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Virtual Medical Training: Don’t Call It Virtual Reality

A student interacts with a virtual patient.

The Virtual Patient project at the USC Institute for Creative Studies uses virtual human technology to create realistic lifelike character avatars and uses speech recognition, natural language, non-verbal behavior, and realistic scenarios to train clinici

Credit: USC Institute for Creative Technologies

Immersive virtual reality (VR) received a lot of coverage during the annual Electronic Entertainment Expo (E3) video game conference and show in Los Angeles in June, but it is not clear whether consumers will flock to buy cumbersome VR headsets and related accessories when they start to roll out late this year. However,  VR technologies, in the form of computer-generated environments, show great promise in their potential impact on medical education and training. Currently used in simulation training or to provide intelligent virtual humans for medical personnel to practice on, VR will continue to grow increasingly important to the development of training or practice apps for wellness and behavior modification.

Just refrain from using the term "virtual reality." Walter Greenleaf, a pioneer in the use of virtual environment technology in the medical field and visiting scholar with the  Virtual Human Interaction Lab at Stanford University, observes that although VR "is already well developed following 25 to 26 years of effort, it’s just not called ‘medical virtual reality.’ It’s been validated and proven in universities for surgical simulation and training, from neurosurgical to endoscopic training, but there’s been considerable debate about using [the term] ‘virtual reality’; better may be ‘alternate reality." That is because the medical field changes very slowly, so any affiliation to a technology deemed "sci-fi" needs to be branded and marketed differently.

Regardless, VR technology in medical training and education has been gaining acceptance. As Greenleaf remarked, "Training has transitioned. You don’t need to practice on the job or use pigs or dogs." In fact, market research firm MarketsandMarkets reported the global healthcare/medical simulation market is expected to grow from $863.5 million in 2014 to reach $2.069 billion by 2019, demonstrating a compound annual growth rate of 19.1% over that five-year period.  The company defines the market as including "mannequin-based simulators; web-based simulation, including serious games and second life; simulation software, including performance recording software and virtual tutors, and simulation training services." Spurring the sector’s robust growth, according to MarketsandMarkets, is the drive to improve patient outcomes and safety by reducing medical errors and improving training for health care professionals, ultimately resulting in reduced health care costs.

Virtual reality is not a single technology. First, there is immersive or augmented VR. Through the use of special computerized display tools, notably headsets or head-mounted displays (HMDs), along with sensory trackers, users can "immerse" themselves in a computer-generated environment that responds to their physical interactions with it. Surgeons can use it to rehearse before surgery, to see if there are any surprises for which they can prepare beforehand to make surgeries shorter and safer. 

A cave augmented virtual environment (CAVE) is an immersive virtual environment in which surround-sound and encompassing screens are implemented in a room-sized cube. The Electronic Visualization Laboratory at the University of Illinois at Chicago pioneered CAVE and currently has a research project underway on virtual reality for medical trainingThe Weill Cornell Medical College CAVE from the "Weill Cornell Visualization Facility is the world’s first high-definition 3D virtual reality environment. It uses the highest resolution blended images possible, projected on three walls and a walk-on floor. An interactive tracking device, worn by the primary user, coupled with a hand-held electronic wand to manipulate the images, allows multiple researchers to ‘move around’ simultaneously within a three-dimensional data set or structure."

Second, there is non-immersive VR, which can be projections on a screen as well as simulation training—no HMDs required. Simulation training has been around for years—at the low-end, it includes those plastic mannequins on which emergency response professionals practice learning cardio-pulmonary resuscitation (CPR). However, non-immersive technology has become a lot more sophisticated in recent years, with pricing that reflects it—costs range from $10,000 to $300,000. For example, Simbionix "offers state-of-the-art simulators, a simulation management system, and 3D visualization for patient-specific procedures that give professionals the opportunity to train and rehearse a procedure before cutting into a patient."  Simulaids makes mannequins for medical training simulations that can be managed via an app on an iPad. And Clinispace Virtual Sim Center, "a 3D, immersive, computer application for practicing patient care and clinical management with interactive devices affecting the health of virtual patients," collaborates with the University of Memphis, University of Miami School of Nursing & Health Studies, and Northern Virginia Community College to provide students opportunities to practice various scenarios before spending time on more expensive simulation mannequins.

As Greenleaf clarified, VR "is nuanced…it’s a spectrum of applications; some that are subclinical and can be downloaded from an app store to change your own behavior to a more sophisticated prep area." At one end of this spectrum is the established use of VR as therapy for returning veterans with post-traumatic stress disorder (PTSD). Further along the spectrum, VR is moving onto technology platforms for medical training and education. The University of Toledo’s UT-Interprofessional Immersive Simulation Center (IISC) "was developed to positively impact patient safety and improve the quality of care by training health care professionals using simulation models, simulated clinical settings, and 3D Virtual Immersive Environments." And the University of Nebraska plans to create a training center, the Interprofessional Experiential Center for Enduring Learning (iEXCEL), which will use "near 'real life virtual reality scenarios' to transform performance in career-long health care education and training," according to university chancellor Jeffrey P. Gold. 

Another non-immersive VR technology used for training purposes is a virtual human that supplants actors playing patients by simulating various scenarios. The Virtual Patient project of the University of Southern California Institute for Creative Technologies  "uses virtual human technology to create realistic lifelike character avatars and uses speech recognition, natural language, non-verbal behavior, and realistic scenarios for both military and non-military issues to train clinicians in interpersonal areas such as rapport, interviewing and diagnosis."

The next development along the VR spectrum, predicts Greenleaf, will be a move into behavioral medicine, especially in the areas of stress and addiction. He says VR can be a "powerful tool for addictions where you can practice to activate an emotional part of the brain, which is not possible in an office or group session."

Tatjana Meerman is a freelance technology writer based in the Washington, D.C. area.


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