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

Abstract

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

Comparison of the effect of 360° versus two-dimensional virtual reality video on history taking and physical examination skills learning among undergraduate medical students: a randomized controlled trial

“…Furthermore, the 360º VR learners may decide to look at something which is not relevant (whatever is happening behind the physician), while the 2D VR video learners can quickly focus on the relevant part of the scenario that the physician controls. In our preliminary study, the 360º VR learners watched the instructional scenes of physical examination with higher interest and engagement and longer secondary-task reaction time than the 2D VR video learners (Chao et al 2021 ). On the other hand, the 2D VR video learners emphasized that they found the 2D VR video module was easy to follow and highly efficient because the video was directed through the physician’s view.…”

“…Therefore, immersive 360° VR video with a higher field of view and degree of freedom is a cost-effective pedagogical tool by increasing learner attention, presence, skill enhancement, confident usability, performance, satisfaction, motivation, and engagement (Blair et al 2021 ; Buttussi & Chittaro 2018 ). Notably, although the 360° VR video (i.e., immersive VR) was more effective in teaching clinical skills such as patient communication (Sultan et al 2019 ), knot tying (Yoganathan et al 2018 ), dental anesthesia (Collaço et al 2021), procedure safety (Buttussi & Chittaro 2021 ), and fundamental H&P skills (Chao et al 2021 ) than the 2D VR video (i.e., non-immersive VR), not all VR participants preferred immersive VR-based learning activity (Chao et al 2021 ). In contrast, users of non-immersive VR (such as desktop-VR) preferred desktop-VR more for mine rescuing (Pedram et al 2021 ) or had better knowledge gain for virtual biology learning (Makransky et al 2019 ) than immersive 360° VR.…”

“…To reduce stimulator sickness's intensity, we developed a high-quality 360° VR application by using high-resolution (4 K) 360° videos, ergonomic VR software, and a high-end head-mounted display. After improving the quality of the 360° VR video, none of the pilot study subjects reported intolerable simulator sickness after experiencing a 10-min 360º VR video (Chao, et al 2021 ). Furthermore, a pre-briefing session of the teaching clinic was usually less than 15 min; thereby, we considered a 10-min 360° VR video review was suitable for the H&P skill learning.…”

“…Two experienced instructors (Chuang HH & Kang CJ) verified that the 360° and 2D VR videos contained similar learning materials. The main differences between both modules included visual angle (360° versus 120°), immersion (immersive versus non-immersive), and perspective (first person versus third person) (Chao et al 2021 ). Courseware with the same user interface of the 360°and 2D VR video modules was then developed using Unity 2017.3.1 Editor (Unity Technologies, San Francisco, CA, USA) by two investigators (Chao YP & Lee LA).…”

A New Virtual World? The Future of Immersive Environments in Anesthesiology

“…VR-360 videos have been used to create IVEs to raise the participation factor and improve the learning experience. 25,[27][28][29][30] Existing examples are already in place, such as the Oxford Medical Education lab (www.oxfordmedicaleducation.com) and the Collaborative Human ImmerSive Interaction Laboratory (CHISIL; www.chisil.ca) at the University of Toronto. These sites have released teaching programs in an effort to improve decision-making skills around topics such as advanced life support, trauma management, and cardiac arrest/code blue scenarios using VR-360 video simulations.…”