Harshit Singh¹*, Jaime Weber, MS¹*, Angela Pierce, PhD²

¹OMS-III, Kansas City University, College of Osteopathic Medicine

²Phase II Director, Kansas City University, College of Osteopathic Medicine

*These authors contributed equally to this work.

The global spread of a novel coronavirus in 2019 and 2020 (COVID-19) resulted in significant and detrimental effects on health, social, and economic factors around the world. Nonessential businesses closed, recreational sporting events were canceled, and academic programs suspended in-person education. In an effort to prevent the delay of educational progress, academic programs quickly adopted a variety of online curricula. While the elements of didactic education were relatively easy to transition online, simulation-based education, which traditionally relied on in-person practice and assessment, was a particular challenge to implement remotely.  Virtual reality (VR) provides a unique opportunity to integrate simulation-based education vital to healthcare programs. This article describes a medical student perspective regarding the feasibility and importance of virtual reality as an educational tool for future medical programs.

Virtual reality technology has only gained traction as an educational resource in recent years. There are few studies investigating the impact of VR in medical education, most likely due to the novelty of the technology available to health professions education. There is evidence to suggest VR improves knowledge and skills among health professions students following the virtual patient encounter¹ and as an adjunct to cadaveric dissection.²

Consequent to the COVID-19 pandemic was the closure of in-person laboratories in medical schools, thereby limiting the opportunity to practice communication, empathy, and interprofessional skills. Interestingly, VR has been shown to improve empathy among health-profession.³ Furthermore, Jack Pottle, the CEO of Oxford Medical Simulations, believes virtual reality also opens the door to interdisciplinary education in team settings.

There are two forms of simulated clinical education commonly utilized during the preclinical years: Standardized Patient Encounters (SPE) and Human Patient Simulators (HPS). SPE are simulated clinical office visits, while HPS sessions simulate emergent hospital settings with other healthcare workers. These sessions allow medical students to practice clinical medicine during didactic years. While SPE utilizes hired actors, HPS sessions are conducted live with a programmable mannequin. Currently, this is the primary tool to adequately simulate the critically-ill patient on a medical school campus. Each session requires trained staff to operate the mannequins and a faculty facilitator to provide group feedback following completion. Due to these significant demands, medical schools are only able to conduct a limited number of HPS sessions, and there is rarely an opportunity for students to repeat a specific simulation.

Immersive learning experiences can be recreated using VR, where pre-programmed cases allow students to engage with a virtual patient imitating many of the signs and symptoms of a live- or simulated-patient. The student utilizes an interface to select the desired actions, beginning with their entrance into the virtual room and concluding with orders for patient follow up. On screen, the student visualizes digital hands palpating an abdomen, auscultating heart sounds, and performing procedures. VR technology allows medical students increased access to immersive clinical education. The accessibility of VR as an educational tool during the pandemic is a major advantage when compared to traditional standardized patient encounters.

Medical VR technology has the ability to expand upon the capabilities of animatronic mannequins. As the VR headset is placed over the eyes, the medical student is immediately placed in a patient’s room with a nurse. The student gathers a history, orders laboratory studies or a variety of medical imaging, performs a physical exam, collaborates with the virtual nurse, and implements treatment and patient management interventions as appropriate. Time in the virtual room may be limited according to administrative settings. Following the encounter, the student reviews a checklist of their performance and may receive feedback on a variety of issues, such as selecting inappropriate diagnostic procedures, administering incorrect treatment, or poor use of time management. Personalized feedback is key to the success of VR as an educational tool. Following a review of their performance, students have the option to repeat the encounter and practice improvement. In addition, students have the opportunity to review key concepts associated with the case, such as mechanisms of action of the pharmacology treating the presenting pathology, indications for appropriate pharmaceuticals, or interpretation of diagnostic studies utilized in the case. This repetition is a valuable element to VR, which encourages practice, applies key concepts, and builds self-confidence in the medical student.

Medical schools have the tremendous responsibility of training the next generation of physicians. This responsibility is difficult even in the best of times but has become even more complicated in the wake of COVID-19. During the pandemic, as we wrote this article from our quarantined living spaces, the need for virtual medical education could not be more compelling. The use of virtual reality technology in medical education would help to minimize any detrimental effects of the COVID-19 pandemic on the training of medical students.

References:

1. Kyaw BM, Saxena N, Posadzki P, Vseteckova J, Nikolaou CK, George PP, Divakar U, Masiello I, Kononowicz AA, Zary N, Tudor Car L. Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res. 2019; 21(1):e12959. doi:10.2196/12959
2. Moro C, Stromberga Z, Raikos A, Stirling A. The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ. 2017; 10(6):549-559. doi:10.1002/ase.1696
3. Dyer E, Swartzlander BJ, Gugliucci MR. Using virtual reality in medical education to teach empathy. Journal of the Med Library Assoc. 2018; 106(4):498-500. doi:10.5195/jmla.2018.518