Title: Virtual Reality (VR)-based Training in Medical Schools
Author Name: April Crisp
1. Introduction
This chapter is on the topic of virtual reality (VR)-based training in medical schools, which are often at the forefront of new training technology. Although VR-based training is not widely used in corporate and most higher education settings, it has been used in medical schools since at least the early 1990s (e.g., Satava, 1993) and was fairly common in this setting by the early 2000s (Seymour et al., 2002). Due to technological advances in the last several years significantly reducing the cost and increasing the accessibility of VR equipment, combined with increased public and media interest in this technology, VR training is becoming or will likely soon become a widespread trend in general higher education and corporate settings. In a recent article published by the American Association of Medical Colleges (Breining, 2018), the author identified several medical schools currently using VR-based training, including Children’s Hospital of Los Angeles (CHLA), the Mayo Clinic Multidisciplinary Simulation Center, and the University of California (UC) Irvine School of Medicine.
By definition, the term ‘VR technology’ includes the headset worn by the user and software designed to present three-dimensional models or images onto the lenses of the headset, which is usually attached by straps. Most VR headsets are paired with two hand-held controllers with motion-sensing/tracking technology and buttons to interact with objects in the virtual reality environment. VR technology allows complex information to be presented in a visually appealing way, which students often find easier to understand and recall (Virtual Reality Society, 2017). Other aspects of VR-based training that are particularly useful in the medical school setting are its ability to (1) facilitate the deconstruction of complex information into manageable chunks, (2) explore virtual scenarios in preparation for performing in real-world scenarios, (3) simulate risky or dangerous situations in a safe environment, (4) present realistic and accurate simulations, (5) provide for feedback and ongoing assessment, and (6) be deployed to a larger number of students than is typically feasible in a traditional classroom setting (Virtual Reality Society, 2017). Tabatabai (2020) notes that clinical experiences can be effectively presented in VR-based training and states that simulation is integral to medical education.
2. Overview of the Case
This case focuses on the UC Irvine School of Medicine, which enrolls 104 students each year, for a total of 416 students in the program at any given time. The school’s curriculum must prepare students to become competent medical doctors and surgeons, which are job roles that require a deep understanding of the highly complex systems of the human body, diagnostic and treatment protocols, and the development and maintenance of effective working relationships with patients (i.e., “bedside manner”). Traditionally, during medical school, most students’ interactions with patients have been with cadavers in their anatomy and physiology labs or with actors playing the part of a patient. Typically, they first encounter “real” patients upon beginning the residency portion of their training.
3. Solutions Implemented
In 2010, UC Irvine built a 65,000-square-foot Medical Education Simulation Center on its campus in Irvine, California at a cost of $40 million; this center provides VR-based educational programs for its students, as well as continuing medical education (CME) courses taken by thousands of healthcare providers each year (UC Irvine, 2022). In 2010, UC Irvine adopted the technology-enhanced, activity-coordinated, humanistic (iTEACH) curriculum approach, which utilizes simulation as one of the foundational teaching methods (Le-Bucklin, Stamos, & Yourm, 2020). Since 2007, the UC Irvine School of Medicine has focused on active learning using instructional technology and simulation, as well as small-group teaching and case-based discussions (Maguire & Clayman, 2010).
UC Irvine is using VR-based training in its medical school to help students learn empathy for suffering patients who are experiencing, for example, vision loss due to macular degeneration and Alzheimer’s disease, as well as discussing end-of-life issues (Brazil, 2019). The VR simulations mimic vision loss due to macular degeneration by placing a blind spot in the user’s vision and the confusion caused by Alzheimer’s by jumbling the speaker’s words, making it difficult for the user to understand what is being said (Brazil, 2019).
The Hospital Acute Response Training course provided by UC Irvine’s Medical Education Simulation Center teaches critical incident response and team dynamics in a virtual hospital setting. Other VR simulation-based courses provided by the center include the American Heart Association’s Basic Life Support (BLS) course and Maintenance of Certification in Anesthesiology (UC Irvine, 2022).
4. Outcomes
One of the drawbacks to VR-based training is that some of the techniques involved require specialized technical knowledge that the teacher must learn, and most professors in medical schools have a medical, rather than a technical, background (Grainger, Liu, & Geertshuis, 2020). It is also costly to develop VR training software, as it currently requires the skills of an experienced computer programmer (Grainger, Liu, & Geertshuis, 2020). However, medical schools at universities with computer programming degree programs could partner to incorporate the development of VR simulation software into the computer programming degree program, especially master’s and doctoral programs. Funding graduate assistantships to develop VR software in association with an instructional designer and medical education subject matter expert already employed by the institution is another alternative.
In the U.S., medical school graduates must pass the United States Medical Licensing Exam (USMLE) to be licensed and practice as a physician. In terms of student-related outcomes, it would be useful to compare the USMLE scores of students graduating from the UC Irvine School of Medicine to those graduating from similar-sized and funded medical schools. However, despite a thorough online search, USMLE pass rates for individual medical schools do not seem to be available.
According to U.S. News and World Report (2022), the University of California, Irvine School of Medicine ranks #51 in best medical schools for research and #61 in best medical schools for primary care, out of 192 medical schools. Although these rankings are calculated based on several factors (e.g., faculty resources and research activity), not just scores on the USMLE (U.S. News and World Report, 2022), they do indicate that the UC Irvine School of Medicine is in the top 26% of medical schools in the U.S.
In terms of other institutional-level outcomes, the UC Irvine School of Medicine has produced an impressive body of research on VR-based medical training and healthcare. For example, the school’s faculty and doctoral students have published research on the topics of neurorehabilitation via brain-computer interface systems (King, 2014), an immersive VR gaming-based exercise program for the pediatric population (Huh, 2019), a preoperative planning tool for a specific type of kidney surgery (Parkhomenko et al., 2019), a review of simulation used to teach emergency medicine in the medical school setting (Chakravarthy et al., 2010), and improving residency training in arthroscopic knee surgery (Cannon et al., 2014).
5. Implications
The UC Irvine School of Medicine has taken the approach of building a Medical Education Simulation Center to deliver VR training of medical students. This training is built into the curriculum at the organizational level, so it is not left to individual teachers to incorporate VR and simulation training. Therefore, one of the known draw-backs of technology adoption in educational settings, teacher buy-in (Grainger et al., 2020), is avoided. However, other medical schools may not have the necessary funding for such an approach, so they would have to address teacher buy-in. Moreover, the VR training-related research published by faculty and doctoral students at the UC Irvine School of Medicine has the potential to provide evidence-based practice resources for other medical schools, and the healthcare-related VR training research could improve the lives of many patients.
6. References
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