Review Article

Virtual Reality in Medical Institutions: Innovative Tool to Strengthen the

Process of Delivery of Medical Education

Abstract Saurabh
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The process of medical education delivery has evolved constantly considering the rapid progress in RamBihariLal
the field of medical sciences, and the varied roles expected of a health‑care professional. The current Shrivastava,
review has been done to explore the role of virtual reality in medical education, and to identify the
potential challenges and the suggestions that can aid in the successful introduction of the same in the Prateek Saurabh
undergraduate teaching period. An extensive search of all materials related to the topic was carried Shrivastava1
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 09/23/2023

out in the PubMed search engine, and a total of 23 articles were selected based on their suitability Deputy Director – Academics,
with the current review objectives and analyzed. Keywords used in the search include virtual reality Sri Balaji Vidyapeeth – Deemed
and medical education in the title alone only. Virtual reality is a kind of dynamic and adaptive to be University, Medical
Education Unit Coordinator
learning and has been associated with multiple benefits that extend much beyond what is being
and Member of the Institute
offered by conventional teaching. Regardless of the multiple benefits, we must realize that it should Research Council, Department
be used to keep the intended learning outcomes in mind, so as to ensure that it can be integrated into of Community Medicine, Shri
the curriculum effectively. In conclusion, the tool of virtual reality has all the potential to transform Sathya Sai Medical College and
medical education delivery in the coming days. Since virtual reality advocates principles of adult Research Institute, Ammapettai,
learning and gives them a platform to apply their knowledge to practice and subsequently improve Nellikuppam, 1Department of
on, it is quite necessary that all the medical colleges look to introduce the same within their setup Community Medicine, Shri
and integrate it with conventional learning. Sathya Sai Medical College
and Research Institute, Sri
Keywords: Medical education, skills, virtual reality Balaji Vidyapeeth – Deemed
to be University, Ammapettai,
Nellikuppam, Chengalpet
District, Tamil Nadu, India
Introduction Methods
The process of medical education delivery An extensive search of all materials related
has evolved constantly, considering the to the topic was carried out in the PubMed
rapid progress in the field of medical search engine. Relevant research articles Submitted: 23‑Nov‑2021
Revised: 15‑Mar‑2022
sciences, changes in the expectations of the focusing on research skills among medical Accepted: 11‑Sep‑2022
general population, reforms in the healthcare students published in the period 2004–2021 Published: 24-Mar-2023
atmosphere, and the varied roles expected were included in the review. A total of 26
of a health‑care professional.[1] In the studies similar to the current study objectives
Address for correspondence:
process of producing a competent medical were identified initially, of which three were Dr. Saurabh RamBihariLal
graduate, we aim to provide experiential excluded due to the unavailability of the Shrivastava,
and self‑directed learning, so that the complete version of the articles. Overall, Professor, Department of
medical student gives utmost priority to 23 articles were selected based upon their Community Medicine, Shri
Sathya Sai Medical College and
patient safety and the quality of care offered suitability with the current review objectives Research Institute, Sri Balaji
to the patients. Considering the vast amount and analyzed. Keywords used in the search Vidyapeeth (SBV) – Deemed
of information available in the current include virtual reality and medical education to be University, Thiruporur
world, the priority is not about retaining in the title alone only (viz., virtual reality [ti] - Guduvancherry Main Road,
Ammapettai, Nellikuppam,
the facts, but the way in which it is used, AND medical education [ti]). The articles Chengalpet District - 603 108,
interpreted, and applied to the overall published in only the English language Tamil Nadu, India.
patient care.[1,2] The current review has been were included in the review [Figure 1]. The E‑mail: drshrishri2008@gmail.
done to explore the role of virtual reality collected information is presented under the com
in medical education, and to identify the following subheadings, namely Virtual reality,
potential challenges and the suggestions that Conventional teaching versus Virtual reality,
Access this article online
can aid in the successful introduction of the Merits of virtual reality in medical education,
Website: www.jscisociety.com
same in the undergraduate teaching period. Potential challenges and recommended
solutions, Lessons from the field, Implications DOI: 10.4103/jss.jss_159_21

for practice, and Implications for research. Quick Response Code:

This is an open access journal, and articles are
distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work How to cite this article: Shrivastava SR,
non‑commercially, as long as appropriate credit is given and Shrivastava PS. Virtual reality in medical institutions:
the new creations are licensed under the identical terms. Innovative tool to strengthen the process of delivery
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com of medical education. J Sci Soc 2023;50:23-7.

© 2023 Journal of the Scientific Society | Published by Wolters Kluwer - Medknow 23

 Shrivastava and Shrivastava: Virtual reality
Virtual Reality
Virtual reality refers to the use of software applications
to generate an immersive simulated learning experience,
wherein the users (in the current case – medical students)
wear a head‑mounted display, which enables them to
engage with the virtual environment and the characters
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in such a way that it gives a feeling of being real.[1,2] In
recent years, significant advancement has been reported
in the field of virtual reality, with useful applications in
various sectors (viz., automobile, architecture, engineering,
medicine, etc.). Such a wide application with encouraging
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 09/23/2023
results can be attributed to the very fact that virtual
reality offers a standardized, repeatable, and controllable
environment for the users.[1‑3]
Virtual reality has been employed in both medical and
nursing streams and helps students to learn from their
experience in the virtual world.[3,4] The delivery of
standardized experience under controlled settings can
prove to be extremely useful for facilitating learning
among medical students. The virtual environment can be
present in a virtual ward, wherein the students can interact
with patients, or colleagues, or even with the caregivers,
very much similar to the interactions that can happen in
real settings. In other words, such a learning experience
prepares medical students to take action during the
authentic clinical experience.[1‑4] Furthermore, virtual reality
has been employed in the demonstration of 3D anatomy,
simulation of surgical procedures, teaching empathy to
medical students, treatment of phobia or anxiety disorders,
rehabilitation of patients, etc.[3‑7]
Conventional Teaching versus Virtual Reality
The conventional mode of teaching is often lecture
centered and has key attributes of memorization and
attendance. In addition, we cannot ignore that hands‑on
practical training is a crucial aspect of conventional
teaching.[2,4] Nevertheless, this method of teaching has
its own limitations, such as being monotonous, lack of
standardization across the nation, inability to target all
types of learners, constraints pertaining to assessment, and
absence of feasible practices which can aid the students
to acquire practical skills.[8‑10] Steps like promotion of
Figure 1: Flowchart for selection of research articles
24
e‑learning or employment of technology or implementation
of problem‑based learning, communication skills training,
and simulation‑based learning have been adopted to make
conventional training more interactive and effective,
keeping in mind the principles of adult learning.[6‑9]
Virtual reality is a kind of simulation wherein
computer‑created graphics are employed to produce a
realistic world depending on the commands of users.
However, considering the possibility of real‑time
interactivity, this technology aids in changing the
input, which then brings about a change in the virtual
environment.[10‑12] Such kinds of exposure eliminate the
possibility of being monotonous and ensure both theoretical
and practical learning for different types of learners.[8‑10]
Virtual reality plays a significant role in the strengthening
of surgical skills and improving the overall competence
in different specialties.[6] The findings of a meta‑analysis
demonstrated that students who are trained with virtual
reality had better pass rates, improvement in the
acquisition of complex skills, and specialized knowledge,
in comparison to the students who were trained using the
conventional teaching methods.[13]
Merits of Virtual Reality in Medical Education
Virtual reality is a kind of dynamic and adaptive learning
and has been associated with multiple benefits that extend
much beyond what is being offered by conventional
teaching.[7‑9] Exposure to virtual reality can help medical
students to refine their history taking skills, patient
examination skills, improve their abilities to make
an evidence based decision for ordering appropriate
investigations, aid them in reaching a potential diagnosis
and even acquire the skills to effectively treat the
patients.[14,16] The learning can be further enhanced by the
inclusion of other human factors (viz. family members
or team members), or clinical parameters of patients that
are revised to make the overall experience enriching and
similar to real life scenarios.[15,17]
Further, the patients can be made to look restless and
confused, that acts as a stressful factor for the trainee
students and thereby prepare them for augmenting
their performance in stressful circumstances. In short,
medical students learn the skill of critical thinking,
clinical reasoning, problem‑solving, and decision‑making,
which are quite essential for successful clinical
practice.[3‑6] Further, virtual reality plays an important
role in improving the satisfaction of students as they not
only gain knowledge but even acquire useful skills.[13‑15]
Moreover, due to the immediate feedback received on the
technical or nontechnical skills, or owing to the debriefing
received after the session, the probability of deep learning
significantly enhances. In addition, the involved students
can share their learning experiences with one another
and the feedback received, so that the process of learning
continues even after virtual learning.[16‑19]
Journal of the Scientific Society | Volume 50 | Issue 1 | January-April 2023
 Shrivastava and Shrivastava: Virtual reality
Virtual reality in medical education ensures access to
clinical experience, and as these devices are available
in the market, thus they can be easily set up and used
subsequently without being detrimental to the patients or
students.[12,14] Further, as students can learn even in the
absence of teachers, they learn at their pace at their time
of convenience. In other words, the learning does not
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remain confined to specific settings but can be merged into
daily routine, in the form of simulation‑based education.
Moreover, as all the learning experiences can be done
a multiple time via virtual reality, it helps the student
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to practice the same till they become better in their
performance.[3‑7]
From the medical college perspective, virtual reality
enables the delivery of simulation at a minimal cost with
limited resources. Further, as the role of teachers is limited,
they can focus more on other learning attributes, which do
not fit within the scope of virtual reality.[5‑8] At the same
time, the potential scope for gamification and enjoyable
learning ensures the active engagement of the students. In
the long run, students become more confident in not only
completing the assigned task but also comprehending the
process of the learning experience.[18‑20] Finally, as these
can be used in any geographical location, the use of virtual
reality removes the equation of physical presence at the
place of learning or assessment.[2‑4,21]
Potential Challenges and Recommended
Solutions
The above discussion clearly suggests that virtual reality
is linked with numerous benefits for medical students,
faculty members, and administrators. However, we
must realize that it should be used to keep the intended
learning outcomes in mind, so as to ensure that it can be
integrated into the curriculum effectively.[13‑15] For instance,
virtual reality cannot be employed in all settings, like the
ideal way to teach palpation of the abdomen is via direct
contact with the patient and there is no need to introduce
virtual reality in this case. On a similar note, we need
not introduce virtual reality for breaking the bad news, as
the most authentic exposure which a student will get is
when s/he is interacting with humans instead of a virtual
patient.[15,22]
In addition, there are a number of other potential challenges
that need to be considered before introducing virtual
reality in any medical institution [Table 1]. At the same
time, with systematic planning and support from different
stakeholders, these challenges can be effectively addressed,
and the effectiveness of the same can be significantly
enhanced.[20‑23] The ground reality is that virtual reality
should not be looked upon as the replacement of a medical
teacher. Similarly, physical simulation cannot substitute
clinical training, as both have their pros and cons. Virtual
reality is definitely a technique that has immense potential
Journal of the Scientific Society | Volume 50 | Issue 1 | January-April 2023
in the current era and in the times to come. Nevertheless,
we have to be smart enough to decide about the
competencies that can be taught via conventional teaching
and the competencies that require the introduction of virtual
reality.[19‑22] If we are able to make this call, not only we
will be able to produce a health workforce ready for future
developments but also minimize the cost related to virtual
reality and reduce the workload on faculty members.[11,13]
Illustrations from Academic Field
As already mentioned, virtual reality has found immense
applications in both medical and nursing streams, and
that too in both undergraduate and postgraduate education
worldwide. These applications range from performing a
cardiac examination on a virtual patient, or learning suturing
or cardiopulmonary resuscitation skills, or observing
the pupillary response to light, etc. At the University of
Northampton, virtual reality has been employed for nursing
students to enable them to learn various skills (viz., soft
skills, clinical skills, etc.) in small groups. The virtual
environment is simultaneously projected on a screen to
help other students also to experience the same and thus
envisage peer learning. The students are given immediate
feedback, and upon the end of the session, there will be a
debriefing session as well, and thus, the learning becomes
long term.[1]
At the University of Oxford, virtual reality has been
implemented for training both medical students and
doctors. Apart from using it for teaching, the university has
been using virtual reality during the times of recruitment
of faculty members as a proxy indicator to ascertain their
competence levels.[1] Moreover, the utility of virtual reality
has been explored in conducting objective structured
clinical examinations, as it will significantly minimize the
efforts and the cost involved. We must acknowledge that
the employment of virtual reality during faculty recruitment
or during assessments can significantly aid in saving time,
eliminate the need for space constraints, and the need for
the mandatory presence of experts.
Implications for Practice
Considering the widespread utility of virtual reality in the
field of medicine, all medical colleges should look forward
to implementing the same within their settings.[5‑7] This
will essentially require faculty development programs to
train them about different applications and the ways, in
which they can be used to develop skills among students.
This has to be followed by a department‑level meeting,
wherein the entire team of faculty members decides on the
competencies that will need a virtual reality for training
or assessment.[12,14] The pros and cons of the same should
also be discussed in depth and then batch‑wise students
can be exposed to the same. It is very essential that the
administration should support the entire process.[2,3]
25
 Shrivastava and Shrivastava: Virtual reality

Table 1: Potential challenges and recommended solutions

Potential challenges
Extensive planning (viz., to be as close
to the real settings, a lot of thought
process has to go in for the selection of
patient attributes)
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Recommended solutions
Start training with the basic parameters initially and then gradually introduce clinical parameters
and subsequently only introduce complex emotions (like fear, anxiety, etc.) among the patients
The clinicians have to be thoroughly involved in the planning stage
Do not select virtual reality for providing treatment to people with severe anxiety

Also, look for the readiness among the students

Decrease in face‑to‑face communication Do not substitute routine clinical teaching with virtual teaching
(as the medical student interacts with Maintain a balance between both forms of teaching
virtual patients in a virtual environment,
Institutions can plan for the conduct of assessment in real settings
the exposure to real patients decreases)
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Cost involved (initial establishment
requires high‑quality hardware,
high‑speed systems, graphic cards, and
other accessories)
Unnecessary use or misuse
Not appealing content
Acceptance by medical students and
safety
The administration or management has to be supportive and should essentially support the
introduction of virtual teaching in both the teaching‑learning and assessment process
We should not forget that clinical teaching is still an indispensable part of the medical
curriculum, and thus, we have to carefully decide about what things require virtual reality and
what not. There is no need for training basic clinical skills using virtual reality; rather we can
adhere to conventional teaching and not make the learning process complex
In order to ensure student engagement, the content has to be attractive and appealing. This
will obviously require support from the technical team, not only for good content but also to
introduce the provision of real‑time feedback
The created virtual space should be realistic and adequately interactive (such as allowing a
sense of touch and feel of virtual objects)
The need of the hour is to make them user‑friendly so that they are excited to use it
Adoption of an interdisciplinary approach
Keeping it safe for the users (reducing the probability of cyber‑sickness or eye strain and
headache) by limiting the duration of exposure
The health status of the medical students can be monitored periodically, and based on the
presence of a complaint or not, the subsequent training can be planned

Implications for Research
As virtual reality is still finding its feet in most of the
developing nations, especially with regard to medical
education delivery, there is ample amount of scope for
conducting research work.[9‑18] The research activity can start
itself with carrying out a needs assessment among medical
students about introducing virtual reality as a part of the
curriculum. At the same time, even the readiness of faculty
members to adopt another tool for teaching‑learning can be
ascertained and the potential barriers can be identified.[20‑22]
Further, once virtual reality has been implemented, it
is always a good strategy to explore the experiences
of different stakeholders. It will be ideal to carry out a
qualitative study, wherein the opinion of medical students
as well as faculty members can be identified pertaining to
what they liked and what needs further modification. Based
on the given suggestions, subsequent modifications can be
brought about.
Conclusion
The tool of virtual reality has all the potential to transform
medical education delivery in the coming days. Since
virtual reality advocates principles of adult learning and
gives them a platform to apply their knowledge to practice
and subsequently improve upon, it is quite necessary that
all the medical colleges look to introduce the same within
their setup and integrate it with conventional learning.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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