Heart Rate Variability and Cognitive Load on Image-Based Virtual Reality Instructional Design in Otolaryngology
Condition: Cognitive Function 1, Social; Competence; Heart Rate Fast; Learning, Spatial; Otolaryngologic Disorder
MeSH terms: Tachycardia
Study type: Interventional

Summary: 
      This study aims to compare heart rate variation, cognitive load, and learning outcomes of
      novel image-based virtual reality with traditional video in learning for otolaryngology. Half
      of participants will receive image-based virtual reality learning, while the other half will
      receive video-based learning.
    

Detailed description: 
      Background: Workplace-based assessments, such as mini-clinical evaluation exercise
      (mini-CEX), direct observation of procedural skills (DOPS), and milestones, target the
      highest level of clinical competence and collect information about doctors' performance in
      their normal practice. Recent advances in virtual reality (VR) simulation, lowering the
      complex of learning task and the cognitive load (CL) of the learner, make this novel
      technology well suited for the initial training of novices. Reduced heart rate variation
      (HRV), an indicator of stress, is associated with decreased cognitive efficiency in health.
      Accordingly, this study hypothesizes that VR-based instruction can help novices to increase
      HRV, decrease CL, and then improve their outcomes of workplace-based assessments.

      Aims: This prospective study aims (1) to design an image-based VR (IBVR) instruction for
      clinical medical education, (2) to compare HRV and CL in traditional video-based (VB)
      learning and novel IBVR-based learning, (3) to compare outcomes of mini-CEX, DOPS, and
      milestone between two modules, (4) to perform a qualitative evaluation of IBVR-based learning
      using a 360-degree video review, and (5) to assess various levels of novice learners
      (undergraduate medical students and postgraduate year residents) for their participation in
      and acceptance of this novel IBVR-based learning.

      Study Designs: This 3-year study includes two parts: (1) Design a VR-based curriculum
      including fundamental otolaryngological skills, and (2) Validation of an IBVR-based history
      taking and physical examination (H&P) learning activity using a blinded randomized,
      parallel-controlled trial in convenience-sampled novice undergraduate medical students and
      postgraduate year residents.

      Materials and Methods: This study will be implemented between August 1, 2017 and July 30,
      2020. Firstly, a VR-based curriculum will be designed including H&P using the analysis,
      design, development, implementation, and evaluation model and a modified Delphi approach. VB
      module and IBVR module of the same contexts will be developed. Secondly, an IBVR-based H&P
      learning activity will be validated by measuring CL questionnaires, reaction time, HRV,
      mini-CEX, DOPS, milestones, global satisfaction scale and AttrakDiff2 questionnaires (n =
      64). Age, sex, and cognitive style (determined by the Group Embedded Figures Test) of both
      groups are matched. Differences in variables of interests will be statistically analyzed.
    

Intervention name(s): image-based virtual reality learning; video-based learning
Intervention type(s): Other; Other
Intervention description(s): The participants will use a whole-view, 360 degree image-based virtual reality to learn a competence of history taking and physical examination for otolaryngology and they can see the response of the staffs and standard patients (including image, voice, face expression, movement, ... etc).; voice of the staffs and standard patients.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This randomized controlled trial will recruit 64 subjects who are novices in otolaryngology at an academic teaching hospital. The cognitive style of the participants is assessed using the Group Embedded Figures Test. The subjects are randomly assigned (1:1) to a novel image-based virtual reality group and conventional video-based group matched by age, sex, and cognitive style.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: cognitive load; competence; heart rate variation; learning; otolaryngology; video; virtual reality