Samadbeik M et al.

The applications of virtual reality in medical groups teaching

Original Article

Journal of Advances in Medical Education & Professionalism

The applications of virtual reality technology in medical groups

teaching
M A H NA Z S A M A D B E I K 1, D O N YA YA AG H O B I 1, P E I VA N D BA S TA N I 2, S H A H A B E D -
DI N A B H A R I 3, R I TA R E Z A E E 4, A L I G A R AVA N D 5*
1
Department of Health Information Technology, Social Determinants of Health Research Center, Lorestan University of Medical Sciences,
Khorramabad, Iran; 2Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University
of Medical Sciences, Shiraz, Iran; 3School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; 4Clinical
Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 5School of Allied Medical Sciences, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
Introduction: Virtual reality is a new method for training *Corresponding author:
Abstract

different medical groups. Based on this technology, professionals Ali Garavand,

and students of various medical sciences can determine their level School of Allied Medical
Sciences,
of competence for medical treatment before any performance on
Shahid Beheshti University
the patient. Therefore, the aim of this study was to identify the of Medical Sciences,
applications of virtual reality technology for training the medical Tehran, Iran
groups. Tel: +98-938-2122250
Methods: This is a scoping review study conducted in 2016. Email: virya67@yahoo.com
Articles were retrieved through the search of related keywords in Please cite this paper as:
databases such as Pub Med, Scopus, Web of Sciences, Springer, Samadbeik M, Yaaghobi D,
and Google scholar. Then, after applying the entry criteria, 21 Bastani P, Abhari S, Rezaee
papers were selected from a total of 1343. Data extraction was done R, Garavand A. The applica-
by a data collection form. The collected data were summarized tions of virtual reality tech-
nology in medical groups
and reported using content analysis technique according to the
teaching. J Adv Med Educ
study purpose. Prof. 2018;6(3):123-129
Results: The findings of the study indicated that 11 cases (48%)
have used virtual education technology for laparoscopic surgery Received: 21 November 2017
training. Using virtual reality has improved learning in 17 (74%) Accepted: 9 May 2018
studies. A higher accuracy in medical practice by people trained
through VR has been reported in 20 (87%) studies.
Conclusion: The results indicate that the application of virtual
reality capabilities plays an important role in improving the
performance of different medical groups. According to the results,
it can be suggested that virtual reality capabilities should be used
to train different medical groups based on their individual and
collective needs.
Keywords: Virtual reality, Training, Clinical trials, Technology

Introduction tools (vision, hearing, tactile and power

irtual reality is a new technology that has
V been widely used in the health field in
recent years and it is applied in a wide range
transmitter), input devices (mouse, chaser,
gloves, etc.), a virtual environment’s graphical
manufacturing system as well as an information
of diseases. In fact, this technology is the software. In a virtual environment, all the
simulation of the peripheral world through a features of activity such as duration, severity
computer as well as communication through a and type of feedback can be adopted based on
receiver (1). Virtual reality consists of output the type of treatment and individuals’ ability (2,

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Samadbeik M et al.

3). In addition, individuals can see their motor aimed at identifying the applications of virtual
results and correct them if necessary. reality in training various medical groups.
One of the most important applications of
VR in medical science is in medical education, Methods
which has been widely used in the last decade. This study is a scoping review which aimed
Many studies have paid attention to various to identify virtual reality applications in training
VR applications in medical education (4, 5), the medical groups in 2016. The research question
including the understanding of fracture anatomy was identified based on the PCC (Population,
by orthopedic residences (6), improving the Concept and Context) elements. This particular
knowledge and skills of clinical residences in question includes: medical groups that use VR
the MICU and as an adjunct complement for for training (Population); the effect of Virtual
standard clinical education if internal residences Reality in Medicine Groups training (Concept);
in MICU, as well as general objections regarding use of Virtual Reality in medical teaching centers
the patient safety, ethical concerns and financial (context).
constraints for education of medical students Consistent with Best Evidence Medical
have led to a widespread application of non- Education (BEME) recommendations, the
human and inanimate models for training the search was performed on valid databases as
laparoscopic skills because simulation-oriented well as PubMed, Scopus, ISI Web of Science
syllabus is very effective in transferring skills to and Springer. During the search, the restrictions
the operating room (7-13). and related keywords were retrieved. To search
The American Board of Internal Medicine for related papers, the combination of
(ABIM) has announced that it is better for keywords (Table 1), with the English language
residents to be trained by simulation tools and 5-year period restrictions were applied.
before attempting any interventions on patients Also, a search expert helped us to improve the
because it has been effective in performing quality of searches.
invasive hemodynamic monitoring, mechanical The inclusion criteria were clinical trial
ventilation, and standardized educational and exclusion criteria were commentary non-
intervention (14). randomized trials and non-clinical trials. Erratum
Stefanidis et al. concluded that suture training Review, Commentary, contact with Editor and
using simulator improves the speed and mobility available Studies were considered. The process
of practitioners in the operation room (15). In the of selection of articles was based on the PRISMA
same line, Lin et al. found that given the fact that chart (Figure 1), and 24 articles were selected
performing bone cut or bone surgery requires high out of 1343 retrieved articles. In accordance with
experience and sensitivity, training the simulation BEME, all stages of the selection and evaluation
of virtual and tactical surgery with feedback can of the quality of the articles were done by two
be a safe, repeatable and cost-effective method researchers and in the case of disagreement, a
compared to traditional methods (16). third person was available to help.
Given the importance of medical education Considering BEME, to assess the quality of
using the virtual reality tools and its role in the studies, we excluded Consortium Assessment
improving t he quality of medical education Tool 2010 (was used) and 3 papers with
in various medical specialties, many papers undesirable quality from the study. Finally, 21
examined this field in recent years. Although qualified papers of clinical trials were selected.
Walsh et al. instead of using conventional methods Consistent with BEME, the required
systematically reviewed education of endoscopy information of the selected papers was collected
using virtual reality, but there was no systematic using a data collection form (including items
study regarding its applications (17). Therefore, of the type of study, the year of the study,
the present study was a systematic review that the sample number, the country where the

Table 1: The search strategy of the research

Search strategy
Search Engines and Databases: Pub Med, Springer, ISI Web of Sciences, Scopus, Google Scholar (2012 to 2016)
Limits: Language (only resources with at least an abstract in English)
Date: up to 2016,May, 20
Search strategy: #1 AND #2 AND #3
#1 “VR” OR “virtual reality” OR “computer simulate” OR “Augmented Reality”
#2 “education” OR “training” OR “learning” OR “teaching”
#3 “medicine” OR ”medical” OR “medical students” OR “residents” OR “medical groups”

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The applications of virtual reality in medical groups teaching The applications of virtual reality in medical groups teaching
Samadbeik M et al.

Figure 1: The PRISMA flowchart for the paper selection process

study was conducted, first author, the most in medical education.

important findings, the proposed solutions and The findings of the present study indicated
the limitations of each study) and the data were that the average period of training different
summarized and reported in Tables according to medical groups using virtual reality was between
the objectives of the study. six months to one year. In addition, according to
the findings of the present study, the application
Results of virtual reality reduced the time required for
All of 21 clinical trials with inclusion criteria training medical groups. The secondary results
were selected for the current study. 2013 had of this study are shown in Table 2 to address the
the largest number of studies (9). Studies were advantages and disadvantages of virtual reality
conducted in Denmark (4 studies), Canada, the in teaching medical groups.
United States and Germany (3 studies for each), Other secondary results of the current study
England and Australia (2 studies for each), and the include suggestions for improving the application
Netherlands, Switzerland, Norway, and Austria, of virtual reality that are presented in Table 3.
(each with 1 study). Using pre-test and post-test
was the most common method for data collection. Discussion
Based on the other results, the effect of The results indicated that all studies were
using virtual reality was ranked from 1-4 (very conducted in developed countries. 95% of the
effective, effective, ineffective, and negative); studies that have been studied emphasize the
only two studies reported the negative effect improvement of the skills of trainees (various
on the use of virtual reality in training medical medical groups) using virtual reality although a few
groups. In addition, two studies have reported studies noted the ineffectiveness of virtual reality
the ineffectiveness of the use of virtual reality on medical education. Julie Enne et al. proposed

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Samadbeik M et al.

Table 2: Advantages and disadvantages of training various medical groups using virtual reality
Disadvantages Advantages
The high cost of the simulators Decrease in the frequency of training and the ease of training using VR
The long nature of some studies in the field of (22-28)
virtual reality Decrease in the time of surgery in the real environment (23, 29, 30)
The high cost of these studies (high cost of Positive psychological effect on learners (23)
monitors, programming, implementation Increase in accuracy and accuracy of trainers and reduction of errors (21)
environment, participants, etc.) Improving the teamwork in the medical team (31)
It can never replace the real environment Increase in self-confidence in learners using VR compared to other groups
training (23, 32)
Its implementation requires identification of the Decrease of harm to those being treated by people who are trained by VR,
effective factors and conditions of that society decrease in mistakes and more successful surgeries (29, 33-35)
Additional training using VR without Increase in skills of learners (18, 21, 24, 28, 36)
supervision can cause extra stitching, and lead to Better learning of anatomical positions (27)
damages to tissues, and more Better understanding of the exterior and interior space relationships
The course of studies is very limited; therefore, between the organs (27)
further studies and more accurate evaluations Valuable approach for Standard and unified education of medical groups
are necessary (28)
Some studies have also pointed to the increase in Increase in the skill of surgeon (21)
training time (18-21) Increase in the safety of the physician and patients (21, 33, 34)
Decrease in the costs and increase in the efficiency (18, 22, 26, 37)
Overall performance improvement (32, 35, 38)

Table 3: Proposals for the improvement of the application of virtual reality for training various medical groups
No Proposals
1 The use of virtual reality simulator automatic feedback combined with educational feedback during laparoscopic
training in simulated way (17)
2 The divergence between educational concepts of students is decreased. Perhaps significant implications can be
stablished for learning using virtual reality technology (20)
3 The presence of an instructor is very influential (guided- education), and in the absence of such a person there may be
distortion and in the training process and the performance can be reduced (22, 26)
4 The application of virtual reality equipment for training than traditional medical education (39)
5 Using Portable Learning equipment by virtual reality (23)
6 Application of virtual reality is appropriate for midterm training in medical groups and it is not recommended for
long-term education (17, 24)
7 Retraining courses alongside learning using virtual reality (24)
8 The use of VR for the training the medical groups should be considered as an additional training and it cannot replace
the main method (25, 29)
9 Understanding the general and specific parameters of the participants in the training will lead to
identification of the effective factors in the implementation of more precise laparoscopic surgeries (30)
10 Using feedback during the training using virtual reality (17, 26, 32, 37, 38)

the implementation of virtual reality training However, Brydges et al. indicated that “contrary
courses for the acquisition of hysteroscopic skills to expectations of researchers, intervention group
for clinical professionals who are interested in did not have more advantages over self-regulated
learning sterilization techniques (36). learning (SRL), and in fact they spent more time
The application of virtual reality in training on doing it” (20). However, most studies reported
different medical groups includes different effects. the positive impact of the application of virtual
That is, in some specialties virtual reality is very reality for training the medical groups. Given
effective, and in several studies and specialties that a small number of studies reported the lack
no positive effects are noted regarding the use of effectiveness of the virtual reality application,
of virtual reality compared to the control group. further studies are required to be conducted in
A recent study on gynecology and obstetrics this area.
reported the impact of VR application on the In addition, Bongers et al. noted that “this
enhancement of infant and maternal health (35). study proposed that multitasking could be taught
A study conducted in 2012 concluded using virtual reality simulator equipment. But the
that simulation-based education significantly effectiveness of surgery reduced in trainees with
increased the skills and knowledge of residents multiple trainings and this level of skill requires
in the intensive care unit. It is an invaluable more research” (18).
approach for standard medical education (28). The results emphasize a better understanding

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The applications of virtual reality in medical groups teaching The applications of virtual reality in medical groups teaching
Samadbeik M et al.

of the exterior and interior spatial relationships it is suggested that it should be used as a
of the organs and development of the anatomical complementary educational tool along with
knowledge of students through the application of main education. Considering that laparoscopic
VR. Yanping et al. emphasized the improvement surgery is one of the most important surgical
of the skills of beginners and experienced procedures that is taught using virtual reality,
bone sawing rescuers because the application individual and general factors affecting its exact
of surgical simulations helps the trainees to implementation should be identified. In addition,
increase their recognition skill of the anatomical given the importance of the issue, it is suggested
positions (16). Therefore, virtual reality can that more studies should be carried out on the
be used for training the anatomy courses of training of medical groups using virtual reality
different medical groups. to determine the type and extent of its impact on
Other results showed that virtual reality should the performance and efficiency of the students.
be used as a complementary training along with With respect to the results of the present study,
main training and it can never replace the training it is suggested that virtual reality should be used
in the real environment. A study in the field of in training such skills as laparoscopic surgery,
software development of virtual reality used for education of orthopedic residents, Gynecology
education of nursing emphasized guidance in the residents, suturing, ultrasound, nursing
objectives of simulation training software and its procedures and paramedical interventions. In
combination with conventional trainings (40). In addition, it seems necessary to do studies to
addition, some studies pointed the effective and determine the effectiveness and usefulness of
positive effects of simulation-oriented syllabus on the method and satisfaction of the trainees and
transferring skills to the operating rooms (8-13). patients. Furthermore, considering the needs of
The results revealed that the presence of an trainees, designing virtual reality tools can be
instructor is very influential (guided-training) an appropriate solution for its effective use for
since his absence may lead to disruption in the training the medical groups.
learning process and the performance can be
reduced (22, 26). Acknowledgement
One of the issues of conducting this area is This study is the result of a research project
the high cost of these studies, such as the high done through the financial support of Health
cost of monitors, programming, implementation Human Resources Research Center, School of
environment, participants, and so on. A higher Management and Medical Informatics, Shiraz
number of student were proposed in a study to University of Medical Sciences with grant No.
cover the high cost of using virtual reality (39). 95-01-68-12720.
Given the importance of continuous
monitoring of education, the use of feedback Conflict of Interest: None declared.
during training is recommended (17, 26, 32, 37,
38). Also, the use of virtual reality is suggested References
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