by Neal E Seymour et al. found that surgical trainees who received virtual reality simulation training outperformed those who did not in actual laparoscopic surgical procedures (Seymour et al., 2002).

Another study shows the benefits of virtual reality for the training of staff in radiology departments. Radiology departments have begun exploring the use of these technologies to help with radiology education and clinical care (Uppot et al., 2019). The study showed that virtual and augmented reality technologies are a novel means to communicate and have potential for supplementing radiology training; communicating with colleagues, referring clinicians, and patients; and aiding in interventional radiology procedures. It is also shown that as opposed to textbooks or online learning modules, immersing the learner in a virtual world is associated with a higher level of active learner participation because of increased social, environmental, and personal presence within the learning activity.

However, virtual reality can probably help and comprehensively train a doctor to work with a patient - from taking an anamnesis and examination to prescribing examinations and making a diagnosis.

One of the fundamental skills that medical professionals must acquire is the ability to take a patient history and order investigations. A patient's medical history provides valuable information about their current health status, medical conditions, and potential risk factors. However, training medical professionals to master these skills can be a challenging task that requires significant effort and dedication.

Several research studies have explored the difficulty in training medical professionals to take a patient history and order investigations. These studies highlight some of the challenges faced by medical students and professionals in acquiring these essential skills.

Several studies have revealed deficiencies in the history-taking skills of medical students. In one study less than 40% of students were found to have acquired the necessary skills for identifying major health issues, symptom analysis, gathering past medical information, and covering social aspects (Ahmed, 2002). These students frequently struggled to generate multiple hypotheses or ask relevant questions. In another study, only 23% of patients were given the opportunity to fully express their concerns, with physicians often interrupting and redirecting the conversation towards a specific issue in 69% of visits (Beckman & Frankel, 1984). At Michigan State University, one-third of third-year medical students failed to introduce themselves to their patients, and inadequate performance was also reported for other skills such as ruling out alternative diagnoses (60%), gathering social (38%) and family history (35%), characterizing problem dimensions (23%), gathering past medical history (17%), and analyzing chief complaints (6%) (Mavis et al., 2013).

Another study found that residents in internal medicine struggled to order appropriate investigations. The study found that residents often ordered unnecessary tests or failed to order appropriate tests, leading to delays in diagnosis and treatment (Sedrak, 2016).

Goal of scientific work:

The use of virtual reality in medical education has been gaining popularity in recent years, and

the Proven Solution company has developed an innovative application that allows medical students to interact with virtual patients and practice various clinical skills. The goal of this scientific work is to evaluate the effectiveness of the virtual reality application in training pharmacy students to collect anamnesis and order investigations.

Materials and methods:

The Proven Reality virtual reality application was integrated into the College of Pharmacy's Professional Skills modules at Gulf Medical University. The course covers various topics, such as the assessment of the cardiovascular and gastrointestinal systems and provides learning outcomes for each topic. Students are expected to develop a comprehensive understanding of the common symptomatology, assessment techniques, and diagnostic tests for each system. The virtual reality application, utilizing the advanced Oculus Quest 2 headset, allows students to practice these skills in an immersive and interactive environment, enhancing their learning experience and promoting better retention of knowledge.

The study involved 34 pharmacy students, divided into two groups of 17 students each. One group was trained for three weeks on cardiac clinical cases, including Myocardial Infarction, Cardiac Arrhythmias, and Heart Failure, while the second group studied for three weeks on gastroenterological clinical cases, including Peptic Ulcer, Irritable Bowel Syndrome, and Liver Cirrhosis. Both groups were trained using the Proven Solution virtual reality application (“Patient examination”).

• VR equipment: Oculus Quest 2 virtual reality headset, featuring a display resolution of 1832x1920 per eye, a refresh rate of 90 Hz, 6 GB of RAM, and built-in cameras for tracking the user's position and movements in a 1000-degree field of view. The headset provides room-scale tracking without external sensors and allows users to be fully immersed in a 360° virtual environment. It also includes two touch controllers, which emulate the user's hands, and built-in positional audio for an enhanced experience.
• Number of cases and time spent: Students used the virtual reality application during two modules in the Health Assessment course, specifically the Assessment of Cardiovascular System and Assessment of Gastrointestinal System. The VR training was incorporated into these modules, with each student spending a total of 30-40 minutes on VR training, distributed over four 3-hour sessions (2 sessions per group).
• Feedback: After completing a case, learners receive immediate, objective feedback on their performance, highlighting areas of improvement and reinforcing correct actions.
• Academic year: The study involved second-year pharmacy students in their 3rd semester in the professional skills session at the College of Pharmacy, Gulf Medical University.
• Prior/concurrent experiences: The students had limited prior experience in obtaining patient histories, performing physical examinations, and ordering labs. However, they had concurrent experiences through their regular course work.
• Training environment: Immersive virtual reality environment simulating a clinical setting.

The training with this application included:

1. Obtaining important relevant history, including patient's data, disease history, general complaints, past medical history, allergies, medication history, family history, and social history.

2. Examining the patient's appearance (Figure 1).

Figure 1: An example of the patient's appearance. On the left, a patient with a stomach ulcer complains of pain in the epigastrium. On the right - a patient with cirrhosis of the liver, a characteristic appearance: jaundice, venous pattern, hepatic palms.

3. Conducting a physical examination, including measuring temperature and body mass index, conducting auscultation of the lungs, heart (Figure 2), and stomach, conducting percussion of the chest and abdomen, measuring blood pressure, inspecting the palms, and examining the throat (Figure 3).

Figure 2: An example of auscultation of the heart of a virtual patient.

Figure 3: The choice of method of physical examination of the patient.

4. Conducting a laboratory examination of the patient, including complete blood count, blood chemistry, endocrine tests, coagulogram, immunology, tumor markers, serology, analysis of urine, and fecal analysis. (Figure 4)

5. Conducting an instrumental examination of the patient, including ultrasound (reading the conclusion), chest x-ray (viewing the image), computed tomography (viewing the study in two projections), MRI (reading the conclusion), endoscopy (reading the conclusion), spirometry (seeing the study results), and electrocardiogram (seeing the ECG). (Figure 4)

Figure 4: The study of data from instrumental and laboratory studies. Above is an x-ray of the chest, below are the results of a complete blood count.

6. Choosing the correct diagnosis.

The development of the Proven Solution virtual reality application was carried out using Unity software (game engine). The team involved in the creation of the application consisted of one product manager, one programmer, one 3D artist, two UI designers, and a medical expert.

The 3D artist created the design of the medical room and its interior and patient models using the universal character system Reallusion. The user interface was developed by a team of two UI designers, who ensured that the application was user-friendly and easy to navigate.

The scenarios of clinical cases were drafted by a medical expert based on notes from teachers at Gulf University, ensuring that the virtual reality application was medically accurate and relevant to the training needs of the pharmacy students.

The application was specifically designed for the Oculus Quest 2 system. However, it can be adapted for any headset that works with virtual reality, making it versatile and accessible for various educational institutions and training facilities.

In terms of design cost and equipment, the Proven Solution virtual reality application was developed with affordability in mind, making it a cost-effective solution for medical education institutions. The equipment required for the application includes just a compatible virtual reality headset, such as the Oculus Quest 2.

To evaluate the effectiveness of the virtual reality training, the researchers conducted a survey of the participating students. The survey aimed to assess their level of engagement with the educational process and their ability to assimilate the material. The results of the survey were analyzed to determine the impact of the virtual reality training on the students' learning outcomes.

In addition to the 34 pharmacy students (Figure 5), the study also involved 4 teachers who participated in the study and filled out the questionnaire. The questionnaire posed inquiries to educators about their satisfaction with the learning possibilities provided VR technology, as well as the learning outcomes achieved through its usage. It also addressed the ease with which the teachers were able to adopt VR. Furthermore, the questionnaire solicited the views of educators on the benefits they perceive VR technology offers for educational purposes and what modifications they would propose for the current approach to VR utilization. The questionnaire also asked if they would consider incorporating VR into their regular practical exercises. The teachers' feedback and evaluations of the students' performance were also considered in the analysis of the study's results.

Figure 5: A student of a medical university conducts an examination of a patient in a virtual reality application.

Results

The results of the study indicate that the pharmacy students (n=34) found the use of virtual reality (VR) in patient examinations to be a generally positive experience. On a 10-point scale, the average score for the experience was 8.6 out of 10 (SD=1.12), with a range of scores from 6 to 10 (on the 10-point scale used in the study, 1 represents a bad experience, 5 is neutral, and 10 indicates a positive experience).

The advantages identified by the students in using VR for patient examinations were its effectiveness in learning, motivation, and its ability to provide a realistic experience. Students found it helpful in understanding complex concepts and felt that it boosted engagement during practical learning. They appreciated the ability to hear real sounds during procedures and found it helpful in dealing with real patients.

On the other hand, some disadvantages of VR in patient examinations were reported, including time consumption and lack of real communication. Eyestrain and discomfort due to the inability to move freely were also reported.

In terms of changes, students suggested the addition of more variety in cases and the integration of VR and education. Additionally, some students suggested the need for backup VR headsets and better physical examination tools.

The teacher questionnaires provided valuable insights into their perceptions and experiences of using virtual reality in practical sessions. The teachers assessed the students' experience with VR on topics such as Learning Capabilities, Learning Outcomes, Ease of use of conducting VR session, Advantages in VR Tech, Change in Approach of VR, and Use of VR for Teaching. Overall, the teachers were highly satisfied with both the learning capabilities and outcomes using VR technology, with an average satisfaction score of 8.5 (SD=0.87) for both questions. In terms of the ease of getting started with VR, the average score was 8.25 (SD=0.89), indicating that it was not too difficult to begin using the technology.

The teachers also identified several advantages of using VR technology, including the ability to examine patients from different angles, multiple variations of cases, easy mastery, and excellent visualization of pathology in patients. Additionally, they appreciated the experience of interaction with the patient and the ability to listen to the sounds of the heart, lungs, and abdomen.

The teachers suggested some changes to improve the approach to using virtual reality, such as introducing an easier case selection system, adding more virtual patient interactions, patient positions (for example, on a bed), and an explanation of pathological mechanisms (e.g., increased blood pressure). The teachers expressed a desire to use VR on a permanent basis for practical sessions, indicating that they saw value in incorporating this technology into their teaching practices.

Discussion

The results of this study suggest that virtual reality technology can be an effective tool for training medical students in the collection of anamnesis and ordering of investigations. The use of the Proven Solution virtual reality application resulted in a significant improvement in the students' ability to collect patient histories and order investigations, as reported by the survey results.

The virtual reality training allowed students to practice these skills in a safe and controlled environment, without putting real patients at risk. The application also provided a high level of interactivity, allowing students to engage in realistic simulations of patient interactions and clinical procedures. This immersive and engaging learning experience may have contributed to the improvement in learning outcomes observed in this study.

The study also highlights some of the challenges faced by pharmacy students in acquiring these essential skills. Previous research has shown deficiencies in medical students' ability to collect patient histories and order investigations, which can lead to delays in diagnosis and treatment. The use of virtual reality technology may help to address these challenges by providing a safe and effective training environment.

The responses from the teacher questionnaires suggest that the use of virtual reality technology in practical medical education was well received. The teachers expressed satisfaction with the learning capabilities and outcomes with virtual reality technology. They also found it easy to get started with VR during the first session. Moreover, the teachers recognized the advantages of using virtual reality in medical education, such as the ability to examine patients from different angles, experience interaction with the patient, and visualization of pathology. The teachers also provided some suggestions for improving the approach, such as introducing an easier case selection system and adding more virtual patient interactions. Overall, the positive feedback from the teachers supports the potential benefits of using virtual reality technology in medical education.

However, it is important to note that this study had some limitations. The sample size was relatively small, and the study was conducted in a single institution. Further research is needed to confirm these findings in larger and more diverse populations.

There are other applications that allow students to work with virtual patients (eg: iHuman Patients). Features of such applications are life-like patient interactions, where the virtual patient breathes, blinks, answers questions, and responds to interventions. Furthermore, many of such applications can be accessed 24/7 on laptops and tablets wherever an internet connection is available.

In contrast, the Proven Solution virtual reality application has several innovations that set it apart from existing virtual patient applications. Firstly, it does not require a permanent internet connection, which can be advantageous for institutions with limited connectivity or for users who want to practice in various settings. This flexibility allows medical students to engage with the application at their convenience, ensuring that the learning process is not hindered by connectivity issues.

Another innovative aspect of the Proven Solution application is its immersive virtual reality environment. Unlike iHuman, which primarily relies on laptops and tablets for display, the Proven Solution application is designed for virtual reality headsets, creating a more realistic and engaging experience for users. This increased level of immersion can lead to better knowledge retention and improved clinical decision-making skills.

Moreover, the Proven Solution application can be easily adapted for various virtual reality headsets, making it more versatile and accessible than some other virtual patient applications on the market. Its development using Unity software and collaboration with medical experts ensures that the application is not only technologically advanced but also medically accurate and relevant.

Conclusion

In conclusion, this study suggests that virtual reality technology can be an effective tool for training medical students in the collection of anamnesis and ordering of investigations.

The immersive and engaging learning experience provided by virtual reality training may help to address some of the challenges faced by medical students in acquiring these essential skills. However, further research is needed to confirm these findings in larger and more diverse populations.

The positive feedback from the participating teachers supports the effectiveness and potential of virtual reality technology in medical education. The suggestions and feedback provided by the teachers can help improve the VR program for better outcomes and a more user-friendly experience.

Overall, the results of this study support the use of virtual reality technology in medical education, particularly in the training of pharmacy students in the collection of anamnesis and ordering of investigations. As virtual reality technology continues to advance, it has the potential to revolutionize medical education and improve the quality of healthcare worldwide.

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