Immersive Virtual Reality Simulation Research Articles

Development of Immersive Virtual Reality Hospital Fire Management and Evacuation Training Program for Nursing Students in Hong Kong

While nursing students never experience hospital fire, they should know how to evacuate the patients under their care. Using Virtual Reality (VR) can offer students a unique leaning experience of this uncommon situation. The purpose of this study was to development a VR simulation program of a hospital fire evacuation training for the nursing students and evaluated the satisfaction of the participants. It was a pilot study conducted in a local private university offering a pre-registration, higher diploma of mental health nursing program. A VR simulation program regarding fire evacuation in a psychiatric hospital was newly developed. The students enrolled in the final year of this program were recruited by convenience sampling. A questionnaire was employed to evaluate participants' satisfaction after they completing the program. Descriptive statistics was employed to analyze the participants' characteristics and quantitative results of the questionnaires. The study was approved by the institution review board of the study university. The overall satisfaction of this workshop was 4.6/5 (n = 65). The highest score was the knowledge (4.7/5), presentation and facilitation skill (4.7/5) of facilitator. Half of the students rated excellent to the design, content and facilities of this workshop. In the narrative comment, some students were satisfied with authentic 3-dimension environment at the VR cave. Besides, the students treasured the chance to act as ward in-charge in evacuation. The first immersive VR simulation program for hospital fire management was developed and generally well-received by the nursing students.

Virtual Reality Technology in Practical Teaching Methods

This paper explores the integration of virtual reality (VR) technology into practical teaching methods, enhanced by the Whale Optimized Feature Extraction Recurrent Classification (WOFERC) model. The study aims to enhance the effectiveness and engagement of practical learning experiences through immersive VR simulations. Using simulated experiments and empirical validations, the efficacy of the WOFERC-enhanced VR teaching approach is evaluated. Results demonstrate significant improvements in student performance and engagement compared to traditional methods. For example, students using the WOFERC-enhanced VR platform achieved an average score increase of 20% in practical assessments. Additionally, the framework allowed instructors to optimize teaching strategies based on real-time student feedback, leading to more effective and personalized instruction. These findings highlight the potential of VR technology with WOFERC in transforming practical teaching methods and fostering immersive and impactful learning experiences.

The Effects of Virtual Reality Used in Healthcare Education on Cybersickness and Sense of Presence: A Systematic Review

Abstract The purpose of this systematic review was to present the current state of the science related to healthcare students’ outcomes associated with virtual reality effects on cybersickness and sense of presence. Results of the database searches of MEDLINE/PubMed, Scopus, ISI Web of Science, CINAHL, and Cochrane identified 101 articles. Seven articles were isolated for inclusion in this review. The primary search terms were “healthcare students,” “virtual reality,” “cybersickness,” and “sense of presence.” The studies were published between 2016 and 2020 and were conducted in Israel, the United States, the United Kingdom, Singapore, Belgium, and Brazil. The research design was quasi-experimental in six studies and experimental design in one study. Interventions were mostly carried out with nursing, medical, and dental students. Three studies used immersive virtual reality simulation with a head-mounted display, while the others used non-immersive three-dimensional visuals. According to the results, students perceived a high sense of presence and a low level of cybersickness in virtual reality simulations. There is limited robust research exploring healthcare students’ outcomes related to virtual reality on cybersickness and sense of presence.

Breaking presence in Immersive Virtual Reality toward behavioral and emotional engagement

Background and objectiveMany recent studies in virtual reality (VR) have managed the sense of Presence to assess the suitability of their designs, mainly when focused on learning goals that require high user engagement, such as in serious games for psychomotor training. However, the place and plausibility illusions needed to promote Presence are achieved by combining different VR-based design cues, and their individual contribution to preserving the Presence's engagement/involvement component is still unclear. This article explored the single effect of breaking the sense of Presence per VR factor, i.e., removing VR cues related to Social Presence (human interactions), Self-Presence (embodiment), and Physical Presence (Scenario realism). MethodsThirty-three participants were asked to play an immersive VR simulation of an arcade game three times by experiencing a stepped Break of Illusion in one of the VR factors, i.e., while two factors were kept high, the remaining one was reduced to a low and null (hypothetical) level. The game difficulty was fixed after assessing each person's skills. ResultsResults showed that psychophysiology indicators (heart rate and skin conductance) were not affected by the level of illusion, whereas exercise intensity was significantly higher with low body and social presence-based conditions. Moreover, skin conductance was lower in the Social-presence group, which suggests that perspiration is only affected by breaks in realism (scenario and body representations). Based on the obtained evidence, we proposed some guidelines for adapting the design of immersive virtual environments through Breaks in Presence, mainly by changing the realism of the scenario and body representation depending on the skin conductance or the interaction with virtual humans depending on exercise intensity.

An Immersive Virtual Reality Simulator for Echocardiography Examination

Echocardiography is a medical examination that uses ultrasound to assess and diagnose the structure and function of the cardiac. Through the use of ultrasound waves, this examination allows medical professionals to create visualizations of the cardiac muscle, enabling them to diagnose and monitor conditions such as cardiac diseases, abnormalities, and functional disorders. An echocardiogram plays a crucial role in the early detection and diagnosis of various cardiac issues such as hypertension, myocardial infarction, valvular cardiac disease, and myocardial hypertrophy. It significantly contributes to determining treatment and management strategies. To achieve accurate disease diagnosis and develop appropriate treatment plans through echocardiography, it is essential to have a thorough understanding of proper probe usage, the precise acquisition of echocardiographic images, and the ability to interpret various echocardiographic examinations such as two-dimensional, M-mode, Doppler, etc. To enhance the skills required for echocardiography, medical educational institutions conduct theoretical classes, practical sessions using patient models, and clinical practice sessions with actual patients. However, issues such as inadequate practical adaptation due to theory-centric education, limitations in practical opportunities due to insufficient practice equipment, ethical or safety concerns arising during clinical practice, and a lack of educators leading to insufficient feedback, are currently being encountered. Hence, there is a need for new educational methods that can address the existing challenges in echocardiography education. In this paper, as part of these efforts, we propose a virtual reality-based immersive simulator for practical echocardiography training. The proposed echocardiography simulator allows users to explore a virtual echocardiography examination space by wearing a head-mounted display (HMD). This simulator consists of 3D virtual space models, interactive models manipulated by interaction devices, and 3D patient models containing normal or abnormal anatomical cardiac models. Using interactive devices such as HMD controllers and haptic devices, users can manipulate 3D models related to echocardiography within the simulator and interact with 3D patient models containing normal or abnormal anatomical cardiac models, allowing for the practice of echocardiography examinations. Ultimately, a performance evaluation of the developed immersive virtual reality simulator and usability validation targeting medical university students were conducted. The evaluation and validation results confirmed the potential efficacy of the proposed echocardiography VR simulator.

Virtual reality to provide caregiver skill development and problem solving

Background:Caring for persons with dementia (PWD) leads to disproportionate vulnerability to physical, mental, and social adverse health consequences among caregivers (CGs). The VR-SIMS CARERS Initiative aims to engage Knowledge Users (KUs), older adults and community stakeholders in the co-design of a Virtual Reality (VR) simulation training environment for dementia caregivers, and to explore end-user’s perspectives, design and implementation challenges and opportunities (e.g. digital literacy, technology readiness, VR acceptability), to ensure that the resulting “Minimally Viable Prototype” is clinically efficacious, scalable and sustainable.Objectives & Methodology:The specific objectives of this study are to: 1.employ a co-design approach to develop and validate an immersive VR simulation training environment for CGs to be in touch with realities of caregiving, practice communications and behavioural management of PWD based on the well-established CARERS Program;2.to evaluate feasibility, acceptability, tolerability informed by VR-CORE Framework and Hybrid development-implementation design, and to explore issues around implementation of the VR simulation training platform; and3.to conduct pilot testing to examine a) initial clinical efficacy of VR-based CG training in improving quality of relationship with PWD, competence, resilience, and reducing depression and stress in dementia CGs and its b) readiness for implementation in the community.Anticipated Outcomes:VR-SIMS CARERS innovation is intended to be an accessible, scalable and sustainable VR simulation training platform that will support CGs in the practice and acquisition of essential dementia caregiving skills, enhancing their caregiving competence and resilience. Training CGs to recognize and manage stressors can lower their risk of overall mental health decline.

A Systematic Review of Immersive Virtual Reality for Nontechnical Skills Training in Surgery

Immersive virtual reality (IVR) can be utilized to provide low cost and easily accessible simulation on all aspects of surgical education. In addition to technical skills training in surgery, IVR simulation has been utilized for nontechnical skills training in domains such as clinical decision-making and pre-operative planning. This systematic review examines the current literature on the effectiveness of IVR for nontechnical skill acquisition in surgical education. A literature search was performed using MEDLINE, EMBASE, and Web of Science for primary studies published between January 1, 1995 and February 9, 2022. Four reviewers screened titles, abstracts, full texts, extracted data, and analyzed included studies to answer 5 key questions: How is IVR being utilized in nontechnical skills surgical education? What is the methodological quality of studies? What technologies are being utilized? What metrics are reported? What are the findings of these studies? The literature search yielded 2340 citations, with 12 articles included for qualitative synthesis. Of included articles, 33% focused on clinical decision-making and 67% on anatomy/pre-operative planning. Motion sickness was a recorded metric in 25% of studies, with an aggregate incidence of 13% (11/87). An application score was reported in 33% and time to completion in 16.7%. A commercially developed application was utilized in 25%, while 75% employed a noncommercial application. The Oculus Rift was used in 41.7% of studies, HTC Vive in 25%, Samsung Gear in 16.7% of studies, Google Daydream in 8%, and 1 study did not report. The mean Medical Education Research Quality Instrument (MERSQI) score was 10.3 ± 2.3 (out of 18). In all studies researching clinical decision-making, participants preferred IVR to conventional teaching methods and in a nonrandomized control study it was found to be more effective. Averaged across all studies, mean scores were 4.33 for enjoyment, 4.16 for utility, 4.11 for usability, and 3.73 for immersion on a 5-point Likert scale. The IVR nontechnical skills applications for surgical education are designed for clinical decision-making or anatomy/pre-operative planning. These applications are primarily noncommercially produced and rely upon a diverse array of HMDs for content delivery, suggesting that development is primarily coming from within academia and still without clarity on optimal utilization of the technology. Excitingly, users find these applications to be immersive, enjoyable, usable, and of utility in learning. Although a few studies suggest that IVR is additive or superior to conventional teaching or imaging methods, the data is mixed and derived from studies with weak design. Motion sickness with IVR remains a complication of IVR use needing further study to determine the cause and means of mitigation.

A pilot study comparing immersive virtual reality simulation and computerized virtual patient simulation in undergraduate medical education

Simulation-based teaching is an integral feature within medical education and following the emergence of virtual simulation, an array of possibilities exists for educators to choose between. However, evidence informing their use is scarce, particularly regarding outcomes assessing user experience and knowledge acquisition, and experimental studies comparing different approaches to virtual simulation. Therefore, this study compared immersive virtual reality (VR) simulation to computerized virtual patient (VP) simulation measuring their effect on knowledge acquisition and retention, as well as user experience, in fifth-year medical students. This pilot study, of a randomized crossover design, comprised 18 participants independently completing an immersive VR simulation and a computerized VP simulation. All participants completed the same two scenarios and received an induction to both modalities. Multiple-choice questions were employed to assess knowledge acquisition and retention, with participants completing the questions immediately before and after the simulation and following a 12-week interval. User experience questionnaires were completed after the simulation, utilizing both Likert scale and open-ended questions. Statistical analysis comprised a Student’s Both interventions achieved statistically significant levels of knowledge acquisition and retention. However, VR simulation achieved higher levels of acquisition (2.11; 95% CI = 0.89, 3.32, The findings indicated that both interventions are effective and acceptable educational tools. However, learning does not appear to be uniform across different virtual simulators, with participants achieving higher levels of learning following immersive VR simulation. Moreover, participants reacted significantly more positively to VR simulation, though potential applications were identified for both interventions. This study highlights the importance of an evidence-based approach to the implementation of novel simulation technologies. The findings contribute to an underexplored area of the literature and offer a step towards enabling medical educators to make an informed decision regarding the application of virtual simulation in their context.

A9Immersive Technology Experience Measure (ITEM): pilot study on participant experience using novel questionnaire and VR scenario

A scoping review identified a significant growth in research with immersive technology in healthcare education. However, there are few validated measures that capture the user experience of participants [1]. This study aims to investigate the use of an immersive virtual reality (VR) simulation on sepsis management and measure user experience using a validated tool, the Immersive Technology Evaluation Measure (ITEM) [2]. ITEM was formulated on a learning theory called Model for Immersive Technology in Healthcare Education (MITHE), which borrows cognitive and behavioural theories to help explain our level of immersion and enjoyment that can be facilitated by technology (see Model of immersive technology in healthcare education (MITHE) This single-study quasi-experimental investigation was conducted at a single site. Nine participants were recruited, consisting of medical students and healthcare professionals. Participants were trained on varied immersive devices: sepsis management using an immersive VR simulation developed by Gogglemind, and augmented reality (AR) holographic patient with respiratory distress, which included realistic patient scenarios and interactive decision-making. User experience was measured using the ITEM, which assesses user; immersion, cognitive load, intrinsic motivation, debrief and technology usability. Nine participants had high levels of immersion (mean 39.6, total 50), high levels of intrinsic motivation (mean 39.6, total 50), high technology score (mean 79.4, total 100), optimum cognitive load (average 59.5, optimum 39–61) and moderate score on debrief (mean 18.1, total 25). ITEM subscores indicated an enjoyable and immersive experience with good technology interface on usability scores. Self-directed debrief in VR had lower scores with emotional considerations and identifying domains of performance and learning. The use of the ITEM provided valuable insights into the user experience of the VR simulation, which can be used to improve the design and implementation of future simulations. This contributes to an ongoing ITEM validation process. This study highlights the importance of training in healthcare and the potential benefits of using immersive technologies such as VR and AR simulations. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Impact of an immersive virtual reality simulator education program on nursing students' intravenous injection administration: A mixed methods study

BackgroundUndergraduate nursing students often face limited opportunities to gain hands-on experience in performing invasive procedures and techniques. Immersive media tools may be helpful in training and enhancing skill development among nursing students. ObjectivesThe specific aims of this study were threefold: (1) to describe the development process of an intravenous injection virtual reality simulator (IIVRS) program, (2) to determine the effect of the IIVRS program on intravenous injection knowledge, and (3) to examine the acceptability, learning motivation, and experience of the IIVRS program among nursing students. MethodsThis study is a mixed method design, encompassing a one-group pre- and post-test approach and the utilization of reflection logs among 128 second-year nursing students enrolled at a university in northern Taiwan. An innovative gamification IIVRS program was developed by our research team. Knowledge of intravenous injection was assessed using a point visual analog scale at pre-and post-testing. Acceptability and motivation were assessed using items on a 5-point Likert scale. The IIVRS program experience was evaluated using open-ended questions of reflection. A paired t-test was used for comparing knowledge at pre-and post-tests, independent t-tests were conducted to compare levels of acceptance and learning motivation among different students' characteristics, and content analysis was used for qualitative data. ResultsStudents' knowledge of intravenous injection was significantly improved (Pre-test Mean = 3.08 vs. Post-test Mean = 4.96, p < 0.001). Students reported high levels of acceptance (Mean = 4.65) and learning motivation (Mean = 4.69). Students reported three themes of their experience: (1) attracts my attention and stimulates my motivation to learn, (2) enhanced memorization of the skill and process, and (3) a sense of presence and realism/unrealism. ConclusionThe virtual reality program for intravenous injection administration can be an effective education tool, fostering students' motivation to learn and a heightened sense of accomplishment.

Development and usability testing of a fully immersive VR simulation for REBOA training

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially life-saving procedure for bleeding trauma patients. Being a rare and complex procedure performed in extreme situations, repetitive training of REBOA teams is critical. Evidence-based guidelines on how to train REBOA are missing, although simulation-based training has been shown to be effective but can be costly and complex. We aimed to determine the feasibility and acceptance of REBOA training using a fully immersive virtual reality (VR) REBOA simulation, as well as assess the confidence in conducting the REBOA procedure before and after the training.MethodsProspective feasibility pilot study of prehospital emergency physicians and paramedics in Bern, Switzerland, from November 2020 until March 2021. Baseline characteristics of trainees, prior training and experience in REBOA and with VR, variables of media use (usability: system usability scale, immersion/presence: Slater-Usoh-Steed, workload: NASA-TLX, user satisfaction: USEQ) as well as confidence prior and after VR training were accessed.ResultsREBOA training in VR was found to be feasible without relevant VR-specific side-effects. Usability (SUS median 77.5, IQR 71.3–85) and sense of presence and immersion (Slater-Usoh-Steed median 4.8, IQR 3.8–5.5) were good, the workload without under-nor overstraining (NASA-TLX median 39, IQR 32.8–50.2) and user satisfaction high (USEQ median 26, IQR 23–29). Confidence of trainees in conducting REBOA increased significantly after training (p < 0.001).ConclusionsProcedural training of the REBOA procedure in immersive virtual reality is possible with a good acceptance and high usability. REBOA VR training can be an important part of a training curriculum, with the virtual reality-specific advantages of a time- and instructor-independent learning.

EP02.47: Immersive virtual reality simulation training for Caesarean section: a randomised controlled trial

EP02.47: Immersive virtual reality simulation training for Caesarean section: a randomised controlled trial

ENERGYSIM: techniques for advancing building energy education through immersive virtual reality (VR) simulation

An important practice for reducing the effects of global warming is the design and construction of energy-efficient buildings. In design education, the full comprehension of thermal behavior in buildings based on their geometry and material composition is required. The complexity of energy simulation principles, vis-a-vis the number of elements that impact the energy loads, their linkages, and their relationships to one another all combine to make this a challenging subject to absorb. Virtual Reality (VR) provides an immersive way to learn the concepts of building energy responses; however, the development of VR applications for education is difficult due to the knowledge, skill, and performance resource-related gaps. Unoptimized VR applications can adversely impact learning if user experiences are broken due to performance lags. This research, therefore, explores VR as a teaching tool for building energy education while showcasing the development process toward a visually accurate simulation and performant application. We developed EnergySIM; a multi-user VR building energy simulation prototype of the famous Farnsworth House. Using this prototype, we document rigorously tested development workflows for improved VR game performance, high visual fidelity, and user interaction, the three key factors which positively contribute to user knowledge retention. The study combines menu-driven interaction, virtual exploration, and miniature model manipulation approaches with the aim of testing user understanding and knowledge retention. Highlighted results provide reduced barriers of entry for educators towards developing higher quality educational VR applications. EnergySIM showcases pre-simulated building exterior surface heatmaps response from four seasons (winter, summer, fall, and spring) alongside an all-year-round sun-hour scenario. Four different material pre-simulated scenarios (single glazing, double glazing, concrete, and wood) for interior atmospheric temperature mapping are also explored. Preferred interaction methods are documented by allowing users’ visual appraisal of alternative building materials based on insulation capacity or resistance to heat flow (R-value). The significance of this work lies in its potential to revolutionize how students, designers, and instructors approach building energy education in today’s world. EnergySIM provides a hands-on and visually engaging learning experience towards the enhancement of knowledge retention and understanding. It pushes the boundaries of development for visual fidelity using geometry/mesh modeling input from various software into game engines and optimizing game performance using the HTC Vive Pro Eye and Meta Quest Pro headsets.

Investigating the impact of scenario and interaction fidelity on training experience when designing immersive virtual reality-based construction safety training

Safety training is an effective method to reduce safety issues. Immersive virtual reality (IVR) for safety training has gained attention in high-risk industries, but the trade-off between realism and abstraction in IVR-based training is not fully understood. This study investigated the impact of scenario and interaction fidelity on IVR-based forklift safety training, focusing on presence and usability. Scenario fidelity varied the Level of Development (LOD) in IVR model (high LOD vs. low LOD), while interaction fidelity varied the control interface (steering wheel and pedals vs. keyboard). A 2-by-2 experiment with 120 participants examined high/low scenario and interaction fidelity. Results showed scenario fidelity enhanced presence and usability significantly, while interaction fidelity had no effect. The realism of training scenarios is more influential for presence and immersion than control interface realism. These findings aim to balance IVR simulation fidelity and learning outcomes and help guide the development of cost-efficient IVR-based safety training.

Virtual Reality and Augmented Reality Training in Disaster Medicine Courses for Students in Nursing: A Scoping Review of Adoptable Tools.

Nurses and paramedics play a pivotal role when mass casualty incidents (MCI) occur, yet they often feel unprepared for such events. Implementation strategies for training activities, including virtual reality (VR) and augmented reality (AR) simulations, offer realistic and immersive learning experiences, enhancing skills and competencies for nursing students. The aim of this work was to investigate the adopted tools in studies on VR and AR simulations for training nursing and paramedic students in managing MCI. A scoping review was performed following the PRISMA-ScR statement, and the search strategy was conducted through five electronic databases from December 2022 to March 2023. Of 162 records identified, 27 full texts were screened and, six studies were included in this review. These studies involved students who were assigned to different training methods, including immersive VR simulation, written instruction, and traditional lecture. VR and AR and immersive simulation generally show promising evidence in enhancing practical skills and knowledge in MCI management. VR and AR showed to be promising in disaster education and preparedness training, offering different levels of immersiveness and engagement, encouraging active and experiential learning. Further research is needed to determine their long-term effectiveness. The choice of training method should consider program goals, target population, and available resources.

Prebrief Time for Immersive Virtual and Augmented Reality Simulation: An Integrative Review.

Virtual reality and augmented technology are rapidly advancing and hold the potential to transform nursing education by offering a convenient, efficient, learner-centered way to educate students. A comprehensive and time-oriented prebrief is essential to the process. This review analyzes the status of scientific exploration regarding the prebrief and time allotments for virtual and augmented reality simulation. Whittemore and Knafl's 5-stage method guided this integrative review. The authors searched 6 databases and selected 7 articles based on inclusion criteria. The findings from this review demonstrated objectives, a safe learning environment, orientation, preparation materials, and time in the prebrief; yet, inconsistencies persist in the virtual and augmented reality prebrief. Defining a comprehensive and consistent prebrief is essential for high-quality simulation. A more standardized process, including time allotments, must be established for virtual and augmented reality.

IMMERSIVE VIRTUAL REALITY IS SUPERIOR TO CONVENTIONAL TRAINING FOR SURGICAL TEAM MEMBERS LEARNING ANTERIOR APPROACH TOTAL HIP ARTHROPLASTY: A RANDOMIZED CONTROLLED TRIAL

Superior team performance in surgery leads to fewer technical errors, reduced mortality, and improved patient outcomes. Scrub nurses are a pivotal part of this team, however they have very little structured training, leading to high levels of stress, low confidence, inefficiency, and potential for harm. Immersive virtual reality (iVR) simulation has demonstrated excellent efficacy in training surgeons. We tested the efficacy of an iVR curriculum for training scrub nurses in performing their role in an anterior approach total hip arthroplasty (AA-THA).Sixty nursing students were included in this study and randomised in a 1:1 ratio to learning the scrub nurse role for an AA-THA using either conventional training or iVR. The training was derived through expert consensus with senior surgeons, scrub nurses and industry reps. Conventional training consisted of a 1-hour seminar and 2 hours of e-learning where participants were taught the equipment and sequence of steps. The iVR training involved 3 separate hour-long sessions where participants performed the scrub nurse role with an avatar surgeon in a virtual operation. The primary outcome was their performance in a physical world practical objective assessment with real equipment. Data were confirmed parametric using the Shapiro-Wilk test and means compared using the independent samples student's t-test.53 participants successfully completed the study (26 iVR, 27 conventional) with a mean age of 31±9 years. There were no significant differences in baseline characteristics or baseline knowledge test scores between the two groups (p&gt;0.05). The iVR group significantly outperformed the conventionally trained group in the real-world assessment, scoring 66.9±17.9% vs 41.3±16.7%, p&lt;0.0001.iVR is an easily accessible, low cost training modality which could be integrated into scrub nursing curricula to address the current shortfall in training. Prolonged operating times are strongly associated with an increased risk of developing serious complications. By upskilling scrub nurses, operations may proceed more efficiently which in turn may improve patient safety.

Mastery experiences in immersive virtual reality promote pro-environmental waste-sorting behavior

The rapid digitalization following COVID-19 necessitates best-practice knowledge on how to use educational technologies such as immersive virtual reality (IVR). At the same time, to deal with climate change, we require new ways to embed climate change education in formal education. The current study is one of the first to investigate the feasibility of an alternative educational approach to improving waste management in the classroom as part of formal education, utilizing mastery experiences in IVR. We explore the use of a novel IVR simulation on waste management, an example of pro-environmental behavior, for climate change education. A total of 173 high school students participated in a pre-registered intervention investigating the impact of IVR on knowledge and intentions to act pro-environmentally. A 2x2 design was used to compare different design approaches to the IVR simulation based on the instructional design elements of the instruction sequence (Direct Instruction vs. Productive Failure) and feedback (Corrective Feedback vs. Exaggerated Feedback). The results indicated that IVR was effective for increasing students’ knowledge (η2 = 0.41), intentions (η2 = 0.10), self-efficacy (η2 = 0.4), and response efficacy (η2 = 0.35) and that students found the simulation interesting and enjoyable. Furthermore, self-efficacy was found to predict intentions (B = 0.190, p = .015), supporting the idea that cognitive and affective factors drive the effectiveness of IVR. No significant differences were found in the effectiveness of the instructional design elements. This suggests that IVR can be an effective educational technology for learning through mastery experiences, but that more research on the boundary conditions of how and when to apply different instructional design elements effectively is needed.

Virtual Reality Simulation for Suicide Risk Assessment Training: Prevalence of Adverse Effects.

Virtual reality (VR) simulation is changing the landscape of simulation-based medical education. Immersive VR allows users to interact with a computer-generated environment and digital avatars using a VR headset and controllers. However, current literature regarding the use of immersive VR simulation in psychiatric medical education is sparse. This study describes its use and considerations regarding tolerability. At a mental health hospital in Canada, two immersive VR suicide risk assessment (SRA) case simulations were developed. These simulations have participants interview VR patients to characterize their suicide risk, offering a novel and safe way to engage healthcare providers in SRA training. Regarding user tolerability of these VR simulations, the Simulator Sickness Questionnaire (SSQ) was administered to participants after the simulation to characterize any motion sickness symptoms experienced. Of the 22 participants in this study, the overall SSQ scores demonstrated good tolerability of the VR SRA, with the majority of participants reporting no or minimal simulator sickness symptoms. Moreover, the majority of participants reported being satisfied with this training and that the VR SRA simulation enhanced their learning experience. These study findings are novel, given the current dearth of data regarding the use of immersive VR in simulation-based psychiatric medical education. Further studies exploring the educational effectiveness of VR SRA in simulation-based psychiatric medical education are indicated.

Use of Virtual Reality Simulations to Embody a Patient: Exploring the Impact on Nursing Students' Confidence, Feelings, and Perceptions.

Using immersive virtual reality (VR), students are able to physically and emotionally embody patients while interacting in simulated environments with family and health care providers. This pilot study explored how embodying patients with Alzheimer disease and terminal cancer at end of life using highly immersive VR impacted nursing students' confidence, feelings, and perceptions. A quasi-experimental design was used with a convenience sample of bachelor of science in nursing students who completed pre/posttest scaled and open-ended questions. Participants (N = 32) reported significant confidence increases; feelings about dying and hospice were also significantly changed. The majority described how the simulations would impact their future nursing care. Using VR, students experienced disease, dying, and health care from the patient's perspective reporting differences in confidence, feelings, and perceptions. Immersive VR simulations warrant further study and have the potential to transform nursing education and impact health care.