JMIR Publications

ABSTRACT

Background:

Learning through a 360° virtual reality (VR) or two-dimensional (2-D) video represents an alternative way to learn a complex medical education task. However, how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills are unknown.

Objective:

The study aimed to study how learning materials (VR or 2-D video) impact learning outcome and experience through the changes in cognitive load estimates and HRV for learning H&P skills.

Methods:

This prospective mixed-methods evaluation study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned (1:1) to a 360° VR video group and a 2-D video group matched by age, sex, and cognitive style. The contents of both videos were different with regards to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, NASA Task Load Index, and secondary-task reaction time, respectively. Cardiac autonomic function was assessed using HRV measurement. The learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at two-sided P<.01.

Results:

All of the participants (24 [62%] males and 12 [38%] females; median age 24 years, interquartile range 23‒25 years) received the intended intervention. The 360° VR video group seemed to have a higher Milestone level than the 2-D video group (P=.04). The reaction time at the 10th min in the 360° VR video group was significantly higher than those of the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with the reaction time at the 10th min≥3.6 sec (exp B=18.8, 95% CI 3.2–110.8, P=0.001) and Milestone level≥3 (exp B=15.0, 95% confidence interval [CI] 2.3–99.6, P=0.005), respectively. However, the reaction time-10th min≥3.6 sec was not related to Milestone level≥3. The low frequency/high frequency ratio between the 5th and 10th min≥1.43 seemed to be inversely associated with the hedonic stimulation scale≥2.0 (exp B=0.14, 95% CI 0.03–0.68, P=0.015) after adjustment for the video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2-D video module was easy to follow and tedious.

Conclusions:

Our preliminary results showed that 360° VR video learning might lead to a better Milestone level than 2-D video, which seemed to be not related to cognitive load estimates and HRV indexes in novice learners. Noteworthily, an increased sympathovagal balance could be associated with a lower hedonic stimulation, which might meet learners’ needs and prompt their learning through different video modules. Clinical Trial: Clinicaltrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 (Archived by WebCite at http://www.webcitation.org/72f59ImWm)