VR for Womens Health
VR to improve female health outcomes: Review of use cases, technologies, content, research and evaluation practices, barriers, and solutions
Current literature and future investigations
Evolution of VR HMDs is transforming immersive medical education and training at the Torbay Hospital
At Torbay hospital, we use immersive solutions in three domains- patients, staff, and students. Years 4 and 5 medical students from Plymouth University and Exeter University are based at Torbay hospital. The focus of immersive medical education and training is primarily non-technical in nature as skills of effective communication, team work and empathy are critical, yet staff and students are not trained specifically in these areas. Affordable, accessible and hassle free standalone VR Head Mounted Devices (HMDs) have enabled us in successfully continuing our efforts to transform medical education.
Our journey began with Google Cardboard HMDs geared up by iPhones and Galaxy phones, slowly we included Samsung Gear VRs, Oculus Rift, HTC Vive and eventually Oculus Quest and Oculus Go devices. Keeping up with changing technology has inspired us in tweaking and improving the experiences we offer.
What literature says about transforming VR HMDs and uses in medical education and training?
Technology has revolutionized medical education and training (Scalese, Obeso and Issenberg, 2008). Specifically, the development of sophisticated immersive virtual reality (VR) simulation systems has led to a paradigm shift in the area of medical Technology Enhanced Learning (TEL) (Sanchez-Vives and Slater, 2005; Reiner, 2011; Handa, Aul and Bajaj, 2012; Cummings, Bailenson and Fidler, 2015). The traditional model of educators/physicians teaching students has changed as immersive VR simulators dominate the culture of applied training, offering students experiential learning that reduces the costs and training hours (Grant and Marriage, 2012).
VR HMDs have been successfully integrated into the healthcare education context (UCI, 2014; Tully et al., 2015; White, 2015; Xu et al., 2015). At present, the HTC Vive, Microsoft HoloLens 2, Oculus Go and Oculus Quest are shown promising potential. Current VR HMDs have already created a stir through their ability to blend reality with the virtual (Case Western Reserve University, 2016; Yang, 2016). According to the Case Western Reserve University (2016), the HoloLens’ interactive features can solve medical problems and enhance learning to a manner that cannot be achieved with real-life organs. Mark Zuckerberg, upon Facebook’s acquisition of Oculus Rift made a statement that VR might be the next major computing and communication platform, following mobile phones. According to Zuckerberg (2014), the reason for this is the functionality of VR, which always has the power to translate and share full sensory and emotional experiences with people. Pierce (2016) states that immersive VR is not limited to the area of gaming; it has been showing its multi-functional utility as a medium for imparting experiences that are educational. Along with HMDs, VREs like CAVE, Altspace VR and the VOID have gained popularity amongst healthcare researchers (Tossavainen, 2004; Stephens, 2015). Specifically, CAVE is used within health care settings to conduct simulation-based experiments (Stephens, 2015). VRE’s like CAVE are viewed as a useful tool for research on human cognition and behaviour (Tossavainen, 2004; Stephens, 2015) within the environment of experiential learning. Moreover, applications developed in game engines like Unity can be transferred to the CAVE environment, thereby increasing the level of realism and immersion (Stephens, 2015).
However, despite the advantages of CAVE, the VRE systems are not being adopted widely across healthcare education, possible due to their costs or the set-up hassle. Revolutionary advances that have been made in computation speed and power, graphics rendering, display systems, interface devices, haptics tools, wireless tracking etc., have brought down the cost of usable VR systems, which is good news for researchers, educators and those working in healthcare . As VR HMDs are mass manufactured their prices are going down, which will eventually improve accessibility to such devices (Falah et al., 2015). This predicted improvement in accessibility suggests that VR HMDs could become integral to the technological developments in healthcare education and training, as more efforts will be concentrated toward designing simulations that could run on low-cost VR HMDs (Hoffman et al., 2014; Turban et al., 2016).
Within healthcare, VR systems are crucial for advancements in medical education as they can present virtual objects to the human senses in a manner that can be considered the most identical to their natural real-world counterparts (Riva and Wiederhold, 2015). For a long time, VR has been considered an expensive toy (Rizzo et al., 2012). Today, VR as a tool for medical education and training is used in a variety of healthcare environments, for example-in developing cognitive and motor rehabilitation in psychology, (Saposnik, et al., 2016) and neuropsychology (Rizzo et al., 2012), treating phobias (Parsons and Rizzo, 2009), treating PTSD and management of stress amongst cancer patients (Rizzo et al., 2012). In medical education and training, simulations are used to enhance the understanding of skills to improve student performance and to assess their learned competencies (Gutiérrez, 2007). Simulation training within the area of healthcare has continued to grow since the early 2000s, partly due to innovation in technology and partly owing to the fact that there has been a decrease in training opportunities as societal attitude toward using live human bodies or cadavers has changed. According to Rudarakanchana et al. (2015), the primary aim of healthcare simulation training is to shorten the learning curve for any surgical procedure, by allowing learners to achieve proficiency before they perform the actual procedure on a real patient.
Today, VR simulations are displaying their potential as an effective alternative to traditional teaching methods, which have been used within classrooms and operating rooms for a long time (Cohen et al., 2013). Roy et al. (2006) highlight that medical education has historically been provided through didactic lectures even though adult learners would prefer experiential and/or self-directed learning. Given that younger health-workers have extensive experience working on computers and being involved in gaming environments, these aspects of virtual reality can be used to educate them more effectively. The immersive quality of VR simulations is able to aid students in a variety of areas such as learning human anatomy, training for competencies, surgical practice, credentialing and recertification (Cohen et al., 2013). This negates the requirement to perform studies on a real patient, allowing students to practise the same task a number of times, until they feel confident performing the procedures (Okuda, 2009; Newby et al., 2010). Realistic immersive VR simulation based training for students can provide significant support if used in adjunction with traditional lectures (Newby, Keast and Adam, 2010). Moreover, skills gained through VR healthcare systems translate into positive outcomes for healthcare, such as patient safety, error management and higher standards for care (Scalese, 2008). Despite, the positive implications of VR systems and the availability of a wide-array of VR devices, the research on the implementation of the newer VR systems like Oculus Rift and Vive, within healthcare contexts is lagging behind (Riva and Wiederhold, 2015).
VR has proven its crucial role in the advancement of medical knowledge given its unique ability to create interactivity, enhance imagination and deliver a combination of experiences that can either be used by themselves or combined with other teaching methods (Shi, 2014).
Technology moves at a rapid pace. Through the early to mid-90s, virtual reality technology attempted to establish itself but failed due to several reasons. However, virtual reality received a makeover with the Oculus Rift, which was introduced in 2011. The immersive virtual reality HMDs market has since taken off with the introduction of a number of low, mid and high-end HMDs.
There has been a surge in the number of studies that have been published around the application of healthcare VR interventions via VR simulation systems such as the Oculus Rift, Samsung Gear, Google Cardboard or other similar head-mounted devices (HMDs) (Hoffman et al, 2014; Stephens, 2015; Turban et al., 2016). These HMDs have been used to research and evaluate medical communication, medical education, surgical simulation and patient rehabilitation (Handa et al., 2012; Boast, 2013; Merchant, Goetz, Cifuentes, Keeney-Kennicut and Davis, 2014).
What needs to be investigated next?
Although more and more medical schools are investigating the application of VR HMDs for improving technical and non-technical skills education, an evidence base must be established. Current literature on VR HMDs use within medical education is scattered and in plenty. What is required is consolidation of the works, potentially systematic reviews specific to technical and non-technical specialties. Currently, we at Torbay are engaged in understanding,
What immersive VR simulation interventions are used in healthcare education and training? Currently, there do not appear to be any categorisations of the various interventions used within healthcare settings.
How are the immersive VR simulation interventions evaluated? There does not appear to be a classification of the various techniques used to evaluate the efficacy of the VR simulation interventions.
How effective are these interventions within healthcare settings? Ascertaining the effectiveness of VR interventions will help in contributing constructively to the future of VR study and practice.
Boas, Y. (2013). Overview of Virtual Reality Technologies. Mms.Ecs.Soton.Ac.Uk. Retrieved from http://mms.ecs.soton.ac.uk/2013/papers/yavb1g12_25879847_finalpaper.pdf
Burden, C., Oestergaard, J., & Larsen, C. R. (2011). Integration of laparoscopic virtual-reality simulation into gynaecology training. BJOG: An International Journal of Obstetrics and Gynaecology. http://doi.org/10.1111/j.1471-0528.2011.03174.x
Case Western Reserve University (2016) CWRU takes the stage at Microsoft’s Build conference to show how HoloLens can transform learning. Retrieved fromhttp://case.edu/hololens/ Last Accessed: 26th October, 2016
Cho, K. H., Lee, K. J., & Song, C. H. (2012). Virtual-Reality Balance Training with a Video-Game System Improves Dynamic Balance in Chronic Stroke Patients. The Tohoku Journal of Experimental Medicine, 228(1), 69–74. http://doi.org/10.1620/tjem.228.69
Claudio, P., & Maddalena, P. (2014). Overview: Virtual Reality in Medicine. Journal of Virtual Worlds Research, 7(1), 1–34. http://doi.org/http://dx.doi.org/10.4101/jvwr.v7i1.6364
Cohen, A. R., Lohani, S., Manjila, S., Natsupakpong, S., Brown, N., & Cavusoglu, M. C. (2013). Virtual reality simulation: Basic concepts and use in endoscopic neurosurgery training. Child’s Nervous System, 29(8), 1235–1244. http://doi.org/10.1007/s00381-013-2139-z
Cummings, J. J., Bailenson, J. N., & Fidler, M. J. (2015). How immersive is enough? A meta-analysis of the effect of immersive technology on user presence. Media Psychology, (May), 1–57. http://doi.org/10.1.1.363.6971
Case Western Reserve University (2016) Education interventions to promote clinical reasoning: a BEME systematic review protocol. Retrieved fromhttp://bemecollaboration.org/downloads/1874/Da%20Silva%20-%20BEME%20Protocol.pdf Last Accessed: 26th October, 2016
Eppich, W., Howard, V., Vozenilek, J., & Curran, I. (2011). Simulation-based team training in healthcare. Simulation in Healthcare, 6 Suppl(1), S14-9. http://doi.org/10.1097/SIH.0b013e318229f550
Falah, J., Charissis, V., Khan, S., Chan, W., Alfalah, S. F. M., & Harrison, D. K. (2015). Development and evaluation of virtual reality medical training system for anatomy education. Studies in Computational Intelligence, 591, 369–383. http://doi.org/10.1007/978-3-319-14654-6_23
Gonçalves, R., Pedrozo, A. L., Coutinho, E. S. F., Figueira, I., & Ventura, P. (2012). Efficacy of Virtual Reality Exposure Therapy in the Treatment of PTSD: A Systematic Review. PLoS ONE. http://doi.org/10.1371/journal.pone.0048469
Gordon, C. J., & Buckley, T. (2009). The effect of high-fidelity simulation training on medical-surgical graduate nurses’ perceived ability to respond to patient clinical emergencies. Journal of Continuing Education in Nursing, 40(11), 491-498-500. http://doi.org/10.3928/00220124-20091023-06
Grant, D. J., & Marriage, S. C. (2012). Training using medical simulation. Archives of Disease in Childhood, 97(3), 255–9. http://doi.org/10.1136/archdischild-2011-300592
Gurusamy, K. S., Aggarwal, R., Palanivelu, L., & Davidson, B. R. (2009). Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database of Systematic Reviews. http://doi.org/10.1002/14651858.CD006575.pub2
Gutiérrez, F., Pierce, J., Vergara, V. M., Coulter, R., Saland, L., Caudell, T. P., … Alverson, D. C. (2007). The effect of degree of immersion upon learning performance in virtual reality simulations for medical education. Studies in Health Technology and Informatics, 125, 155–160.
Haig A and Dozier M. (2003). Systematic searching for evidence in medical education. BEME Guide, 25(3), pp. 155–160.
Handa, M; Aul, G; Bajaj, S. (2012). Immersive Technology- Uses, Challenges and Opportunities. International Journal of Computing and Business Research. Retrieved from http://www.researchmanuscripts.com/isociety2012/12.pdf
Hilty, D. M., Alverson, D. C., Alpert, J. E., Tong, L., Sagduyu, K., Boland, R. J., … Yellowlees, P. M. (2006). Virtual reality, telemedicine, web and data processing innovations in medical and psychiatric education and clinical care. Academic Psychiatry, 30(6), 528–533. http://doi.org/10.1176/appi.ap.30.6.528
Hoffman, H. G., Meyer, W. J., Ramirez, M., Roberts, L., Seibel, E. J., Atzori, B., … Patterson, D. R. (2014). Feasibility of Articulated Arm Mounted Oculus Rift Virtual Reality Goggles for Adjunctive Pain Control During Occupational Therapy in Pediatric Burn Patients. Cyberpsychology, Behavior, and Social Networking, 17(6), 397–401. http://doi.org/10.1089/cyber.2014.0058
Jack, D., Boian, R., Merians, A. S., Tremaine, M., Burdea, G. C., Adamovich, S. V., Poizner, H. (2001). Virtual reality-enhanced stroke rehabilitation. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 9(3), 308–318. http://doi.org/10.1109/7333.948460
Kalawsky, R.S (1996).AGOCG Report. Exploiting Virtual Reality Techniques in Education and Training:Technological Issues
Merchant, Z., Goetz, E. T., Cifuentes, L., Keeney-Kennicutt, W., & Davis, T. J. (2014). Effectiveness of virtual reality-based instruction on students’ learning outcomes in K-12 and higher education: A meta-analysis. Computers and Education, 70, 29–40. http://doi.org/10.1016/j.compedu.2013.07.033
Newby, J. P., Keast, J., & Adam, W. R. (2010). Simulation of medical emergencies in dental practice: Development and evaluation of an undergraduate training programme. Australian Dental Journal, 55(4), 399–404. http://doi.org/10.1111/j.1834-7819.2010.01260.x
Okuda, Y., Bryson, E. O., DeMaria, S., Jacobson, L., Quinones, J., Shen, B., & Levine, A. I. (2009). The utility of simulation in medical education: What is the evidence? Mount Sinai Journal of Medicine. http://doi.org/10.1002/msj.20127
Parsons, T. D., Rizzo, A. a, Rogers, S., & York, P. (2009). Virtual reality in paediatric rehabilitation: a review. Developmental Neurorehabilitation, 12(4), 224–238. http://doi.org/10.1080/17518420902991719
Pierce, D. (2016). Immersive Virtual Reality: The Next Frontier For Education. Retrieved from https://insights.samsung.com/2016/04/20/immersive-virtual-reality-the-next-frontier-for-education/
Reiner, M. (2011). Presence: Brain, virtual reality and robots. Brain Research Bulletin, 85(5), 243–244. http://doi.org/10.1016/j.brainresbull.2011.05.012
Riva, G., & Wiederhold, B. K. (2015). The New Dawn of Virtual Reality in Health Care@ Medical Simulation and Experiential Interface. Annual Review of Cybertherapy and Telemedicine, 2015. Retrieved from http://www.academia.edu/22013517/The_New_Dawn_of_Virtual_Reality_in_Health_Care_Medical_Simulation_and_Experiential_Interface
Rizzo, A., Parsons, T; Kenny, P.; Buckwalter, J. G. (2012). Using Virtual Reality for Clinical Assessment and Intervention. In: Handbook of Technology in Psychology, 277–318. Retrieved from http://ict.usc.edu/pubs/Using Virtual Reality for Clinical Assessment and Intervention.pdf
Roy, M. J., Sticha, D. L., Kraus, P. L., & Olsen, D. E. (2006). Simulation and virtual reality in medical education and therapy: A protocol. Cyberpsychology & Behavior, 9(2), 245–247. http://doi.org/10.1089/cpb.2006.9.245
Rudarakanchana, N., Herzeele, I. Van, Desender, L., & Cheshire, N. J. (2015). Virtual reality simulation for the optimization of endovascular procedures: current perspectives On behalf of eVeReST (european Virtual reality endovascular ReSearch Team). Vascular Health and Risk Management, 11, 195–202. http://doi.org/10.2147/VHRM.S46194
Sanchez-Vives, M. V, & Slater, M. (2005). From presence to consciousness through virtual reality. Nature Reviews. Neuroscience, 6(4), 332–339. http://doi.org/10.1038/nrn1651
Scalese, R. J., Obeso, V. T., & Issenberg, S. B. (2008). Simulation technology for skills training and competency assessment in medical education. Journal of General Internal Medicine. http://doi.org/10.1007/s11606-007-0283-4
Shi, Y. L. (2014). Application of virtual reality technology in medical education. Lecture Notes in Electrical Engineering. http://doi.org/10.4028/www.scientific.net/AMM.556-562.6716
Stephens, T. (2015). “CAVE Lab” offers immersive virtual reality tools for research and teaching. Retrieved from http://news.ucsc.edu/2015/05/cave-lab.html
Tossavainen, T. (2004). Comparison of CAVE and HMD for visual stimulation in postural control research. Studies in Health Technology and Informatics, 98, 385–7. Retrieved from http://books.google.com/books?hl=en&lr=&id=m0sccMIKGp0C&oi=fnd&pg=PA385&dq=Comparison+of+CAVE+and+HMD+for+visual+stimulation+in+postural+control+research&ots=lSCyZLl8Bt&sig=XIngWSuk4iiAk4FicanwzwVxiv8\nhttp://www.ncbi.nlm.nih.gov/pubmed/15544310\nhttp://b
Tully, J., Dameff, C., Kaib, S., & Moffitt, M. (2015). Recording medical students’ encounters with standardized patients using Google Glass: providing end-of-life clinical education. Academic Medicine : Journal of the Association of American Medical Colleges, 90(3), 314–6. http://doi.org/10.1097/ACM.0000000000000620
Turban, L., Urban, F., & Guillotel, P. (2016). Extrafoveal Video Extension for an Immersive Viewing Experience. IEEE Transactions on Visualization and Computer Graphics, 1–1. http://doi.org/10.1109/TVCG.2016.2527649
UCL (2014). UCI School of Medicine first to integrate Google Glass into curriculum. Retrieved from: https://news.uci.edu/press-releases/uci-school-of-medicine-first-to-integrate-google-glass-into-curriculum/ Last Accessed: July 1st,2016
White, T. (2015). Medical student’s startup uses Google Glass to improve patient-physician relationship. Retrieved from https://med.stanford.edu/news/all-news/2015/02/medical-students-startup-uses-google-glass.html
Xu, X., Chen, K. B., Lin, J. H., & Radwin, R. G. (2015). The accuracy of the Oculus Rift virtual reality head-mounted display during cervical spine mobility measurement. Journal of Biomechanics, 48(4), 721–724. http://doi.org/10.1016/j.jbiomech.2015.01.
VR to improve female health outcomes: Review of use cases, technologies, content, research and evaluation practices, barriers, and solutions
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