The affordances of clinical simulation immersive technology within healthcare education: a scoping review.

Whilst clinical simulation is established as an effective education tool within the healthcare community, the inability to offer authentic educational learning environments remains problematic. Advances in technology such as immersive virtual reality offer new opportunities to enhance traditional practice to an extent that may transform learning. However, with traditional clinical simulation stress and anxiety can both hinder performance and learning, yet it is unknown what nuances are applicable within a clinical virtual simulation environment. Determining potential benefits, drawbacks (including related stress and anxiety) and affordances of immersive technology clinical simulation designs may help provide an understanding of its usefulness. The aim of this scoping review is to investigate the range and nature of evidence associated with immersive virtual reality clinical simulation and education design. In addition, the review will describe authentic immersive technology clinical simulation use and reported stress response measurements. A search of seven electronic database and grey literature was performed in accordance with the Joanna Briggs Institute methodology. A key term search strategy was employed with five themes identified and investigated: (1) Healthcare professionals, (2) Clinical simulation, (3) Immersive virtual reality, (4) Stress/anxiety and (5) Authentic learning design. Application of the search strategy resulted in a hit total of 212 articles. Twelve articles met inclusion criteria. With most literature focusing on procedural performance and non-transferable education needs, there was a paucity of research that specifically investigated immersive virtual reality clinical simulation education and related stress. Therefore, this scoping review contributes new understandings by providing valuable insight and potential research gaps into current immersive virtual reality clinical simulation, its relationship to stress and the education design models currently being utilised to develop these concepts.

Immersive reality for robotic surgical training: a pilot study using 3D visors for immersive view of the operating field.

Immersive intracorporeal vision is a key feature of robotic surgery, limited today to only one trainee per operation when the dual console is available. We developed a tool that provides a virtually unlimited number of surgeons with the operator's view, with the possibility to also watch the surgeon's hand movements and the operating table. In this study, we aim to assess trainees' reaction to this innovative training method. Medical students and surgery residents were offered an immersive experience with head-mounted devices, showing a didactic video in a 360° virtual space with 3D intracorporeal robotic vision, the surgeon's hand movements and the surrounding operating room during a robotic rectal resection with total mesorectal excision. Subsequently, participants were asked to fill a questionnaire evaluating the user's reaction to the new training tool including the validated System Usability Scale (SUS) and Simulator Sickness Questionnaire (SSQ), and non-validated questions. 102 participants took part in the training and the assessment questionnaires, 94 (92%) medical students and 8 (8%) surgery residents. Users' feedback was overall positive. In the engagement and intention to use items, almost 90% of the respondents voted for a complete or near complete agreement. The median SUS score was 80 [IQR 70-90]. The median SSQ score was 44.88 [IQR 22.44-82.28]. Exposing trainees to immersive robotic vision of the surgical field had a positive reaction from our audience. Our initial results encourage further implementing this technology in surgical training of medical students and residents to prove its efficacy.

Cardiac arrest and cardiopulmonary resuscitation in the next decade: Predicting and shaping the impact of technological innovations.

INTRODUCTION: Cardiac arrest (CA) is the third leading cause of death, with persistently low survival rates despite medical advancements. This article evaluates the potential of emerging technologies to enhance CA management over the next decade, using predictions from the AI tools ChatGPT-4 and Gemini Advanced. METHODS: We conducted an exploratory literature review to envision the future of cardiopulmonary arrest (CA) management. Utilizing ChatGPT-4 and Gemini Advanced, we predicted implementation timelines for innovations in early recognition, CPR, defibrillation, and post-resuscitation care. We also consulted the AI to assess the consistency and reproducibility of the predictions. RESULTS: We extrapolate that healthcare may embrace new technologies, such as comprehensive monitoring of vital signs to activate the emergency system (wireless detectors, smart speakers, and wearable devices), use new innovative early CPR and early AED devices (robot CPR, wearable AEDs, and immersive reality), and post-resuscitation care monitoring (brain-computer interface). These technologies could enhance timely life-saving interventions for cardiac arrest. However, there are many ethical and practical challenges, particularly in maintaining patient privacy and equity. The two AI tools made different predictions, with a horizon for implementation ranging between three and eight years. CONCLUSION: Integrating advanced monitoring technologies and AI-driven tools offers hope in improving CA management. A balanced approach involving rigorous scientific validation and ethical oversight is necessary. Collaboration among technologists, medical professionals, ethicists, and policymakers is crucial to use these innovations ethically to reduce CA incidence and enhance outcomes. Further research is needed to enhance the reliability of AI predictive capabilities.

Virtual reality in managing Complex Regional Pain Syndrome (CRPS): a scoping review.

Background: Complex Regional Pain Syndrome (CRPS) is a severe pain disorder that does not yet have a specific treatment. Patients with CRPS not only suffer from a wide range of symptoms that affect their quality of life but also present psychological affections to the way they see their body and specifically their affected limb. Virtual Reality (VR) modalities have become a targeted treatment for chronic pain and in the case of CRPS, may be a valuable approach to the mechanisms that affect these patients. Objectives: Using the PRISMA Scoping Review guidelines, we intend to uncover the key information from the studies available about VR modalities in the treatment of CRPS. We focus on the improvement of pain levels, body perception disturbances (BPD), and limb movement/daily function. Results: Our search strategy resulted in 217 articles from PubMed. Twenty were assessed for eligibility and seven were included in the final qualitative synthesis. Of these seven articles, we included a clinical trial, three pilot studies, a blinded randomized controlled trial, a crossover double-blind trial, and a randomized controlled trial. These studies provide important subjective patient findings, along with some statistically significant results in the experiences of VR therapies modulating pain, BPD, and improving limb movement/daily function. However, not all the studies included statistical analysis, and there are contradicting data found from some patients that did not perceive any improvement from VR therapies. Conclusions: We describe the results found in 7 articles that focus on the treatment of CRPS with VR modalities. Overall, the articles have various limitations, but the strategies related to immersive virtual reality, cardiac signaling, body switching and limb modulation have shown the most promising results for pain reduction and BPD improvement. These strategies reflect on pathophysiological mechanisms that are hypothesized to be affected in CRPS patients leading to the chronic pain and BPD that they experience. Not much evidence was found for improvement in limb movement and daily function. This review is a pathway for future studies on this topic and a more extensive data synthesis when more information is available.

Immersive Reality Experience Technology for Reducing Social Isolation and Improving Social Connectedness and Well-being of Children and Young People Who Are Hospitalized: Open Trial.

BACKGROUND: Children and young people who are hospitalized can feel disconnected from their peers and families, which can, in turn, predispose them to psychological problems, including anxiety and depression. Immersive reality experience technology, recently developed by the New Zealand Patience Project Charitable Trust, may help to overcome these issues. Immersive reality experience technology uses immersive 360° live streaming and a virtual reality headset to enable children and young people who are hospitalized to connect through cameras located in either their school or home environment and via SMS text messaging with a designated buddy. OBJECTIVE: This trial aims to expand qualitative findings from a previous smaller proof of concept trial to ascertain the views of New Zealand children and young people who are hospitalized, their caregivers, and teachers regarding immersive reality experience technology and quantitatively evaluate the effectiveness of immersive reality experience technology in reducing social isolation and improving social connectedness and well-being using validated outcome measures. METHODS: An open trial of immersive reality experience technology was conducted between December 2019 and December 2020 for which 19 New Zealand children and young people aged 13 to 18 years who had been hospitalized at Starship Hospital-a specialist pediatric hospital in Auckland-for at least 2 weeks were recruited. All young people completed the Short Warwick-Edinburgh Mental Well-Being Scale, an abbreviated version of the Social Connectedness Scale, and the Social Inclusion Scale at baseline. Of the 19 participants, 10 (53%) used immersive reality experience technology as often as they wished over a 6-week period and completed postintervention measures. Semistructured interviews with a subset of the 10 young people, 4 caregivers, and 6 teachers were conducted immediately after the intervention. RESULTS: Participants reported improvements in social inclusion (mean change 3.9, SD 2.8; P=.06), social connectedness (mean change 14.2, SD 10.0; P=.002), and well-being (mean change 5.7, SD 4.0; P=.001). Key themes from interviews with participants, caregivers, and teachers were the importance of support for using immersive reality experience technology, connecting versus connectedness, choice and connection, and the value of setting it up and getting it right. Recommendations for improving connectedness via immersive reality experience and related technologies were also provided. CONCLUSIONS: Immersive reality experience technology can improve the social inclusion, social connectedness, and well-being of New Zealand children and young people who are hospitalized. With some technological modifications and simplified implementation, immersive reality experience and related technology could become part of standard care and support children and young people who are hospitalized in New Zealand and elsewhere to sustain family and peer cohesion, experience fewer psychological problems, and more easily return to normal life following the completion of treatment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Network Registry ACTRN12619000252112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376837&isReview=true.

Linking Emotional Reactivity Between Laboratory Tasks and Immersive Environments Using Behavior and Physiology.

An event or experience can induce different emotional responses between individuals, including strong variability based on task parameters or environmental context. Physiological correlates of emotional reactivity, as well as related constructs of stress and anxiety, have been found across many physiological metrics, including heart rate and brain activity. However, the interdependances and interactions across contexts and between physiological systems are not well understood. Here, we recruited military and law enforcement to complete two experimental sessions across two different days. In the laboratory session, participants viewed high-arousal negative images while brain activity electroencephalogram (EEG) was recorded from the scalp, and functional connectivity was computed during the task and used as a predictor of emotional response during the other experimental session. In an immersive simulation session, participants performed a shoot-don't-shoot scenario while heart rate electrocardiography (ECG) was recorded. Our analysis examined the relationship between the sessions, including behavioral responses (emotional intensity ratings, task performance, and self-report anxiety) and physiology from different modalities [brain connectivity and heart rate variability (HRV)]. Results replicated previous research and found that behavioral performance was modulated within-session based on varying levels of emotional intensity in the laboratory session (t (24) = 4.062, p < 0.0005) and stress level in the simulation session (Z = 2.45, corrected p-value = 0.0142). Both behavior and physiology demonstrated cross-session relationships. Behaviorally, higher intensity ratings in the laboratory was related to higher self-report anxiety in the immersive simulation during low-stress (r = 0.465, N = 25, p = 0.019) and high-stress (r = 0.400, N = 25, p = 0.047) conditions. Physiologically, brain connectivity in the theta band during the laboratory session significantly predicted low-frequency HRV in the simulation session (p < 0.05); furthermore, a frontoparietal connection accounted for emotional intensity ratings during the attend laboratory condition (r = 0.486, p = 0.011) and self-report anxiety after the high-stress simulation condition (r = 0.389, p = 0.035). Interestingly, the predictive power of the brain activity occurred only for the conditions where participants had higher levels of emotional reactivity, stress, or anxiety. Taken together, our findings describe an integrated behavioral and physiological characterization of emotional reactivity.

Virtual reality videos used in undergraduate palliative and oncology medical teaching: results of a pilot study.

BACKGROUND: Virtual reality (VR) immersive environments have been shown to be effective in medical teaching. Our university hospital received funding from our deanery, Health Education in Wales, to film teaching videos with a 360-degree camera. AIMS: To evaluate whether VR is an effective and acceptable teaching environment. VR headsets were set up for medical students who rotated through Velindre Cancer Hospital's Palliative Care department. METHODS: Students were asked to put on a VR headset and experience a pre-recorded 27 min presentation on nausea and vomiting in palliative care settings. They subsequently viewed a radiotherapy treatment experience from a patient's point of view. RESULTS: Of the 72 medical students who participated, 70 found the experience comfortable, with two students stating they felt the experience uncomfortable (1=headset too tight; 1=blurry visuals). Numerical scoring on ability to concentrate in VR from 0 to 10 (0=worst, 10=best) scored an average of 8.44 (range, 7-10). Asked whether this format suited their learning style, average score was 8.31 (range 6-10). 97.2 % (n=70) students stated that they would recommend this form of learning to a colleague, with one student saying he/she would not recommend and another stating he/she was unsure. Students left anonymous free-text feedback comments which helped frame future needs in this emerging area. DISCUSSION: This study suggests that there is room for exploring new ways of delivering teaching and expanding it more widely in palliative care and oncology, but also provides feedback on areas that need further careful attention. Comments from students included: "Might have been the novelty factor but I learnt more from this 20 min VR thing than I have from many lectures". SUMMARY: The project has proved sufficiently popular in medical student feedback, that the VR experience is now available on YouTube and has been permanently introduced into routine teaching. Further 360-degree teaching environments have been filmed. Of note is that our 360-degree videos have been viewed in Africa, so this format of teaching could prove valuable due to its global reach.

Virtual Reality-Based Simulators for Cranial Tumor Surgery: A Systematic Review.

BACKGROUND: Virtual reality (VR) simulators have become useful tools in various fields of medicine. Prominent uses of VR technologies include assessment of physician skills and presurgical planning. VR has shown effectiveness in multiple surgical specialties, yet its use in neurosurgery remains limited. OBJECTIVE: To examine all current literature on VR-based simulation for presurgical planning and training in cranial tumor surgeries and to assess the quality of these studies. METHODS: PubMed and Embase were systematically searched to identify studies that used VR for presurgical planning and/or studies that investigated the use of VR as a training tool from inception to May 25, 2017. RESULTS: The initial search identified 1662 articles. Thirty-seven full-text articles were assessed for inclusion. Nine studies were included. These studies were subdivided into presurgical planning and training using VR. CONCLUSIONS: Prospects for VR are bright when surgical planning and skills training are considered. In terms of surgical planning, VR has noted and documented usefulness in the planning of cranial surgeries. Further, VR has been central to establishing reproducible benchmarks of performance in relation to cranial tumor resection, which are helpful not only in showing face and construct validity but also in enhancing neurosurgical training in a way not previously examined. Although additional studies are needed to better delineate the precise role of VR in each of these capacities, these studies stand to show the usefulness of VR in the neurosurgery and highlight the need for further investigation.

Usefulness of Three-Dimensional Modeling in Surgical Planning, Resident Training, and Patient Education.

BACKGROUND: Imaging has a critical impact on surgical decision making and three-dimensional (3D) digital models of patient pathology can now be made commercially. We developed a 3D digital model of a cancer of the head of the pancreas by integrating actual CT data with 3D modeling process. After this process, the virtual pancreatic model was also produced using a high-quality 3D printer. PATIENTS AND METHODS: A 56-year-old female with pancreatic head adenocarcinoma presented with biliary obstruction and jaundice. The CT scan showed a borderline resectable tumor with a clear involvement of the gastroduodenal artery but doubtful relationships with the hepatic artery. Our team in collaboration with the Immersive Touch team used multiple series from the CT and segmented the relevant anatomy to understand the physical location of the tumor. An STL file was then developed and printed. RESULTS: Reconstructing and compositing the different series together enhanced the imaging, which allowed clearer observations of the relationship between the mass and the blood vessels, and evidence that the tumor was unresectable. Data files were converted for printing a 100% size rendering model, used for didactic purposes and to discuss with the patient. CONCLUSIONS: This study showed that (1) reconstructing enhanced traditional imaging by merging and modeling different series together for a 3D view with diverse angles and transparency, allowing the observation of previously unapparent anatomical details; (2) with this new technology surgeons and residents can preobserve their planned surgical intervention, explore the patient-specific anatomy, and sharpen their procedure choices; (3) high-quality 3D printed models are increasingly useful not only in the clinical realm but also for personalized patient education.