Describing, Evaluating, and Exploring Barriers to Adoption of Virtual Reality: An International Modified Delphi Consensus Study Involving Clinicians, Educators, and Industry Professionals.

Medical schools are increasingly adopting immersive virtual reality (VR) to practice clinical and communication skills, and VR may also be useful for challenging topics in preclinical curricula related to complex spatial understanding. VR may provide benefits for medical education over traditional education materials by providing both immersion and interactivity relevant to the learning content. This study explored the effectiveness of incorporating a novel VR lesson into the neuroanatomy course for first-year medical students. Neuroanatomy is a difficult subject for medical students (and other health professional students) due to the complex geometry of the brain. Many key structures are small and are organized around non-geometric surface contours and internal fluid spaces called ventricles. The narrated VR lesson guided students through brain structures and spatial relationships and asked students to manipulate the high-resolution volumetric renderings (i.e., rotating structures, and bisecting planes). Prior research supports the idea that manipulating three-dimensional (3D) visualizations in VR may provide additional visuospatial information useful for understanding anatomy. This study sought to investigate the effectiveness of integrating VR content into the medical school curriculum, assessing the primary outcome of learning neuroanatomy knowledge and the secondary outcome of student experience with the novel VR technology. The learning outcome of neuroanatomy knowledge was measured quantitatively using a pre- and post-test of neuroanatomy from the course instructor. We hypothesized that students would improve significantly between neuroanatomy knowledge pre- and post-tests. Student experiences with the VR technology were measured quantitatively using a validated measure of usability (i.e., System Usability Scale [SUS]) and a Subjective Experience Questionnaire that included Likert-type survey items. We hypothesized that students would rate usability scores above the benchmark on the SUS (>68 on a 100-point scale) and questionnaire items above the midpoint of the scale (>3 on a 5-point scale). Students were also asked to provide written responses about their experiences with the VR technology, which were analyzed qualitatively for response themes. Furthermore, this study explored the potential relationship between spatial ability (Paper Folding Test; [PFT]) and the primary outcome of improved neuroanatomy knowledge post-VR intervention in an exploratory analysis. We hypothesized that the VR intervention would help students with lower spatial ability perform at the level of individuals with higher spatial ability on the post-test of neuroanatomy knowledge. Implications for the logistical considerations of implementing VR in course labs are discussed. There is growing evidence that VR in healthcare education is beneficial for learning, yet results vary based on many factors: Achievement of learning outcomes from VR educational interventions depends on the type of task being trained (e.g., procedural, decision-making), the type of VR being implemented (e.g., 3D animated environment, 360° video), the usability of the VR system, the learner’s level of knowledge and individual characteristics (e.g., student, resident, and healthcare professional), among many other factors. For example, a scoping review published in 2023 found that there were over 60 commercially available VR applications for healthcare education, and each may have specific benefits and limitations for different intended learning outcomes. Another systematic review of VR in medical education found that most content fit into one of five categories: anatomical knowledge, procedural skills, surgical procedures, communication, or clinical decision-making. The review found evidence that learning basic anatomical knowledge in VR was effective (i.e., learning outcomes were achieved) but not necessarily better than other methods (e.g., textbook, tablet, augmented reality materials). Evidence for the other categories was inconclusive (i.e., procedural skills, communication, and clinical decision-making), highlighting the need for more primary studies of VR in medical education with more consistent use of reporting guidelines. The effectiveness of VR may vary depending on the specific learning objectives, as different features of VR technology can be more or less beneficial for specific tasks. There are several potential explanations for why VR may be useful for medical education compared to traditional methods. From a cognitive psychology perspective, researchers have explored the characteristics of VR training that impact learning outcomes, focusing on the roles of immersion and interactivity as critical factors that affect cognitive processing. For example, VR may benefit neuroanatomy education by offering detailed, 3D visualizations that more accurately represent the real human complex spatial relationships between brain structures. This immersive