Saxena, Nakul

Annali dell'Istituto Superiore di Sanità

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Letter
Virtual reality environments for 
healthcare professional education
Ann Ist Super Sanità 2015 | Vol. 51, No. 1: 1-2
DOI: 10.4415/ANN_15_01_01
Key words
•  e-learning
•  education
•   virtual reality
•  simulation
Dear Editor,
I refer to the paper by Walsh on the future of e-learning in healthcare professional ed-
ucation [1]. The paper aptly states that the e-learning has moved from simple text based 
learning to more interactive, multimedia social learning resources. While e-learning has 
been around ever since the internet was formally established, advanced techniques in 
e-learning, such as digital game based learning, virtual patients and virtual reality envi-
ronments have only recently begun to take center stage. Walsh also points to the fact 
that simulation will be the future of e-learning. Within the simulation schema, I would 
specifically like to focus on virtual reality environments and their potential role in e-
learning for healthcare professionals in the future.
Over the last two decades, there has been a rapid advancement in the field of simula-
tion and healthcare professional education. A simple PubMed search for “simulation 
education and healthcare” showed a greater than twelvefold increase in the number 
of publication from 1994 to 2014 and the number of publications are only going to 
increase with time.
Virtual reality environments (VREs), which provide an immersive experience to the 
user, is an area which possesses tremendous potential in the field of healthcare profes-
sional education. Several systems such as Second Life, VisCube and Oculus Rift provide 
the users with an opportunity to don the role of a virtual avatar and enable users to 
respond to different situations and circumstances in a virtual world. This provides an op-
portunity for the users to gain knowledge and experience specific situations that, under 
normal circumstances, might not always be possible.
VRE offers several advantages, especially in healthcare professional education. For 
example, the simulation of a virtual disaster site could help medical trainees experience 
the intricacies and difficulties faced during a disaster and can help prepare them in a 
virtual world. Studying anatomy structures in a VRE could help trainees understand and 
appreciate the structural complexities of certain organs such as the inner ear. 
Several studies have quantified the improvement in knowledge for healthcare profes-
sionals via VRE based interventions [2-6]. A systematic review on the effectiveness of 
VRE based interventions for healthcare professional education is underway by our team 
and this will provide clarity on the true impact of VRE based education on knowledge, 
skills attitude and satisfaction of healthcare professionals. However, to date, no com-
prehensive cost analysis for VREs has been performed. Setup cost, sustainability as well 
as indirect costs like teacher’s time for designing the VRE education module need to 
be evaluated. Cost effectiveness of the VRE based interventions needs to be addressed 
and standard guidelines pertaining to the incremental cost effectiveness ratio (ICER) 
threshold should be formulated. This information will help decision makers decide upon 
appropriate interventions in different settings. 
From the healthcare professional education point of view, the features of VREs such 
as immersion, role playing opportunities and the provision of personal connection to the 
simulated environment must be evaluated extensively to determine their influence on 
knowledge gain. Do VREs truly improve the knowledge for a user? If so, what aspects 
of the VRE influences the users’ knowledge gain the most? How impactful is the VRE 
in cementing the knowledge for a user and how frequently does a user have to re-enter 
the virtual world to re-learn and re-familiarize himself with the learning objective? How 
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adaptable are VRE based interventions in different geographic and socio-economic set-
tings? These are questions that need to be addressed to have a better understanding 
of the role that VREs are likely to play in the healthcare education space in the future.
Nakul Saxena
Author affiliation:
Health Services & Outcomes Research
National Healthcare Group
Singapore
E-mail: Nakul_SAXENA@nhg.com.sg
Conflict of interest statement: none
RefeRences
1. Walsh K. Commentary. The future of e-learning in healthcare professional education: some 
possible directions. Ann Ist Super Sanità 2014;50(4):309-10.
2. Richardson A, et al. Use of a three-dimensional virtual environment to teach drug-receptor 
interactions. Am J Pharm Educ 2013;77(1):11.
3. Pierce J, et al. Comparative usability studies of full vs. partial immersive virtual reality simula-
tion for medical education and training. Studies Health Technol Informat 2008;132:372-7.
4. Persky S, Eccleston CP. Medical student bias and care recommendations for an obese versus 
non-obese virtual patient. Int J Obes (London) 2011;35(5):728-35.
5. LeFlore JL, et al. Can a virtual patient trainer teach student nurses how to save lives-teaching 
nursing students about pediatric respiratory diseases. Simul Health 2012;7(1):10-7.
6. Farra S, et al. Improved training for disasters using 3-D virtual reality simulation. West J Nurs 
Res 2013;35(5):655-71.


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