JMIR Publications

ABSTRACT

Background:

Virtual Reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional (3D) multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice.

Objective:

The aim of this systematic review was to evaluate the effectiveness of virtual reality (VR) for educating health professions and improving their knowledge, cognitive skills, attitudes and satisfaction.

Methods:

We performed a systematic review of the effectiveness of virtual reality in pre- and post-registration health professions education following the gold standard Cochrane methodology. We searched seven databases from the year 1990 up to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data and assessed risk of bias, then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. We used the GRADE approach to rate the quality of the body of evidence.

Results:

Thirty-one studies (N = 2407) were included. Meta-analysis of eight trials found that VR slightly improves post-intervention knowledge scores when compared with traditional learning (SMD = 0.44, 95% CI: 0.18, 0.69, I2 = 49%, N = 603) or to other types of digital education such as online or digital education (SMD = 0.43, 95% CI: 0.07, 0.79, I2 = 78%, N = 608, low certainty evidence). Another meta-analysis of four trials found that VR improves health professions cognitive skills when compared with traditional learning (SMD = 1.12, 95% CI: 0.81, 1.43, I2 = 0%, N = 235). Two studies compared VR to other forms of digital education on skills, favoring the VR group (SMD = 0.50, 95% CI: 0.32, 0.69, I2 = 0%, N = 467, moderate effect size, low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. No studies reported patient-related outcomes, behavior change or unintended/adverse effects of the VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of the evidence primarily because of the risk of bias and/or inconsistency.

Conclusions:

We found evidence suggesting that virtual reality improves post-intervention knowledge and skills outcomes of health professions when compared to traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate more on the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness and clinical practice or behavior change.