This paper presents an empirical study and related activity system analysis regarding the implementation and use of Moodle specifically, and learning management systems in general, in problem-based learning. The research involved an exploration of the characteristics that defined use of Moodle at a Danish university, the reasons why Moodle was or was not used in specific contexts and the way in which Moodle use was perceived by students. Some of the obstacles and challenges identified through this study highlighted the need for a deeper analysis of the elements that characterised the activity system(s) and their contradictions in this contextual setting, leading to a consideration of possible implications for change processes. The investigation consisted of a literature review, a survey of 345 students regarding their experiences with Moodle in conjunction with a nomination for the best Moodle course, an analysis of the 178 nominated courses and interviews with four university teachers about their use of Moodle. This examination revealed that many existing Moodle activities at Aalborg University focus more on sharing information and teaching materials and less on the students’ problem-based learning activities and projects. This finding is intriguing, as use of Moodle does not reflect that problem-based learning comprises the pedagogical foundation of Aalborg University’s academic programme. The investigation uncovered several reasons for the lack of focus on problem-based learning in Moodle structures and content and explored them through the contradictions identified within the activity systems and between the double contextual frame surrounding the interacting activity system.

The primary aim was to evaluate the effect of immersive virtual reality learning for training medical students in basic clinical ultrasound. Secondary outcomes were to explore if virtual reality learning had an effect on hand-eye coordination skills and if the medical students wanted more virtual reality learning.This pilot study was a double-blind, parallel-group, block-randomized, controlled trial. Participants (n = 20) were blinded and randomized to virtual reality or e-learning for basic ultrasound education. Medical students with no previous ultrasound education were recruited voluntarily from the University of Southern Denmark. Data were collected during introductory courses on ultrasound from March to May 2019. Participants were assessed with Objective Structured Assessment on Ultrasound Skills. Assessing supervisors were blinded.The virtual reality group (n = 11) scored a significantly higher Objective Structured Assessment on Ultrasound Skills score (143 [95% confidence interval {CI}, 135 to 151]) compared with the e-learning group (n = 9; 126 [95% CI, 113 to 138]; mean difference, 17 points [95% CI, 4 to 30]; P < 0.01). No significant effect on the hand-eye score was found (mean difference, 3 points [95 % CI, −3 to 9]; P = 0.32). Ninety-one percent of the virtual reality group wanted more virtual reality learning.Immersive virtual reality learning improved medical students’ ultrasound skills significantly compared with e-learning. The hand-eye score was higher in the virtual reality group, although not at a significant level. Students wanted more virtual reality learning. Further research is needed to clarify immersive virtual reality's educational role in the future.

Summary StatementSimulation-based training using virtual reality head-mounted displays (VR-HMD) is increasingly being used within the field of medical education. This article systematically reviews and appraises the quality of the literature on the use of VR-HMDs in medical education. A search in the databases PubMed/MEDLINE, Embase, ERIC, Scopus, Web of Science, Cochrane Library, and PsychINFO was carried out. Studies were screened according to predefined exclusion criteria, and quality was assessed using the Medical Education Research Study Quality Instrument. In total, 41 articles were included and thematically divided into 5 groups: anatomy, procedural skills, surgical procedures, communication skills, and clinical decision making. Participants highly appreciated using VR-HMD and rated it better than most other training methods. Virtual reality head-mounted display outperformed traditional methods of learning surgical procedures. Although VR-HMD showed promising results when learning anatomy, it was not considered better than other available study materials. No conclusive findings could be synthesized regarding the remaining 3 groups.