The healthcare industry is an intersection of emerging science, technology, and educational and legal policy. Medical knowledge doubles every six to eight years, there are new innovations in medical procedures every day, and it is the obligation of every healthcare practitioner to keep their knowledge and skill set up to date. The average physician will practice for over 30 years, while the average nurse practices for 40 years. It is painfully obvious that continuing education is an important challenge within healthcare education.
Given the scale of the training required, new educational technologies offer solutions that enable widespread use of these training simulations among trainees and also allow for easy updating of the course content. Virtual reality (VR) is one such innovation that is promising a paradigm shift in the approach to healthcare training for both continuing professionals and students within healthcare. Virtual reality training contextualizes training and offers an experiential, exploratory form of learning through rich, interactive simulations. Being a new consumer technology, the novelty factor helps raise interest and motivation to complete the training, and ultimately, effectively support the acquisition and transfer of skills.
Today, as VR technology is becoming more and more pervasive, there is a wide spectrum of variation in technological sophistication, incurred costs, and the types of skills-training needed by medical personnel. For instance, Fortune reported that Nicklaus Children’s Hospital in Miami partnered with Samsung Gear VR to create VR training scenarios to teach procedures like Foley catheter insertion, starting an IV, the Heimlich maneuver, wound care, cardiopulmonary resuscitation, and nasal-gastric tube insertion. The preliminary results have been outstanding. Dr. Narendra Kini, CEO at Miami Children’s Health System, reported that the retention level remained at 80 percent one whole year after training, compared to a traditional training methods retention level of 20 percent after only a week.
The study above and many others have proved that virtual reality is poised to revolutionize the healthcare training industry as it enables critical, time-sensitive, and job-specific training. Enabling exploratory learning in a risk-free environment is ideal for formative learning and training.
Applications of VR in healthcare training
Over the last few years, big players in the tech industry like Facebook, Google, Samsung, and HTC have invested in the future of VR. The technology has since evolved dramatically, providing high-fidelity VR experiences at affordable price points. Academia has been a proponent of VR as education technology for many years now. In 1962, the Sensorama simulator (Figure 1) was invented to prevent trainees from undergoing hazardous conditions during training with expensive equipment. The objective was realistic experience simulation through artificial sensory stimulation.
Figure 1: The Sensorama simulator (1962)
Traditional simulations cost millions of dollars to develop; require expensive, specialized hardware; and need a lot of support to deploy on a large scale. With virtual reality training—and with the visual feedback combined with haptic, force-feedback technology—surgeons can experience feedback within both sensory modalities. The benefits of VR training move beyond surgical training to training for any healthcare practitioner. It’s an immersive, engaging, and safe way to receive training on new protocols, equipment, and techniques. This education technology enables physicians to gain confidence, learning critical skills in a risk-free environment. They can even simulate low-frequency scenarios and create better assessment techniques.
Another important avenue for VR training is for emergency response protocol. Catastrophes are inevitable, and emergency medical (EM) personnel must respond rapidly and effectively. Training EM personnel can be challenging due to the variability in the types of disasters, the emotional and physical stressors when working in potentially dangerous environments, and the challenges of training for infrequently used, but critical, skills. VR technology enables us to provide a deeply immersive and interactive experience of first responder duties. The firsthand experience in performing contextualized disaster triage sets trainees up for success in a real-world, high-pressure disaster situation.
As mentioned earlier, the types of VR content are varied, and so are its benefits. Within dentistry, there is a new medical VR training tool called “hapTEL.” This VR dental chair has a 3-D virtual set of teeth to work on, and students of dentistry practice protocols like doing a filling using a VR drill that uses force feedback and mimics the movement and pressure of a real drill.
While this exciting new technology opens many avenues for healthcare training applications, it’s important to consider the rationale behind the benefit of this technology. While experiential learning is known to be more beneficial than traditional chalk-and-talk-style lectures, how does one justify the higher costs and how are learning outcomes improved?
Human beings evolved to experience the world primarily through the visual system. The ability to perceive depth enables the learner to visualize the presented information more effectively, reducing the cognitive load. When learning a procedural task that must be carried out in a 3-D environment, it becomes difficult to visualize and perform that task when the learning materials are all 2-D. Virtual reality decreases the intrinsic cognitive load during learning, enabling a faster, more efficient training process. So although the deployment costs for VR training are high upfront, over a period of time that cost is more than recovered by faster learning time among trainees, thus saving costs on training resources and also making the trainee operational faster.
Clinical applications of VR
The potential for VR training in healthcare is vast, and many companies have begun investing in simulation-based learning. However, there is another avenue of VR application in healthcare that has a more direct impact on patients, through their own experiences of personal healthcare.
An obvious opportunity that simulated realities present is for exposure therapy. Whether it is for phobias, anxiety, or post-traumatic stress disorder (PTSD), one method of treatment involves low-dosage, graded, and controlled exposure to the stressor. Prior to VR, patients would engage in imaginal exposure therapy, the benefits of which have been well documented (see References: Rothbaum, Meadows, et al., and Rothbaum and Schwartz). However, a defining symptom of such disorders, especially PTSD, is an inherent avoidance of imaging the traumatic events. Virtual reality enables a graded, safe, and controlled exposure to stressors that result in significant improvement and maintenance of these gains. The University of Southern California Institute for Creative Technologies has been involved in many efforts for therapeutic virtual reality applications, PTSD being an extremely successful one. Dr. Albert Rizzo from USC has spent 20 years using VR to develop novel treatments for those with PTSD. As Dr. Rizzo himself said to Business Insider, “It has not been the theory or research that has held back clinical VR, rather the availability, adoption, and costs that have limited its widespread use.” The heavy financial investment in newer, cheaper hardware is going to see to an explosion in the VR market for both content and hardware.
The University of Washington HITLab, in collaboration with Harborview Burn Center, developed a virtual reality therapy tool that aids in quelling pain symptoms in burn victims. The virtual environment distracts the patient from the pain of having wound dressings changed. Pain management is an important and complex domain within healthcare, given the danger of opioids. The results with VR therapy were staggering. It was found that for identical procedures experienced by the same person, reported pain was less than half when distracted using VR technology versus a standard Nintendo console.
Conclusion
The world of VR has seemingly endless applicability within the healthcare industry. Its benefits will affect all students of healthcare, healthcare professionals across services and levels of expertise, and ultimately, with the appropriate clinical research, every single person in the way their healthcare is delivered to them and their options for treatment.
As artificial intelligence, bio-feedback sensors, and deep learning technologies improve, there will be a massive integration of these technologies to improve education and training systems—creating individualized, smart, and adaptive simulators that will forever change the way healthcare training is delivered in the future.
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References
Gaudiosi, John. “Here’s why hospitals are using virtual reality to train staff.” Fortune. 17 August 2015.
Heilig, Morton L. Sensorama Simulator. US Patent 3,050,870, issued 28 August 1962.
Loria, Kevin. “Virtual reality is about to completely transform psychological therapy.” Business Insider. 22 January 2016.
Mesko, Bertalan. “5 Ways Medical Virtual Reality Is Already Changing Healthcare.” The Medical Futurist. 21 July 2016.
Rothbaum, Barbara Olasov, Elizabeth A. Meadows, Patricia Resick, and David W. Foy. “Cognitive-Behavioral Therapy.” In “Guidelines for Treatment of PTSD,” Journal of Traumatic Stress, Vol. 13, No. 4. 2000.
Rothbaum, Barbara Olasov, and Ann C. Schwartz. “Exposure Therapy for Posttraumatic Stress Disorder.” American Journal of Psychotherapy, Vol. 56, No. 1. 2002.
Senson, Alex. “Virtual Reality In Healthcare: Where’s The Innovation?” TechCrunch. 16 September 2015.
Virtual Reality Society. “What is virtual reality training?” 28 June 2017.
Wallis, Thomas. “6 VR uses in Healthcare that will blow your mind.” VR Intelligence. 19 May 2016.