| Title | Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360 degrees virtual reality application for medical education: a post hoc analysis of a randomized controlled trial. | ||
| Author | Hsin, Li-Jen; Chao, Yi-Ping; Chuang, Hai-Hua; Kuo, Terry B J; Yang, Cheryl C H; Huang, Chung-Guei; Kang, Chung-Jan; Lin, Wan-Ni; Fang, Tuan-Jen; Li, Hsueh-Yu; Lee, Li-Ang | ||
| Journal | Virtual Real | Publication Year/Month | 2022-Sep |
| PMID | 36118174 | PMCID | PMC9470506 |
| Affiliation | 1.Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China. GRID: grid.454211.7. ISNI: 0000 0004 1756 999X;Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Department of Computer Science and Information Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305 Taiwan. GRID: grid.454211.7. ISNI: 0000 0004 1756 999X;Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Department of Family Medicine, Taipei Branch and Linkou Main Branch, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305 Taiwan, Republic of China. GRID: grid.413801.f. ISNI: 0000 0001 0711 0593;Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, 10608 Taiwan. GRID: grid.412087.8. ISNI: 0000 0001 0001 3889;School of Medicine, National Tsing Hua University, Hsinchu, 300044 Taiwan. GRID: grid.38348.34. ISNI: 0000 0004 0532 0580;Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan. GRID: grid.260539.b. ISNI: 0000 0001 2059 7017;Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan. GRID: grid.260539.b. ISNI: 0000 0001 2059 7017;Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305 Taiwan. GRID: grid.454211.7. ISNI: 0000 0004 1756 999X;Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China. GRID: grid.454211.7. ISNI: 0000 0004 1756 999X;Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China. GRID: grid.454211.7. ISNI: 0000 0004 1756 999X;Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China. GRID: grid.454211.7. ISNI: 0000 0004 1756 999X;Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China. GRID: grid.454211.7. ISNI: 0000 0004 1756 999X;Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China. GRID: grid.454211.7. ISNI: 0000 0004 1756 999X;Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan. GRID: grid.145695.a. ISNI: 0000 0004 1798 0922;Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan. GRID: grid.260539.b. ISNI: 0000 0001 2059 7017;School of Medicine, National Tsing Hua University, Hsinchu, 300044 Taiwan. GRID: grid.38348.34. ISNI: 0000 0004 0532 0580. | ||
Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360 degrees VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360 degrees VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and </= 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360 degrees VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.