The document summarizes literature on the pedagogy of virtual reality (VR) and augmented reality (AR) in medical education. It discusses several learning theories and models that can inform the design of VR and AR experiences, including TPACK, SAMR, and jobs-to-be-done models. Studies have found that VR and AR can increase student engagement and motivation, but more research is needed on their impact on learning outcomes. The document also raises questions about whether engagement necessarily leads to learning and how to balance realism with costs. Several medical schools are piloting the use of VR and AR technologies like HoloLens to teach anatomy.

1. What is known from the literature
about the pedagogy of VR and AR
Dr Poh-Sun Goh
MBBS(Melb), FRCR, FAMS, MHPE(Maastricht), FAMEE
Associate Professor and Senior Consultant
Department of Diagnostic Radiology
National University of Singapore (NUS) and National University Health System
Associate Member
Center for Medical Education, NUS
AMEE 2018 Symposium 3B PowerPoint
Presentation Version

2. Literature/Pedagogy VR/AR
in MedEd
Maps/Guides
Why before What,
and How
Questions Job(s) to be doneModels
Literature

4. General Learning Theory
“CEO” – Content, Engagement, Outcomes
Theory/Literature Practice/Outcomes
Design Thinking
TPACK Model
SAMR Model
“Jobs to be done”
What would you “hire” AR for?
Adoption of Technology model
https://en.wikiversity.org/wiki/Instructional_design
/SAMR_Model/What_is_the_SAMR_Model%3F
http://matt-koehler.com/tpack2/tpack-explained/
https://www.slideshare.net/dnrgohps/digital-scholarship-in-meded
https://www.slideshare.net/dnrgohps/adoption-of-elearning-
in-med-ed-costs-and-value-add-82738401
https://hbr.org/2016/09/know-your-customers-jobs-to-be-done
(Clayton Christensen et. al. 2016)
https://www.slideshare.net/dnrgohps/tel-in-medical-education-content-engagement-and-outcomes
https://www.slideshare.net/dnrgohps/reflect-on-how-blooms-taxonomy-and-millers-pyramid-might-apply-to-learning-continuum-map
informing
Why before What, and How Pedagogy, Literature/Evidence before (iterative) selection of Tech

5. Lets ask some critical questions (use of AR/VR in MedEd)
Does interest, attention, “engagement” = learning?
and the ability to recall, use-apply, transfer to practice
Does “liking’ = better learning and training outcomes?
Does novelty, newness, eye-catching, “cool” = better?
Does speed/efficiency = effectiveness?
Do we replace or blend?
What is effect of fidelity, realism, detailed rendering? Costs?
Superficial vs Deep Learning? Can we maintain engagement?
Get repeat use? Deeper insights with each iteration?
For example, reading and learning from printed text vs digital?
(digital review quicker, equal for getting gist, but print better for
deeper meaning, unless digital review is slow(ed) down)
https://theconversation.com/the-enduring-power-of-print-for-learning-in-a-digital-world-84352

6. Learning – How
Content – Engagement – Outcomes
Transfer to Practice

11. Illustrations
Analogies

12. Literature, (Online) Articles/Reports
Experience from other TEL initiatives
Costs
Hardware
Closed systems
Immersive
Visualization (3D)
Interactive
Collaborative,
“new” learning
Cognitive overload
strain
Lower costs
Smaller devices, mobile-wearable
Open AR developer kits
Eventually open systems and content
PROS CONS
Ongoing advances

13. Improved academic performance, increase in students’ engagement, motivation, and satisfaction …
limitations of technical thresholds, design considerations and small sample size
Saltan, F., & Arslan, Ö.
(2017)
Learning gains and motivation … (review of 55 studies) better learning performance and promoting learning
motivation … deeper student engagement, improved perceived enjoyment, and positive attitudes of AR
Chen P., Liu X., Cheng W.,
Huang R. (2017)
Both VR and AR as effective teaching tools, where student learning is as successful as with tablet-based
applications … adverse effects such as blurred-vision and disorientation with VR … relatively large portion of
students also reported “difficulty concentrating” across all three learning modes (tablet, VR, AR) … increased
student engagement, interactivity and enjoyment with VR and AR
Moro, C., Štromberga, Z.,
Raikos, A. and Stirling, A.
(2017)
Cognitive Information Processing Theory … Dual Coding Theory … Social Learning Theory … Communities of
Practice Theory … game-based learning theory, place-based learning, participatory simulations, problem-based
learning, role playing, studio-based pedagogy, and jigsaw method theory etc.
Bitter, Gary. (2014)
Learners can accept AR as a learning technology, and that AR can improve the learning effect by acquisition of
skills and knowledge, understanding of spatial relationships and medical concepts, enhancing learning retention
and performance on cognitive psychomotor tasks, providing material in a convenient and timely manner that
shortens the learning curve, giving subjective attractiveness, and simulating authentic experiences … decreased
amount of practice needed, reduced failure rate, improved performance accuracy, accelerated learning,
shortened learning curve, easier to capture learner’s attention, better understanding of spatial relationships,
provided experiences with new kinds of authentic science inquiry and improved assessment of trainees ... Lack
of learning theories to guide the design of AR. Of the included papers, 80% did not clearly describe which kind
of learning theory was used to guide design or application of AR in healthcare education …
Zhu, E., Hadadgar, A.,
Masiello, I., & Zary, N.
(2014)
First understand the type of learning experiences and therefore pedagogies that are sought, following by asking
the question as to what type of technology can enable that … a powerful technology combined with a strong
pedagogy is a recipe for advanced teaching and learning …
Groff, J. (2013)

14. Rapid evolution of lightweight, untethered, head mounted displays … need to match technology with need …
Stanford Virtual Heart Project using an immersive VR headset to help kids and families understand cardiac anatomy
better and to teach medical students …
HoloAnatomy at Case Western Reserve University with the Cleveland Clinic uses the HoloLens (Microsoft) computer
headset and educational software to enable students to perform holographic dissections, visualize and understand
the body’s organs and systems better … EchoPixel system (EchoPixel) allows users wearing specialized glasses to see
and manipulate cardiovascular anatomy for preprocedural planning … Early data show that this improved
visualization will allow the physician to learn more quickly, interpret images more accurately, and accomplish
interventions in less time …
Silva, JNA., Sourthworth, M., Raptis, C., Silva, J.
(2018)
and
Silva, J. online interview with Cox, C. @
tctmd.com (2018)
Taking advantage of younger generation familiarity with VR to make medical education more hands on … AR and VR
help students understand anatomical spartial relationships easier than on gross specimen (McBride, J from Clevland
Clinic piloting HoloLens) …. 3D environments in VR and AR perceived by students as more lifelike, interesting and
enjoyable (Moro, C from Bond University Queensland) …
Kuehn, BM. (2018)
and
Rohman, M online article/interviews @
healthimaging.com (2018)
Immersive Media Initiative (IMI), Ohio University's Scripps College of Communication 360-degree, fully immersive
trauma room experience for simulation training ……. Ohio's Case Western Reserve University (CWRU) HoloLens in
medical education to study anatomy in 3D with interactivity … and practice procedures ….. AR and VR will also
become a standard part of medical training as costs decrease …
Mueller, LD online article/interviews @
cardinalhealth.com (2017)
HoloLens at CWRU allows immersive, interactive, 3D visualization individually or in groups/collaboratively … Early
results are very positive and show that students learn at least as well, in less time, than they did in the cadaver lab …
Workman, Su online article/interviews @
er.educause.edu
(2018)
UCSF Bridges Curriculum (2016) … 1st year med students use virtual reality as an optional part of anatomy
curriculum to supplement lectures, traditional textbooks, online learning and cadaver lab … wow students,
immersive, better visualize, participate in simulations …
Baker, M online article/interviews @
ucsf.edu/news (2017)
ARKit 2.0 emphasizes multiuser experience in AR. This means that now people on different iOS devices can interact
and experience the same AR in real time
Part of Apple iOS12 announcement @ WWDC
2018
Recent release of AR developer platforms by Google and Apple is enabling the creation of new apps for Android and
Apple devices, potentially making it easier for artists to create their own AR art ….
Smith, MK. Online article BBC News business
section 10 August 2018 'There are boats
floating above my head in Times Square'

15. Lets ask some critical questions (use of AR/VR in MedEd)
Does interest, attention, “engagement” = learning?
and the ability to recall, use-apply, transfer to practice
Does “liking’ = better learning and training outcomes?
Does novelty, newness, eye-catching, “cool” = better?
Does speed/efficiency = effectiveness?
Do we replace or blend?
What is effect of fidelity, realism, detailed rendering? Costs?
Superficial vs Deep Learning? Can we maintain engagement?
Get repeat use? Deeper insights with each iteration?
For example, reading and learning from printed text vs digital?
(digital review quicker, equal for getting gist, but print better for
deeper meaning, unless digital review is slow(ed) down)
https://theconversation.com/the-enduring-power-of-print-for-learning-in-a-digital-world-84352

17. Thank You