In this study, we report the development of a 180-degrees stereoscopic LP video in clinical setting. The evaluation of this video in a pilot study on 168 subjects, including 108 LP naive- trainees, showed a good tolerance and feasibility and high satisfaction among the students. Third-year medical students rated higher the perceived benefits and interests of the experience than subjects with prior LP experience, suggesting a real added-value of the video. Overall, it was found that implementing 180-degrees VR video into LP training could provide a beneficial learning experience.
Previous studies have highlighted the promise of VR video in medical education (Hu Au and Lee 2017; Taubert et al. 2019; Pottle 2019; Lohre et al. 2020). Interactive media and online materials provide engaging experience and can help in conceptualizing intricate 3D data (in surgery or anatomy) or integrating the sequences of medical technical procedures (Zhao et al. 2020; Sattler et al. 2020; Chan et al. 2021). In a survey by Sultan et al, 93 % of 169 undergraduate medical students were willing to engage in VR support for medical education(Sultan et al. 2019). Moreover, knowledge retention and skills acquisition scores were higher regarding after a 360-degrees video training compared to a classical lecture in a basic sciences module session. A meta-analysis on 21 studies reported higher accuracy in medical practice by people trained through VR for laparoscopic surgery training in 87% of cases compared to conventional training (Samadbeik et al. 2018).
LP is an essential tool in daily clinical practice and despite being a relatively safe procedure performed at patient bedside, a negative attitude appears to persist both in general population and in medical students (Duits et al. 2016; Tsvetkova et al. 2017). In several studies, medical trainees associated LP with a high level of difficulty and a low level of confidence compared to other similar bedside procedures (Dehmer et al. 2013; von Cranach et al. 2019). The development of simulation based training has allowed practice in a safe environment and significantly increased confidence and real life procedural skills (Barsuk et al. 2012; Gaubert et al. 2021).
Our aim was to develop a 180-degree video that would constitute an educational precursor to simulation session. Preliminary feedback received on this new teaching tool was positive. Our preliminary assessment showed that overall satisfaction score was high. Cybersickness characterized by blurred vision, nausea or headache was seldom experienced by our participants. The video was evaluated an interesting enhancement to the simulation training. Interestingly, the medical students groups had a significantly higher satisfaction, perceived a higher interest in the video and were keener to have the video in open access for repeated use than the group of attendings and residents with prior LP experience. This suggests that the video provided them with additional content, probably on real-life setting conditions (patient and operator installation during the gesture, communication with the patient during the procedure) that was not given by the simulation-training and that was not perceived by subjects that had already performed LP. The 3D characteristic of the video was seen as an addition of more moderate interest compared to conventional 2-dimension video. It is known that the perceived interest of 3D increases with the interaction level, lower in a passive video, which could account for this lower rating (Pottle 2019). All in all, the association of LP training session on simulators allowing for technical skills learning and the 3D-video providing education about patients installation and full conduct of the procedure in "real life" could be an optimal teaching method.
VR 180- or 360-degrees video present with several advantages. On a technical level, the material requirement is low: a connected screen device (VR headset, computer or mobile device) on which the video has been charged is the only required material. Each group can perform the activity in any environment being provided the VR headset. A large number of trainees can use this tool simultaneously and its viewing can be repeated as needed. There is no need for continuous supervision. On a practical level, it was easy to produce, compared to immersive VR where the production is time consuming and often requires a large production team. The video could be recorded and edited within a few days. The low cost is also a significant aspect, when considering applying it into education especially for low-income settings. Finally, the video modality allows for remote teaching, which is very valuable in the current Covid pandemic context and the associated need to restrict physical contact (Sandrone et al. 2021).
We made the choice of a VR 180-degrees video(Stefaniak 2020). Evolving in a 180-degrees space, viewers focus could be guided in a stereoscopic first-person point-of-view. The video did not provide full-immersion as in 360-degrees or the ability to look in any direction, but in our cases, it was not needed as the patient's back and the hands of the operator were the points of interest. The 180-degrees format also eliminated resolution and bandwidth issue that can be observed with 360-VR video format.
Our study has several limitations. VR is a relatively new pedagogical technique, so there is no high-quality evidence on the effectiveness of VR- based teaching. Evaluation of the effect of the video training on the performance of LP for the first time on a patient will be the next step of assessment, as it was done for evaluation of simulation training(Gaubert et al. 2021). A better perception of benefit could also be achieved by involving students from several academic levels. Recording different clinical situations (LP procedure on an obese subject or in lateral decubitus) would also allow students to confront themselves to the different situations a physician can encounter in clinical practice (Edwards et al. 2015). Nevertheless, we think our results open a door for future studies to further investigate the development of a VR-based LP training system by demonstrating the feasibility of the administration of the video and encouraging data regarding student’s interest.