The use of virtual-reality (VR) technology in education is increasing in popularity with students and educators alike. Technological advancements have opened countless doors to innovative, active, and experiential learning opportunities. One of the innovative and impactful areas that this technology can positively affect is emergency medicine. Emergency medicine, a fast-paced, high-risk, ever-evolving field, presents unique and varied challenges to educators.¹ Could virtual reality be the right tool to assist in addressing these challenges?

History of Simulation

In order to train emergency physicians, many educational institutions rely on scenario-based simulations. Simulation can be defined as the imitation of clinical experience, and it has been present in medical education for over 50 years, beginning when Dr. Peter Safar, known as the father of CPR, simulated mouth-to-mouth resuscitation for students by administering a paralytic to stop the breathing of volunteers in the 1950s.² Since then a wide variety of simulation-based educational aids have been developed for medical training. These tools range from basic task trainers (intravenous-practice arms and intubation mannequins) to fully immersive, virtual-reality, patient-assessment simulators. Multiple studies have shown that simulation is at least as effective as traditional education.^3-9

The successful implementation of traditional simulation presents notable challenges. Building realistic backgrounds, obtaining supplies, and training instructors can be time-consuming and expensive.¹⁰ Ensuring consistency in each student’s experience across multiple cohorts is challenging. Prioritizing the safety of students and instructors during necessarily dangerous patient simulations without compromising the authenticity of the scenario is challenging.

Virtual-reality simulations allow institutions to provide the exact same scenario consistently between repetitions, students, and cohorts in a safe and realistic manner that is impossible to achieve in a more traditional manner. Students are able to fully and independently immerse themselves in an environment with a patient in which they must rely solely on their individual cognitive process in assessment, diagnosis, and decision making. In order to successfully implement VR simulation, a financial, educational and time commitment is required.

Virtual Reality

Educators around the world have been using virtual reality to effect real results with students and practitioners in impressive and innovative ways. Let’s start with a look at VR patient-assessment simulation. Multiple platforms exist for practitioners and students alike to jump into a virtual emergency room, prehospital environment, or ambulance and perform patient assessments, treatments, and transports—all from the comfort of the hospital break room.

VR Patients is one example of this. The VR Patients platform offers clients the opportunity to attempt simulations in both pre- and in-hospital environments using either 3-dimensional (3D) or 2-dimensional modalities. That means that the same scenarios can be attempted on laptops or iPads, or through VR goggles.

One main benefit of this platform is the case-authoring tool available that allows clients the ability to recreate and assign scenarios to users at will, making it an excellent resource for remediation and high-risk patient interaction practice. Having the ability to recreate and alter specific patient interactions for practitioners to learn from mistakes can be invaluable in a well-trained educator’s hands.

A recent publication highlighted the use of VR Patients, assessing the efficacy of the tool in comparison to traditional in-person simulation.¹¹ Researchers, using scenarios from the National Association of Emergency Medical Technicians (NAEMT), created six scenarios in virtual reality. 203 paramedic students from across the United States completed the six scenarios using VR or traditional in-person simulation. The results of this study showed that there was not a statistically significant difference in exam scores between VR and traditional simulation. This suggests that students benefit just as much from the use of VR simulation as from traditional in-person simulation.

Another notable article published in the Australasian Journal of Educational Technology highlighted the use of 3D printing as a way to bridge the gap between the virtual and physical educational environments.¹² Students from a paramedic-education distance program were struggling with a lack of opportunities to practice hands-on skills like intubation. In response to this struggle, a 3D printer was used to make representations of a Macintosh laryngoscope blade with handle and Magill forceps. Students were sent one 3D-printed intubation kit, as well as a Color-Cross universal mobile phone VR headset. Using the tools provided, students were able to get hands-on practice while immersed in a virtual environment throughout their distance-education program. Results from this study showed that the students who had access to 3D-printed devices and VR scored higher on key performance indicators. These simulation techniques could easily be translated to physician-learners.

Conclusion

Technological advancements have exponentially increased the opportunities for practitioners, students, and educators. The potential advantages of including virtual, augmented, or mixed reality into training in medical education are limited only by the imagination of the educator.

Erin Donathan is adjunct faculty with the public safety and emergency services institute at Pima Community College in Tucson, Ariz.

References

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2. Lenzer J. Obituary: Peter Josef Safar. BMJ. 2003;327(7415):624.
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9. Macauley K, Brudvig TJ, Kadakia M, et al. Systematic review of assessments that evaluate clinical decision making, clinical reasoning, and critical thinking changes after simulation participation. Journal of Physical Therapy Education. 2017;31(4):64-75.
10. Kononowicz AA, Woodham LA, Edelbring S, et al. Virtual patient simulations in health professions education: systematic review and meta-analysis by the digital health education collaboration. J Med Internet Res. 2019;21(7):e14676.
11. Donathan E, LaLumia A, Foat C, et al. *SMARTSIM* A multicenter prospective randomized trial of 3D virtual reality versus traditional patient simulation. JACEP Open. 2024;5:e13092.
12. Birt J, Moore E, Cowling M. Improving paramedic distance education through monocle mixed reality simulation. Australasian Journal of Educational Technology,2017;33(6):69-83.

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