Exploring the Design and Deployment Considerations for the use of Virtual Reality for Clinical Education. An Exploratory Mixed-methods Study

Abstract

Introduction

The challenges facing clinicians of increasing patient acuity, reduced capacity for face-to-face training, and an ever-increasing demand to do more with less requires considered planning as to how to support their educational requirements. Virtual Reality (VR) is a technology with increasing interest and potential to help address some of these challenges. Decreasing costs, increasing processing power and “de-tethering” the headsets from traditional requirements of high-cost external computers have made portable VR an accessible solution for widespread deployment in the healthcare setting. There is however minimal guidance for clinicians and educators striving to design, develop and deploy VR based solutions into complex healthcare environments. This thesis involved the design, development and deployment of custom-built VR based applications together with a series of mixed-method studies conducted to evaluate and refine the applications in the clinical context.

Aim

The aims of this thesis were as follows: (1) to generate a framework of guidelines for clinicians to design and test VR based applications for clinical use, and (2) to generate tangible assets and applications to model successful and scalable solutions for use in the clinical educational setting.

Methods

A series of mixed-method studies were conducted on several locally developed VR based applications which were designed, developed, and deployed as part of this thesis. Firstly, the prototype ALS-SimVR application was developed and tested by expert clinicians who were interviewed and surveyed with thematic analysis was conducted on the results. Secondly, when the COVID-19 pandemic emerged, an expert group was brought together with the NSW Health Clinical Excellence Commission to develop the state guidelines for the cleaning and disinfection of head-mounted displays to allow the resumption of research and use of VR by clinicians in the clinical setting. A follow up publication was then produced to further outline the rationale for the guideline development. Following further application development verbal interactions were implemented into the applications so a second mixed-methodology multi-hospital study was conducted to explore the use of verbal interactions with a VR based conversational agent in the context of our Code Black verbal de-escalation trainer. Users of the application were surveyed, observed and user data obtained during use were all included in a subsequent thematic analysis to further inform the development of our user needs framework.

Results

The results of the thematic analysis’ allowed the development of a framework to be used by educators and clinicians to inform their design and development of VR based applications for clinical education. The CEC guidelines for the cleaning and disinfection of head-mounted displays has allowed for the safe deployment of VR during the COVID-19 pandemic and allowed the resumption of research during these challenging times. The guidelines have attracted international interest and adoption. Finally, both the formal and informal research conducted as part of this thesis has allowed for the successful design, development and deployment of multiple VR based applications into healthcare settings supporting vital workforce needs including Advanced Life Support, Code Black, verbal de-escalation skills, clinical communication, mindfulness/wellbeing and dignity in the workplace.

Conclusion

VR has the potential to meaningfully support the educational demand of a time and resource poor clinical workforce. When designing and developing VR based applications for use in healthcare, there are user needs and considerations which must be considered may not translate into other settings. In addition to the design considerations to ensure and enable adoption there are practical deployment considerations such as infection control which must be addressed to ensure safe use of this technology.