Table 1.
Characteristics of selected 25 studies included in the systematic review.
| Author (Year) /Country |
Study Design | Sample Size | Participants | Age [Mean/Median] (SD/Range) |
VR Device (FI/LI) | Feedback | Intervention | Comparator | Session (Total Time) |
Outcome | Measurement Tool (Items) |
||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total | Exp. | Cont. | |||||||||||
| Andreatta et al. (2010)/ USA |
RCT | 15 | 7 | 8 | postgraduate year 1 to 4 emergency medicine residents | NR | VR CAVE (FI) | NR | VR triage training | SP (standardized patient) | 1 (NR) |
Knowledge | Self-developed MCQ (24) |
| Brinkmann et al. (2017)/ Germany |
RCT | 36 | 18 | 18 | medical students | E 23 (21–29) C 23.5 (22–40) |
Lap Mentor; Simbionix (LI) | Intensive feedback and individual coaching | VR laparoscopic cholecystectomy | FLS Program | 8 (NR) |
Skill Self-efficacy |
GOALS (5) self-assessment (6) |
| Cannon et al. (2014)/ USA |
RCT | 48 | 27 | 21 | postgraduate year 3 orthopedic residents | NR | ArthroSim (LI) | Tactile feedback | VR arthroscopic knee surgery | standard education | 4 (11 h) |
Skill | GRS (7) Procedural checklist (21) |
| Chou et al. (2006)/ USA |
RCT | 16 | 8 | 8 | first-year medical students | E 23.9 (2.2) C 23.4 (1.7) |
UROMentor; Simbionix (LI) | Tactile feedback | VR ureteroscopy training | TMU (mannequin) | 1 (2 h) |
Skill | OSATS (6) |
| Farra et al. (2013)/ USA |
RCT | 47 | 22 | 25 | 2nd-year associate degree nursing students | (18–57) | 3-D Second Life platform (FI) | Provided to the learner note cards and message | VRS in disaster training | web-based modules | 1 (20 min) |
Knowledge | Validated MCQ (20) |
| Feifer et al. (2011)/USA | RCT | 20 | E1:5 E2:5 |
C1:5 C2:5 |
medical students | (20–46) | LapSIM; daVinci robotic platform (LI) | NR | VR for robotic surgical training | C1:ProMIS C2:no training |
5 (NR) |
Skill | MISTELS |
| Halloran et al. (2017)/ USA |
RCT | 137 | 70 | 67 | undergraduate nursing students | 27.75 (6.43) | ATI Real Life modules (LI) | NR | Virtual patient simulation for pediatric | no training | 2 (2.5 h) |
Anxiety | STAI (40) |
| Jiang et al. (2018)/ China |
RCT | 46 | 23 | 23 | 3-years anesthesia residents | E 25.1 (1.8) C 25.0 (1.6) |
GI-Bronch Mentor; Simbionix (LI) | Tactile feedback and oral instructions | VR fiberoptic bronchoscope manipulation | high-fidelity mannequin | 25 (NR) |
Skill Confidence |
GRS (6) 5-point Likert rating scale |
| Jung et al. (2012)/ Korea |
RCT | 114 | E1:38 E2:38 |
38 | 1-years nursing students | E1 21.13 (3.53) E2 19.08 (0.71) C 19.26 (1.22) |
ARSim IV-100 (LI) | Haptic feedback | VR intravenous practical exercise | catheterization on mannequins | 1 (10 min) |
Anxiety Procedure score |
VAS Checklist score (10) |
| Ko et al. (2018)/ China |
RCT | 36 | 12 | C1:12 C2:12 |
junior residents, interns, and elective students |
NR | LAP Mentor; Simbionix (LI) | Unclear | VRS for gynecology laparoscopic suturing training |
C1:box training C2:no training |
2 (4 h) |
Skill | GOALS (4) |
| Kowalewski et al. (2018)/ Germany |
RCT | 64 | 33 | 31 | postgraduate year 3–6 senior residents | E 28.1 (2.4) C 28.5 (2.6) |
Lap Mentor II; Simbionix (LI) | NR | Multi-modality training (VR with box training) for laparoscopic cholecystectomy | no training | 8 (12 h) |
Skill | GOALS (5) |
| Leblanc et al. (2013)/ Canada |
RCT | 22 | 11 | 11 | orthopedic surgery residents | (25–40) | Tabs with the haptic device; PHANTOM (LI) | Haptic feedback | VR surgical fixation for ulnar fracture | Sawbones simulator | NR | Skill | GRS (6) |
| Lucas et al. (2008)/ USA |
RCT | 32 | 16 | 16 | first- and second-year medical students | NR | Lap Mentor; Simbionix (LI) | NR | VRT for laparoscopic cholecystectomy | no training | 6 (3 h) |
Skill Knowledge |
OSATS (8) |
| Nickel et al. (2015)/ Germany |
RCT | 84 | 42 | 42 | medical students | E 24.5 (2.6) C 24.1 (2.1) |
Lap Mentor; Simbionix (LI) | NR | VRT for laparoscopic cholecystectomy | Blended Learning (10 h of box training + 2 h of E-learning) | 3 (12 h) |
Skill Knowledge |
OSATS (7) |
| Padilha et al. (2019)/ Portugal |
RCT | 42 | 21 | 21 | second-year nursing students | E 19.29 (0.46) C 20.29 (2.19) |
VSIM (LI) | NR | Clinical virtual simulation scenario using case-based learning | low-fidelity simulator | 1 (45 min) |
Knowledge Self-efficacy Satisfaction |
True/false and multiple-choice test General self-efficacy scale (10) learner satisfaction with simulation tool (20) |
| Park et al. (2007)/ Canada |
RCT | 24 | 12 | 12 | general surgery and internal medicine residents | NR | AccuTouch colonoscopy simulator (LI) | Haptic feedback | VRT for colonoscopy | no further training | 1 (2–3 h) |
Skill | GRS (7) |
| Rossler et al. (2018)/ USA |
RCT | 20 | 5 | 15 | prelicensure baccalaureate nursing students |
NR | Virtual Electrosurgery Skill Trainer (LI) | NR | VRS for OR fire drill scenario | traditional programmatic education | NR | Knowledge | Self-developed MCQ (7) + true/false test (3) |
| Stepan et al. (2017)/ USA |
RCT | 66 | 33 | 33 | first- and second-year medical students | NR | Oculus Rift VR system, LLC, a VR head-mounted display (FI) | NR | VRS for neuroanatomy | online textbook | 1 (20 min) |
Knowledge Self-efficacy Satisfaction |
Self-developed MCQ (10/30) + fill-in-the-blank questions IMMS (36) |
| Suebnukarn et al. (2011)/ Thailand |
RCT | 32 | 16 | 16 | fourth-year dental students | NR | 2.8-GHz Pentium 4PC, with 256 MB RAM and a 13-in computer monitor, connected to two haptic devices (LI) | Haptic feedback | VR for cavity preparation training | training using extracted teeth and phantom head | 3 (2 h) |
Skill | 4-point scale (4) |
| Tubelo et al. (2016)/ Brazil |
RCT | 18 | 9 | 9 | undergraduate dentistry students | NR | Articulate Storyline 2 (LI) | Positive or negative message feedback | Virtual simulation for dentistry | traditional method of education (book) | 1 (20 min) |
Knowledge | True/false question (10) |
| Vaccaro et al. (2013)/ USA |
RCT | 18 | 9 | 9 | postgraduate years 2–5 resident physicians | NR | DaVinci surgical simulator (FI) | NR | Robotic VRS for surgical skill | Standard Robotic Orientation | 1 (3 h) |
Skill | GRS (5) |
| Vargas et al. (2016)/ USA |
RCT | 36 | 19 | 19 | medical students | 24.9 | daVinci Surgical Simulator (FI) | Expert surgeon provided instruction to all participants | VRT for gynecologic surgery of a cystotomy closure | standard education | 10 (NR) |
Skill | GEARS (5) |
| Waterman et al. (2016)/ USA |
RCT | 22 | 12 | 10 | orthopedic surgery trainees | E (32) C (33) |
Arthro VR shoulder simulator; Smbionix (LI) | Haptic feedback | VRS for diagnostic shoulder arthroscopy | standard practice | 4 (1 h) |
Skill | ASSET (8) |
| Wilhelm et al. (2002)/ | RCT | 21 | 11 | 10 | medical students | E 23.7 (1.8) C 24.2 (1.4) |
UROMentor; Simbionix (LI) | Expert endoscopists provided supervised training to the training group | VR case scenario for basic endoscopic performance | no further training | 5 (2 h 30) |
Skill Self-efficacy |
GRS (5) 5-point self-evaluation (10) |
| Wong et al. (2019)/ | RCT | 31 | 16 | 16 | medical students, anesthesia assistants, anesthesia residents | E 54.8 (10) C 55.1 (18) |
ORSIM airway simulator (LI) | NR | VR bronchoscopy simulator training to FOB | no further training | 1 (1 h) |
Skill | GRS (8) |
E = Experimental group; C = Control group; VR = Virtual reality; VRS = Virtual reality simulation; VRT = Virtual reality training; FI = Fully immersive virtual reality; LI = Less immersive virtual reality; NR = Not reported; RCT = Randomized Controlled Trials; MCQ = Multiple choice questions; FLS = the Fundamentals of Laparoscopic Surgery; GOALS = the Global Operative Assessment of Laparoscopic Skills score; GRS = global rating scale; TMU = the ureteroscopy training model; OSATS = Objective Structured Assessment of Technical Skills; STAI = the State-Trait Anxiety Inventory; VAS = Visual Analog Scale; IMMS = Instructional Materials Motivational Survey; GEARS = Global Evaluative Assessment of Robotic Skills; ASSET = the Arthroscopic Surgery Skill Evaluation Tool; FOB = Flexible optical bronchoscopic.