The creation and validation of an immersive virtual reality simulator to teach and assess clinical reasoning

Abstract

Introduction Emerging technologies such as virtual reality(VR) and 360-degree cameras have been presented as a technological solution that, through increased realism and presence, could lead to improved learning gains versus existing teaching modalities. Aims The main aim of the thesis is to create an immersive VR simulator using 360-degree camera technology to teach and assess clinical reasoning skills. Methods A multi-method approach across a series of studies were used to achieve the thesis aims. The first study aimed to develop a VR clinical scenario and scoring system using validated virtual patient guidelines, VR usability guidelines and scoring rubrics. A 360-degree camera and VR editing software were used for scenario construction. Three experimental studies were performed. Study 1: randomised controlled trial(RCT) comparing the simulator across two delivery modes - 2D screen(n=19) versus immersive head-set(n=20); assessing system usability and level of presence. Study 2: cohort study assessing the contrast validity of the simulator (medical students; n=16), foundation year doctors (n=21), and core surgical doctors (n=19). Study 3: RCT assessing learning gains (using Script Concordance test) with the simulator versus traditional methods(n=53). Results

Four scenarios were created with scoring systems. The system was equally usable in both delivery forms(80.3 control vs 80 in treatment; p>0.05) with significantly higher levels of presence in the immersive group(0.81 vs 0.67; p<0.05). The simulator was able to differentiate between the most and least experienced group(57.3% vs 46.4%; p<0.05). Finally, the simulator learning gains were significantly higher compared to the traditional learning group(2.35 vs 1.64, p<0.05). Discussion This thesis demonstrates the feasibility of construction of a series of immersive VR clinical scenarios using 360-degree video. Taken together the results present a robust methodology for the creation and assessment of simulations using this technology and demonstrate the educational benefit for the teaching and assessment of clinical reasoning.