Table 2 Data Extraction Table

1.Yoganathan et al., 2018 [58]

360 degrees virtual reality video for the acquisition of knot tying skills: A randomised controlled trial

Pilot RCT

N = 40 male and female foundation year doctors. Participants were randomised to either the 360° video (n = 20) or 2D video teaching (n = 20).

Two identical videos demonstrating “a single-handed surgical reef knot” were produced based on Royal College of Surgeons (RCP) basic Surgical Skills video.

Conventional video: recorded using an iPhone 7 (Apple) to play in HD 2D format on a laptop screen. 360° video: recorded using Insta360™ Nano and played through an HMD

To determine the effectiveness of knot tying skills taught with a 360° Virtual Reality video compared to 2-D video teaching.

Participants were shown their allocated video for 15 min; then, their ability to tie “a single-handed reef knot” was then assessed against a marking criterion developed by RCP.

UK

During and post.

Knot tying scores improved significantly in the 360° video teaching arm when compared with conventional methods (p = 0.04). More people in the 360° arm constructed a reef knot than in the 2D arm following face to face teaching (17/20 vs 12/20). This study shows there is significant use for 360° video technology in surgical training, both as a unique teaching aid and when used as an adjunct to conventional teaching.

The participants were not re-assessed to see if the difference in skill retention between the two arms was maintained.

2.Ulrich et al., 2019 [59]

Learning effectiveness of 360° video: experiences from a controlled experiment in healthcare education

Experimental study

N = 81 male and female physiotherapy students. Group 1 (n = 28) used 360° video. Group 2 (n = 26) used a regular video. Group 3 (n = 27) received traditional teaching.

The first group used 360° video shown on a VR-HMD (Samsung Gear VR). The second group used regular video shown on a laptop.

All videos were recorded with the same teacher in physiotherapy education and the videos were recorded without using cut scenes to avoid interference from post-production (recording technology was not described).

To measure the effectiveness of 360° video in the students’ performance, satisfaction, and learning climate in an educational healthcare setting

A 3 × 3 factorial design. The 3 treatment groups were the independent variables (1) academic performance (2) perceived user satisfaction and (3) perception of learning climate. User satisfaction and perception of learning climate was measured using an adapted version of Chou and Liu’s [60] Learning Satisfaction Questionnaire.

Denmark

Pre and Post

360° video and regular video were less effective than conventional teaching in students’ learning satisfaction. 360° video was more effective at providing a “learning climate” (emotional impact). Results showed that traditional teaching was on most constructs as or more effective.

Small sample therefore, the sample may lack statistical power and generalising the results should be done with caution

3.Sultan et al. 2019 [61]

An Experimental Study on Usefulness of Virtual Reality 360 degree In Undergraduate Medical Education

Experimental study

N = 169 male and female undergraduate medical students. Group one (N = 57) experienced 360° video whereas group two (N = 112, control group) was provided with the interactive lecture

360° cameras, a smartphone and VR goggles (HMDs). Specific technology was not described. Group one received 3 VR videos which include (effective communication with patient, effective communication with relatives and non-health care professions and importance of the multidisciplinary team in healthcare).

To determine knowledge retention, perception level, satisfaction level and skill acquisition using 360 videos in medical education.

Objective Structured Clinical Examination (OSCE) and MCQ scores were used for measurement

Saudi Arabia

Pre and post.

The majority of students (93%) thought that 360° videoing could be used in medical education. Post-MCQs score was significantly higher in the 360° group when compared to the conventional group (p < 0.001). The OSCE score was also significant with the 360° group (p-< 0.001). 73% of participants were satisfied with the 360° video experience.

There were significantly fewer females when compared to males.

Also all participants were UG medical students, the study’s strength would be increased by involving students from different academic levels.

4. Harrington et al., 2018 [62]

360° Operative Videos: A Randomised Cross-Over Study Evaluating Attentiveness and Information Retention

A randomised cross-over study

N = 40 male and female students in preclinical years of a medical university. Group 1: used the 360° video followed by the 2D experience Group 2 was reversed.

GoPro Omni was suspended and recorded an elective laparoscopic cholecystectomy. Samsung Gear VR HMDs enabled viewing followed by the 2D experience on a 75-in. television. Group 2 was reversed.

To evaluate variances of inattentiveness, information retention, and appraisal of 360° videos vs 2D formats.

8-point multiple choice questionnaires were used to assess engagement levels and task-unrelated images or thoughts. A 15-point questionnaire related to demographics and their video experiences.

Ireland

During (2 time-points) and post

During the 360° video participants had lower task-unrelated images or thoughts (p < 0.01) and were significantly engaged (p < 0.01) There were no significant variances in information retention between group 1 and 2. Most participants (65%) reported the 360° video as their learning platform of choice for learning, immersion, and entertainment.

Small participant numbers. The novelty factor of the new technology may have positively influence results.

The retention questionnaires were more technically than observationally orientated

5. Huber et al., 2017 [63]

New dimensions in surgical training: immersive virtual reality laparoscopic simulation exhilarates surgical staff.

Feasibility study

N = 10 staff from the surgical department

The VR laparoscopic simulator was a LapSim, Samsung Gear 360° was used to record a video (including audio) sequence inside the operating room during laparoscopic surgery (artificial scenario). Startech online was used to transfer the video output signal of the simulator to a VR-ready laptop computer. Unity3D® was used to integrate the simulator display into the recorded 360° OR-video. Noise-canceling Bluetooth headphones (Bose® Quietcomfort® 35) were also used.

Assess and analyse the feasibility of using an immersive 360 video laparoscopy setup to measure extent of performance immersion and motion sickness.

The Validated Motion Sickness Scale [64] was used during the IVR session.

Measurement of Presence and Its Consequences in Virtual Environments [65], was used after the course to evaluate the immersive effects the training.

Germany

During and post

Fine dissection took significantly longer for participants in the 360 video session [p = 0.022) with higher error rates. Motion sickness did not occur at any time for any participant. Participants in the 360 video session experienced immersion and a high level of exhilaration, “rarely thought about others in the room”, and had a strong feeling of presence.

The particularly small number of participants and the non-randomised study design.

6. Taubert et al., 2019 [66]

Virtual reality videos used in undergraduate palliative and oncology medical teaching: results of a pilot study.

Pilot Study

N = 72 male and female medical students

Oculus Rift HMD was used, videos were based on nausea and vomiting management in palliative care and oncology settings. They were also able to view the Radiotherapy Patient view VR experience.

Details of camera used to video the experience was not available.

To determine the usefulness of using 360 videos as a teaching tool for undergraduate palliative and oncology medical teaching.

A questionnaire was used to measure comfort and ability to concentrate after the intervention. Participants were asked if they felt that the 360° experience suited their learning style and whether they would recommend.

UK

Post

Participants rated their experience on a scale of 0 to 10 (0 = worst, 10 = best). Their ability to concentrate had an av. score 8.44, suited their learning style av. score 8.31. 70 (97%) students confirmed that they would recommend this form of learning to a colleague.70 (97%) participants found the experience comfortable.

Validated measures measurement and analysis would have given more validity to the findings.

7.Pulijala et al., 2018 [67]

An innovative virtual reality training tool for orthognathic surgery.

Exploratory study

N = 7 consultant oral and maxillofacial surgeons

Stereoscopic visualisation of orthognathic surgery and 3D interaction using the Oculus Rift Development Kit 2, HMD and a Leap Motion controller. Six GoPro Hero cameras were used in the operating room

To determine the realism and usability, and the applicability of 360 videos for orthognathic surgical training.

Pre-intervention questionnaire regarding training needs 2. Post-intervention to gather data on the efficacy, usability, and acceptability of the system.

UK

Pre and post

Participant agreed with the validity of the content of the 360° video clips (mean score = 4.28). The participants also saw significant benefits from using the various components of the application (mean score = 4.46). Overall, there was validity for the content and use of the application of 360° videos to enable trainees to participate in a surgery environment

The particularly small number of participants and given that the technology was developed and evaluated by expert surgeons makes generalising the results difficult.

8. Buchman and Henderson, 2019 [68]

Qualitative Study of Interprofessional Communication through Immersive Virtual Reality 360 Video among Healthcare Students

Exploratory study

N = 39 male and female Inter-Professional (IP) healthcare students’

The VR 360 immersion lasted for 7 minutes and had six mini scenarios that merged into the one simulation VR 360 experience to immerse students in the role of a patient with macular degeneration and high-frequency hearing loss. Students were asked to wear a hearing headset and visual ocular set (no description of camera or HMD) experience.

To examine the experiences and attitudes of students following a 360° video which simulated the experience of a patient.

Immediately following each VR 360° video immersive experience, a 60 min focus group was held (semi-structured format).

USA

Post

Students found that 360 video experience increased their empathy and ability to understand a patient with hearing loss through verbal and nonverbal signs will lead to improved patient experience.

The immersive element was evident in the comments about the realism and presence of feeling as if they “were in the patient’s shoes “or actively the patient’ in the 360° video experience.

Background noise was noted as a distraction. There was not an equal number of participants across healthcare professions.

9. Bernard, et al., (2019) [69]

Toward the development of 3-dimensional virtual reality video tutorials in the French neurosurgical residency program. Example of the combined petrosal approach in the French College of Neurosurgery.

Exploratory study

N = 17 seventeen senior neurosurgery residents and N = 5 ear, nose and throat (ENT) specialists

The study reports on the development of a commented 3D video displayed via Samsung Gear VR Virtual Reality Headset as a surgical tutorial. The team also developed 3D video capture, 3D legend and studio sound recording tools, to produce a 3D video adapted to several platforms

To to present a project of surgical neuro-anatomy teaching through a 3D video tutorial and assess the effectiveness of this teaching method.

At the end of the 3D surgical anatomy session students filled out an assessment form based on a 5-point Likert scale to assess the teaching and the positive and negative points of the teaching tool.

France

Post

Most participants had positive feelings about ease of use and their experience of the 3D video tutorial (n = 14, 63.6%) and 20 (90.9%) enjoyed using the video. 18 felt that the 3D video enhanced their understanding of the surgical approach (81.8%). 15 (68.2%) thought the video provided good 3D visualization of anatomical structures and 20 (90.9%) that it enabled better understanding of anatomical relationships. 12 (54.5%) considered that the cadaver dissection workshop was more instructive.

Sample size was small, study was specifically centered on the French training in neurosurgery in a specialist and complex area which requires anatomical knowledge.

10. Dawson et al., 2019 [70]

The use of virtual reality for public health education concerning Syrian refugee camps

Exploratory study

N = 17 public health students. N = 6 male and female first-year UG Public Health students from the UK and N = 11 s-year Public Health UG students from Lebanon

Samsung Gear 2 k was used by students in Lebanon to film footage of the visit for UK students which was edited into a 5-min clips from the camp and inside a family home. Students started viewing the footage using VR Box smartphone headsets then moved on to 2.5D viewing using a laptop or tablet screen to explore the footage.

Assess the impact of 360° videoing as a method of increasing UK students understanding of public health challenges faced by Syrian refugees

A questionnaire was used before and after (after included additional questions on the use of 360° video). A video interview was used for analysis after the exchange.

UK and Lebanon

Pre and Post

All participants involved in the evaluation deemed the use of 360° video as a positive experience where learning was enhanced, and emotions impacted. Participants thought that the 360° video had the potential to become more widely used in education as an adjunct or stand-alone teaching method. However, all users complained of simulator sickness, which was thought to detract from the immersive experience and possibly reduce the emotional impact of the experience.

Difficulties in regards to processing requirements for downloading 360° footage.

11. Taylor and Layland, 2018 [71]

Comparison study of the use of 360-degree video and non-360-degree video simulation and cybersickness symptoms in undergraduate healthcare curricula

Exploratory study

N = 60 undergraduate healthcare students participated in one of four identical (but different simulation) learning outcome simulation events.

This study compared four standard simulation tools, 360° video (using Samsung Gear VR), high-fidelity manikin, video case study and standardised patient, and analysed the self-reported cybersickness symptoms.

Determine the level of cybersickness symptoms in simulation learning and teaching tools in 360° video, manikin, standardised patient and video case study

Simulator Sickness Questionnaire (SSQ) [72].

UK

Post

360° videos are no more likely to provoke cybersickness symptoms than the other simulation methods. 360° videos were reported as less fatiguing than other modes of simulation learning. The fatigue symptom of participants in the non-360° condition was significantly higher than those in the 360° condition (p = 0.001). No other significant effects between simulations were found.

Need to control photorealism aspect, image refresh rate or alteration to the field of view to more accurately assess which can impact cybersickness.

12. Chan et al., 2021 [73]

Impact of 360 degree vs 2D Videos on Engagement in Anatomy Education

Experimental study

N = 39 fourth-year medical students. Participants were randomised into two groups: Group A viewed the 360° videos using the Oculus Go VR headset while Group B viewed the 2D videos on a laptop.

Samsung 360° Round Stereoscopic 3D camera and a NeXT PC stitching computer (NeXT Inc., Fremont, California) and 64 GB Oculus Go Headset was used Group A viewed the 360° videos using the Oculus Go VR headset. Each group watched both a 4 minute demonstration and explanation of upper endoscopy as well as a four-minute demonstration and explanation of liver biopsy in the same order.

To examine if 360° videos can promote increased engagement over standard two-dimensional (2D) videos among medical students learning anatomy.

Pre video: background questions as baseline for knowledge and attitudes towards immersive technology

During video: participants answered questions to gauge their engagement

Post video: participants completed a survey.

USA

Pre, during (3 time-points) and post

Seven out of eight questions assessing engagement were rated significantly higher in the 360° video group as opposed to the 2D group (Q1-6 and Q8 p < 0.05; Q9 p = 0.16), including feeling more stimulated and involved in the lab experience. Although the 2D group reported more ease and confidence with using the video playback feature (p < 0.05), there was no statistical difference in regards to perceived ease of learning between the two groups (p < 0.45). The 360° video was also rated as more practical (p < 0.007) and interesting (p < 0.001) than 2D.

Did not focus on the effectiveness of the use of immersive technologies to enhance knowledge. Did not assess changes in knowledge retention.

13. Sullivan et al., 2021 [74]

The Use of Virtual Reality Echocardiography in Medical Education

Cross-sectional observational study.

N = 15 medical students and staff. N = 3 cardiac electrophysiologists and N = 12 paediatric trainees, this included cardiology fellows (n = 4), general paediatric registrars (n = 7), and a senior house officer (n = 1).

Garmin VIRB® 360 and a head-mount display was used to record live echocardiography exams in a pediatric population. An Oculus Go™ was used to view the 360° immersive/VR videos.

To assess the utility of a VR echocardiogram in teaching echocardiography to paediatric trainees vs. live demonstration.

Trainees responded to a written questionnaire afterwards which included a 5-point Likert scale based on the usefulness of the technology.

Ireland

Post

All participants reported that VR echocardiography was a useful teaching tool and 87% (n = 13) rated it as good or very good on a 5-point Likert scale 93% (n = 14) said that they would recommend VR echocardiography to others as a teaching modality. The HMD was preferred by 80% (n = 12) in comparison to the tripod mount viewpoints. In comparison to live demonstration, 67% of respondents (n = 10) reported that VR echocardiography was the same or better. When asked how VR echo compared to traditional video for teaching, 80% (n = 12) rated it as better or much better.

A larger number of participants and using validated measures for data collection would have given more validity to the findings.

14. Lanzieri et al., 2021 [75]

Virtual Reality: An Immersive Tool for Social Work Students to Interact with Community Environments

Pilot study

N = 30 first-year Masters in Social Work (MSW) Students

The 360 VR simulation takes place in the Lower East Side (LES) of Manhattan, New York. The 360 VR simulation was developed by an internal media design and development team who used a Nikon KeyMission™ 360 camera and standard tripod and stitched together using Adobe Premiere software and Wonda VRTM, was used to edit the footage, an actor provided a recorded voice-over audio. Google Daydream headsets were used.

To investigate whether a virtual reality simulation impact student learning of a community environment

Pre-survey: designed to determine if participants’ prior experience influenced their performance.

Post-survey: contained 28 questions divided into three parts (Learning Experience, Technology Experience, General Attitudes).

USA

Pre and post

Students felt the virtual simulation was like a real world (M = 5.63, SD =1.33), focused (M = 5.93, SD = 1.05), and immersed (M = 5.73, SD = 1.17). They also reported the ability to locate objects in the environment with ease (M = 5.67, SD = 1.27). Overall, perceptions on immersion rate were high (M = 5.79, SD = 1.2).

Responses also showed an even split between “leaning toward VR” and “real-world environment” with a mean of 2.9

(SD = 1.24). Reflective questions alongside the technology was also considered helpful to increasing the immersive experience.

An experimental design that randomises participants into more than two groups to compare learning design features or methods using validated methods would have strengthened the study.