Effects of a Novel Blended Virtual Reality and Clinical Learning Environment on the Learning Transfer of Anesthesiology Residents
,
Abstract
The use of educational technology is considered a necessity due to the increasing changes in medical education. This study aimed to design a novel blended virtual reality and clinical learning environment (CLE) and to investigate its effectiveness in the learning transfer of anesthesiology residents during spinal anesthesia procedures. In this experimental study, 25 residents (academic year 2020/2021) were randomly divided into blended (n=11) and clinical (n=14) groups. Spinal anesthesia training for the blended group was performed in the virtual training laboratory (week 1) and the operating room (from week 2 to week 4), while for the CLE group, it was only performed in the operating room. Training, based on task-centered learning, was provided for both groups, and then, a 360-degree assessment of learning transfer was conducted by professors, patients, co-workers, and self-assessments using a standard questionnaire. Data were analyzed using non-parametric tests. There was a significant difference in the learning transfer of residents between the blended and CLE groups (U=39, P=0.03<0.05). There was also a significant difference in the subcategories of learning transfer according to the professors and co-workers; however, there was no significant difference according to the patients and self-assessments. The blended VR/CLE learning environment was more effective than CLE in improving residents’ learning transfer. Besides, an increase in scores indicated an improvement in professional competence.
1. Andrews JS, Lomis KD, Richardson JA, Hammoud MM, Skochelak SE. Expanding innovation from undergraduate to graduate medical education: A path of continuous professional development. Med Teach 2021;43:S49-55.
2. Haas MRC, He S, Sternberg K, Jordan J, Deiorio NM, Chan TM, et al. Reimagining Residency Selection: Part 1-A Practical Guide to Recruitment in the Post-COVID-19 Era. J Grad Med Educ 2020;12:539-44.
3. Hsieh CC, Yen HC, Kuan LY. The Relationship among Principals’ Technology Leadership, Teaching Innovation, and Students’ Academic Optimism in Elementary Schools. International Association for the Development of the Information Society; 2014 Dec. 2014;30014:113-20.
4. Vallee A, Blacher J, Cariou A, Sorbets E. Blended learning compared to traditional learning in medical education: Systematic review and meta-analysis. J Med Internet Res 2020;22:e16504.
5. Anwar A, Seger C, Tollefson A, Diachun CA, Tanaka P, Umar S. Medical education in the COVID-19 era: Impact on anesthesiology trainees. J Clin Anesth. 2020;66:109949.
6. Jallad ST, Işık B. The effectiveness of virtual reality simulation as learning strategy in the acquisition of medical skills in nursing education: a systematic review. Irish J Med Sci 2021 Jul 5:1-20.
7. Heng K, Sol K. Online Learning During COVID-19: Key Challenges and Suggestions to Enhance Effectiveness. Cambodian Educ Forum 2020;1-15.
8. Kundra P, Kurdi M, Mehrotra S, Jahan N, Kiran S, Vadhanan P. Newer teaching-learning methods and assessment modules in anaesthesia education. Indian J Anaesth 2022;66:47-57.
9. Norris MW, Spicer K, Byrd T. Virtual Reality: The New Pathway for Effective Safety Training. Prof Saf 2019;64:36-39.
10. In Chan JJ, Ma J, Leng Y, Tan KK, Tan CW, Sultana R, et al. Machine learning approach to needle insertion site identification for spinal anesthesia in obese patients. BMC Anesthesiol 2021;21:246.
11. Gropper MA. Miller’s Anesthesia. 9th ed. Elsevier; 2019.
12. Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: Causes and management. Br J Anaesth 2012;109:144-54.
13. Ready LB. Acute pain: Lessons learned from 25,000 patients. Reg Anesth Pain Med 1999;24:499-505.
14. Mace HS, Paech MJ, McDonnell N. Obesity and obstetric anaesthesia. Anaesth Intensive Care 2011;39:559-70.
15. De Filho GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of Successful Neuraxial Block: A Prospective Study. Eur J Anaesthesiol 2002;19:447-51.
16. Sawyer RJ, Richmond MN, Hickey JD, Jarrratt JA. Peripheral nerve injuries associated with anaesthesia. Anaesthesia 2000;55:980-91.
17. Paech MJ, Godkin R, Webster S. Complications of obstetric epidural analgesia and anaesthesia: A prospective analysis of 10,995 cases. Int J Obstet Anesth 1998;7:5-11.
18. Goy RWL, Ithnin F, Lew E, Sng BL. Exploring the challenges of task-centred training in obstetric anaesthesia in the operating theatre environment. Int J Obstet Anesth 2019:39:88-94.
19. Abdolmaleki M, Afshar L, Momeni S. A review of the conflict between student and patient rights in clinical education. J Med Ethics 2014;8:115-27.
20. Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 era: A systematic review. In Vivo 2020;34:1603-11.
21. Khajavi MR, Alavi F, Moharari RS, Etezadi F, Imani F. Evaluation of Acute and Chronic Back Pain After Spinal Anesthesia in Midline and Paramedian Approach: Incidence and Functional Disability. Arch Anesthesiol Crit Care 2018;4:535-7.
22. Mladenovic R, Dakovic D, Pereira L, Matvijenko V, Mladenovic K. Effect of augmented reality simulation on administration of local anaesthesia in paediatric patients. Eur J Dent Educ 2020;24:507-12.
23. Vandewaetere M, Manhaeve D, Aertgeerts B, Clarebout G, Van Merriënboer JJ, Roex A. 4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93. Med Teach 2015;37:4-20.
24. Gibbs T, Durning S, Van Der Vleuten C. Theories in medical education: Towards creating a union between educational practice andresearch traditions. Med Teach 2011;33:183-7.
25. Kirkpatrick JD, Kirkpatrick WK. Kirkpatrick's four levels of training evaluation. Association for Talent Development; 2016 Oct 1.
26. Komasawa N, Berg BW, Minami T. Problem-based learning for anesthesia resident operating room crisis management training. PLoS One 2018;13:e0207594.
27. El Beheiry M, Doutreligne S, Caporal C, Ostertag C, Dahan M, Masson JB. Virtual Reality: Beyond Visualization. J Mol Biol 2019;431:315-21.
28. Lee C, Wong GKC. Virtual reality and augmented reality in the management of intracranial tumors: A review. J Clin Neurosci 2019;62:14-20.
29. Zhang M, Zhang Z, Chang Y, Aziz ES, Esche S, Chassapis C. Recent developments in game-based virtual reality educational laboratories using the microsoft kinect. Int J Emerg Technol Learn 2018;13:138-59.
30. Gunn T, Lee Jones, Bridge P, Rowntree P, Nissen L. The use of virtual reality simulation to improve technical skill in the undergraduate medical imaging student. Interact Learn Environ 2017;26:1-8.
31. Jalo H, Pirkkalainen H, Torro O, Kärkkäinen H, Puhto J, Kankaanpää T, eds. How can collaborative augmented reality support operative work in the facility management industry? IC3K 2018-Proceedings of the 10th International Joint Conference on Knowledge Discovery, Knowledge Engineering and Knowledge Management.Science and Technology Publications.Vol 3; 2018:41-51.
32. Mousavi SS, Karami M, Mireskandari SM, Samadi S. Effects of Virtual Reality Technology on Knowledge, Attitudes, and Skills of Anesthesia Residents. Arch Anesthesiol Crit Care 2022;8:358-63.
33. Roy E, Bakr MM, George R. The need for virtual reality simulators in dental education: A review. Saudi Dent J 2017;29:41-7.
34. Mousavi SS, Samadi S. Application of virtual reality technology to sleep-disorders: a systematic review of databases. J Popul Ther Clin Pharmacol 2024;31.1:843-55.
35. Keri Z, Sydor D, Ungi T, Holden MS, McGraw R, Mousavi P, et al. Computerized training system for ultrasound-guided lumbar puncture on abnormal spine models: a randomized controlled trial. Can J Anesth 2015;62:777-84.
36. Våpenstad C, Hofstad EF, Bø LE, Kuhry E, Johnsen G, Mårvik R, et al. Lack of transfer of skills after virtual reality simulator training with haptic feedback. Minim Invasive Ther Allied Technol 2017;26:346-54.
37. van Merriënboer JJG, Kirschner PA. Ten Steps to Complex Learning: A systematic approach to four-component instructional design. Routledge; 2017 Oct 23.
38. Masjedi M, Neshatavar R, Mahbodi A, Moeini L. Evaluating the Anesthesiology Residents’ Performance, Using a Modified 360-degree Assessment Questionnaire in Shiraz University of Medical Sciences. Bangladesh J Med Sci 2011;4:10-9.
39. Marei HF, Donkers J, Van Merrienboer JJG. The effectiveness of integration of virtual patients in a collaborative learning activity. Med Teach 2018;40:S96-103.
40. Cooper N, Millela F, Cant I, White M, Meyer G. Transfer of training Virtual reality training with augmented multisensory cues improves user experience during training and task performance in the real world. PLoS One. 2021;16:e0248225.
41. Salles J, Birmes P, Schmitt L, Bastiani B, Soto M, Lafont-Rapnouil S, et al. Teaching emergency situations during a psychiatry residency programme using a blended learning approach: a pilot study. BMC Med Educ 2021;21:473.
2. Haas MRC, He S, Sternberg K, Jordan J, Deiorio NM, Chan TM, et al. Reimagining Residency Selection: Part 1-A Practical Guide to Recruitment in the Post-COVID-19 Era. J Grad Med Educ 2020;12:539-44.
3. Hsieh CC, Yen HC, Kuan LY. The Relationship among Principals’ Technology Leadership, Teaching Innovation, and Students’ Academic Optimism in Elementary Schools. International Association for the Development of the Information Society; 2014 Dec. 2014;30014:113-20.
4. Vallee A, Blacher J, Cariou A, Sorbets E. Blended learning compared to traditional learning in medical education: Systematic review and meta-analysis. J Med Internet Res 2020;22:e16504.
5. Anwar A, Seger C, Tollefson A, Diachun CA, Tanaka P, Umar S. Medical education in the COVID-19 era: Impact on anesthesiology trainees. J Clin Anesth. 2020;66:109949.
6. Jallad ST, Işık B. The effectiveness of virtual reality simulation as learning strategy in the acquisition of medical skills in nursing education: a systematic review. Irish J Med Sci 2021 Jul 5:1-20.
7. Heng K, Sol K. Online Learning During COVID-19: Key Challenges and Suggestions to Enhance Effectiveness. Cambodian Educ Forum 2020;1-15.
8. Kundra P, Kurdi M, Mehrotra S, Jahan N, Kiran S, Vadhanan P. Newer teaching-learning methods and assessment modules in anaesthesia education. Indian J Anaesth 2022;66:47-57.
9. Norris MW, Spicer K, Byrd T. Virtual Reality: The New Pathway for Effective Safety Training. Prof Saf 2019;64:36-39.
10. In Chan JJ, Ma J, Leng Y, Tan KK, Tan CW, Sultana R, et al. Machine learning approach to needle insertion site identification for spinal anesthesia in obese patients. BMC Anesthesiol 2021;21:246.
11. Gropper MA. Miller’s Anesthesia. 9th ed. Elsevier; 2019.
12. Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: Causes and management. Br J Anaesth 2012;109:144-54.
13. Ready LB. Acute pain: Lessons learned from 25,000 patients. Reg Anesth Pain Med 1999;24:499-505.
14. Mace HS, Paech MJ, McDonnell N. Obesity and obstetric anaesthesia. Anaesth Intensive Care 2011;39:559-70.
15. De Filho GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of Successful Neuraxial Block: A Prospective Study. Eur J Anaesthesiol 2002;19:447-51.
16. Sawyer RJ, Richmond MN, Hickey JD, Jarrratt JA. Peripheral nerve injuries associated with anaesthesia. Anaesthesia 2000;55:980-91.
17. Paech MJ, Godkin R, Webster S. Complications of obstetric epidural analgesia and anaesthesia: A prospective analysis of 10,995 cases. Int J Obstet Anesth 1998;7:5-11.
18. Goy RWL, Ithnin F, Lew E, Sng BL. Exploring the challenges of task-centred training in obstetric anaesthesia in the operating theatre environment. Int J Obstet Anesth 2019:39:88-94.
19. Abdolmaleki M, Afshar L, Momeni S. A review of the conflict between student and patient rights in clinical education. J Med Ethics 2014;8:115-27.
20. Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 era: A systematic review. In Vivo 2020;34:1603-11.
21. Khajavi MR, Alavi F, Moharari RS, Etezadi F, Imani F. Evaluation of Acute and Chronic Back Pain After Spinal Anesthesia in Midline and Paramedian Approach: Incidence and Functional Disability. Arch Anesthesiol Crit Care 2018;4:535-7.
22. Mladenovic R, Dakovic D, Pereira L, Matvijenko V, Mladenovic K. Effect of augmented reality simulation on administration of local anaesthesia in paediatric patients. Eur J Dent Educ 2020;24:507-12.
23. Vandewaetere M, Manhaeve D, Aertgeerts B, Clarebout G, Van Merriënboer JJ, Roex A. 4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93. Med Teach 2015;37:4-20.
24. Gibbs T, Durning S, Van Der Vleuten C. Theories in medical education: Towards creating a union between educational practice andresearch traditions. Med Teach 2011;33:183-7.
25. Kirkpatrick JD, Kirkpatrick WK. Kirkpatrick's four levels of training evaluation. Association for Talent Development; 2016 Oct 1.
26. Komasawa N, Berg BW, Minami T. Problem-based learning for anesthesia resident operating room crisis management training. PLoS One 2018;13:e0207594.
27. El Beheiry M, Doutreligne S, Caporal C, Ostertag C, Dahan M, Masson JB. Virtual Reality: Beyond Visualization. J Mol Biol 2019;431:315-21.
28. Lee C, Wong GKC. Virtual reality and augmented reality in the management of intracranial tumors: A review. J Clin Neurosci 2019;62:14-20.
29. Zhang M, Zhang Z, Chang Y, Aziz ES, Esche S, Chassapis C. Recent developments in game-based virtual reality educational laboratories using the microsoft kinect. Int J Emerg Technol Learn 2018;13:138-59.
30. Gunn T, Lee Jones, Bridge P, Rowntree P, Nissen L. The use of virtual reality simulation to improve technical skill in the undergraduate medical imaging student. Interact Learn Environ 2017;26:1-8.
31. Jalo H, Pirkkalainen H, Torro O, Kärkkäinen H, Puhto J, Kankaanpää T, eds. How can collaborative augmented reality support operative work in the facility management industry? IC3K 2018-Proceedings of the 10th International Joint Conference on Knowledge Discovery, Knowledge Engineering and Knowledge Management.Science and Technology Publications.Vol 3; 2018:41-51.
32. Mousavi SS, Karami M, Mireskandari SM, Samadi S. Effects of Virtual Reality Technology on Knowledge, Attitudes, and Skills of Anesthesia Residents. Arch Anesthesiol Crit Care 2022;8:358-63.
33. Roy E, Bakr MM, George R. The need for virtual reality simulators in dental education: A review. Saudi Dent J 2017;29:41-7.
34. Mousavi SS, Samadi S. Application of virtual reality technology to sleep-disorders: a systematic review of databases. J Popul Ther Clin Pharmacol 2024;31.1:843-55.
35. Keri Z, Sydor D, Ungi T, Holden MS, McGraw R, Mousavi P, et al. Computerized training system for ultrasound-guided lumbar puncture on abnormal spine models: a randomized controlled trial. Can J Anesth 2015;62:777-84.
36. Våpenstad C, Hofstad EF, Bø LE, Kuhry E, Johnsen G, Mårvik R, et al. Lack of transfer of skills after virtual reality simulator training with haptic feedback. Minim Invasive Ther Allied Technol 2017;26:346-54.
37. van Merriënboer JJG, Kirschner PA. Ten Steps to Complex Learning: A systematic approach to four-component instructional design. Routledge; 2017 Oct 23.
38. Masjedi M, Neshatavar R, Mahbodi A, Moeini L. Evaluating the Anesthesiology Residents’ Performance, Using a Modified 360-degree Assessment Questionnaire in Shiraz University of Medical Sciences. Bangladesh J Med Sci 2011;4:10-9.
39. Marei HF, Donkers J, Van Merrienboer JJG. The effectiveness of integration of virtual patients in a collaborative learning activity. Med Teach 2018;40:S96-103.
40. Cooper N, Millela F, Cant I, White M, Meyer G. Transfer of training Virtual reality training with augmented multisensory cues improves user experience during training and task performance in the real world. PLoS One. 2021;16:e0248225.
41. Salles J, Birmes P, Schmitt L, Bastiani B, Soto M, Lafont-Rapnouil S, et al. Teaching emergency situations during a psychiatry residency programme using a blended learning approach: a pilot study. BMC Med Educ 2021;21:473.
| Files | ||
| Issue | Vol 61 No 9 (2023) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v61i9.15285 | |
| Keywords | ||
| Learning transfer Virtual reality Spinal anesthesia Blended learning environment | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mousavi SS, Karami M, Mireskandari SM, Samadi S. Effects of a Novel Blended Virtual Reality and Clinical Learning Environment on the Learning Transfer of Anesthesiology Residents. Acta Med Iran. 2024;61(9):539-546.
