The merger of game-based approaches and Virtual Reality (VR) environments that can enhance learning and training methodologies have a very promising future, reinforced by the widespread market-availability of affordable software and hardware tools for VR-environments. Rather than passive observers, users engage in those learning environments as active participants, permitting the development of exploration-based learning paradigms. There are separate reviews of VR technologies and serious games for educational and training purposes with a focus on only one knowledge area. However, this review covers 135 proposals for serious games in immersive VR-environments that are combinations of both VR and serious games and that offer end-user validation. First, an analysis of the forum, nationality, and date of publication of the articles is conducted. Then, the application domains, the target audience, the design of the game and its technological implementation, the performance evaluation procedure, and the results are analyzed. The aim here is to identify the factual standards of the proposed solutions and the differences between training and learning applications. Finally, the study lays the basis for future research lines that will develop serious games in immersive VR-environments, providing recommendations for the improvement of these tools and their successful application for the enhancement of both learning and training tasks.

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A review of immersive virtual reality serious games to enhance learning and training

Background The use of e-learning, defined as any educational intervention mediated electronically via the Internet, has steadily increased among health professionals worldwide. Several studies have attempted to measure the effects of e-learning in medical practice, which has often been associated with large positive effects when compared to no intervention and with small positive effects when compared with traditional learning (without access to e-learning). However, results are not conclusive. Objectives To assess the effects of e-learning programmes versus traditional learning in licensed health professionals for improving patient outcomes or health professionals' behaviours, skills and knowledge. Search methods We searched CENTRAL, MEDLINE, Embase, five other databases and three trial registers up to July 2016, without any restrictions based on language or status of publication. We examined the reference lists of the included studies and other relevant reviews. If necessary, we contacted the study authors to collect additional information on studies. Selection criteria Randomised trials assessing the effectiveness of e-learning versus traditional learning for health professionals. We excluded non-randomised trials and trials involving undergraduate health professionals. Data collection and analysis Two authors independently selected studies, extracted data and assessed risk of bias. We graded the certainty of evidence for each outcome using the GRADE approach and standardised the outcome effects using relative risks (risk ratio (RR) or odds ratio (OR)) or standardised mean difference (SMD) when possible. Main results We included 16 randomised trials involving 5679 licensed health professionals (4759 mixed health professionals, 587 nurses, 300 doctors and 33 childcare health consultants).When compared with traditional learning at 12-month follow-up, low-certainty evidence suggests that e-learning may make little or no difference for the following patient outcomes: the proportion of patients with low-density lipoprotein (LDL) cholesterol of less than 100 mg/dL (adjusted difference 4.0%, 95% confidence interval (CI) -0.3 to 7.9, N = 6399 patients, 1 study) and the proportion with glycated haemoglobin level of less than 8% (adjusted difference 4.6%, 95% CI -1.5 to 9.8, 3114 patients, 1 study). At 3- to 12-month follow-up, low-certainty evidence indicates that e-learning may make little or no difference on the following behaviours in health professionals: screening for dyslipidaemia (OR 0.90, 95% CI 0.77 to 1.06, 6027 patients, 2 studies) and treatment for dyslipidaemia (OR 1.15, 95% CI 0.89 to 1.48, 5491 patients, 2 studies). It is uncertain whether e-learning improves or reduces health professionals' skills (2912 health professionals; 6 studies; very low-certainty evidence), and it may make little or no difference in health professionals' knowledge (3236 participants; 11 studies; low-certainty evidence).Due to the paucity of studies and data, we were unable to explore differences in effects across different subgroups. Owing to poor reporting, we were unable to collect sufficient information to complete a meaningful 'Risk of bias' assessment for most of the quality criteria. We evaluated the risk of bias as unclear for most studies, but we classified the largest trial as being at low risk of bias. Missing data represented a potential source of bias in several studies. Authors' conclusions When compared to traditional learning, e-learning may make little or no difference in patient outcomes or health professionals' behaviours, skills or knowledge. Even if e-learning could be more successful than traditional learning in particular medical education settings, general claims of it as inherently more effective than traditional learning may be misleading.

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E-learning for health professionals.

Serious games are computer-based games designed for training purposes. They are poised to expand their role in medical education. This systematic review, conducted in accordance with PRISMA guidelines, aimed to synthesize current serious gaming trends in health care training, especially those pertaining to developmental methodologies and game evaluation. PubMed, EMBASE, and Cochrane databases were queried for relevant documents published through December 2014. Of the 3737 publications identified, 48 of them, covering 42 serious games, were included. From 2007 to 2014, they demonstrate a growth from 2 games and 2 genres to 42 games and 8 genres. Overall, study design was heterogeneous and methodological quality by MERQSI score averaged 10.5/18, which is modest. Seventy-nine percent of serious games were evaluated for training outcomes. As the number of serious games for health care training continues to grow, having schemas that organize how educators approach their development and evaluation is essential for their success.

A Systematic Review of Serious Games in Training Health Care Professionals.

Training that future practitioners receive in software project management is a topic of great importance. The objective of this systematic literature review is to summarize the current state of the art of the different methods and procedures used to assess serious games. The review follows a predefined procedure that involves automatically searching well-known digital databases. 1199 papers were found by the automatic searches in the digital databases and 102 papers were selected as primary studies. The process was complemented with manual searches using author and backward snowballing techniques. Our systematic literature review identified the main methods followed to assess serious games, the application domains in which the assessments took place, the categories of serious games assessed, the main features considered to assess the educational effectiveness of serious games, the procedures followed for the assessments and the size of the population that participated in the assessments. The results are useful to researchers and practitioners willing to assess serious games in different fields, but specially to those interested in assessing serious games in the area of software project management. We present a systematic literature review on serious games (SG) evaluation.We summarize the different methods and procedures used to assess SG.We observe the application domains and the categories of SG assessed.We identify the main methods, features, procedures and size of population to assess SG.Results are intended to be applied in the area of SG in software project management.

A systematic literature review on serious games evaluation

In the education process, students face problems with understanding due to the complexity, necessity of abstract thinking and concepts. More and more educational centres around the world have started to introduce powerful new technology-based tools that help meet the needs of the diverse student population. Over the last several years, virtual reality (VR) has moved from being the purview of gaming to professional development. It plays an important role in teaching process, providing an interesting and engaging way of acquiring information. What follows is an overview of the big trend, opportunities and concerns associated with VR in education. We present new opportunities in VR and put together the most interesting, recent virtual reality applications used in education in relation to several education areas such as general, engineering and health-related education. Additionally, this survey contributes by presenting methods for creating scenarios and different approaches for testing and validation. Lastly, we conclude and discuss future directions of VR and its potential to improve the learning experience.

https://www.mdpi.com/2078-2489/10/10/318/pdf

Virtual Reality and Its Applications in Education: Survey

Collaborative virtual reality based advanced cardiac life support training simulator using virtual reality principles

The use of virtual reality (VR) training tools for medical education could lead to improvements in the skills of clinicians while providing economic incentives for healthcare institutions. The use of VR tools can also mitigate some of the drawbacks currently associated with providing medical training in a traditional clinical environment such as scheduling conflicts and the need for specialized equipment (e.g., high-fidelity manikins). This paper presents the details of the framework and the development methodology associated with a VR-based training simulator for advanced cardiac life support, a time critical, team-based medical scenario. In addition, we also report the key findings of a usability study conducted to assess the efficacy of various features of this VR simulator through a postuse questionnaire administered to various care providers. The usability questionnaires were completed by two groups that used two different versions of the VR simulator. One version consisted of the VR trainer with it all its features and a minified version with certain immersive features disabled. We found an increase in usability scores from the minified group to the full VR group.

Design and Development of a Virtual Reality Simulator for Advanced Cardiac Life Support Training

Central venous catheter related complications are a large burden on our healthcare system. Many of these complications can be prevented by the use of proper technique. One methodology to aid in the teaching non-technical aspects of procedures, serious games, has not been utilized in our field. The authors therefore set out to design a serious game aimed at teaching proper central venous catheter placement. The objective of this manuscript is to examine the challenges encountered while designing and executing our serious gaming trial. Ultimately, they found their game to be an effective teaching tool, although the game development phase of our study was long. The authors therefore concluded that serious gaming is an effective tool for teaching proper technique for the placement of central venous catheters.

Using Serious Gaming to Improve the Safety of Central Venous Catheter Placement: A Post-Mortem Analysis

This paper provides a novel approach for training in collaborative environment by integrating collaborative virtual environment (CVE) and haptic joystick. Active World is used as the CVE and Novint Falcon is the preferred haptic device to send force back to the user(s). As our test scenario, we consider cardiopulmonary resuscitation (CPR) skills training simulator for re-training purpose. CPR is not just a compress-and-release procedure - it is a collaborative work and is affected by the performance of each team member. This study also explains the transferability of the CPR skills from this system to the real world case. The data collected from 12 participants verify that this simulator helps users to improve the accuracy of compression rate, and also to retain the skill afterwards.

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Interactive Haptic Virtual Collaborative Training Simulator to Retain CPR Skills

Serious games are gaining popularity in being used for training purposes in various fields. They were first used for training various medical and military procedures. At present, there are several platforms available for developing serious games. In this paper, we present a serious game designed using a gaming engine called Unreal Engine, which facilitates the development of serious games for PCs as well as mobile iOS devices. The serious game that is presented in this paper is designed to provide training for the aseptic method for Central Venous Catheter (CVC), also known as central line, placement procedure. The pilot study was performed with first year residents from the department of anesthesiology at Mount Sinai Medical Center, NY and the residents claimed they felt it aided them in their line placements.

Prabal Khanal

Papers

Collaborative virtual reality based advanced cardiac life support training simulator using virtual reality principles

Design and Development of a Virtual Reality Simulator for Advanced Cardiac Life Support Training

Using Serious Gaming to Improve the Safety of Central Venous Catheter Placement: A Post-Mortem Analysis

Interactive Haptic Virtual Collaborative Training Simulator to Retain CPR Skills

Design and development of a serious game for central line placement