JMIR Publications

ABSTRACT

Background:

Immersive virtual reality (VR) and artificial intelligence (AI) was used to determine if a simulated clinical practical exam setting could reduce anxiety levels of first-year occupational therapy (OT) students as they prepared for upcoming Objective Structured Clinical Examinations (OSCEs). Test anxiety is a common issue among post-secondary students, leading to negative consequences such as the increased risk of dropout, lower grades, and limited employment opportunities. Students unfamiliar with the test-taking environment for a particular exam are more likely to have test anxiety. VR simulation of an OSCE may allow students to familiarize themselves with the test environment and potentially reduce their anxiety levels.

Objective:

To assess the efficacy of a VR simulation depicting clinical settings to reduce student anxiety for a clinical exam, while gathering student perspectives on their curricular experiences to better understand their learning environment.

Methods:

An experimental, nonrandomized controlled trial compared state anxiety, trait test anxiety, and OSCE grades in two groups of first-year OT students, analyzed using independent t tests. Group 1 (NoVR) was not exposed to the VR simulation and acted as a control group for members of Group 2 (YesVR), who were exposed to the VR simulation. The VR utilized AI in the form of a generative pre-trained transformer (GPT) to generate responses from virtual patients as the students interacted with them in natural language. Self-reported psychometric scales measured anxiety levels, three days before the OSCE. YesVR students completed perceived preparation surveys at two time points; three weeks and three days before the OSCE, analyzed with dependent t tests. Semi structured interviews and focus groups were conducted within a one-week timeframe after the OSCE. Student perspectives on their OT program and VR experiences were summarized using interpretative thematic analysis.

Results:

A total of 60 participants—32 in the NoVR group and 28 in the YesVR group—showed a significant reduction in state anxiety in the YesVR group (t58=3.96, P=<.001, Cohen d = 1.02). The mean difference was 11.96 units (95% CI 5.92-18.01). Trait test anxiety and OSCE scores remained relatively static between groups. There was an increase in all variables for perceived preparedness for the YesVR group. 25 participants making up interview and focus group data provided major themes affecting OSCE performance including student experience and background, feedback and support, fear of the unknown, self-consciousness and knowledge of the exam environment.

Conclusions:

Intolerance for uncertainty may cause students to interpret ambiguous exam situations as precarious events, yet students reported the usefulness of VR simulation, providing them familiarity with clinical practical exam settings. With the addition of new, cutting-edge components, VR simulators can be improved to give students what they most frequently requested- performance feedback on the simulated OSCE.