Virtual reality—a change for the better in medical education

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Virtual reality (VR) can be used to simulate rich, multimodal and highly controllable environments, which makes it a very useful technology in healthcare. From training healthcare professionals (HCPs) and rehabilitating patients to diagnosing and treating diseases, the variety of ways in which VR is being used is constantly growing. In this article, we will explore some of these uses, including how VR is helping investigators to understand the factors that influence how doctors respond to ethically challenging prescription situations.

Among the most popular healthcare-related applications of VR is exposure therapy (VRET), a technique that has been found to be effective in the treatment of social anxiety1, specific phobias2 and post-traumatic stress disorder.3 VRET utilises a computer-generated virtual environment to present fear-relevant stimuli in a private, controlled and safe setting, allowing patients to face fears, practise coping strategies and break avoidance behaviour patterns.

VR’s ability to simulate immersive and very detailed artificial environments makes it ideal for surgical training, which usually involves assisting experienced surgeons before gradually taking over surgeries. VR provides basic skills training in a controlled environment without supervision and free from the pressures of operating on real patients. Surgical training involving VR has been shown to decrease operating time and improve performance.4 It has also demonstrated lower cognitive load than traditional training.5

Another well-established deployment of VR in healthcare is in pain management. The technology’s efficacy in relieving pain has been demonstrated in a number of acute areas, including burn care6, cancer treatment7, dental procedures8 and wound management.9 Significant reductions in subjective ratings of chronic pain have also been reported.10 Researchers have hypothesised that VR acts as a non-pharmacologic form of analgesia by influencing emotional and attentional processes of the intricate pain modulation system.11

VR’s usefulness in cancer treatment doesn’t just extend into pain management. In addition to decreasing chemotherapy-associated anxiety, distress and fatigue12, and promoting the emotional wellbeing of hospitalised oncology patients13, the technology has been shown to alter time perception during chemotherapy sessions, making the procedures more tolerable.14

VR also offers a promising approach to rehabilitating stroke victims. Stroke can leave patients with a variety of short- and long-term physical, emotional and cognitive problems. Studies using VR have reported improvements in upper limb function15, attention and memory16, and balance and mobility.17,18 In cognitive rehabilitation, VR even offers cost benefits.16

More recently, a new and very interesting use of VR has been published.19 The study involved exposing GPs and medical trainees to a VR simulation in which an angry woman keeps insisting that her mother be prescribed antibiotics despite inconclusive evidence that antibiotics are necessary. The aim of the study was to explore the extent to which VR can help researchers understand the factors that influence a doctor’s response to such ethical challenges. By investigating whether doctors would take the virtual situation seriously, the study also evaluated VR’s potential to train doctors to face such dilemmas.

The doctors in the study were found to be more resistant to the woman’s demands than the trainees. What’s more, evaluations of the participants’ level of presence suggested that they did tend towards the illusion of being in a real consultation—thus providing evidence in favour of VR’s usefulness in training doctors to deal with ethically challenging prescription-related situations.

At emotive, we are fully aware of VR’s usefulness in medical education and its potential to change behaviour, having worked with VR extensively for a number of years. We are proud to have been one of the first companies anywhere in the world to combine Oculus Rift and XBox Kinect to deliver a fully immersive, multisensory, interactive medical education experience. Known as Diabetes Voyager, the experience went on to win multiple awards. We have since adapted the strategy for other clients, producing medical education experiences that transcend standard teaching methods and creatively harness VR’s full potential as a teaching medium.

As is clear from the above examples, VR’s usefulness and versatility in healthcare and medical education is remarkable. It will be interesting to see how else the technology can be developed, adapted and utilised in the future. As specialists in providing solutions that harness the latest technology to improve outcomes, we’ll be keeping an eye on VR’s evolution and other technological advancements that could help our clients to achieve objectives.

References

  1. Anderson PL, Price M, Edwards SM, et al. Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. J Consult Clin Psychol. 2013;81(5):751–60.
  2. Morina N, Ijntema H, Meyerbröker K, et al. Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behav Res Ther. 2015;74:18–24.
  3. Botella C, Serrano B, Baños RM, et al. Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability. Neuropsychiatr Dis Treat. 2015;11:2533–45.
  4. Nagendran M, Gurusamy KS, Aggarwal R, et al. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2013;8:CD006575.
  5. Andersen SA, Mikkelsen PT, Konge L, et al. Cognitive Load in Mastoidectomy Skills Training: Virtual Reality Simulation and Traditional Dissection Compared. J Surg Educ. 2016;73(1):45–50.
  6. Morris LD, Louw QA, Grimmer-Somers K. The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. Clin J Pain. 2009;25(9):815–26.
  7. Gershon J, Zimand E, Pickering M, et al. A pilot and feasibility study of virtual reality as a distraction for children with cancer. J Am Acad Child Adolesc Psychiatry. 2004;43(10):1243–9.
  8. Asl Aminabadi N, Erfanparast L, Sohrabi A, et al. The impact of virtual reality distraction on pain and anxiety during dental treatment in 4–6 year-old children: a randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects. 2012;6(4):117–24.
  9. Hua Y, Qiu R, Yao WY, et al. The effect of virtual reality distraction on pain relief during dressing changes in children with chronic wounds on lower limbs. Pain Manag Nurs. 2015;16(5):685–91.
  10. Wiederhold BK, Gao K, Sulea C, et al. Virtual reality as a distraction technique in chronic pain patients. Cyberpsychol Behav Soc Netw. 2014;17(6):346–52.
  11. Gold JI, Belmont KA, Thomas DA. The neurobiology of virtual reality pain attenuation. Cyberpsychol Behav. 2007;10(4):536–44.
  12. Schneider SM, Prince-Paul M, Allen MJ, et al. Virtual reality as a distraction intervention for women receiving chemotherapy. Oncol Nurs Forum. 2004;31(1):81–8.
  13. Espinoza M, Baños RM, García-Palacios A, et al. Promotion of emotional wellbeing in oncology inpatients using VR. Stud Health Technol Inform. 2012;181:53–7.
  14. Schneider SM, Kisby CK, Flint EP. Effect of virtual reality on time perception in patients receiving chemotherapy. Support Care Cancer. 2011;19(4):555–64.
  15. Laver KE, George S, Thomas S, et al. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2015;2:CD008349.
  16. Gamito P, Oliveira J, Coelho C, et al. Cognitive training on stroke patients via virtual reality-based serious games. Disabil Rehabil. 2015;2:1–4.
  17. Lloréns R, Gil-Gómez JA, Alcañiz M, et al. Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke. Clin Rehabil. 2015;29(3):261–8.
  18. Corbetta D, Imeri F, Gatti R. Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. J Physiother. 2015;61(3):117–24.
  19. Pan X, Slater M, Beacco A, et al. The responses of medical general practitioners to unreasonable patient demand for antibiotics—a study of medical ethics using immersive virtual reality. PLoS One. 2016;11(2):e0146837.

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