The Use of Immersive 360-degree Video in Improving Spatial Orientation.

Study Overview
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Brief Summary
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As medical students rotate through different hospital sites as part of their studies, the students are frequently exposed to new and unfamiliar environments. This can cause anxiety in some students, and can potentially result in students becoming lost, and arriving late to their activities. To prevent this, students are currently provided with instructions in the form of written directions, photographs, maps, and/or 2-dimensional videos. In this study, the investigators will test if immersive 360-degree virtual reality videos (videos shown using a headset/goggles that allow the wearer to experience the video as though they were actually there), are better at teaching medical students how to navigate the hospital and find new locations, compared to normal, 2-dimensional video instructions. Medical students will be asked to find their way to two new locations within the hospital, after being given instructions using either 2-dimensional (standard) video or 360-degree virtual reality video. The investigators will measure how long it takes students to find the new locations, and how often the students get lost or confused along the way. If successful, the investigators believe that this new method of teaching will help students to get around in new places more easily and lessen student anxiety. This will also increase knowledge related to 360-degree virtual reality video for teaching medical students.

Detailed Description
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Background: The recent emergence and commercialization of immersive virtual reality (VR) shows great promise in its application to medical education. While several surgical, critical care, and procedural 'virtual reality simulators' are described, very few immersive VR experiences that use 360-degree videos have been described. 360-degree video is a form of virtual reality that shows video content in a globe creating a sense of immersion and realism that is not possible in standard 2D-videos. The videos are viewed using a virtual reality headset capable of displaying the 360-degree content. Among the few studies that do describe immersive learning experiences in medical training, very few have explored the modality from a pedagogical perspective. It is still unclear whether learning via an immersive experience through 360-degree videos is better than traditional methods such as 2D videos. The use of traditional 2D video is quite well established in medical education as it enhances knowledge transfer, communication skills, attitude formation, and appeals to learners with various learning styles. Videos are commonly used for clinical skills training as they provide standardized and consistent learning experiences. They can also be used as resources for 'just-in-time' learning, where students preview content by watching videos before attending didactic or hands-on sessions. Patient case videos allow for rare clinical scenarios to be available to students in perpetuity. The use of video has allowed for the delivery of educational content in both asynchronous and synchronous (i.e. live or real-time) formats allowing for streaming of video to distant locations with real-time dialogue at all sites. These advantages of video have enabled the rapid expansion of some medical schools to multiple hospitals. As medical students rotate through these sites during their clinical years, the students often face the challenge of adjusting to unfamiliar environments. Anecdotal as well as survey feedback from the investigators site 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. Furthermore, the unfamiliarity may cause students to get lost and arrive late to their clinical assignments. Current solutions include text-based directions for way-finding and orientation, which are at times are supplemented by photographs and standard 2-dimensional video. The realism of 360-degree videos may provide a sense of direction with better wayfinding skills because it will allow the learner to explore and 'experience' the depicted location. To date, there is no study reported comparing 2D with 360-degree video on wayfinding and the orientation experience for medical students. The use of video to assist with wayfinding and orientation exists but is not currently reported in the literature. A randomized controlled trial was conducted to evaluate the utility of standard lecture and 2D video in orienting students to the anesthesia machine and the operating room setup. The orientation 2D video group performed significantly better with higher post-test scores but scored lower on satisfaction as students preferred the traditional lecture. The study did not assess the utility of orientation videos for wayfinding. Furthermore, the efficacy in improving spatial orientation, reducing anxiety, or enhancing the orientation process is not well known. Hypothesis: The investigators hypothesize that 360-degree videos enhance the spatial orientation of medical students by Improving way-finding and sense of orientation Conferring a sense of presence Increasing level of satisfaction with the learning experience Decreasing anxiety with a new environment Objectives: To investigate whether immersive 360-degree video enhances spatial orientation and recall for pre-clerkship students To compare immersive 360-degree video to two-dimensional videos for spatial orientation Methods: This will be a prospective randomized controlled trial. Pre-clerkship (year 1 and 2) medical students from the University of Toronto, Temerty Faculty of Medicine will be recruited to take part in the study. Participants will complete a baseline questionnaire collecting data quantifying key potentially confounding factors such as previous 360 videos, previous visits to Sunnybrook Hospital, physical gait disability, and navigation experience. Students will be randomized to two groups (see below) and given video orientation for each route. It takes approximately 4 minutes to walk each one. Route 1: Anesthesia lounge on 3rd floor to the fracture clinic (CG 15) on the ground floor using the B wing stairs. Route 2: Anesthesia lounge on 3rd floor to Interventional Radiology front doors on the ground floor using the A wing stairs. The under armour smart phone application (https://www.mapmyrun.com/) was used to ensure both routes were Equidistant (approximately 100m). The goal of having each group complete different routes is to assess internal validity within each group when given traditional vs. VR instructions. Group 1 and 2 will also be compared to assess which learning method is superior. Group A VR - Route 1: Students will be first taken to the anesthesia lounge. Here the students will receive VR instructions on how to navigate Route 1 (i.e. the students will watch a 360-degree immersive video using Oculus VR headset). Then the students will be assessed with an observed walkthrough of Route 1. Traditional - Route 2: After completing the Route 1 walkthrough, the same group will be given traditional instructions (2D video) on navigating Route 2, followed by an observed walkthrough of Route 2. Group B Traditional - Route 1: Students will be first taken to the anesthesia lounge. Here the students will receive traditional instructions (2D video) on how to navigate Route 1. Then the students will be assessed with an observed walkthrough of Route 1. VR - Route 2: After completing the Route 1 walkthrough, the same group will be given VR instructions on how to navigate Route 2, followed by an observed walkthrough of Route 2. Study Design Group Task/Condition Task/Condition Remarks A 1/1 2/2 Group A performs Task 1 under Condition 1 first, then Task 2 under Condition 2 B 1/2 2/1 Group B performs Task 1 under Condition 2 first, then Task 2 under Condition 1 Task 1 = Route 1; Task 2 = Route 2 Condition 1 = VR; Condition 2 = Traditional 2D Video A 2x2 study design will be used to implement counterbalancing as a way to control for two important sources of systematic variation in this type of study: practice and boredom effects. Both might otherwise lead to different performance of participants due to familiarity with or tiredness of the treatments. Participants will be allowed to watch the video (360-degree or 2D) only once. There will be a 7-minute cool off period after the video and before the navigation task is attempted.

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

Conditions
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Virtual Reality

Intervention / Treatment
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* Other: Immersive 360 (3D) video


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pre-clerkship (year 1 and 2) medical students from the University of Toronto, Temerty Faculty of Medicine. Exclusion Criteria: Experience visiting Sunnybrook for personal reasons or previous coursework, shadowing, research, or clinical rotations. Having a familiarity with the floor plan of the hospital.

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Participants will be asked to complete 2 navigation tasks within Sunnybrook Hospital. Prior to each task, video instructions will be provided using either 2D video or immersive 360-degree VR video. Participants will be randomized to two groups with different task orders and for which each task is matched with a different form of instruction (2D or VR).
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group A<br>VR - Route 1: Students will be first taken to the anesthesia lounge. Here the students will receive VR instructions on how to navigate Route 1 (i.e. they will watch a 360-degree immersive video using Oculus VR headset). Then the students will be assessed with an observed walkthrough of Route 1. Traditional - Route 2: After completing the Route 1 walkthrough, the same group will be given traditional instructions (2D video) on navigating Route 2, followed by an observed walkthrough of Route 2. | Other: Immersive 360 (3D) video<br>* Group A VR - Route 1: Students will be first taken to the anesthesia lounge. Here the students will receive VR instructions on how to navigate Route 1 (i.e. they will watch a 360-degree immersive video using Oculus VR headset). Then the students will be assessed with an observed walkthrough of Route 1. Traditional - Route 2: After completing the Route 1 walkthrough, the same group will be given traditional instructions (2D video) on navigating Route 2, followed by an observed walkthrough of Route 2. Group B Traditional - Route 1: Students will be first taken to the anesthesia lounge. Here the students will receive traditional instructions (2D video) on how to navigate Route 1. Then the students will be assessed with an observed walkthrough of Route 1. VR - Route 2: After completing the Route 1 walkthrough, the same group will be given VR instructions on how to navigate Route 2, followed by an observed walkthrough of Route 2.<br>* Other names: Traditional (2D) Video;|
| Active Comparator: Group B<br>Traditional - Route 1: Students will be first taken to the anesthesia lounge. Here the students will receive traditional instructions (2D video) on how to navigate Route 1. Then the students will be assessed with an observed walkthrough of Route 1. VR - Route 2: After completing the Route 1 walkthrough, the same group will be given VR instructions on how to navigate Route 2, followed by an observed walkthrough of Route 2. | Other: Immersive 360 (3D) video<br>* Group A VR - Route 1: Students will be first taken to the anesthesia lounge. Here the students will receive VR instructions on how to navigate Route 1 (i.e. they will watch a 360-degree immersive video using Oculus VR headset). Then the students will be assessed with an observed walkthrough of Route 1. Traditional - Route 2: After completing the Route 1 walkthrough, the same group will be given traditional instructions (2D video) on navigating Route 2, followed by an observed walkthrough of Route 2. Group B Traditional - Route 1: Students will be first taken to the anesthesia lounge. Here the students will receive traditional instructions (2D video) on how to navigate Route 1. Then the students will be assessed with an observed walkthrough of Route 1. VR - Route 2: After completing the Route 1 walkthrough, the same group will be given VR instructions on how to navigate Route 2, followed by an observed walkthrough of Route 2.<br>* Other names: Traditional (2D) Video;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time assessment | A blinded research assistant will follow and time how long it takes the medical student to travel from the starting to end point. | 1 hour | 
| Distance assessment: | The number of steps and distance travelled will be measured using a standardized pedometer | 1 hour | 
| Way-finding corrective measures: | 1. Number of wrong turns/wrong floors/doors entered 2. Number of times student asks for help. | 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Satisfaction Survey | Comfort and satisfaction in learning through VR and traditional methods. | 1 hour |