The Effect of 360° Virtual Reality versus 2-Dimensional Video Reviews on History Taking and Physical Examination Skills Learning in Undergraduate Medical Students: A Randomized Controlled Trial (Preprint)

BACKGROUND History taking and physical examination (H&P) is an important core competency of undergraduate medical education. Recent advances in virtual reality (VR) simulation, lowering the complexity of learning tasks and the cognitive load of the learners, make this novel technology well suited for the initial training of novices. Reduced heart rate variation (HRV) is associated with decreased cognitive efficiency. Whether a 360° VR video review can impact learning outcome, cognitive load, and HRV while learning H&P skills in undergraduate medical students is unknown. OBJECTIVE We explored the effectiveness of 360° VR versus 2-dimensional (2D) video review to learn H&P skills with regards to learning outcome, cognitive load, and HRV. METHODS In 2018, we randomly assigned (1:1) 64 undergraduate medical students to either a 360° VR or 2D video group (matched by age, sex, and cognitive style) with allocation concealment to learn H&P skills using VR headsets and controllers. Subsequently, the participants each performed a focused H&P with a real outpatient. Two raters used the Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) questionnaires to assess the participants’ performance blindly. The Cognitive Load Component questionnaire and a portable electrocardiogram monitor were used to measure cognitive load and HRV, respectively. RESULTS All participants completed the study (mean age=24.2 years, standard deviation=0.9 years; 44 [69%] males and 20 [31%] females). The physical examination and student’s satisfaction scores (Mini-CEX), total DOPS score, total and intrinsic cognitive load scores, and standard deviation of normal to normal R-R intervals in the 360° VR video group were significantly higher than those in the 2D video group (effect size=0.63, 0.56, 0.72, 0.53, 0.67, and 0.52, respectively). Differences in the other aspects of the Mini-CEX and cognitive loads of both groups were not statistically significant. CONCLUSIONS This study provides a high level of evidence to confirm that 360° VR video review can help undergraduate medical students to perform fundamental H&P skills as effectively as traditional 2D video review. Furthermore, a 360° VR video review could be used to more efficiently examine the body of a real patient with higher learner’s satisfaction. These findings may inspire the design of 360° VR video-based training protocols to enhance competencies other than history taking. CLINICALTRIAL Clinicaltrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 (Archived by WebCite at http://www.webcitation.org/72f59ImWm)

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Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial

JMIR Serious Games ◽

10.2196/13124 ◽

2021 ◽

Vol 9 (4) ◽

pp. e13124

Author(s):

Yi-Ping Chao ◽

Hai-Hua Chuang ◽

Li-Jen Hsin ◽

Chung-Jan Kang ◽

Tuan-Jen Fang ◽

...

Keyword(s):

Virtual Reality ◽

Reaction Time ◽

Medical Students ◽

Cognitive Load ◽

Learning Outcomes ◽

History Taking ◽

Undergraduate Medical Students ◽

Qualitative Feedback ◽

Video Group ◽

Video Module

Background Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. Objective The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. Methods This pilot system–design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. Results All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. Conclusions Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners’ needs and prompted learning through the different video modules. Trial Registration ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641

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Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial (Preprint)

10.2196/preprints.13124 ◽

2018 ◽

Author(s):

Yi-Ping Chao ◽

Hai-Hua Chuang ◽

Li-Jen Hsin ◽

Chung-Jan Kang ◽

Tuan-Jen Fang ◽

...

Keyword(s):

Virtual Reality ◽

Reaction Time ◽

Medical Students ◽

Cognitive Load ◽

Learning Outcomes ◽

History Taking ◽

Undergraduate Medical Students ◽

Qualitative Feedback ◽

Video Group ◽

Video Module

BACKGROUND Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. OBJECTIVE The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. METHODS This pilot system–design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. RESULTS All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. CONCLUSIONS Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners’ needs and prompted learning through the different video modules. CLINICALTRIAL ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641

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Comparison of the effectiveness of lecture instruction and virtual reality-based serious gaming instruction on the medical students’ learning outcome about approach to coma

BMC Medical Education ◽

10.1186/s12909-021-02771-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Meysam Siyah Mansoory ◽

Mohammad Rasool Khazaei ◽

Seyyed Mohsen Azizi ◽

Elham Niromand

Keyword(s):

Virtual Reality ◽

Medical Students ◽

Learning Outcomes ◽

Learning Outcome ◽

Serious Game ◽

Control Group ◽

Serious Gaming ◽

E Learning ◽

The Mean ◽

Lecture Instruction

Abstract Background New approaches to e-learning and the use of virtual reality technology and serious game in medical education are on the rise. Therefore, the purpose of this study was to compare the effectiveness of lecture method and virtual reality-based serious gaming (VRBSG) method on students learning outcomes about the approach to coma. Methods We adopted a randomized trial method for this study and selected 50 medical students dividing them into experimental and control groups. Students’ learning outcome was measured with a 10-item test. Serious game usability scale was used to evaluate the usability of the serious game. Descriptive and inferential statistics were used for data analysis by SPSS-22 software. Results Students’ familiarity with e-learning and VRBSG was low. The mean usability of a VRBSG was 126.78 ± 10.34 out of 150. The majority of students were eager to be instructed through VRBSG. The mean score of learning outcomes in the experimental group was significantly higher than the control group (t = − 2.457, P = 0.019). Conclusion Students’ learning outcomes in the VRBSG group in the test approach to coma were significantly better than the lecture group. The usability of the serious game instruction method was high. Taken together, instruction through VRBSG had an effective role in medical students’ learning.

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Use of Virtual Reality to Educate Undergraduate Medical Students on Cardiac Peripheral and Collateral Circulation

Medical Science Educator ◽

10.1007/s40670-020-01104-x ◽

2020 ◽

Author(s):

Roberto Galvez ◽

Robert C. Wallon ◽

Laura Shackelford ◽

Jennifer R. Amos ◽

Judith L. Rowen

Keyword(s):

Virtual Reality ◽

Medical Students ◽

Collateral Circulation ◽

Undergraduate Medical Students

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The reach of Spanish-language YouTube videos on physical examinations made by undergraduate medical students

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2017.14.31 ◽

2017 ◽

Vol 14 ◽

pp. 31 ◽

Cited By ~ 1

Author(s):

José M. Ramos-Rincón ◽

Isabel Belinchón-Romero ◽

Francisco Sánchez-Ferrer ◽

Guillermo Martínez-de la Torre ◽

Meggan Harris ◽

...

Keyword(s):

Puerto Rico ◽

Medical Students ◽

Physical Examination ◽

Performance Metrics ◽

First Language ◽

Spanish Language ◽

Undergraduate Medical Students ◽

Physical Examinations ◽

Youtube Videos ◽

The Mean

This study was conducted to evaluate the performance and reach of YouTube videos on physical examinations made by Spanish university students. We analyzed performance metrics for 4 videos on physical examinations in Spanish that were created by medical students at Miguel Hernández University (Elche, Spain) and are available on YouTube, on the following topics: the head and neck (7:30), the cardiovascular system (7:38), the respiratory system (13:54), and the abdomen (11:10). We used the Analytics application offered by the YouTube platform to analyze the reach of the videos from the upload date (February 17, 2015) to July 28, 2017 (2 years, 5 months, and 11 days). The total number of views, length of watch-time, and the mean view duration for the 4 videos were, respectively: 164,403 views (mean, 41,101 views; range, 12,389 to 94,573 views), 425,888 minutes (mean, 106,472 minutes; range, 37,889 to 172,840 minutes), and 2:56 minutes (range, 1:49 to 4:03 minutes). Mexico was the most frequent playback location, followed by Spain, Colombia, and Venezuela. Uruguay, Ecuador, Mexico, and Puerto Rico had the most views per 100,000 population. Spanish-language tutorials are an alternative tool for teaching physical examination skills to students whose first language is not English. The videos were especially popular in Uruguay, Ecuador, and Mexico.

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Effect of formative assessment on documentation of pediatric physical examination by undergraduate medical students

Pediatric Review International Journal of Pediatric Research ◽

10.17511/ijpr.2017.i10.04 ◽

2017 ◽

Vol 4 (10) ◽

pp. 603-610

Author(s):

Dr Arun Kumar T ◽

◽

Dr Sangeeta A ◽

Dr Rashmi R ◽

Dr Jyothi S ◽

...

Keyword(s):

Medical Students ◽

Physical Examination ◽

Formative Assessment ◽

Undergraduate Medical Students

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Motivating Medical Students Using Virtual Reality Based Education

International Journal of Emerging Technologies in Learning (iJET) ◽

10.3991/ijet.v15i02.11394 ◽

2020 ◽

Vol 15 (02) ◽

pp. 160 ◽

Cited By ~ 4

Author(s):

Mian Usman Sattar ◽

Sellappan Palaniappan ◽

Asiah Lokman ◽

Nauman Shah ◽

Usman Khalid ◽

...

Keyword(s):

Virtual Reality ◽

Medical Students ◽

Student Motivation ◽

Teaching And Learning ◽

Statistical Investigation ◽

Learning Motivation ◽

Medical Studies ◽

Undergraduate Medical Students ◽

Training Simulation ◽

Intrinsic Motivation Inventory

An exploratory study to compare the effects of immersive virtual reality based training on the learning motivation of final year medical students as compared to video and text-based learning. Different modes of delivery of a training simulation of laparoscopy operation were presented to students and learning motivation corresponding to which were evaluated using the Intrinsic Motivation Inventory. The study was conducted from September 2018 to May 2019. Undergraduate medical students from 8 medical colleges and universities across Punjab, Pakistan participated in this study. A total of 87 students with a mean age of 22.5 ± 4 years were recruited for the study. Of these, 57.4% (n = 50) were males and 42.6% (n = 37) were females. Paired sampled t-test was chosen for the statistical investigation for the study. The tests were conducted by comparing means of text, video, and virtual reality learning methodologies in medical students. All executed statistical models are having significance value P=.000. Therefore, results are generalizable and can be implemented across the population. Medical student motivation was observed to be the greatest in Virtual Reality settings as compared to video-based and text-based learning settings. Both theoretical and practical studies have importance in medical studies, whereas practical hand-on-practice can enhance medical students’ professional proficiency. Virtual reality was at the top in User experience, perceived competence, usefulness, and motivation for final year medical students. It can play a signficant role in contemporary teaching and learning methodology with medical educationist and students can get benefit from this technology.

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Point-of-care ultrasound augments physical examination learning by undergraduate medical students

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-137773 ◽

2020 ◽

Vol 97 (1143) ◽

pp. 10-15

Author(s):

Chun Ka Wong ◽

JoJo Hai ◽

Kwong Yue Eric Chan ◽

Ka Chun Un ◽

Mi Zhou ◽

...

Keyword(s):

Medical Students ◽

Physical Examination ◽

Medical Curriculum ◽

Instant Messaging ◽

Point Of Care ◽

Group Discussion ◽

Point Of Care Ultrasound ◽

Undergraduate Medical Students ◽

Significant Difference ◽

The Impact

BackgroundLittle is known about the impact of the provision of handheld point-of-care ultrasound (POCUS) devices on physical examination skills of medical students.MethodsWe describe an educational initiative that comprised a POCUS workshop followed by allocation of a POCUS device to medical students for use over the subsequent 8 weeks. They were encouraged to scan patients and correlate their physical examination findings. A mobile instant messaging group discussion platform was set to provide feedback from instructors. Physical examination skills were assessed by means of clinical examination.Results210 final-year medical students from the University of Hong Kong participated in the programme. 46.3% completed the end of programme electronic survey: 74.6% enjoyed using the POCUS device, 50.0% found POCUS useful to validate physical examination findings and 47.7% agreed that POCUS increased their confidence with physical examination. 93.9% agreed that the programme should be incorporated into the medical curriculum and 81.9% would prefer keeping the device for longer time from 16 weeks (45.6%) to over 49 weeks (35.3%). Medical students who participated in the POCUS programme had a higher mean score for abdominal examination compared with those from the previous academic year with no POCUS programme (3.65±0.52 vs 3.21±0.80, p=0.014), but there was no statistically significant difference in their mean score for cardiovascular examination (3.62±0.64 vs 3.36±0.93, p=0.203).ConclusionThe POCUS programme that included provision of a personal handheld POCUS device improved students’ attitude, confidence and ability to perform a physical examination.

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Virtual Integrated Patient: An AI supplementary tool for second-year medical students

The Asia Pacific Scholar ◽

10.29060/taps.2021-6-3/sc2394 ◽

2021 ◽

Vol 6 (3) ◽

pp. 87-90

Author(s):

Juanita S. M. Kong ◽

Boon See Teo ◽

Yueh Jia Lee ◽

Anu Bharath Pabba ◽

Edmund J.D. Lee ◽

...

Keyword(s):

Medical Students ◽

Pilot Study ◽

Physical Examination ◽

Clinical Skills ◽

History Taking ◽

Clinical Rotations ◽

Face To Face ◽

Second Year ◽

Standardised Patients ◽

Real Patients

Introduction: With the COVID-19 pandemic, Singapore underwent a national lockdown in which most organisations, including schools were closed. Halting face-to-face tutorials resulting in decreased clinical contact for medical students. Prior to the pandemic, we had developed the Virtual Integrated Patient (VIP). Equipped with conversational technology, it provides students online practice in various clinical skills such as history-taking, physical examination and investigations. The aim of this paper is to describe the supplementary use of VIP in the second-year class, in which a pilot study was conducted. Methods: The VIP platform was introduced to the cohort and used to supplement the teaching of history-taking in the “Communication with Patients” (CWP) module for second-year students. Traditionally, CWP tutorials involve face-to-face history-taking from standardised patients (SPs). Students, who consented to participating in the trial, had an additional 3 weeks’ access to VIP to practice their history-taking skills. They completed a survey on their user experience and satisfaction at the end of the 3 weeks. Results: Out of the 106 participants, 87% strongly agreed or agreed that using VIP helped in remembering the content while 69% of them felt that VIP increased their confidence and competence in history-taking. Conclusion: VIP was well-received by students and showed promise as a tool to supplement history-taking tutorials, prior to students’ encounter with SPs and real patients. Hence, this trend showed its potential as an alternative when clinical rotations were delayed or cancelled. Further research can be done to evaluate its effectiveness in this context.

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