Telemedicine, Virtual Reality
Conditions
Keywords
Neurosurgical education, live-streaming, clerkship training
Brief summary
The goal of this randomized controlled trial was to learn whether a hybrid telemedicine curriculum that combines virtual-reality (VR) simulation with interactive live-streamed neurosurgical cases improves neurosurgical intentionality and clinical decision-making in fourth-year medical students whose clerkships were disrupted by COVID-19. It also assessed technical skills, theoretical knowledge, and student experience. The main questions it aimed to answer were: Does the 4-week hybrid model (VR + live cases) produce greater gains in neurosurgical intentionality and decision-making than traditional online videos and readings? Does the hybrid model improve VR technical skill performance and student satisfaction without harming theoretical knowledge? Researchers randomized 112 students 1:1 to the hybrid intervention (15 h VR neuroanatomy/procedures + 20 h live-streamed surgeries/ICU rounds + real-time Q&A) or a time-matched control group (pre-recorded videos, textbook readings, asynchronous forums). Participants in both groups: Completed 40 hours of remote content over 4 weeks Were tested at baseline and post-course on intentionality (modified Zwisch scale), decision-making (neurosurgery-specific SCT), 50-item MCQ knowledge, and VR proficiency metrics Joined focus groups and rated satisfaction on a 5-point Likert scale
Interventions
OTHERVR Simulation (15 hours)+Live-Streamed Neurosurgical Procedures (20 hours)+Live-Streamed Neurocritical Care Rounds (5 hours)
1. VR Simulation (15 hours): Customized modules on the NeuroVR Platform (validated for neurosurgical education): * Neuroanatomy (5 hours): 3D interactive models of cerebral cortex, brainstem, cranial nerves, and spinal cord (with vascular/meningeal overlays). * Procedural skills (10 hours): Craniotomy basics, ventriculostomy, lumbar puncture, and spine decompression-with real-time feedback on instrument handling and anatomical precision. 2. Live-Streamed Neurosurgical Procedures (20 hours): 18 diverse cases (brain tumor resection \[n=6\], spine fusion \[n=5\], aneurysm clipping \[n=3\], epilepsy surgery \[n=4\]) via HIPAA-compliant Zoom for Healthcare. Each session included: * Pre-procedure briefing (anatomical landmarks, surgical goals). * Intraoperative expert commentary (neurosurgeon + neuroanesthesiologist). * Real-time Q&A (focused on neurocritical decision-making: e.g., How do you adjust resection for eloquent cortex mapping?). 3. Live-Streamed Neurocritical Care Rounds (5 hours): Week
Sponsors
West China Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Fourth-year medical students assigned to the neurosurgical clerkship rotation 2. Able to participate fully in remote learning (stable internet and VR-headset compatible computer) 3. Provided written informed consent
Exclusion criteria
1. Had already completed a prior neurosurgical elective 2. Lacked reliable internet access or hardware required for VR/live-streaming 3. Declined to consent or unable to complete the 4-week curriculum
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Neurosurgical Intentionality | 4 weeks | Neurosurgical Intentionality: Intervention group post-intervention scores were compared with controls, the higer the score, the better the outcome |
| Clinical decision-making score | 4 weeks | Clinical Decision-Making Score Range: 24-120 points (5-point Likert, 24 items) Levels: 24-48 = low 49-84 = moderate 85-120 = high The higher the score, the better the outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Theoretical Knowledge | 4 weeks | These comprised of theoretical knowledge with 50-item multiple-choice-questions (MCQ) exam on neuroanatomy, pathology, and surgical indications ,the higer the score, the better the outcome |
| Technical Skill Performance score | 4 weeks | Technical Skill Performance with VR proficiency metrics such as time to completion, anatomical accuracy, and instrument error rate from NeuroVR's built-in assessment tool. The higer the score,the better the outcome |
| Student experience score | 4 weeks | Student experience using semi-structured focus groups such as 6 groups of 8-10 students/group and reflective journals, analyzed via Braun & Clarke's thematic analysis ; and satisfaction using 12-item Likert scale (1=strongly dissatisfied to 5=strongly satisfied) measuring curriculum relevance, engagement, and skill development. The higher the score, the better the outcome |
Countries
China
Outcome results
None listed