Traditional medical education has recently seen major changes due to the coronavirus (COVID-19) pandemic. New pedagogical methods, including augmented reality (AR) and virtual reality (VR), are on the rise as alternatives to traditional teaching methods. While AR enhances real world experiences by overlaying information, VR immerses users in a computerized world rather than enhancing reality. It is crucial to understand the limitations of these learning modalities and that at best these modalities should be used to supplement and not replace traditional medical education

Dufeau, David, Ph.D

El-Araby, Nermeen, OMS-2

Kocemba, Joshua, OMS-2

English

Marian University Indianapolis

MUShare 
MU-COM Research Day College of Osteopathic Medicine 
2020 
Limitations of Visualization Technology and Virtual Instruction in 
Medical Education 
Joshua Kocemba OMS-2 
Marian University - Indianapolis 
Nermeen El-Araby OMS-2 
Marian University - Indianapolis 
David Dufeau Ph.D 
Marian University - Indianapolis 
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 Part of the Medicine and Health Sciences Commons 
Recommended Citation 
Kocemba, Joshua OMS-2; El-Araby, Nermeen OMS-2; and Dufeau, David Ph.D, "Limitations of Visualization 
Technology and Virtual Instruction in Medical Education" (2020). MU-COM Research Day. 175. 
https://mushare.marian.edu/mucom_rd/175 
This Poster is brought to you for free and open access by the College of Osteopathic Medicine at MUShare. It has 
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information, please contact emandity@marian.edu. 
Limitations of Visualization Technology and Virtual 
Instruction in Medical Education
Joshua Kocemba, Nermeen El-Araby OMS II MU-COM and Dr. David Dufeau, 
PhDjkocemba746@marian.edu nelaraby545@marian.edu
Introduction
Traditional medical education has recently seen major
changes due to the coronavirus (COVID-19) pandemic.
New pedagogical methods, including augmented reality
(AR) and virtual reality (VR), are on the rise as
alternatives to traditional teaching methods. While AR
enhances real world experiences by overlaying
information, VR immerses users in a computerized
world rather than enhancing reality. It is crucial to
understand the limitations of these learning modalities
and that at best these modalities should be used to
supplement and not replace traditional medical
education.
Clinical Skills
Conclusio
n
Professional and Interpersonal Skill 
Development
Traditional teaching provides students with early 
exposure to their first patient in the anatomy lab. Donors, 
like patients, surrender their bodies to future doctors to be 
handled with care and professionalism. Student doctors 
develop empathy and respect for donors under the 
guidance of experienced faculty and academics. 
Instructor-led discussions permit students to express their 
personal views on inevitable topics like mortality and 
grief. This prepares students for future difficult patient 
situations and enables them to develop coping skills. 
Problem-Solving Skills
In a study where arm cadaver models were used to implant nerve fascicle
electrodes, it was concluded that having this microsurgery conducted on
cadaver models before patients is necessary especially for the development
of operating protocols to be established before practicing this high-risk
methodology on nerve structures with great anatomical variability.
Physician-Patient Relationship
Physical interaction cannot be properly replicated within the confines of a
VR or AR learning experience. In current medical education models
students are taught a “voiceless dialogue”, which includes the way the
physician approaches, touches, and deals with the patient, making the
patient feel whole, respected and integrated; a satisfying and rewarding
feeling that can have positive mental outcomes. Touch has limbic
connections to past experiences, meanings, and emotions and therefore
allows a dynamic assessment of one of the major osteopathic practice
models, the biopsychosocial model.
Financial Challenges
In a study published in 2019, Farra et al compared costs of a VR simulation
and hands-on training for an evacuation training event for nurses. It
estimated the total cost for the development and VR training simulation for
34 nurses to be $106,951.14. Of that cost nearly $80,000 was for the
development of the virtual simulation. If this form of education is adopted
in medical programs, they will need to develop many unique training
simulations, which will rapidly drive up the implementation costs for this
educational approach.
Technological Limitations
One challenge for VR headsets is to reduce the latency
of the video rendering time, which if is greater than 15
ms, can cause a sensory mismatch leading to
cybersickness. Also, wireless headsets struggle to
present the video quality that would be integral to a
realistic virtual learning environment.
Conclusion
Virtual and augmented reality are rapidly being adopted
in many academic fields, and while it is almost inevitable
that these will be used in medical programs, it is
important to understand the limitations that these
learning modalities pose. VR and AR learning
environments can be incredibly fruitful, but in their
still-nascent state these technologies are best used as a
supplementation to tried-and-true educational
approaches rather than a replacement.
References
● Cooper C, Gray LA. 2014. Lack of anatomy training could lead to shortage of 
surgeons. The Independent. 9 June 2020. Independent Digital News & Media Ltd, 
London, UK. URL: https://www.indep endent.co.uk/life-style/ health-
andfamilies/health-news/lack-of-anato my-train ing-could-lead-: to-short age-of-
surgeons-95706 84.html [accessed 3 April 2020].
● Elbamby, Mohammed S., et al. “Towards Low-Latency and Ultra-Reliable Virtual 
Reality.” ArXiv.org, 23 Jan. 2018, arxiv.org/abs/1801.07587.
● Gregory SR, Cole TR. 2002. The changing role of dissection in medical education. 
JAMA 287:1180–1181
● Howarth PA, Costello PJ. 1997. The occurrence of virtual simulation sickness 
symptoms when an HMD was used as a personal viewing system. Displays 18:107–
116
● Krähenbühl SM, Čvančara P, Stieglitz T, et al. Return of the cadaver: Key role of 
anatomic dissection for plastic surgery resident training. Medicine (Baltimore). 
2017;96(29):e7528. doi:10.1097/MD.0000000000007528
● Weeks SE, Harris EE, Kinzey WG. Human gross anatomy: a crucial time to 
encourage respect and compassion in students. Clin Anat. 1995;8(1):69-79. 
doi:10.1002/ca.980080113
References 
Consedine, Seth et al. “Knowing hands converse with an expressive body: An experience of osteopathic touch.” International Journal of Osteopathic Medicine 19 (2016): 3-12
Cooper C, Gray LA. 2014. Lack of anatomy training could lead to shortage of surgeons. The Independent. 9 June 2020. Independent Digital News & Media Ltd, London, UK. URL: 
https://www.indep endent.co.uk/life-style/ health-andfamilies/health-news/lack-of-anato my-train ing-could-lead-: to-short age-of-surgeons-95706 84.html [accessed 3 April 2020].
Elbamby, Mohammed S., et al. “Towards Low-Latency and Ultra-Reliable Virtual Reality.” ArXiv.org, 23 Jan. 2018, arxiv.org/abs/1801.07587.
Elkiss ML, Jerome JA. Touch--more than a basic science. J Am Osteopath Assoc. 2012;112(8):514-517
Gregory SR, Cole TR. 2002. The changing role of dissection in medical education. JAMA 287:1180–1181
Guéguen N. Touch, awareness of touch, and compliance with a request. Percept Mot Skills. 2002;95(2):355-360. doi:10.2466/pms.2002.95.2.355
Howarth PA, Costello PJ. 1997. The occurrence of virtual simulation sickness symptoms when an HMD was used as a personal viewing system. Displays 18:107–116
Krähenbühl SM, Čvančara P, Stieglitz T, et al. Return of the cadaver: Key role of anatomic dissection for plastic surgery resident training. Medicine (Baltimore). 2017;96(29):e7528. 
doi:10.1097/MD.0000000000007528
Mikolajczak M, Gross JJ, Lane A, Corneille O, de Timary P, Luminet O. Oxytocin makes people trusting, not gullible [published online ahead of print July 14, 2010]. Psychol Sci. 
2010;21(8):1072-1074. doi:10.1177/0956797610377343.
Schweitzer, L. 1985 The rewards and hazards of medicine as a profession. In Understanding Human Behavior in Health and Illness, 3rd Ed. R.C. Simons (ed.). Baltimore: Williams 
and Wilkins, pp. 432-440.
Weeks SE, Harris EE, Kinzey WG. Human gross anatomy: a crucial time to encourage respect and compassion in students. Clin Anat. 1995;8(1):69-79. doi:10.1002/ca.980080113
Hi, I am Josh kocemba and I will discuss the financial and technological challenges of VR and AR 
implementation in medical education
Financial
The costs for developing the software and acquiring the equipment can accumulate rapidly. A 
recent study calculated the cost for developing one training exercise, totalled nearly $107,000. 
It is important to note that medical programs would have many of these simulations, each with 
their own cost. It is likely that these new financial burdens would be passed on to the students.
Technology
A major hurdle for bringing VR into the medical classroom is the limitation of making it feel like 
a real experience. Most of the current model VR headsets are wired, which tethers the user to 
a computer. These allow for high-fidelity audio and visual input, however wireless headsets, 
which would be better suited for creating an environment free of tripping hazards, and thus a 
more immersive experience, cannot achieve the high quality of video, compared to the wired 
counterpart. Slow latency limits the user experience, and can lead to motion sickness, which is 
commonly called cyber sickness. 
]Conclusion
Virtual and augmented reality are rapidly being adopted in many academic fields, and while it is almost inevitable that
these will be used in medical programs, it is important to understand the limitations that these learning modalities
pose. VR and AR learning environments can be incredibly fruitful, but in their still-nascent state these technologies
are best used as a supplementation to tried-and-true educational approaches rather than a replacement.
Visuohaptic Training
Visuohaptic training promotes statistically significant better recall results
than either visual or haptic training alone. Current AR/VR haptic simulation
has not proven to adequately replace anatomy lab haptic experience. Vishy
Mahadevan, professor of anatomy at the Royal College of Surgeons, notes an
increasing number of surgeons with lack of confidence. He attributes this to
an inadequate understating of anatomy. Current VR/AR anatomical
simulations may not be ready to foster an appreciation in this subject which
can carry heavy downstream costs.


Limitations of Visualization Technology and Virtual Instruction in Medical Education

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Limitations of Visualization Technology and Virtual Instruction in Medical Education

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