Integrating Telemedicine and Embodied Virtual Reality: A Novel Functional Training Intervention for Chronic Shoulder Pain.

Extended reality technology (XRT) is gaining interest within health care, particularly in the context of medical education, employee health and well-being, and as pain relief during invasive procedures. Virtual reality (VR) is a subtype of XRT and, following linguistic review of the health care literature, has been deemed complex to describe. The cited linguistic review forms part of a larger body of work interested in widening access to health care education using VR, within which, this study also sits. Throughout the health care literature, myriad contrasting descriptions for this emerging technology exists. There is no consensus around which describes it most accurately, leading to confusion within the educational and academic community. This confusion can have several negative impacts across academia, health care, and the technological ecosystem including slowing technology adoption due to lack of understanding, failure to communicate the value proposition of VR training stifling implementation, and the slowing of academic progress due to a misaligned literature base. There is a steadily strengthening evidence-base for the role of VR training in areas of emergency medicine, human factors, nontechnical skills, community-based learning, and surgery. There are examples of VR being used to replace long-standing, nationally accepted tracheostomy safety courses. In these platforms, equivalent educational outcomes have been obtained alongside demonstrating the opportunity to reduce the financial and environmental burden of traditional simulation. VR is a well-regarded tool in the armamentarium of the surgical educator involved in training laparoscopic skills, with educational benefit clear across several modalities. Despite the steadily strengthening body of data, there is no evidence or consensus guideline for the optimal way to evaluate these novel learning resources. There is a rising interest in VR in the context of medical education and as further technology developments are presented, the data presented in the literature are becoming increasingly heterogenous. If these teaching tools show educational and cost-effectiveness, owing to the complex nature of technology diffusion, implementation, and widespread adoption cannot be assumed. Without optimizing the environment in which XRT is expected to be embedded, uptake may be limited, thus decreasing the potential benefits within health care education. This study aimed to approach consensus agreement around terminology used to describe VR in the context of health care training, and determine the most appropriate methodological approach for its evaluation. Additionally, by identifying the most potentially prohibitive barriers to VR education adoption, we aimed to reach consensus around design and development decisions which may promote uptake within postgraduate health care systems. Ultimately, this the first step toward guideline development for researchers, educators, and clinicians interested in using, developing, and conducting research in VR education. This study was an international, Modified Delphi Consensus study, which ran over two rounds in a fully-remote, online format. The study advisory group (SAG) was formed from educationalists, consultant clinicians, and medical VR experts based in several academic and care-providing institutions across the United Kingdom and the United States. Full prospective ethical approval was granted by The University of Manchester Research Ethics Committee (ref. 2023-17884-30743).