The Efficacy of Immersive 360-degree Video in Improving Spatial Orientation Among Medical Students.

Background and Rationale: Effective medical education requires continuous adaptation, including adoption of new technologies. Readily affordable and accessible new technologies have the potential to improve trainee performance, build their confidence, and prepare them for the demands of clinical care. At their best, new medical education technologies achieve these goals without requiring a significant investment of time and resources, which are understandably limited in the modern education system. A classic example is the adoption of 2-dimensional (2D) videos for medical training, which can provide a standardized and consistent learning experience that enhances knowledge transfer, appeals to learners with various learning styles, and allows for both synchronous and asynchronous teaching.

An emerging and promising technology for use in medical education is immersive virtual reality (IVR). Combined with a head-mounted display (such as a VR headset), this technology fully immerses the user in a virtual setting, allowing the user to feel present in the virtual space. As commercial VR headsets become readily affordable and available, IVR presents as a cost-effective educational tool that does not require significant time and resources such as staff and hospital spaces.

There is a growing literature on the use of IVR in medical education. A recent systematic review found that trainees were very receptive to IVR, rating it more highly than most other training methods. Users found IVR to be a "positive learning experience, increasing self-efficacy, attentiveness, and motivation". Furthermore, IVR can be highly effective: when compared with other training methods, those trained with IVR had better performance scores for surgical procedures such as total hip arthroplasty or tibia intramedullary nailing. However, it must be noted that IVR is not universally superior to other training methods. For instance, IVR was similar to existing study materials for learning medical knowledge about total hip arthroplasty and anatomy, or general lower cognitive skills such as remembering facts. Thus, IVR must be tested on a case-by-case basis before being adopted for a new medical education area.

One intriguing use for IVR is during onboarding and orientation of medical students. Throughout their training, undergraduate medical students rotate through different clinical sites, where they often face the challenge of adjusting to unfamiliar environments. This unfamiliarity may cause students to get lost and arrive late to their clinical assignments. This is a known issue: a survey of surgical clerkship students at a US hospital found that over 30% of respondents wanted more tours of the hospital early in their clerkship. Anecdotal and survey feedback from Sunnybrook Health Sciences Centre also suggests that unfamiliarity with a new environment induces anxiety among trainees and may result in some 'false' starts on the first day of the rotations. Given that stress and anxiety is associated with impaired medical student learning and burnout, strategies that improve wayfinding for medical students will positively impact their learning, confidence, and overall education experience.

Currently, wayfinding and orientation for medical students primarily utilize text-based directions, which are at times supplemented by photographs and standard 2D videos. The addition of such 2D videos for hospital induction has been shown to improve learners' experiences, allowing them to feel more confident and better oriented on the first day of their placement. Compared to 2D videos, the realism of IVR utilizing 360-degree immersive videos may provide a sense of direction with better wayfinding skills, because it will allow the learner to explore and experience the depicted location. This notion is supported by a 2017 systematic review, which found IVR to be particularly effective in improving users' spatial learning and orientation. However, whether 360-degree video IVR is superior to 2D videos on improving the wayfinding and orientation experience for medical students has not been studied in a randomized trial.