Immersive Training Research Articles

Immersive and Non-Immersive Simulators for the Education and Training in Maritime Domain—A Review

In the domain of Marine Education and Training (MET), simulators have been utilized for the purpose of training seafarers in the norms for avoiding collisions or for developing the skill of ship manoeuvrability, and even the operation of machinery in the engine room, as well as for conducting research on the subject matter of ship structure, specialized vessel operation, working principle of equipment, and shipboard safety training. These tools are even more important when facing disruptive events such as the COVID-19 pandemic. In MET institutions, full-mission bridge and engine room simulators have been utilized for teaching seafarers for more than a decade. A Systematic Literature Review (SLR) was conducted to identify immersive and non-immersive simulator applications produced over the previous ten years to improve seafarers’ experiential teaching and learning, in the maritime domain. We retrieved 27 articles using the four stages of PRISMA paradigm: Identification, Screening, Eligibility, and Inclusion. The selected papers were read and analyzed according to the training type, the area of training, and the technologies used. The utilization of immersive and non-immersive simulators in the context of the MET domain has been identified and mapped. A few research studies (9 out of 27) compared immersive and non-immersive simulator-based training with conventional training. The quality and efficacy of immersive and non-immersive simulator training at MET institutions have been studied. A model from the learner’s perspective is essential and recommended for future research to assess efficiency and efficacy.

Virtual Reality in the Rehabilitation of Cognitive Impairment after Stroke

Virtual reality (VR) is seen by some as a tool that may greatly improve, or even revolutionize cognitive rehabilitation. VR offers distinct advantages compared to classic rehabilitation using paper-and-pencil or computer-based training, such as immersion, the feeling of presence, embodiment of virtual players, ecological and multisensory stimulation. We here review recent clinical studies examining the effects of VR training in patients with stroke-induced cognitive deficits. Several trials reported evidence that VR training improves general cognition compared to standard cognitive training. However, the evidence remains controversial, as some of these studies had a high risk of bias. Regarding mood, there is some indication that immersive training improves depression scores in stroke patients, but the number of studies examining mood changes is very low. Finally, in the domain of spatial cognition the development of specific intervention techniques such as virtual prism adaptation provide avenues for clinical interventions, though well-controlled clinical trials are lacking. Together, the available evidence suggests that VR has the potential to improve rehabilitation particularly in domains requiring repetitive training in an immersed, ecological setting, or when a mismatch between body frames and the environment is created. Controlled clinical studies are required to examine the specific advantages of VR compared to classic interventions.

A Fully Immersive Virtual Reality Cycling Training (vProCycle) and its Findings

Virtual reality (VR) technology is popularly applied in various sports training such as cycling, rowing, soccer, tennis and many more. In VR cycling, however, cyclists are not able to fully immerse themselves during the training due to the hardware and applications limitations required in the setup. In order to be fully immersed during the training, cyclists need to have similar effects to an outdoor training where they will experience cycling resistance, temperature effect, altitude, visual, and audio. For this reason, dedicated stimulus effectors or hardware are required to create these expected effects. On cycling resistance, a realistic cycling experience can be simulated by using a special device that simulates a resistance to the back wheel when cycling uphill in the VR simulation. In addition, the back wheel resistance would need to match the view displayed while paddling on an elevation slope. For higher immersion purposes, and the effect of temperature must be created that matches with the view visible in the display. For example, while the cyclist is on top of a virtual mountain, the cyclist would want to feel the effects of high altitude and low temperature. These stimulus effectors affect the realism experience while cycling in the VR simulation training. In the authors’ previous papers, the setup using a combination of stimulus effectors including uphill elevation climb, altitude, temperature, interaction, visual, and audio were integrated into a product called vProCycle. The study tested on vProcycle was conducted with an assumption that virtual reality can enhance the experience of physical cycling training. The objective of this study is to determine whether or not vProCycle may improve cyclists’ performance. This paper will discuss in detail the findings from data gathered during the experiment using vProCycle. More specifically, the findings are focused on the speed and the heart rate beats per minute which determine their performance improvement.

How Immersive Virtual Reality Safety Training System Features Impact Learning Outcomes: An Experimental Study of Forklift Training

How Immersive Virtual Reality Safety Training System Features Impact Learning Outcomes: An Experimental Study of Forklift Training

Effect of immersive virtual reality training on hand-to-mouth task performance in people with Multiple Sclerosis: A quantitative kinematic study

Although the use of Virtual Reality (VR) has received increasing interest as an add-on treatment in neurorehabilitation programs in the last fifteen years, there is scarce information about the effectiveness of fully immersive VR-based treatments on upper limb (UL) motor function in people with Multiple Sclerosis (PwMS). In this bicentric 2-period interventional crossover study, 19 PwMS with moderate to severe disability (mean EDSS score 5.5) and relevant UL impairment underwent 12 immersive-VR sessions over a period of 4 weeks, using commercially available VR platform (Oculus Quest) and games (Fruit Ninja, Beat Saber and Creed - Rise to Glory). Possible changes associated with the treatment were objectively assessed through instrumental kinematic analysis of the "hand-to-mouth" (HTM) movement by means of optical motion capture system. Clinical tests to assess gross and fine manual dexterity (i.e., the Box and Blocks and Nine Hole Peg Test) were also administered. The results of the kinematic analysis suggest that the VR training positively impacted the ability of the tested PwMS to perform the HTM task. In particular, a significant reduction of the overall time required to complete the task of approximately 20% for both most and least affected limb, and an improved degree of precision and stability of the movement, as indicated by the reduced value of adjusting sway, especially for the most affected limb (-60%). Based on the results of the quantitative analysis, a 4-week treatment with immersive VR is able to improve speed and stability of the HTM movement in PwMS. This suggests that such an approach might be considered suitable to facilitate an immediate transfer of the possible positive effects associated with the training to common activities of daily living.

Immersive training of clinical decision making with AI driven virtual patients - a new VR platform called medical tr.AI.ning.

Medical students need to be prepared for various situations in clinical decision-making that cannot be systematically trained with real patients without risking their health or integrity. To target system-related limitations of actor-based training, digital learning methods are increasingly used in medical education, with virtual reality (VR)- training seeming to have high potential. Virtually generated training scenarios allow repetitive training of highly relevant clinical skills within a protected, realistic learning environment. Thanks to Artificial Intelligence (AI), face-to-face interaction with virtual agents is feasible. Combining this technology with VR-simulations offers a new way of situated context-based, first-person training for medical students. The authors' aim is to develop a modular digital training platform for medical education with virtual, interactable agents and to integrate this platform into the medical curriculum. The medical tr.AI.ning platform will provide veridical simulation of clinical scenarios with virtual patients, augmented with highly realistic medical pathologies within a customizable, realistic situational context. Medical tr.AI.ning is scaled to four complementary developmental steps with different scenarios that can be used separately and so each outcome can successively be integrated early within the project. Every step has its own focus (visual, movement, communication, combination) and extends an author toolbox through its modularity. The modules of each step will be specified and designed together with medical didactics experts. To ensure constant improvement of user experience, realism, and medical validity, the authors will perform regular iterative evaluation rounds.Furthermore, integration of medical tr.AI.ning into the medical curriculum will enable long-term and large-scale detection of benefits and limitations of this approach, providing enhanced alternative teaching paradigms for VR technology.

A human-centered conceptual model for integrating Augmented Reality and Dynamic Digital Models to reduce occupational risks in industrial contexts

The article proposes a human-centered conceptual model to integrate Augmented Reality (AR) and Dynamic Digital Models (DDM) to improve training and reduce occupational risks in industrial contexts. A general model integrating DDM and AR to support immersive training and customized and real-time risk management is missing in the literature. The proposed conceptual model was preliminarily validated with company experts in a laboratory environment. According to the expert's feedback, the system can improve the efficacy of training by means of an immersive environment where users can better perceive hazards and safety-critical situations. Considering the capability of the conceptual model to support real-time and customized risk management, the participating experts argue that the technology seems not to be ready yet, even if it is very interesting and it would be very useful in practice to mitigate occupational risks. Future research activities will consist of the development of a prototypical system based on the presented conceptual model by considering specific user requirements and experts’ feedback.

Virtual Reality in Training: A Case Study on Investigating Immersive Training for Prisoners

Virtual Reality in Training: A Case Study on Investigating Immersive Training for Prisoners

Generative Artificial Intelligence and Virtual Reality Immersive Training Tools, Algorithmic Monitoring and Cognitive Computing Systems, and Voice and Gesture Recognition Technologies in Virtual Immersive Workspaces

Generative Artificial Intelligence and Virtual Reality Immersive Training Tools, Algorithmic Monitoring and Cognitive Computing Systems, and Voice and Gesture Recognition Technologies in Virtual Immersive Workspaces

Generative Artificial Intelligence and Virtual Reality Immersive Training Technologies, Behavior Tracking and Task Collaboration Tools, and Interconnected Monitoring and Holographic Display Devices in Simulated 3D Working Environments

Generative Artificial Intelligence and Virtual Reality Immersive Training Technologies, Behavior Tracking and Task Collaboration Tools, and Interconnected Monitoring and Holographic Display Devices in Simulated 3D Working Environments

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center.

Radiology trainees were uncomfortable going to the CT scanner to review trauma panscans and interacting with trauma surgeons. This study aims to determine if radiology residents can be trained to accurately identify injuries requiring immediate surgical attention at the CT scanner. A high-fidelity simulation model was created to provide an immersive training experience. Between February 2015 and April 2017, 62 class 1 trauma panscans were read at the CT scanner by 11 PGY-3 radiology residents. Findings made at the scanner were compared to resident preliminary and attending radiology reports and correlated with clinical outcomes. Timestamps were recorded and analyzed. Surveys were administered to assess the impact of training on radiology residents' self-confidence and to assess trauma surgeons' preference for radiology at the scanner. Significance level was set at p < 0.05. The mean time to provide results at the CT scanner was 11.1min. Mean time for the preliminary report for CT head and cervical spine was 24.4 ± 9.8min, and for the CT chest, abdomen, and pelvis was 16.3 ± 6.9min. 53 traumatic findings on 62 panscans were identified at the scanner and confirmed at preliminary and final reports, for a concordance rate of 85%, compared to 72% for the control group. Radiology residents agreed or strongly agreed the training prepared them for trauma panscan reporting. Trauma surgeons shifted in favor of radiology presence at the scanner. Radiology residents can be trained to accurately and rapidly identify injuries requiring immediate surgical attention at the CT scanner. These findings support the value-added of an in-person radiologist at the CT scanner for whole-body trauma panscans to facilitate timely detection of life-threatening injuries and improve professional relations between radiologists and trauma surgeons.

Exploring the question of financial incentives for training amongst non-adopters of MOUD in rural primary care

BackgroundMedication for opioid use disorder (MOUD) includes administering medications such as buprenorphine or methadone, often with mental health services. MOUD has been shown to significantly improve outcomes and success of recovery from opioid use disorder. In WV, only 18% of providers including physicians, physician assistants, and nurse practitioners are waivered, and 44% of non-waivered providers were not interested in free training even if compensated. This exploratory research seeks to understand intervention-related stigma in community-based primary care providers in rural West Virginia, determine whether financial incentives for training may be linked to levels of stigma, and what level of financial incentives would be required for non-adopters of MOUD services provision to obtain training.MethodSurvey questions were included in the West Virginia Practice-Based Research Network (WVPBRN) annual Collective Outreach & Research Engagement (CORE) Survey and delivered electronically to each practice site in WV. General demographic, staff attitudes and views on compensation for immersion training for delivering MOUD therapy in primary care offices were returned. Statistical analysis included logistic and multinomial logistic regression and an independent samples t-test.ResultsData were collected from 102 participants. Perceived stigma did significantly predict having a waiver with every 1-unit increase in stigma being associated with a 65% decreased odds of possessing a waiver for buprenorphine/MOUD (OR = 0.35; 95% CI 0.16–0.78, p = 0.01). Further, t-test analyses suggested there was a statistically significant mean difference in perceived stigma (t(100) = 2.78, p = 0.006) with those possessing a waiver (M = 1.56; SD = 0.51) having a significantly lower perceived stigma than those without a waiver (M = 1.92; SD = 0.57). There was no statistically significant association of stigma on whether someone with a waiver actually prescribed MOUD or not (OR = 0.28; 95% CI 0.04–2.27, p = 0.234).ConclusionThis survey of rural primary care providers demonstrates that stigmatizing beliefs related to MOUD impact the desired financial incentive to complete a one-day immersion, and that currently unwaivered providers endorse more stigmatizing beliefs about MOUD when compared to currently waivered providers. Furthermore, providers who endorse stigmatizing beliefs with respect to MOUD require higher levels of compensation to consider such training.

Face, content, and construct validity of the virtual immersive operating room simulator for training laparoscopic procedures.

The aim of this work is to present the face, content, and construct validation of the virtual immersive operating room simulator (VIORS) for procedural training of surgeons' laparoscopic psychomotor skills and evaluate the immersive training experience. The VIORS simulator consists of an HMD Oculus Rift 2016 with a visor on a 1080 × 1200 pixel OLED screen, two positioning sensors with two adapted controls to simulate laparoscopic instruments, and an acrylic base to simulate the conventional laparoscopic setup. The immersion consists of a 360° virtual operating room environment, based on the EndoSuite at Hospital Infantil de Mexico Federico Gomez, which reproduces a configuration of equipment, instruments, and common distractions in the operating room during a laparoscopic cholecystectomy procedure. Forty-five surgeons, residents, and medicine students participated in this study: 27 novices, 13 intermediates, and 5 experts. They completed a questionnaire on the realism and operating room immersion, as well as their capabilities for laparoscopic procedural training, scored in the 5-point Likert scale. The data of instrument movement were recorded and analyzed using 13 movement analysis parameters (MAPs). The experience during training with VIORS was evaluated through NASA-TLX. The participants were enthusiastic about the immersion and sensation levels of the VIORS simulator, with positive scores on the realism and its capabilities for procedural training using VIORS. The results proved that the VIORS simulator was able to differentiate between surgeons with different skill levels. Statistically significant differences were found in nine MAPs, demonstrating their construct validity for the objective assessment of the procedural laparoscopic performance. At cognitive level, the inversion experience proves a moderate mental workload when the laparoscopic procedure is carried out. The VIORS simulator has been successfully presented and validated. The VIORS simulator is a useful and effective device for the training of procedural laparoscopic psychomotor skills.

Intensive care nurse practitioners in Australia: A description of a service model in an adult tertiary intensive care unit

BackgroundAlthough well-established internationally, nurse practitioners (NPs) in Australian adult intensive care units (ICUs) are rare. Australian literature clearly highlights the importance of creating ICU NP roles to meet emerging demands. An ICU NP model of care at a metropolitan hospital in Sydney provides care in four core practice areas: complex case management, vascular access, tracheostomy management, and intrahospital transport of critically ill patients. The ICU NPs also provide training and assessment for ICU nurses and medical officers in these same core practice areas and can efficiently meet service gaps in crisis such as the most recent COVID-19 pandemic. ResultsThe ICU NP program described is an innovative model of care that has demonstrated potential benefits to patients and their families. Potential benefits to the healthcare system including supporting advanced practice nursing development in regional and rural Australia and in addressing future ICU workforce issues are also identified. This model of care provides a clear role and structure for the integration of NPs in the adult ICU. Research to evaluate the impact of the role is required and is underway. ConclusionsThis model is being used to develop a national adult ICU NP fellowship training program for ICU transitional NPs preparing for endorsement or endorsed NPs who require additional ICU-specific training. This immersive clinical training program combined with didactic learning modules offers a framework to support the implementation of the adult ICU NP role as well as a framework for NP fellowship programs in other specialties.

Developmental/behavioral training innovation in a high-need, low-resource state: The child health and development promotion fellowship.

Developmental and behavioral problems are prevalent in early childhood, whereas the workforce available to identify and address early problems is comparatively limited. Beyond workforce shortages, additional barriers to developing and training a highly skilled workforce in this area exist-particularly in rural, high-need, and underserved U.S. states. As the health care landscape emphasizes expertise in interdisciplinary care, training approaches that provide intensive learning opportunities for supporting a skilled early childhood developmental workforce necessitate novel training approaches. This Workforce Catalyst report summarizes the initial conceptualization, development, execution, and evaluation of a Child Health and Development Promotion (CHDP) postgraduate fellowship in a high need, underserved rural area. Three cohorts totaling 15 trainees across fields including psychology, pediatric nursing, speech-language pathology, social work, and occupational therapy were recruited and cross-trained in an intensive postgraduate fellowship in early childhood development and behavior. The CHDP fellowship led to experiences across the care continuum and resulted in multiple clinical, educational, and scholarly products. Outcomes revealed a training program aligned with Infant and Early Childhood Mental Health competencies, high in-state retention (71%) and employment (93%) following training, and graduates who report leadership positions and sharing of specialty developmental-behavioral knowledge in organizations focused on early childhood. The CHDP Fellowship is a novel, immersive, and interdisciplinary training experience demonstrating positive initial training outcomes in Mississippi. The model and experience may serve as a roadmap for bolstering a skilled early childhood workforce in other underserved and high-need states. Aspects regarding scale of reach, funding, and accreditation are discussed as barriers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact of Full-Body Avatars in Immersive Multiplayer Virtual Reality Training for Police Forces

Recent advancements in virtual reality technology contributed to the development of immersive games and simulations of any kind. Simulations are a valuable tool for police forces to practice specific skills within threatening, dangerous, and stressful situations without dangerous real-world implications. Effective virtual simulations need to be realistic in terms of actions and also need to elicit emotion, engagement, and stress. To this end, we developed a multiplayer virtual reality training simulation for police forces to explore the effect of full-body avatars, especially regarding the stress level and response to threats. We analyzed the statistical significance and effect sizes of the data from 32 police officers under two conditions: either they could see an assailant with a full-body avatar or only a head and hands. The results reveal an increase in stress level and threat during the immersion with the full-body avatar. This was shown objectively by analyzing the heart rate variability and subjectively by examining a questionnaire in response to a threat to the assailant’s virtual body. These findings indicate that an assailant with a full-body avatar is beneficial during training for police forces, as it increases the feeling of a threat and contributes to a more realistic training experience.

Gaze Fixation and Visual Searching Behaviors during an Immersive Virtual Reality Social Skills Training Experience for Children and Youth with Autism Spectrum Disorder: A Pilot Study.

Children and youth with Autism Spectrum Disorder (ASD) display difficulties recognizing and interacting with behavioral expressions of emotion, a deficit that makes social interaction problematic. Social skills training is foundational to the treatment of ASD, yet this intervention is costly, time-consuming, lacks objectivity, and is difficult to deliver in real-world settings. This pilot project investigated the use of an immersive virtual reality (IVR) headset to simulate real-world social interactions for children/youth with ASD. The primary objective was to describe gaze fixation and visual search behaviors during the simulated activity. Ten participants were enrolled and completed one social-skills training session in the IVR. The results demonstrate differential patterns between participants with mild, moderate, and severe ASD in the location and duration of gaze fixation as well as the patterns of visual searching. Although the results are preliminary, these differences may shed light on phenotypes within the continuum of ASD. Additionally, there may be value in quantifying gaze and visual search behaviors as an objective metric of interventional effectiveness for social-skills training therapy.

Investigating the effectiveness of immersive VR skill training and its link to physiological arousal.

The online version contains supplementary material available at 10.1007/s10055-022-00699-3.

Body into Narrative: Behavioral and Neurophysiological Signatures of Action Text Processing After Ecological Motor Training

Embodied cognition research indicates that sensorimotor training can influence action concept processing. Yet, most studies employ isolated (pseudo)randomized stimuli and require repetitive single-effector responses, thus lacking ecological validity. Moreover, the neural signatures of these effects remain poorly understood. Here, we examined whether immersive bodily training can modulate behavioral and functional connectivity correlates of action-verb processing in naturalistic narratives. The study involved three phases. First, in the Pre-training phase, 32 healthy persons listened to an action text (rich in movement descriptions) and a non-action text (focused on its characters’ perceptual and mental processes), completed comprehension questionnaires, and underwent resting-state electroencephalogram (EEG) recordings. Second, in the four-day Training phase, half the participants completed an exergaming intervention (eliciting full-body movements for 60 min a day) while the remaining half played static videogames (requiring no bodily engagement other than button presses). Finally, in the Post-training phase, all participants repeated the Pre-training protocol with different action and non-action texts and a new EEG session. We found that exergaming selectively reduced action-verb outcomes and fronto-posterior functional connectivity in the motor-sensitive ∼ 10–20 Hz range, both patterns being positively correlated. Conversely, static videogame playing yielded no specific effect on any linguistic category and did not modulate functional connectivity. Together, these findings suggest that action-verb processing and key neural correlates can be focally influenced by full-body motor training in a highly ecological setting. Our study illuminates the role of situated experience and sensorimotor circuits in action-concept processing, addressing calls for naturalistic insights on language embodiment.

Impact of haptic feedback on surgical training outcomes: A Randomised Controlled Trial of haptic versus non-haptic immersive virtual reality training.

This study aimed to evaluate the educational impact of integrated haptic feedback in an immersive VR bone drilling simulation on the performance of a cohort of junior surgeons. Block randomised, controlled, double-blinded study. St Georges University Hospital, London, United Kingdom. and methods: 31 trainee doctors (postgraduate years 1-3) with limited orthopaedic experience were recruited to participate in this randomised controlled study through e-mail and poster advertising. They were allocated to haptic or non-haptic group through block randomisation prior to entering the study environment. All participants provided verbal and written consent to participate in this study. All participants were blinded to the nature of the study as well as its intervention arms. All participants completed an immersive virtual reality training module with either haptic feedback or no haptic feedback in which they had to drill 3 bicortical holes in a VR tibia bone model in preparation for screw insertion followed by an ex vivo equivalent task on a tibial sawbone model once again drilling 3 holes through both cortices of the tibia. Outcome measures were plunge gap distance, drilling time and objective structures assessment of technical skills (OSAT) as well as qualitative questionnaire outcomes. Haptic feedback in the VR training module showed significantly less plunge gap distance compared to the non-haptic group (7.6mm±4.3 vs 13.6mm±7.4 (p=0.012)). The haptic group also had longer drill times (17.5s±4.0 vs 13.8s±4.2 (p=0.027)), higher combined OSAT cores (14 (10,17) vs 8.5 (7.75, 12), p=0.0006) and greater number of safe drills of <5mm plunge gap in at least 2 out of 3 attempts (6 (40) vs 0 (0), p=0.021. This study demonstrates better performance for an orthopaedic surgical task when using a VR-based simulation model incorporating haptic feedback, compared to one without haptic feedback supporting the pursuit and implementation of haptics in surgical training simulation models to enhance their educational value.