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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
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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-
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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
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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-
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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).
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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.
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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-
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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)
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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
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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
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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
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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.
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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.
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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).
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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.