ChapterPDF Available

Virtual Reality in Medical Education

Authors:

Abstract and Figures

The aim of this research is to examine student acceptance and use of virtual reality technologies in medical education. Within the scope of the research, a questionnaire consisting of 4 sub-dimensions and 21 items was developed by the researchers. This questionnaire consists of sub-dimensions of performance expectancy, effort expectancy, facilitating conditions, and social influence. The study was conducted on 421 university students who participated in courses and activities related to the use of virtual reality applications in medical education. The findings of the research demonstrated that the students' acceptance and use of virtual reality applications were high in medical education. Various suggestions were made for researchers and educators in accordance with the findings.
Content may be subject to copyright.
56
Copyright © 2020, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.
Chapter 4
DOI: 10.4018/978-1-7998-2521-0.ch004
ABSTRACT
The aim of this research is to examine student acceptance and use of virtual reality technologies in medi-
cal education. Within the scope of the research, a questionnaire consisting of 4 sub-dimensions and 21
items was developed by the researchers. This questionnaire consists of sub-dimensions of performance
expectancy, effort expectancy, facilitating conditions, and social influence. The study was conducted on
421 university students who participated in courses and activities related to the use of virtual reality ap-
plications in medical education. The findings of the research demonstrated that the students’ acceptance
and use of virtual reality applications were high in medical education. Various suggestions were made
for researchers and educators in accordance with the findings.
INTRODUCTION
Although Virtual Reality (VR) has been used in a few fields such as some sectors in the military since
the 1970s, technological advances have recently made the accessibility of VR affordable and the use
of it prevalent now (Beheiry et al., 2019). While the affordability of it has increased its usage among
prospective customers, it has evolved to become a sophisticated technology that immerses a user in a
virtual environment that is getting similar to reality, which even draws non-consumer attention towards
Virtual Reality in
Medical Education
Ahmet B. Ustun
https://orcid.org/0000-0002-1640-4291
Bartin University, Turkey
Ramazan Yilmaz
Bartin University, Turkey
Fatma Gizem Karaoglan Yilmaz
Bartin University, Turkey
57
Virtual Reality in Medical Education
this technology. It can be seen as a technological revolution that leads to the triumph of 3-D environ-
ments. Therefore, it is widely used in fields such as healthcare, military and education.
The popularity of VR increases in the realm of medicine. Many researchers emphasize the use of VR in
healthcare as a potentially effective tool that provides innovative techniques for clinical practice settings.
Morel, Bideau, Lardy, and Kulpa (2015) state that standardization, reproducibility and stimuli control
are the benefits of the VR system in clinical assessment and rehabilitation. The use of VR technology
offers a standardized virtual environment in which stimuli can be controlled to accurately evaluate the
balance recovery of patients and their progression, and this standardized environment can be reproducible
to make comparisons among patients in the same condition or between the trials of patients (Morel et
al., 2015). Also, the accessibility and affordability of VR technologies are easier with the commencing
mass production of low-cost devices so rehabilitation can be continued anywhere, anytime in motivating
and entertaining virtual environments (Morel et al., 2015; Riener, & Harders, 2012).
Rose, Nam and Chen (2018) indicate that VR technologies have been employed in treatments of
physical impairments as an emerging rehabilitation technology for those who suffer from “stroke (Jack
et al., 2001), cerebral palsy (Reid, 2002), severe burns (Haik et al., 2006), Parkinson’s disease (Mirelman
et al., 2010), Guillain-Barré syndrome (Albiol-Pérez et al., 2015), and multiple sclerosis (Fulk, 2005)
among others” (p. 153). This aligns with the comprehensive systematic review study conducted by Ravi,
Kumar and Singhi (2017) who state that the utilization of VR technologies in therapeutic interventions
for children and adolescents suffering from cerebral palsy is a promising intervention in order to make
improvement in balance and overall motor capabilities. VR technology can also be used in psychotherapy.
The use of VR applications has been proved as an effective treatment for phobias through the processes
of habituation and extinction (Riva, 2005). In the VR treatment of phobias, patients are exposed to con-
trolled, fear-provoking stimuli to gradually alleviate the anxiety in the realistic environment.
While VR has been gained popularity in the use of interventions for balance assessment, rehabilita-
tion and psychotherapy in the medical field, De Luca et al. (2019) point out that it is commonly cited as
a valuable educational tool used in many fields of study such as medical and dental sciences. When VR
is employed in medical education, it offers a safe environment where students gain fun, engaging, inter-
active and cost-effective experiences by eliminating the risk factors (de Ribaupierre et al., 2014). These
situation-based experiences including specifically surgical experiences generated by VR technologies
represented to students enable them to practice how to perform surgery for knowledge and skill acquisi-
tion without suffering possibly life-changing consequences. When the promise and potential of VR are
considered in medical education, it can be seen that there are few numbers of research. It is important
to increase current knowledge and diversity of research on this subject. Therefore, the aim of the study
is to investigate the students’ acceptance and use of VR technologies in healthcare education.
BACKGROUND
Brief History of VR
Although VR can be seen as a new phenomenon because of recent technological advancements that
support the development of today’s VR systems, the early roots for VR emerged in the 1920s. In 1920,
Edwin Albert Link began working on a flight simulator for flight training and the first flight simulator
was presented in 1929. Link later launched a company that produced flight simulators for flight train-
58
Virtual Reality in Medical Education
ing in the early 1930s (Page, 2000). The evolutionary origins of the VR system can be traced back to
the 1960s when Cinematographer Morton Heilig created a multi-sensorial simulator “Sensorama” that
stimulates the senses through wind and scent emitter, vibratory sensation, audio and a colorful 3D display
(Pelargos et al., 2017). In the mid of 1960s, Ivan Sutherland, a head of computer graphics, developed
the ‘‘Sword of Damocles” that was the first VR systems equipped with head-mounted displays (HMDs),
which enabled users to be able to view the virtual world and interact with objects (Drummond, Houston
& Irvine, 2014). In 1975, Myron Krueger developed the first interactive VR platform, video place, that
captures the users’ image to allow them to see their computer-generated silhouettes imitating their own
movements in 2D screens (Krueger & Wilson, 1985). Besides, VCASS developed by Thomas Furness
in 1982 was for a better flight simulator than previous ones and VIVED – Virtual Visual Environment
Display developed by NASA in 1984 was for their astronauts. Over the last decade, there were many
other advancements in the developments of VR systems such as DataGlove (1985), HMD (1988), BOOM
(1989), CAVE (1992) and Augmented Reality (1990s). In spite of the endeavours of these early research-
ers and companies, the technological improvements in computer efficiency were not sufficient to sup-
port VR systems that could be widely appealing until the year 2010 (Pelargos et al., 2017). VR systems
including Augmented Reality (AR) have therefore been utilized in a variety of fields and worldwide
sales of products and services of VR systems by the Oculus Rift from Oculus VR and Facebook, HTC
Vive from HTC and Valve Corporation, PlayStation VR from Sony Corporation, Samsung Gear VR
from Samsung Electronics, and HoloLens from Microsoft Corporation are expected to increase more
than $162 billion in 2020 (Gaggioli, 2017).
Definition and Description of VR
Zhang et al. (2018) define VR as “a computer-generated simulation of a 3-D environment that users can
interact with in a seemingly real or physical way using special electronic equipment, such as a helmet
with a screen inside or gloves fitted with sensors” (p. 138). Sacks, Perlman and Barak (2013) define
(VR) as “a technology that uses computers, software and peripheral hardware to generate a simulated
environment for its user” (p. 1007). As understood from the definitions, the VR system aims to provide
a sense of being within a simulated environment. Users can experience a generated artificial environ-
ment that is exhibited to them by means of electronic equipment in such a way as to persuade their brain
to perceive this artificial environment as a real environment. Due to this reason, those who viewed this
artificial computer-generated environment for the first time depict their experience as a surprise or “wow
effect” (Beheiry et al., 2019).
It is important to describe VR/AR and how both differ from each other. AR can be categorized as a
subset of VR (Sharif, Ansari, Yasmin, & Fernandes, 2018). Although these technologies have similari-
ties, there are major differences between them to individually provide a distinguished experience. Klop-
fer and Squire (2008) define AR as “a situation in which a real-world context is dynamically overlaid
with coherent location or context sensitive virtual information” (p. 205). According to the definition,
virtual objects are integrated into the real world (Durak, Karaoglan, & Yilmaz, 2019). Therefore, users
can simultaneously experience the blending of the real world and virtual objects instead of being fully
immersed in a virtual world (Pelargos et al., 2017). However, the idea behind VR is the creation of a
simulated three-dimensional world that can be similar to or totally different from the real-world. The
users are completely immersed in this simulated reality in which they can interact by holding, pushing,
pulling and throwing virtual objects. In this sense, VR and AR systems have their own advantages and
59
Virtual Reality in Medical Education
disadvantages to create a safe and simulated setting and therefore; there are concrete differences between
the use of VR and AR systems in medical (Lee & Wong, 2019). On the one hand, the AR system allows
a surgeon to see the surgical field as a real-life structure and at the same time artificial elements such
as digital images of the surgical field and patient’s other vital information (Murthi & Varshney, 2018).
In this surgery, one of the distinguished benefits of AR is to enable the surgeon to see the patient’s
multiple interpreted information without breaking his concentration by looking away from the patient
to obtain this information from multiple different displays (Murthi & Varshney, 2018). On the other
hand, VR system can be used to fully immerse a mental illness patient in a crafted, virtual conditions
where the patient encounters his fear to treat and cure phobia such as a fear of spiders, flying or being in
a small space (Riener & Harders, 2012, p. 5). In this type of treatment, VR applications can be used to
gradually expose the patient to the phobic condition and the treatment of the VR session can instantly
be terminated if necessary.
Virtual Reality in Education
The use of VR technology in education and training has widely attracted attention because of its capabil-
ity to create a virtual environment in which learners are steered toward achieving targeted tasks in order
to acquire a variety of new skills. These tasks can be designed to captivate and engage learners in the
learning process (Norris, Spicer & Byrd, 2019). This system mostly uses head-mounted displays with
headphones and hand controllers as electronic devices to engage their multiple senses. Engaging multiple
senses increases learners’ attention and focus, and fosters meaningful learning experiences to develop
new knowledge or skills in an immersive environment. Gadelha (2018) states that VR is a state-of-the-art
technology product that enables learners to make connections with the instructional material in a way
that has never been possible before by eliminating external distractions in the classroom.
According to Gadelha (2018), VR technology has changed how teachers teach and how learners learn.
It has the potential to help shift from the traditional teacher-centered approach to a student-centered
approach. The Multimedia Cone of Abstraction (MCoA) based on Dale’s Cone of Experience (CoE)
explicating learners retain more information when they learn by doing demonstrates that learners become
active learners by interacting with a purposeful virtual environment in which they learn by doing targeted
tasks (Baukal, Ausburn, & Ausburn, 2013). Basically, the researchers put the VR technology in place of
the base of the CoE that is “Direct Purposeful Experiences” the least abstract level, which means that
VR provides very realistic simulations of things that learners can interact with and learn best by doing.
Under appropriate conditions such as providing immediate feedback and enough time to allow learn-
ers to progress at their own pace, individual students achieve mastery of the task or materials (Bloom,
1974). The use of VR technology gives the opportunity for learners to practice what they have learned
regardless of the number of repetitions until they carry out the targeted tasks. Its use also intrinsically
motivates them to keep striving to successfully practice (Sánchez-Cabrero et al., 2019). In other words,
its use encourages them to perform to their own capacities until mastering a skill or task instead of giving
up repeating instructional sessions. Besides, they can receive immediate feedback on their current level
of mastery in a virtual learning environment. The instant feedback helps them realize what they need
to do better to achieve a skill or task and initiates the visual programming to recreate a virtual learning
environment to be tailored (Norris, Spicer, & Byrd, 2019).
VR technology provides safe learning environments that learners can experience damaging, risky,
dangerous or harmful situations while never putting their safety in jeopardy. Not only safe virtual situ-
60
Virtual Reality in Medical Education
ations that are hazardous in reality such as operating medical devices in healthcare training and combat
training in the military can be created by VR for learners, but also can possibly be personalized according
to each learner’s need by simulating countless scenarios (Norris, Spicer, & Byrd, 2019). While infinite
virtual instructional scenarios that are only limited by imagination and knowledge can be generated,
Zhang et al. (2018) point out that the creation of these scenarios consumes very few natural and social
resources in comparison with a real one.
Virtual Reality in Healthcare Education
Particularly, several studies have shown simulation training as an effective approach to improve knowl-
edge acquisition and skills in healthcare education (Bracq, Michinov, & Jannin, 2019). VR training
enables healthcare professionals to educate medical students by eliminating potential risks resulting in
an adverse outcome in a patient. VR technology is not only considered as interactive and effective expe-
riential learning for medical students to develop skill and confidence needed when they encounter in a
real-life situation, but it is also seen as a cost-effective learning approach to repeatedly practice number
of simulated clinical scenarios in healthcare (King et al., 2018). Therefore, the utilization of VR gives
opportunities for medical learners to rehearse without being anxious about making mistakes and facing
any grave results and to be prepared for recognizing the symptoms of a disease and even conducting
complicated operations.
The utilization of VR simulations eliminates the need for the use of cadavers or animals to acquire
professional knowledge and develop essential practical skills by providing a realistic method of training in
the field of medicine. VR system also provides surgery training and rehearsal for inexperienced trainees
to gain surgical skills in a variety of surgery operations such as endoscopic surgery, laparoscopic surgery,
neurosurgery and epidural injections. Vaughan, Dubey, Wainwright and Middleton (2016) highlight
the importance of attaining practice skills before operating theatre scenarios in real life and indicate
that surgeons have great chance to develop and enhance their operative and decision-making skills in a
controlled, risk-free realistic operating room through the utilization of orthopedic VR training simula-
tions. Thus, the use of these VR simulations can be seen as suitable training opportunities for surgeons
who have a lack of surgical experience to practice key skills in orthopedic and other types of surgeries.
Traditional forms of education like a verbal presentation of information and conveying written ma-
terial may not be appropriate to teach complicated medical information for patients and their primary
caregivers (Hoffmann & McKenna, 2006). Specifically, language proficiency, cultural and socioeco-
nomic backgrounds, levels of education and understanding and language or cognitive impairment should
be taken into consideration in stroke cases where risk factors and causes vary greatly from person to
person in stroke survivors (Thompson-Butel et al., 2019). In this sense, it is a demand to tailor educa-
tion according to the stroke survivor’s needs for providing relevance and comprehensible information
(Eames, Hoffmann, Worrall, & Read, 2010). A study was conducted by Thompson-Butel et al. (2019)
who developed guided and personalized VR education sessions to prevent recurrent stroke and maxi-
mize rehabilitation for stroke survivors and their primary caregivers and explored the use of these VR
sessions in delivering post stroke education to find out its effectiveness. They revealed that the use of
VR provides safe and individualized educational experiences for participants who were highly satisfied
with the education sessions and “demonstrated varied improvements in knowledge areas including brain
anatomy and physiology, brain damage and repair, and stroke-specific information such as individual
stroke risk factors and acute treatment benefits” (p.450).
61
Virtual Reality in Medical Education
Roy, Bakr and George (2017) explored the current situation of VR simulations and evaluated the
value of VR simulations in dental education. According to them, VR devices that are employed in dental
education offer great possibilities for flexible learning and self-learning. Learners can play an active
role in their learning. For instance, the features of VR devices enable them to practice simulations in
the form of VR when and where they want and assess their work after completing practices by storing
and replaying. Besides, the use of VR technology also alleviates anxiety and boredom of a classroom
setting and makes the learning process engaging and effective. The rapid technological advances in VR
provide more effective and efficient realistic pre-clinical dental experiences for students in all disciplines
of dentistry (Roy et al., 2017).
Purpose of the Study
The use of VR to train medical learners for the acquisition of clinical skills has several advantages includ-
ing but not limited to offering safe and reliable clinical learning environments, facilitating self-directed
learning and providing personalized learning (Ruthenbeck & Reynolds, 2015). Riener and Harders
(2012) articulate the aim of the VR system in healthcare as enhanced quality of the education and long
and efficient training sessions through motivating and exciting realistic simulations. Seymour (2008)
indicates that training in a VR environment improves learning outcomes in clinical settings when tak-
ing advantage of the advancing capabilities of VR simulation. A study conducted by Gunn et al. (2018)
who assessed the effect of using VR simulation on the first-year medical imaging students’ technical
skills by comparing their technical skill acquisition via the traditional laboratory-based simulation and
the medical imaging VR simulation revealed that the use of VR simulation improved their technical
skill acquisition better than the use of the traditional laboratory-based simulation. However, VR system
has limitations including the latency, “the delay between the actions of the immersed patient with input
devices and the reaction of the virtual environment” and “the underestimation of perceived distance in
virtual environments compared to real situations” (Morel et al., 2015, p.324). These limitations may
hinder the delivery of effective learning content or make the learning process difficult. Also, educators’
self-perception of inadequate technological skills might hinder the use of VR technology. For example,
VR technology is considered in some instances as a technology that requires a high level of technological
knowledge and skills in order that learners are able to use (Warburton, 2009). Also, Sanchez-Cabrero
et al. (2019) point out that VR as a learning tool “is a relatively unexplored area in its beginnings that
urgently needs to deepen its application in the classroom” (p. 2). In addition, Gunn et al. (2018) indicate
that there are limited scholarly documentations in the realm of undergraduate medical education in spite
of the growing popularity of using VR technologies in healthcare. Taking full advantage of using the
VR system as an educational tool depends ultimately on medical students’ acceptance of VR (Huang,
Liaw, & Lai, 2016). In this sense, it is vital to widen existing knowledge and a variety of research on the
use of VR technologies in medical education. Thus, the purpose of the study is to explore the students’
acceptance and use of VR technologies in medical education.
METHOD
This section includes information about the research design, participants, data collection tool and data
analysis.
62
Virtual Reality in Medical Education
Research Design and Participants
Within the scope of the research, a survey model was used to examine the university students’ opin-
ions about the use of VR technology in medical education. The participants were university students
studying at a public university and taking the anatomy course that is taught by using VR technologies.
Accordingly, this study was carried out on 421 university students. This study was conducted on un-
dergraduate students studying at a public university in Turkey. When the distribution of students was
examined according to their gender; it was determined that 46.8% (n = 197) are female and 53.2% (n
= 224) are male. The students who participated in the research studied in diverse departments includ-
ing health sciences (f = 111, 26.4%), physical education and sports (f = 91, 21.6%), coaching (f = 63,
15%), recreation (f = 81, 19.2%) and sports management (f = 75, 17.8%). The reason why the research
was carried out on students studying at different departments was that an anatomy course was taught
in these departments. It was attempted to contribute to the generalizability of the results by including
students studying at different departments in this research. The students were in the 18-25 age range.
More than half (61%) of the students were freshmen and the rest of them (39%) were sophomores. They
were enabled to experience VR technologies within the scope of their anatomy course At the end of the
research process, a questionnaire was completed by students to determine their acceptance and use of
VR technologies in healthcare education.
Data Collection Tools
The data were obtained by a questionnaire developed by the researchers in this study. In the first phase
of the development process of the questionnaire, the problem situation was determined and then the ap-
propriate themes were composed in accordance with this problem situation by carefully examining the
related literature (Sezer & Yilmaz, 2019; Yilmaz, Karaoglan Yilmaz, & Ezin, 2018). These sub-themes
were ‘Performance Expectancy’, ‘Effort Expectancy’, ‘Facilitating Conditions’, ‘Social Influence’. The
sub-themes were developed by taking into account the Unified Theory of Acceptance and Use of Tech-
nology (UTAUT) model, which is one of the technology Acceptance models. Technology acceptance is a
structure consisting of cognitive and psychological variables underlying the use of technology (Venkatesh,
Morris, Davis, & Davis, 2003). The aim of this structure is to explain the acceptance of individuals to use
a particular technology and the factors that affect this acceptance. Many models (TAM, TAM 2, UTAUT,
UTAUT2, etc.) have been proposed in technology acceptance studies (Schepers & Wetzels, 2007). The
aim of all these models elucidates the factors that affect the effective use of technology. Venkatesh et al.
(2003) believe that it would be inadequate to explain a complicated structure consisting of cognitive and
psychological variables like technology acceptance with a single model. Because of this reason, they
expressed that this complicated structure should be examined in a multidimensional way and formulated
the Unified Theory of Acceptance and Use of Technology (UTAUT) (Venkatesh et al., 2003). UTAUT
model is consisted of four essential elements including “performance expectancy”, “effort expectancy”,
“facilitating conditions” and “social influence” (Venkatesh et al., 2003). The graphic representation of
the model is given in Figure 1.
As shown in Figure 1; Performance expectancy pertains to the belief that performance increases
with the use of technology. Effort expectancy pertains to the belief that the related technology is easy to
use. Social influence pertains to the belief and attitudes of influential individuals (teachers, successful
students, etc.) towards the use of the related technology. The positive belief and attitudes of these indi-
63
Virtual Reality in Medical Education
viduals create a positive social impact on other individuals to use that technology. Facilitating conditions
are related to whether or not various facilitating elements exist to support the use of technology for the
individual (Venkatesh et al., 2003). Within the scope of this research, UTAUT model was taken into
consideration in order to investigate the acceptance and use of VR technologies in healthcare educa-
tion and a measurement instrument consisting of sub-dimensions of ‘Performance Expectancy’, ‘Effort
Expectancy’, ‘Facilitating Conditions’, ‘Social Influence’ was developed.
After the determination of the sub-themes, a pool of 55 items based on the information extracted
from the literature review was created. 35 items that were picked to suit the draft of the opinion form
were selected from the item pool and a pre-application form was created with a Likert-type rating. In
order to discuss the appropriateness of the pre-application form, three experts working in the field of
Turkish language and literature, instructional technologies and health sciences were consulted on. The
linguist evaluated the items in terms of intelligibility, expression and grammar. The experts in the field
of instructional technology and health sciences assessed the items in terms of scope, criteria, structure
and appearance validity. Modifications were carried out to the questionnaire in accordance with the feed-
back from the experts. Subsequently, the pilot test of the questionnaire was conducted on 95 university
students who were excluded in the main study and the questionnaire items were revised and finalized
by evaluating the questionnaire in terms of criteria such as language validity, clarity and appropriate-
ness. Thus, the final version of the student evaluation form prepared for the investigation into the use
of VR technologies in medical education was structured as a five-point Likert type scale consisting of
four sections and 21 items.
Data Analysis
The value of factor loading for the developed data collection tool, KMO (Kaiser-Meyer-Olkin Measure
of Sampling Adequacy) coefficient value to determine the suitability of the sample for measurements,
Bartlett test to determine the consistency of inter-items, and Cronbach α reliability coefficient to estimate
the reliability were used. The values of factor loading for 21 items ranged from .91 to .95. KMO value
Figure 1. Unified theory of acceptance and use of technology
(Source: Venkatesh et al., 2003, p.447)
64
Virtual Reality in Medical Education
was .89. As the KMO value comes close to 1, factor analysis becomes more significant. KMO value
between .50 and .70 is considered to be a medium level, between .71 and .80 is considered to be a good
level and between .81 and .90 is considered to be a very good level and .91 and above is considered to be
a great level (Field, 2005). Therefore, the sample was sufficient that data analysis could be conducted. It
was found that the result of Bartlett’s test was significant (Chi-square = 2329.147, p < 0.01). When the
reliability of the questionnaire was examined, it was found that Cronbach’s alpha reliability coefficient
was .91. These findings confirmed that the data collection tool was reliable. Frequency and percentage
values were used in the analysis of the collected data.
FINDINGS
Particular themes were found out in the process of preparing the data collection tool. These themes were
Performance Expectancy’, ‘Effort Expectancy’, ‘Facilitating Conditions’, ‘Social Influence’. The findings
related to the analysis of the first theme, “Performance Expectation” are given in Table 1.
Table 1 discusses the statistics in regard to the questions of “Performance Expectancy”. The vast
majority of students stated that the use of VR technologies in medical education enables the work to
be done faster, enhances their performance, boosts their productivity and motivation, makes doing the
assignments and practices easier, enhances the quality of the work done by them, and makes their learn-
ing process more effective and efficient. Based on these results, the students’ performance expectancies
Table 1. Performance expectancy
Items
Strongly Disagree --- Strongly Agree
Total
1 2 3 4 5
1. Using Virtual Reality applications help me
do my work more quickly in my courses.
f 18 26 78 197 102 421
% 4.3 6.2 18.5 46.8 24.2 100.0
2. Using Virtual Reality applications improves
my performance in my courses.
f 12 31 70 203 105 421
% 2.9 7.4 16.6 48.2 24.9 100.0
3. Using Virtual Reality applications increases
my productivity in my courses.
f 16 18 74 193 120 421
% 3.8 4.3 17.6 45.8 28.5 100.0
4. Using Virtual Reality applications increases
my motivation in my courses.
f 14 19 72 200 116 421
% 3.3 4.5 17.1 47.5 27.6 100.0
5. Using Virtual Reality applications makes
it easier for me to do my assignments in my
courses.
f 10 30 76 192 113 421
% 2.4 7.1 18.1 45.6 26.8 100.0
6. Using Virtual Reality applications improves
the quality of my work in my courses.
f 10 30 74 191 116 421
% 2.4 7.1 17.6 45.4 27.6 100.0
7. I find the use of Virtual Reality applications
beneficial in my courses.
f 10 25 77 187 122 421
% 2.4 5.9 18.3 44.4 29.0 100.0
8. Using Virtual Reality applications enables
the learning process to be effective in my
courses.
f 14 21 82 184 120 421
% 3.3 5.0 19.5 43.7 28.5 100.0
65
Virtual Reality in Medical Education
regarding the use of VR technologies in medical education were high. This finding can be interpreted
as facilitating students’ acceptance and use of VR technologies in medical education.
The findings related to the analysis of the second theme, “Effort Expectancy” are given in Table 2.
Table 2 discusses the statistics in regard to the questions of “Effort Expectancy”. The vast majority
of students pointed out that learning the use of VR technologies in medical education is easy, they are
effortlessly able to VR applications, the use of VR applications is not challenging and time-consuming,
they feel comfortable while using VR applications, and they can easily do everything with VR applica-
tions. Based on these results, the students’ effort expectancy regarding the use of VR technologies in
medical education was low. In other words, students thought that they can easily utilize VR technologies
by making a little effort. This finding can be interpreted as facilitating students’ acceptance and use of
VR technologies in medical education.
The findings related to the analysis of the third theme, “Facilitating Conditions” are given in Table 3.
Table 3 discusses the statistics in regard to the questions of “Facilitating Conditions”. The vast majority
of students indicated that they have the required knowledge to use VR technologies in medical education,
there are persons whom they can get help when they have difficulty in using VR technologies in medical
education, the use of VR applications is similar to the use other computer systems, they know persons
whom they can get help in solving the problems that they encounter while using VR applications, and
the help that they get will be sufficient to solve the problems they face. Based on these results, students
have facilitating conditions related to the use of VR technologies in medical education. This finding
can be interpreted as facilitating students’ acceptance and use of VR technologies in medical education.
The findings related to the analysis of the fourth theme, “Social Influence” are given in Table 4.
Table 3 discusses the statistics in regard to the questions of “Facilitating Conditions”. The vast majority
of students indicated that people around them think it is important to effectively use VR technologies in
medical education, the effective use of VR technologies increases their eminence among their schoolmates
in medical education, and the effective use of VR technologies increases their respectability among their
friends in medical education. Based on these results, it is concluded that students have social influence
Table 2. Effort expectancy
Items
Strongly Disagree --- Strongly Agree
Total
1 2 3 4 5
9. It is easy for me to learn to use Virtual
Reality applications.
f 10 25 102 183 101 421
% 2.4 5.9 24.2 43.5 24.0 100.0
10. I can easily use Virtual Reality applications. f 12 24 97 189 99 421
% 2.9 5.7 23.0 44.9 23.5 100.0
11. It takes less time to complete a task when I
use Virtual Reality applications
f 12 28 107 170 104 421
% 2.9 6.7 25.4 40.4 24.7 100.0
12. I feel comfortable while using Virtual
Reality applications.
f 11 21 88 186 115 421
% 2.6 5.0 20.9 44.2 27.3 100.0
13. I can do anything I want to do with Virtual
Reality applications.
f 16 40 111 167 87 421
% 3.8 9.5 26.4 39.7 20.7 100.0
66
Virtual Reality in Medical Education
conditions related to the use of VR technologies in medical education. This finding can be interpreted
as facilitating students’ acceptance and use of VR technologies in medical education.
CONCLUSION
This study explored university student acceptance and use of VR technologies in medical education.
The study was conducted with a sample of 421 university students who participated in courses and
activities related to the use of VR applications in medical education. A questionnaire consisting of 4
sub-dimensions and 21 items developed by the researchers was administered to the students. This ques-
tionnaire consisted of sub-dimensions of ‘Performance Expectancy’, ‘Effort Expectancy’, ‘Facilitating
Conditions’ and ‘Social Influence’. The results demonstrated in general that the students’ acceptance
and use of VR technologies are high in medical education.
Table 3. Facilitating conditions
Items
Strongly Disagree --- Strongly Agree
Total
1 2 3 4 5
14. I have the essential knowledge to use
Virtual Reality applications effectively.
f 15 32 134 154 86 421
% 3.6 7.6 31.8 36.6 20.4 100.0
15. There are persons whom I can get help
when I have difficulty in using Virtual Reality
applications.
f 11 23 87 183 117 421
% 2.6 5.5 20.7 43.5 27.8 100.0
16. Using Virtual Reality applications is similar
to using other computer applications.
f 13 29 122 171 86 421
% 3.1 6.9 29.0 40.6 20.4 100.0
17. I know persons whom I can get help in
solving the problems that I encounter while
using Virtual Reality applications.
f 14 21 98 179 109 421
% 3.3 5.0 23.3 42.5 25.9 100.0
18. The help service of Virtual Reality
applications is enough to solve the problems
I face.
f 15 30 105 181 90 421
% 3.6 7.1 24.9 43.0 21.4 100.0
Table 4. Social influence
Items
Strongly Disagree --- Strongly Agree
Total
1 2 3 4 5
19. People around me think it’s important that I
use Virtual Reality applications effectively.
f 15 25 116 176 89 421
% 3.6 5.9 27.6 41.8 21.1 100.0
20. The fact that I use Virtual Reality
applications effectively increases my prestige
among my schoolmates.
f 18 41 123 152 87 421
% 4.3 9.7 29.2 36.1 20.7 100.0
21. My friends who effectively use Virtual
Reality applications have more respectability.
f 25 38 130 137 91 421
% 5.9 9.0 30.9 32.5 21.6 100.0
67
Virtual Reality in Medical Education
When the results related to the performance expectancy sub-dimension were examined, the ma-
jority of the students indicated that the use of VR applications helps make tasks faster, increase their
performance, productivity and motivation in the courses, do assignments easily, improve the quality
of assignments and lectures, and make the learning process more effective. Beheiry et al. (2019) state
that tasks can easily be divided into virtual manageable tasks through the adoption of VR technologies,
which boosts knowledge acquisition and makes knowledge transfer faster and they also state that the use
of VR applications helps close knowledge gaps between experts and novices, which enables an inexpert
to maintain and promote interest and motivation in healthcare.
When the results related to the effort expectancy sub-dimension were probed, the majority of the
students remarked that the use of VR applications is easy to learn, that they can easily use these technolo-
gies and applications, and that they feel comfortable while using these applications. For these reasons,
it can be claimed that the use of VR technologies is simple to operate for students. In other words, they
can use VR technologies without making much effort. This result supported the claim that VR applica-
tions are easy to use (Huang et al., 2016).
When the results related to the facilitating conditions sub-dimension were looked into, the majority
of the students pointed out that they have the required knowledge to use the VR applications effectively,
that they know individuals whom they can get help around them when they have difficulty in using
these applications and technologies, and that the use of VR applications is similar to the use of other
computer systems. Therefore, these findings showed that students have facilitating conditions for using
VR technologies, which increases their acceptance and use of VR technologies in medical education.
This aligns with the study conducted by Sanchez-Cabrero et al. (2019) who explored users’ interest in
the use of VR technologies as a learning tool. They revealed that the desire to utilize VR as a learning
tool is higher than the current use of VR although they didn’t just focus on the interest in the use of VR
in healthcare settings.
When the results related to the social influence sub-dimension were investigated, the majority of
the students stated that the people around them think it is important to effectively use VR technologies
in medical education and that the effective use of these technologies increases the prestige and respect
among their friends. Based on these results, students have social influence for the use of VR technolo-
gies, which increases their acceptance and use of VR technologies in medical education. After Lee, Kim
and Choi (2019) administered a survey with 350 people from South Korea, they reached a similar result
that social interactions have a great effect on the intention to use VR technologies.
Based on these results, it can be asserted that university students are highly prone to accept and use
VR technologies in medical education. Similar studies have shown that medical students have high ac-
ceptance and use of technology in medical education (Sezer & Yilmaz, 2019). These results of studies
have a significant implication in terms of integrating VR technologies into courses and laboratory ap-
plications in medical education. A variety of instructional design models can be used in the VR integra-
tion process. Specifically, one of the instructional design models is ASSURE Model that can be used
by instructors to design and develop an appropriate learning environment in medical education (Sezer,
Yilmaz, & Karaoglan Yilmaz, 2013). Also, when the integration of VR technologies into a medical class
is properly done, it potentially provides interactive and effective virtual learning experiences in which
medical students can learn the subjects that are difficult to understand and practice the burdensome
tasks that result likely in adverse outcomes. Thus, it will be possible to improve student performance,
learning process and outcomes.
68
Virtual Reality in Medical Education
FUTURE RESEARCH DIRECTIONS
This study has some limitations. First, the students’ acceptance and use of VR technologies in medical
education is limited to data collected from the students through a questionnaire developed by research-
ers within the framework of UTAUT Model. Data from the questionnaire were described as item-based
frequency and percentage values and the survey results were interpreted in the study. In future studies,
students’ acceptance and use of VR technologies in medical education would be examined according to
other technology acceptance model in the literature. Besides, instead of item-based analysis of question-
naire items, students’ acceptance and use of VR technologies in medical education would be investigated
by using a questionnaire tested through exploratory factor analysis and confirmatory factor analysis in
future studies. In this research, the students’ acceptance and use of VR technologies in medical educa-
tion were explored within the scope of an anatomy course. In order to increase the generalizability of the
results of the study, students’ acceptance and use of VR technologies would be compared by conduct-
ing similar studies within the scope of different courses in other specialties such as physiology, public
health, emergency medicine, psychiatry. The acceptance and use of VR technologies in medical educa-
tion were discussed in the view of the students in this study. The acceptance and use of VR technologies
in medical education would be examined from the faculty perspective in future research. Therefore, it
would be possible to gain insight into their opinions of utilizing VR technologies. Lastly, this study is
limited to explore the acceptance and use of VR technologies in medical education. In future studies,
the acceptance and use of VR technologies in different fields of higher education would be investigated.
REFERENCES
Baukal, C. E., Ausburn, F. B., & Ausburn, L. J. (2013). A Proposed Multimedia Cone of Abstraction:
Updating a Classic Instructional Design Theory. Journal of Educational Technology, 9(4), 15–24.
Bloom, B. S. (1974). Time and learning. The American Psychologist, 29(9), 682–688. doi:10.1037/
h0037632
Bracq, M. S., Michinov, E., & Jannin, P. (2019). Virtual reality simulation in nontechnical skills training
for healthcare professionals: A systematic review. Simulation in Healthcare, 14(3), 188–194. doi:10.1097/
SIH.0000000000000347 PMID:30601464
De Luca, R., Manuli, A., De Domenico, C., Voi, E. L., Buda, A., Maresca, G., ... Calabrò, R. S. (2019).
Improving neuropsychiatric symptoms following stroke using virtual reality. Case Reports in Medicine,
98(19), e15236. PMID:31083155
de Ribaupierre, S., Kapralos, B., Haji, F., Stroulia, E., Dubrowski, A., & Eagleson, R. (2014). Healthcare
training enhancement through virtual reality and serious games. In Virtual, Augmented Reality and Seri-
ous Games for Healthcare 1 (pp. 9–27). Berlin: Springer. doi:10.1007/978-3-642-54816-1_2
Drummond, K. H., Houston, T., & Irvine, T. (2014). The rise and fall and rise of virtual reality. Vox
Media.
69
Virtual Reality in Medical Education
Durak, A., & Karaoglan Yilmaz, F. G. (2019). Artirilmiş gerçekliğin eğitsel uygulamalari üzerine orta-
okul öğrencilerinin görüşleri [Opinions of secondary school students on educational practices of aug-
mented reality]. Abant İzzet Baysal Üniversitesi Eğitim Fakültesi Dergisi, 19(2), 468–481. doi:10.17240/
aibuefd.2019.19.46660-425148
Eames, S., Hoffmann, T., Worrall, L., & Read, S. (2010). Stroke patients’ and carers’ perception of
barriers to accessing stroke information. Topics in Stroke Rehabilitation, 17(2), 69–78. doi:10.1310/
tsr1702-69 PMID:20542850
El Beheiry, M., Doutreligne, S., Caporal, C., Ostertag, C., Dahan, M., & Masson, J. B. (2019). Vir-
tual Reality: Beyond Visualization. Journal of Molecular Biology, 431(7), 315–321. doi:10.1016/j.
jmb.2019.01.033 PMID:30738026
Field, A. (2005). Discovering statistics using SPSS. London: Sage Publications.
Gadelha, R. (2018). Revolutionizing Education: The promise of virtual reality. Childhood Education,
94(1), 40–43. doi:10.1080/00094056.2018.1420362
Gaggioli, A. (2017). An open research community for studying virtual reality experience. Cyberpsychol-
ogy, Behavior, and Social Networking, 20(2), 138–139. doi:10.1089/cyber.2017.29063.csi
Gunn, T., Jones, L., Bridge, P., Rowntree, P., & Nissen, L. (2018). The use of virtual reality simulation
to improve technical skill in the undergraduate medical imaging student. Interactive Learning Environ-
ments, 26(5), 613–620. doi:10.1080/10494820.2017.1374981
Hoffmann, T., & McKenna, K. (2006). Analysis of stroke patients’ and carers’ reading ability and the
content and design of written materials: Recommendations for improving written stroke information.
Patient Education and Counseling, 60(3), 286–293. doi:10.1016/j.pec.2005.06.020 PMID:16098708
Huang, H. M., Liaw, S. S., & Lai, C. M. (2016). Exploring learner acceptance of the use of virtual re-
ality in medical education: A case study of desktop and projection-based display systems. Interactive
Learning Environments, 24(1), 3–19. doi:10.1080/10494820.2013.817436
Karaoğlan Yılmaz, F. G., & Yılmaz, R. (2019). Examining the opinions of prospective teachers about the
use of virtual reality applications in education [Sanal gerçeklik uygulamalarının eğitimde kullanımına
ilişkin öğretmen adaylarının görüşlerinin incelenmesi]. In Proceedings of the International Congress
on Science and Education. Academic Press.
King, D., Tee, S., Falconer, L., Angell, C., Holley, D., & Mills, A. (2018). Virtual health education:
Scaling practice to transform student learning: Using virtual reality learning environments in healthcare
education to bridge the theory/practice gap and improve patient safety. Nurse Education Today, 71, 7–9.
doi:10.1016/j.nedt.2018.08.002 PMID:30205259
Klopfer, E., & Squire, K. (2008). Environmental detectives: The development of an augmented reality
platform for environmental simulations. Educational Technology Research and Development, 56(2),
203–228. doi:10.100711423-007-9037-6
Krueger, M. W., & Wilson, S. (1985). VIDEOPLACE: A report from the artificial reality laboratory.
Leonardo, 18(3), 145–151. doi:10.2307/1578043
70
Virtual Reality in Medical Education
Lee, C., & Wong, G. K. C. (2019). Virtual reality and augmented reality in the management of intra-
cranial tumors: A review. Journal of Clinical Neuroscience, 62, 14–20. doi:10.1016/j.jocn.2018.12.036
PMID:30642663
Morel, M., Bideau, B., Lardy, J., & Kulpa, R. (2015). Advantages and limitations of virtual reality for
balance assessment and rehabilitation. Neurophysiologie Clinique [Clinical Neurophysiology], 45(4-5),
315–326. doi:10.1016/j.neucli.2015.09.007 PMID:26527045
Mukkamala, S. R., & Madhusudhanan, M. (2016). U.S. Patent Application No. 14/478,277.
Murthi, S., & Varshney, A. (2018). How Augmented Reality Will Make Surgery Safer. Harvard Busi-
ness Review. Retrieved from https://hbr.org/2018/03/how-augmented-reality-will-make-surgery-safer
Norris, M. W., Spicer, K., & Byrd, T. (2019). Virtual Reality: The New Pathway for Effective Safety
Training. Professional Safety, 64(06), 36–39.
Page, R. L. (2000). Brief history of flight simulation. In SimTecT 2000 Proceedings (pp. 11-17). Aca-
demic Press.
Pelargos, P. E., Nagasawa, D. T., Lagman, C., Tenn, S., Demos, J. V., Lee, S. J., ... Bari, A. (2017). Uti-
lizing virtual and augmented reality for educational and clinical enhancements in neurosurgery. Journal
of Clinical Neuroscience, 35, 1–4. doi:10.1016/j.jocn.2016.09.002 PMID:28137372
Ravi, D. K., Kumar, N., & Singhi, P. (2017). Effectiveness of virtual reality rehabilitation for children and
adolescents with cerebral palsy: An updated evidence-based systematic review. Physiotherapy, 103(3),
245–258. doi:10.1016/j.physio.2016.08.004 PMID:28109566
Riener, R., & Harders, M. (2012). Virtual reality in medicine. Springer Science & Business Media.
doi:10.1007/978-1-4471-4011-5
Riva, G. (2005). Virtual reality in psychotherapy [review]. Cyberpsychology & Behavior, 8(3), 220–240.
doi:10.1089/cpb.2005.8.220 PMID:15971972
Rose, T., Nam, C. S., & Chen, K. B. (2018). Immersion of virtual reality for rehabilitation-Review. Ap-
plied Ergonomics, 69, 153–161. doi:10.1016/j.apergo.2018.01.009 PMID:29477323
Roy, E., Bakr, M. M., & George, R. (2017). The need for virtual reality simulators in dental education:
A review. The Saudi Dental Journal, 29(2), 41–47. doi:10.1016/j.sdentj.2017.02.001 PMID:28490842
Ruthenbeck, G. S., & Reynolds, K. J. (2015). Virtual reality for medical training: The state-of-the-art.
Journal of Simulation, 9(1), 16–26. doi:10.1057/jos.2014.14
Sacks, R., Perlman, A., & Barak, R. (2013). Construction safety training using immersive virtual real-
ity. Construction Management and Economics, 31(9), 1005–1017. doi:10.1080/01446193.2013.828844
Sánchez-Cabrero, R., Costa-Román, Ó., Pericacho-Gómez, F. J., Novillo-López, M. Á., Arigita-García,
A., & Barrientos-Fernández, A. (2019). Early virtual reality adopters in Spain: Sociodemographic profile
and interest in the use of virtual reality as a learning tool. Heliyon (London), 5(3), e01338. doi:10.1016/j.
heliyon.2019.e01338 PMID:30923768
71
Virtual Reality in Medical Education
Seymour, N. (2008). VR to OR: A review of the evidence that virtual reality simulation improves op-
erating room performance. World Journal of Surgery, 32(2), 182–188. doi:10.100700268-007-9307-9
PMID:18060453
Sezer, B., & Yilmaz, R. (2019). Learning management system acceptance scale (LMSAS): A validity and
reliability study. Australasian Journal of Educational Technology, 35(3), 15–30. doi:10.14742/ajet.3959
Sezer, B., Yilmaz, R., & Karaoglan Yilmaz, F. G. (2013). Integrating technology into classroom: The
learner-centered instructional design. International Journal on New Trends in Education and Their
Implications, 4(4), 134–144.
Sharif, M., Ansari, G. J., Yasmin, M., & Fernandes, S. L. (2018). Reviews of the Implications of VR/
AR Health Care Applications in Terms of Organizational and Societal Change. Emerging Technologies
for Health and Medicine: Virtual Reality, Augmented Reality, Artificial Intelligence, Internet of Things,
Robotics Industry, 4(0), 1–19.
Thompson-Butel, A. G., Shiner, C. T., McGhee, J., Bailey, B. J., Bou-Haidar, P., McCorriston, M., &
Faux, S. G. (2019). The Role of Personalized Virtual Reality in Education for Patients Post Stroke— A
Qualitative Case Series. Journal of Stroke and Cerebrovascular Diseases, 28(2), 450–457. doi:10.1016/j.
jstrokecerebrovasdis.2018.10.018 PMID:30415917
Vaughan, N., Dubey, V. N., Wainwright, T. W., & Middleton, R. G. (2016). A review of virtual real-
ity based training simulators for orthopaedic surgery. Medical Engineering & Physics, 38(2), 59–71.
doi:10.1016/j.medengphy.2015.11.021 PMID:26751581
Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D. (2003). User acceptance of information
technology: Toward a unified view. Management Information Systems Quarterly, 27(3), 425–478.
doi:10.2307/30036540
Warburton, S. (2009). Second Life in higher education: Assessing the potential for and the barriers to
deploying virtual worlds in learning and teaching. British Journal of Educational Technology, 40(3),
414–426. doi:10.1111/j.1467-8535.2009.00952.x
Yilmaz, R., Karaoglan Yilmaz, F. G., & Ezin, C. C. (2018). Self-directed learning with technology and
academic motivation as predictors of tablet PC acceptance. In Handbook of Research on Mobile Devices
and Smart Gadgets in K-12 Education (pp. 87-102). Hershey, PA: IGI Global. doi:10.4018/978-1-5225-
2706-0.ch007
Zhang, M., Zhang, Z., Chang, Y., Aziz, E. S., Esche, S., & Chassapis, C. (2018). Recent developments
in game-based virtual reality educational laboratories using the Microsoft Kinect. International Journal
of Emerging Technologies in Learning, 13(1), 138–159. doi:10.3991/ijet.v13i01.7773
ADDITIONAL READING
Harders, M. (2008). Surgical scene generation for virtual reality-based training in medicine. Springer
Science & Business Media. doi:10.1007/978-1-84800-107-7
72
Virtual Reality in Medical Education
Kyaw, B. M., Saxena, N., Posadzki, P., Vseteckova, J., Nikolaou, C. K., George, P. P., ... Car, L. T. (2019).
Virtual reality for health professions education: Systematic review and meta-analysis by the Digital
Health Education collaboration. Journal of Medical Internet Research, 21(1), e12959. doi:10.2196/12959
PMID:30668519
Layona, R., Yulianto, B., & Tunardi, Y. (2018). Web based augmented reality for human body anatomy
learning. Procedia Computer Science, 135, 457–464. doi:10.1016/j.procs.2018.08.197
Munzer, B. W., Khan, M. M., Shipman, B., & Mahajan, P. (2019). Augmented Reality in Emergency
Medicine: A Scoping Review. Journal of Medical Internet Research, 21(4), e12368. doi:10.2196/12368
PMID:30994463
Nicholson, D. T., Chalk, C., Funnell, W. R. J., & Daniel, S. J. (2006). Can virtual reality improve anatomy
education? A randomised controlled study of a computer‐generated three‐dimensional anatomical ear
model. Medical Education, 40(11), 1081–1087. doi:10.1111/j.1365-2929.2006.02611.x PMID:17054617
Riener, R., & Harders, M. (2012). Virtual reality in medicine. Springer Science & Business Media.
doi:10.1007/978-1-4471-4011-5
Roland, J. (2018). Virtual reality and medicine. Reference Point Press.
Sezer, B., & Sezer, T. A. (2019). Teaching communication skills with technology: Creating a virtual
patient for medical students. Australasian Journal of Educational Technology, 35(5), 183–198.
Uppot, R. N., Laguna, B., McCarthy, C. J., De Novi, G., Phelps, A., Siegel, E., & Courtier, J. (2019).
Implementing virtual and augmented reality tools for radiology education and training, communication,
and clinical care. Radiology, 291(3), 570–580. doi:10.1148/radiol.2019182210 PMID:30990383
KEY TERMS AND DEFINITIONS
Acceptance of Augmented Reality: Students’ behavioral status of acceptance and adaptation with
regard to usage of augmented reality technologies with the educational purpose.
Acceptance of Virtual Reality: Students’ behavioral status of acceptance and adaptation with regard
to usage of virtual reality technologies with the educational purpose.
Augmented Reality: Augmented reality is a set of technologies that superimpose a computer-
generated image(s) on the physical world, therefore providing a simultaneously mixed experience of
virtual objects and the real world.
Effort Expectancy: The degree of ease associated with the use of the system (Venkatesh et al.,
2003, p. 450).
Facilitating Conditions: The degree to which an individual believes that an organizational and
technical infrastructure exists to support use of the system (Venkatesh et al., 2003, p. 453).
Performance Expectancy: The degree to which an individual believes that using the system will
help him or her to attain gains in job performance (Venkatesh et al., 2003, p. 447).
Simulation: A simulation is an imitation of a real-world process in a controlled environment.
Social Influence: The degree to which an individual perceives that important others believe he or
she should use the new system (Venkatesh et al., 2003, p. 451).
73
Virtual Reality in Medical Education
UTAUT Model: UTAUT Model is the Unified Theory of Acceptance and Use of Technology that is
used for explanation of user perception and acceptance behavior. (Venkatesh et al., 2003).
Virtual Reality: Virtual reality is computer-generated simulations of three or more dimensions cre-
ated by modelling of real objects or environments. Users can interact with these computer-generated
simulations through their senses such as vision, hearing and touch and experience realistic objects by
controlling them (Karaoğlan Yılmaz & Yılmaz, 2019).
Virtual Reality Immersion: Virtual reality immersion is the perception of being physically present
in a non-physical world (Mukkamala & Madhusudhanan, 2016)
Virtual World: A virtual world is a computer-based simulated environment.
... Building on Ustun et al [28], insecurity is the fear that users have towards a new technology, which in turn can result in avoiding the use of such technologies. Invasion of privacy and security remain one of the main concerns for users when using VE technologies. ...
... In our study, the effort expectancy can be viewed as the simplicity associated with users' adoption of VE services. Effort expectations is considered vital aspect users' usage intentions towards VE technology because using VE technology demands certain knowledge and skills [28]. Therefore, it is reasonable to assume that: effort expectancy has a positive effect on their behavioral intention. ...
Conference Paper
Full-text available
Past studies have confirmed that virtual environments play a critical aspect in performing daily tasks. Investigating users’ readiness to use this technology while incorporating social presence and immersion is scarce. In this study, we will focus on Saudi users and their readiness to use virtual environments in business settings. Building on the theoretical lenses of the technology readiness index, UTAUT2, social presence, and immersion, we propose a research model to investigate Saudi users’ readiness to use virtual environments. Particularly, we aim to understand end-users’ readiness to adopt and use virtual environments in business settings. This work could stipulate a better understanding about users’ tendency to use and embrace virtual environments technology in Saudi organizations.
... Luque-Moreno, C. et al. evaluated the effects of a VR rehabilitation program on gait and trunk control in stroke patients, and the results showed that VR intervention was effective in the recovery of lower limb function after stroke [27]. Ustun, A. B et al. examined the performance of virtual reality technology in medical education by combining a questionnaire survey method, and the study provided some theoretical and data references for the integration of virtual reality technology into medical education [28]. ...
Article
Full-text available
At present, the scale of rehabilitation medicine professional education is difficult to meet the needs of society, the traditional one-way transmission of the teaching mode is not effective, and there is a lack of standardized personnel training programs. This paper proposes rehabilitation education and management practices based on virtual reality technology. Using 3DMax software, the VR scene for rehabilitation education and management practice was constructed, and the scene’s rendering effect was optimized with the help of the SSAO algorithm. By exploring the teaching function orientation of virtual reality technology, the VR scene can be integrated into rehabilitation teaching in colleges and universities so as to design a rehabilitation management teaching mode based on VR technology. The results show that no matter which dataset, the frame rate of the improved SSAO algorithm is greater than that of the SSAO algorithm, and the difference is specifically shown as 7~15 frames/s. In addition, there are significant differences between the teaching mode of this paper and the traditional teaching mode in terms of the quality of teaching, assessment scores, and satisfaction (P<0.05). The research in this paper can effectively enhance the theory and skill level of students, resulting in better innovation in rehabilitation education and management practice.
... It is premised on the concept that there are connections between the amount of effort committed at work, results accomplished, and rewards received from that effort. According to Ustun et al. (2020), the ease of using the system is known as effort expectancy. It also refers to the amount of effort required to utilise a system, regardless of how simple or complex it is. ...
Article
Full-text available
The purpose of the current research is to analyze the researches on the use of virtual reality in teaching and learning based on the concepts of post-phenomenology. To achieve this goal, a descriptive-analytical method has been used. Emphasizing on the most important concepts of post-phenomenology, articles on the use of virtual reality in education and learning between 2017 and 2022 were analyzed. The findings of the research in the field of virtual reality mediation in relation to the learner and the learning environment showed that among the relationships described in post-phenomenology, most of them are related to background and immersion and hermeneutic relationship, embodiment and alterity are in the next ranks. In the field of multiple applications of virtual reality technology, in the order of teaching, interaction, evaluation and motivation, it has been considered in the conducted researches. In the field of incremental structures of technology (what technology gives us), interaction and immersion, motivation, deep learning and participation can be dominant in researches, and in the field of decreasing structures of technology (what technology takes from us) in researches Such as high cost, insufficient reality, human communication, high cognitive load and losses for human health have been considered. Finally, it was suggested; so that the way of changing the experience and perception of the learners during the application of virtual reality in education and learning is investigated more closely, so that the dimensions and hidden angles of the technology are revealed for the policy makers and educational technology designers. On the other hand, it can be said that the results of this practice can help improve the quality of technology-based learning.
Article
Full-text available
Experts have called for virtual reality (VR) training and learning applications that can facilitate the changes needed in training programmes for years to come. To help expedite the adoption process, this study used a mixed-methods approach to identify the key factors that promote intentions to use VR technology in medical training. The qualitative research was based on interviews with five doctors and medical students, which focused on identifying the most significant determinants. Next, a survey was conducted to collect data from 154 medical interns and students in Spanish universities and hospitals, whose responses were processed using partial least squares-structural equation analysis. The limited sample size means this study is exploratory. The results indicate that perceived entertainment significantly strengthens behavioural intention to use VR technology in medical courses. The findings also underline the potential uses of VR learning tools in healthcare contexts and the need to incorporate this technology into medical training.
Article
Full-text available
Purpose: This work aimed to utilize virtual reality (VR) in dental radiographic anatomical interpretation in junior dental students and test if it can enhance student learning, engagement, and performance. Methods: VR software for panoramic anatomy was developed. Sixty-nine first-year dental students were divided into a control group (lecture-based) and an experimental group (VR) to learn panoramic radiographic anatomy. Both groups were then tested on knowledge via a 20-question quiz. Student feedback on VR experience was collected via an online survey. Results: There was a statistically significant difference between lecture-based and VR students in the correct identification of anatomical landmarks. Lecture-based students scored higher in identifying the ear lobe, hyoid bone, condylar neck, and external oblique ridge, whereas VR students scored higher in identifying zygoma (Chi-squared test, p < 0.005). The VR group reported high evaluation on all perception items of the online feedback survey on their experience (Student t-test, p < 0.005). Conclusions: Lecture-based students generally showed better performance in panoramic radiographic anatomy. Several structures were not correctly identified in both groups of novice students. The positive feedback of VR experience encourages future implementation in education to augment conventional methods of radiographic anatomy in dentistry with considerations to repeated exposures throughout undergraduate dental education.
Article
The effect of summarizing scaffolding on learning for elementary school students in immersive virtual reality settings with textual cues is unknown. To address this research gap, we conducted a 2 * 2 factorial experimental study to investigate the potential effect and interaction of summarizing scaffolding (yes vs. no) and textual cues (yes vs. no) on learning performance, mental model, and cognitive load. A total of 152 participants from a suburban elementary school were randomly assigned to one of four experimental conditions: no textual cues & no summarizing scaffolding (n = 38), textual cues & no summarizing scaffolding (n = 39), no textual cues & summarizing scaffolding (n = 37), and textual cues & summarizing scaffolding (n = 38). ANOVA results showed that (a) textual cues significantly improved learning performance and the mental model; (b) summarizing scaffolding significantly enhanced the mental model; and (c) no significant interaction effects were identified, indicating that young students can benefit from immersive virtual reality with textual cues or summarizing scaffolding. The implications of the findings on the design of effective immersive learning environments are discussed.
Article
Full-text available
The aim of the study is to address a gap in the literature by developing an educational virtual reality (edVR) attitude measurement instrument, which determines college students’ attitudes towards using VR technology for educational purposes. A sequential exploratory mixed method was employed to develop the measurement instrument. Initially, a qualitative approach was used to establish the face and content validity of the instrument and subsequently a quantitative approach was used to test the construct validity and reliability of attitude statement items. Critical reviews and constructive feedback were gathered from a range of parties, including target users (i.e., college students), learning technology experts, assessment and evaluation authority, and linguists of English and Turkish. The psychometric properties of edVR attitude measurement instrument were tested with a total sample of 305 sophomore, junior and senior students studying at different faculties. The exploratory factor analysis (EFA) results confirmed the single-factor structure with nine items, explaining 63.46% of the total variance and the confirmatory factor analysis (CFA) results indicated a sufficient fit of this single-factor model. The Cronbach’s alpha coefficient for the edVR attitude measurement instrument was 0.92 and the test–retest reliability of the instrument was 0.94. The t-values were significant for all items for 27% of the participants to compare the top and bottom. As a result, the edVR attitude measurement instrument was valid and reliable in measuring students’ attitudes towards educational VR.
Article
Full-text available
Rationale: Post-stroke cognitive impairment occurs frequently in patients with stroke, with a 20% to 80% prevalence. Anxiety is common after stroke, and is associated with a poorer quality of life. The use of standard relaxation techniques in treating anxiety in patients undergoing post-stroke rehabilitation have shown some positive effects, whereas virtual reality seems to have a role in the treatment of anxiety disorders, especially when associated to neurological damage. Patients concerns: A 50-year-old woman, smokers, affected by hypertension and right ischemic stroke in the chronic phase (i.e., after 12 months by cerebrovascular event), came to our observation for a severe anxiety state and a mild cognitive deficit, mainly involving attention and visuo-executive processes, besides a mild left hemiparesis. Diagnosis: Anxiety in a patient with ischemic stroke. Interventions: Standard relaxation techniques alone in a common clinical setting or the same psychological approach in an immersive virtual environment (i.e., Computer Assisted Rehabilitation Environment - CAREN). Outcomes: The patient's cognitive and psychological profile, with regard to attention processes, mood, anxiety, and coping strategies, were evaluated before and after the 2 different trainings. A significant improvement in the functional and behavioral outcomes were observed only at the end of the combined approach. Lessons: The immersive virtual reality environment CAREN might be useful to improve cognitive and psychological status, with regard to anxiety symptoms, in post-stroke individuals.
Article
Full-text available
Virtual patient (VP) is a concept used in the teaching of communication skills, and like physical examinations and other professional skills, must be taught with utmost care. In Turkey, as VPs are yet to be used in medical training, the usual practice when teaching such skills is to use standardised patients (individuals pretending to be patients). The main purpose of this study was to design, develop and evaluate a 3D VP application that can move, has speech-over lip sync, allows written communication and is supported by a strong scenario to improve the communication skills of students. The study was designed and carried out using developmental research methods. The implementation phase involved a pretest posttest quasi-experimental design. The participants in the study consisted of academics specialising in medicine, software experts, an education technology expert, an assessment and evaluation expert, and medical students. The study found that VP applications were accepted by students and were as effective as standardised patients for the teaching of communication skills. The students reported that the VP application developed was very successful in terms of visual and behavioural reality.
Article
Full-text available
This study describes the social and demographic profile of the first generation of users of marketed virtual reality (VR) viewers in Spain and, subsequently, it assesses the interest in its use as a learning tool. For that purpose, an online questionnaire created ad hoc was administered to a sample of 117 participants. The relationship between twelve variables was analysed comparing means through the Snedecor's F distribution and the contingency tables through the Chi-squared test and Somers' D. Among other issues, it was concluded that the virtual reality user profile at present corresponds to a person older than 36, mainly men, with higher education and having acquired their viewer no longer than one year ago. Concerning the interests of virtual reality users as a learning tool, only a few of them currently use virtual reality for this aim, but they mainly show an interest in using the virtual reality as a learning method and they feel optimism regarding the future use of this technology as a learning tool. However, this is not the case among users of video game consoles (PSVR), who are mainly men not interested in their use as a learning tool at present. Finally, it can be stated that current use as a learning tool among teachers and students is occasional and preferably via smartphones.
Article
Full-text available
Background: Augmented reality is increasingly being investigated for its applications to medical specialties as well as in medical training. Currently, there is little information about its applicability to training and care delivery in the context of emergency medicine. Objective: The objective of this article is to review current literature related to augmented reality applicable to emergency medicine and its training. Methods: Through a scoping review utilizing Scopus, MEDLINE, and Embase databases for article searches, we identified articles involving augmented reality that directly involved emergency medicine or was in an area of education or clinical care that could be potentially applied to emergency medicine. Results: A total of 24 articles were reviewed in detail and were categorized into three groups: user-environment interface, telemedicine and prehospital care, and education and training. Conclusions: Through analysis of the current literature across fields, we were able to demonstrate that augmented reality has utility and feasibility in clinical care delivery in patient care settings, in operating rooms and inpatient settings, and in education and training of emergency care providers. Additionally, we found that the use of augmented reality for care delivery over distances is feasible, suggesting a role in telehealth. Our results from the review of the literature in emergency medicine and other specialties reveal that further research into the uses of augmented reality will have a substantial role in changing how emergency medicine as a specialty will deliver care and provide education and training.
Article
Full-text available
Statement: This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, is aimed to review current research in virtual reality (VR) for healthcare training, specifically pertaining to nontechnical skills. PsycInfo and Medline databases were queried for relevant articles published through December 2017. Of the 1377 publications identified, 80 were assessed for eligibility and 26 were finally included in the qualitative synthesis. Overall, the use of virtual training for nontechnical skills is recent in healthcare education and has increased since 2010. Screen-based VR simulators or virtual worlds are the most frequently used systems. The nontechnical skills addressed in VR simulation include mainly teamwork, communication, and situation awareness. Most studies evaluate the usability and acceptability of VR simulation, and few studies have measured the effects of VR simulation on nontechnical skills development.
Article
Full-text available
Background: Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. Objective: The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction. Methods: We performed a systematic review of the effectiveness of VR in pre- and postregistration health professions education following the gold standard Cochrane methodology. We searched 7 databases from the year 1990 to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data, and assessed risk of bias, and then, we compared the information in pairs. We contacted authors of the studies for additional information if necessary. All pooled analyses were based on random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate the quality of the body of evidence. Results: A total of 31 studies (2407 participants) were included. Meta-analysis of 8 studies found that VR slightly improves postintervention knowledge scores when compared with traditional learning (standardized mean difference [SMD]=0.44; 95% CI 0.18-0.69; I2=49%; 603 participants; moderate certainty evidence) or other types of digital education such as online or offline digital education (SMD=0.43; 95% CI 0.07-0.79; I2=78%; 608 participants [8 studies]; low certainty evidence). Another meta-analysis of 4 studies found that VR improves health professionals' cognitive skills when compared with traditional learning (SMD=1.12; 95% CI 0.81-1.43; I2=0%; 235 participants; large effect size; moderate certainty evidence). Two studies compared the effect of VR with other forms of digital education on skills, favoring the VR group (SMD=0.5; 95% CI 0.32-0.69; I2=0%; 467 participants; moderate effect size; low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. None of the studies reported any patient-related outcomes, behavior change, as well as unintended or adverse effects of VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of evidence primarily because of the risk of bias and/or inconsistency. Conclusions: We found evidence suggesting that VR improves postintervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.
Article
Bu çalışmada artırılmış gerçeklik uygulamalarının yarattığı etkinin öğrenci gözünden değerlendirilmesi amaçlanmaktadır. Bu araştırmada ortaokul 7. ve 8. sınıf öğrencilerinin artırılmış gerçeklik uygulamalarına dair görüşlerinin incelenmesi için nitel yöntemden yararlanılmıştır. Bu çalışma Teknoloji ve Tasarım dersine katılan 7. ve 8. sınıf öğrencileri ile gerçekleştirilmiştir. Araştırmanın katılımcılarını 2016-2017 bahar döneminde 43 öğrenci oluşturmaktadır. Araştırma kapsamında öğrencilerin artırılmış gerçekliğe yönelik görüşlerini almak için veri toplama aracı olarak bir form hazırlanmıştır. Araştırmada öğrencilerin geleneksel sınıf ortamlarındaki ders etkinlikleri ile artırılmış gerçeklik uygulamalarını karşılaştırmalarına dair görüşlerine göre en sık belirtilen kodların “eğlenceli öğrenme ortamı sunmak” ve “öğrenme sürecini dikkat çekici ve etkili yapmak” olduğu bulunmuştur. Öğrenciler artırılmış gerçeklik uygulamalarının bundan sonraki derslerde kullanılmasının ders başarısına olumlu katkı yapacağını düşünmektedir. Ancak artırılmış gerçekliğin eğitim süreçlerine katkısının olmayacağını belirten öğrenciler de vardır. Artırılmış gerçeklik uygulamalarını kullanırken yaşanan güçlükler/zorluklar hakkındaki öğrenci görüşlerine göre en sık “akıllı telefon sahipliğinin/erişiminin olmaması” olduğu görülmüştür. Öğrencilerin artırılmış gerçeklik uygulamaları kullanımının en faydalı olacağını düşündüğü dersi “Fen Bilimleri” olarak belirtmektedir.
Article
Virtual reality (VR) has recently become an affordable technology. A wide range of options are available to access this unique visualization medium, from simple cardboard inserts for smartphones to truly advanced headsets tracked by external sensors. While it is now possible for any research team to gain access to VR, we can still question what it brings to scientific research. Visualization and the ability to navigate complex three-dimensional data are undoubtedly a gateway to many scientific applications; however, we are convinced that data treatment and numerical simulations, especially those mixing interactions with data, human cognition, and automated algorithms will be the future of VR in scientific research. Moreover, VR might soon merit the same level of attention to imaging data as machine learning currently has. In this short perspective, we discuss approaches that employ VR in scientific research based on some concrete examples.
Article
Neurosurgeons are faced with the challenge of planning, performing, and learning complex surgical procedures. With improvements in computational power and advances in visual and haptic display technologies, augmented and virtual surgical environments can offer potential benefits for tests in a safe and simulated setting, as well as improve management of real-life procedures. This systematic literature review is conducted in order to investigate the roles of such advanced computing technology in neurosurgery subspecialization of intracranial tumor removal. The study would focus on an in-depth discussion on the role of virtual reality and augmented reality in the management of intracranial tumors: the current status, foreseeable challenges, and future developments.