Agitation in healthcare, particularly in psychiatric settings, is a prevalent and escalating global concern. Despite its significance, healthcare students often feel underprepared to manage agitation, citing fear, stigma, and limited clinical exposure. Traditional teaching methods, such as lectures or simulations, are resource-intensive and offer limited opportunities for repeated practice in low-risk environments. Virtual reality (VR) offers a promising alternative, providing immersive, standardised, and repeatable training for high-stress clinical scenarios. In response, the education team at [redacted for peer review], developed the Managing AGgression using Immersive Content (MAGIC) programme. This three-hour blended learning workshop, a mandatory component of the psychiatry curriculum for medical and nursing students, integrates didactic teaching, role-play, and the Virtual Reality in Agitation Management (VRAM) activity. Through experiential learning, MAGIC aims to enhance healthcare students’ confidence, empathy, mental health literacy, and competence in managing agitation in psychiatric healthcare settings. Using a pre- and post-test quasi-experimental design, we evaluated the programme’s effectiveness among 152 medical and nursing students. Results demonstrated significant improvements in mental health literacy, self-perceived proficiency, and confidence in managing agitated patients; there was also a marked reduction in stigma towards individuals with mental health conditions. In addition, participants responded positively to all aspects of the VRAM software, underscoring its usability and educational value. These findings highlight the potential of integrating immersive VR technology with traditional pedagogical methods to transform healthcare education by fostering deeper engagement, enhancing clinical competence, and ultimately improving patient outcomes.

Organic chemistry is widely recognized as a challenging subject for students, characterized by its requirement for multilevel thinking, three-dimensional visualization, and extensive new vocabulary. Traditional teaching methods often struggle to provide immediate feedback, cooperative learning opportunities, and sufficient in-class engagement. Game-based learning has emerged as a promising approach to address these challenges, offering interactive environments that promote active learning and peer collaboration. Herein, we implemented ChemPOV, a digital multiplayer game designed to alleviate these commonly encountered teaching gaps. Players move across a hexagonally shaped main board, collecting chemical tiles to complete partially filled synthesis schemes. The game incorporates multiple-choice questions and chance elements featuring two difficulty levels to accommodate various undergraduate syllabi. Our chosen game elements were carefully designed around the main theme of assisted retrosynthetic analysis. This study evaluates ChemPOV's impact on student attitudes and its effectiveness at supplementing their learning across various domains. The game was trialed with 28 first-year undergraduate chemistry majors taking introductory organic chemistry during a 1.5 h session. Pre- and post-game surveys assessed shifts in student attitudes while collecting student feedback about the gameplay experience and how ChemPOV supplemented student learning. Our results are encouraging, showcasing a modest positive shift in attitudes toward organic chemistry after students played ChemPOV. The game was perceived by students to be fun and exciting, making organic chemistry revision less of a drudge. Students report that ChemPOV helps them engage with organic chemistry concepts and synthesis planning while serving as a tool for self-assessment.

BACKGROUND:The capacity of health care professionals to perform clinical procedures safely and competently is crucial as it will directly impact patients' outcomes. Given the ability of head-mounted virtual reality to simulate the authentic clinical environment, this platform should be suitable for nurses to refine their clinical skills for knowledge and skills acquisition. However, research on head-mounted virtual reality in learning clinical procedures is limited.OBJECTIVE:The objectives of this study were (1) to describe the design of a head-mounted virtual reality system and evaluate it for education on clinical procedures for nursing students and (2) to explore the experience of nursing students using head-mounted virtual reality for learning clinical procedures and the usability of the system.METHODS:This usability study used a mixed method approach. The stages included developing 3D models of the necessary instruments and materials used in intravenous therapy and subcutaneous injection procedures performed by nurses, followed by developing the procedures using the Unreal Engine (Epic Games). Questionnaires on the perception of continuance intention and the System Usability Scale were used along with open-ended questions.RESULTS:Twenty-nine nursing students took part in this questionnaire study after experiencing the immersive virtual reality (IVR) intervention. Participants reported largely favorable game perception and learning experience. Mean perception scores ranged from 3.21 to 4.38 of a maximum score of 5, while the mean system usability score was 53.53 of 100. The majority found that the IVR experience was engaging, and they were immersed in the game. The challenges encountered included unfamiliarity with the new learning format; technological constraints, such as using hand controllers; and physical discomfort.CONCLUSIONS:The conception of IVR for learning clinical procedures through deliberate practice to enhance nurses' knowledge and skills is promising. However, refinement of the prototypes is required to improve user experience and learning. Future research can explore other ways to use IVR for better education and health care purposes.

BACKGROUND:Virtual reality simulations are shown to be an effective approach for interprofessional nurse-physician communication training. However, its scalability is constrained by unequal medical-nursing cohort size, rendering a great challenge for all nursing students to form an interprofessional team with medical students. With the evolution of artificial intelligence (AI), an AI medical team player can be integrated into virtual reality simulations for more nursing students to engage in interprofessional team training.OBJECTIVES:To describe the development of a novel AI-enabled virtual reality simulation (AI-enabled VRS) and to evaluate nursing students' competencies and experiences in communicating with an AI medical doctor.METHODS:A mixed-methods design using a one-group pretest-posttest design and focus group discussions were employed in the evaluation phase. Nursing students from a university were recruited to undertake the 2-hour AI-enabled VRS. Pre-test and post-tests were administered to evaluate the participants' communication knowledge and self-efficacy. Survey questionnaires were administered to examine their experiences with the virtual reality environment and the AI doctor. Five focus group discussions were conducted to gain deeper insight into their learning experiences.RESULTS:The participants demonstrated significant improvements in communication knowledge and interprofessional communication self-efficacy after the learning. They reported positively on the acceptability, feasibility and usability of the AI-enabled VRS. The subscale of "human-like" feature of the AI medical doctor was rated the lowest. Three themes surrounding participants' experiences of the virtual learning emerged: "relate to the real world", "artificial intelligence versus human intelligence" and "complement with face-to-face learning".CONCLUSIONS:This study demonstrates initial evidence on the potential of AI-enabled VRS in fostering nursing students' learning on interprofessional communication skills. The findings have also provided insights on how to improve the AI-enabled VRS, in particular, the expressiveness of the AI pedagogical agent and facilitating more dialogue trainings with learner-agent conversations.

Effective communication skills in nursing are necessary for high-quality nursing care, but given the decline in nursing students' attitudes and their low self-confidence in effective communication with patients, a participatory and experiential training method is needed. Therefore, a virtual counseling application was developed using artificial intelligence and a three-dimensional avatar to facilitate learning of communication skills. This study aimed to evaluate the effectiveness of this theory-based virtual intervention on nursing students' learning attitudes, communication self-efficacy, and clinical performance. A longitudinal quasi-experimental study was conducted. Ninety-three undergraduate nursing students received virtual patient trainings with four clinical scenarios over 2 years. Data were analyzed using McNemar test and analysis of variance. Virtual patient training improved students' learning attitudes toward communication skills for scenarios involving the pregnant woman (20.4%, P = .03) and depressed patient (17.1%, P = .01) and enhanced perceived self-efficacy for scenarios involving the pregnant woman (22.6%, P = .002) and stressed nursing student (18.3%, P = .002). Students received lower clinical communication scores for pediatric, obstetric, and medical practicums compared with a previous cohort who received no training. Overall, this virtual counseling application can provide a valuable and cost-effective communication learning resource for the nursing curriculum.

BACKGROUND:There has been an increase of mid-career professionals joining nursing. These adult students possess significant expertise in other areas and may benefit substantially in deliberate practice to acquire skills competency using immersive virtual reality (IVR) for clinical procedures before they practise in actual clinical settings.OBJECTIVES:This study aims to (1) examine the impact of IVR clinical procedures on mid-career switch students in knowledge, game perception and user reaction; (2) to explore the mid-career switch students' perceptions and experiences in using the IVR clinical procedures.DESIGN:A mixed methods feasibility study was used.SETTING AND PARTICIPANTS:This study was conducted at a university in Singapore with 34 first-year mid-career switch students.METHODS:This study is a single-group pre-test and post-test experimental study on learning clinical procedures using IVR in the home setting. The study took place from September to November 2021. Focus group discussions were conducted and analysed verbatim using thematic analysis.RESULTS:The students demonstrated significant improvement of knowledge for subcutaneous insulin, but overall, the increase in combined scores for both intravenous therapy and subcutaneous insulin were not statistically significant. Three overarching themes included: 1) Learning and practice, 2) Challenges and barriers, and 3) Personal attributes. Most of the participants found the experiences to be engaging, relevant, and satisfying. Some reported experiencing giddiness, headache, and lack of familiarity with technologies.CONCLUSIONS:IVR simulation can potentially be used as a supplementary learning tool to improve knowledge of clinical procedures in mid-career switch students.

In chemistry education, the visualization of three-dimensional elements has always played an important role. However, it is challenging to teach such concepts because most of them are being done on two-dimensional media. With the recent prevalent rise of virtual reality and augmented reality (VR/AR) technologies in higher education, there have been many attempts at using these technologies to present the concept to students. However, those attempts have their limitations, and our AR project, "Nucleophile's Point of View" (NuPOV), aims to address those limitations. By using NuPOV, users could not only view chemistry concepts from the AR interface, but they can also interact with them. These methods enable users to have an individualized and self-directed experience, which enable them to have a better understanding of the concepts. Our study has shown that such an approach proved to be relatively well received by students.

The rapid shift from traditional face-to-face (F2F) lesson to the online platform had resulted in student-student interactions, and student engagement to decrease. To solve these problems, the National University of Singapore (NUS) Department of Chemistry in collaboration with NUS Information Technology has designed an online board game, ChemPOV, to improve student engagement and student-student interactions for freshmen organic chemistry students, which increases students' motivation. This game can be played by up to four players, and each player competes with one another to see who can complete their organic chemistry synthesis scheme first through strategic and tactical planning, as well as answering organic chemistry-related questions. Players can also compete with one another through the leader board upon completing their synthesis scheme.

Background:An in-house three-dimensional (3D) multiplayer online role-playing game was developed for professional skills training of pharmacy students. Students play the game in a post-apocalyptic world to save humankind from zombies. They solve virtual patient encounters through visual and motion-capture technologies. Their gaming perceptions and experiences were investigated.Method:A self-administered questionnaire obtained participants' demographics, gaming interests, perceptions of game effectiveness, preferences on gaming elements and gameplay experience through the Game Engagement Questionnaire (GEQ). Pre-gameplay and post-gameplay assessments were tracked to assess student learning. Descriptive statistics and paired sample t-tests were used for analysis.Results:Fifty-five students were recruited. Two-thirds of the gameplay group (67.9%) liked the post-apocalyptic fantasy settings and heroic storyline (66.0%). Three quarters liked the modern setting (73.1%), authentic plots (73.5%) and plot animations (72.3%). Participants felt the game was effective in training health communication and patient history-taking skills (81.8%). Participants' test scores for counselling increased from 66.1%±7.6% (pre-gameplay) to 70.3%±8.0% (post-gameplay, p=0.004). The highest scoring GEQ dimension was sensory and imaginative immersion (2.92±0.74).Conclusion:Students found the game useful for pharmacy professional skills training. With proper implementation, this game can become a useful tool to enhance student learning and gear them towards clinical practices.

BACKGROUND:Modern medical pedagogical strategies are shifting toward the use of virtual patient simulations.OBJECTIVE:This study aims to examine students' users' attitudes and experiences and clinical facilitators' perspectives on student performances in the clinical setting post-virtual patient training.DESIGN:A descriptive qualitative study design was used.SETTING:Nursing faculty at a local university in Singapore.PARTICIPANTS:24 nursing undergraduates and six clinical facilitators.METHODS:This study is a follow-up of an experimental study on the Virtual Counseling Application Using Artificial Intelligence (VCAAI). The study took place from the academic year 2017/2018 ended in November 2019. Focus group discussions and individual interviews were conducted. All interviews and focus group discussions were audiotaped, transcribed verbatim, and analyzed using thematic analysis.RESULTS:Two overarching themes (students' virtual patient user experience and clinical facilitators' evaluations of students' clinical communication skills) comprising six themes were generated. Themes under students' user experience included: 1) attitudes toward virtual patient training, 2) virtual patient's role in student development, and 3) enhanced features and implementation suggestions. Themes under clinical facilitators' evaluations included: 1) insights on students' communication skills and 2) approaches to improve communication skills. An overlapping theme titled 'value of technology in teaching communication' comprised of mutual feedback from both students and clinical facilitators. Early implementation, continued accessibility, enhancing realism and technological improvements to the VCAAI were listed as key areas for program improvement, while increased situational sensitivity and language training are recommended to further enhance students' communication skills.CONCLUSION:The mixed attitudes toward virtual patient interactions and recognitions of the benefits of virtual patient simulations suggest the potential effectiveness of the use of virtual patients in teaching effective nursing communication skills. However, the lack of authenticity and other limitations need to be addressed before official implementations of such trainings with virtual patients to undergraduate nursing curricula.

Visualization of three-dimensional (3D) elements has always played a huge role in chemistry education. At the same time, it is a challenge to teach with most representations being shown in two-dimensional (2D) media. With the recent rise of extended reality (XR) that includes virtual and augmented reality (VR/AR) technology in higher education, attempts have been made at presenting 2D representations to students in a manner that is easier to understand. However, the effectiveness of said attempts has limitations. Our AR project has developed a free-to-use mobile application "Nucleophile's Point of View" (NuPOV) that aims to address these limitations. By allowing users to not only view chemistry concepts in an AR setting but also interact with them by hand, they are able to learn and understand at a deeper level through an individualized and self-directed learning experience. Our study has shown that such an approach proved to be relatively well-received by students.

Background: Collaborative learning in interprofessional team care delivery across different healthcare courses and institutions is constrained by geographical locations and tedious scheduling. Three dimensional virtual environments (3D-VE) are a viable and innovative tool to bring diverse healthcare students to learn together. Aim: The aim of this study is to describe the development of a 3D-VE and to evaluate healthcare students' experiences of their collaborative learning in the environment. Method: A mixed methods study design was employed. Participants from six healthcare courses (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) were recruited from three institutions to form six interprofessional teams to participate in team care delivery via a 3D-VE. Pre- and post-tests were conducted to evaluate the students' attitudes toward healthcare teams and interprofessional collaboration. Four focus groups were conducted with 27 healthcare students after they completed questionnaires to evaluate their perceived usability, the sociability of computer-supported collaborative learning, and senses of presence. Interview transcripts were analyzed using thematic analysis. Result: The students demonstrated significant improvements in their attitudes toward healthcare teams (p < 0.05) and interprofessional collaboration (p < 0.001) after the collaborative learning. Four themes emerged from the focus group discussions: "feeling real", whereby the students felt immersed in their own roles; the virtual environment was perceived as "less threatening" compared to face-to-face interactions; "understanding each other's roles" among different healthcare professionals; and there were some "technical hiccups" related to sound quality and navigation. The participants reported positively on the usability (mean 3.48, SD 0.64), feasibility (mean 3.39, SD 0.60) and perceived sense of presence (mean 107.24, SD 17.78) of the 3D-VE in supporting collaborative learning. Conclusion: Given its flexibility, practicality, and scalability, this 3D-VE serves as a promising tool for collaborative learning across different healthcare courses and institutions in preparing for future collaborative-ready workforces.

BACKGROUND:With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes.OBJECTIVE:The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students' learning outcomes on interprofessional competencies.METHODS:A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities-Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)-after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students' learning outcomes on interprofessional competencies.RESULTS:A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence "WI-VR-SE" as their top preference.CONCLUSIONS:This study shows that the instructional sequence of a blended learning approach can have a significant impact on students' learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students' learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments.

Background: The ability of nursing undergraduates to communicate effectively with health care providers, patients, and their family members is crucial to their nursing professions as these can affect patient outcomes. However, the traditional use of didactic lectures for communication skills training is ineffective, and the use of standardized patients is not time- or cost-effective. Given the abilities of virtual patients (VPs) to simulate interactive and authentic clinical scenarios in secured environments with unlimited training attempts, a virtual counseling application is an ideal platform for nursing students to hone their communication skills before their clinical postings. Objective: The aim of this study was to develop and test the use of VPs to better prepare nursing undergraduates for communicating with real-life patients, their family members, and other health care professionals during their clinical postings. Methods: The stages of the creation of VPs included preparation, design, and development, followed by a testing phase before the official implementation. An initial voice chatbot was trained using a natural language processing engine, Google Cloud's Dialogflow, and was later visualized into a three-dimensional (3D) avatar form using Unity 3D. Results: The VPs included four case scenarios that were congruent with the nursing undergraduates' semesters' learning objectives: (1) assessing the pain experienced by a pregnant woman, (2) taking the history of a depressed patient, (3) escalating a bleeding episode of a postoperative patient to a physician, and (4) showing empathy to a stressed-out fellow final-year nursing student. Challenges arose in terms of content development, technological limitations, and expectations management, which can be resolved by contingency planning, open communication, constant program updates, refinement, and training. Conclusions: The creation of VPs to assist in nursing students' communication skills training may provide authentic learning environments that enhance students' perceived self-efficacy and confidence in effective communication skills. However, given the infancy stage of this project, further refinement and constant enhancements are needed to train the VPs to simulate real-life conversations before the official implementation.

There has been a dearth of collaborative learning across tertiary institutions due to challenges in scheduling and geographical locations. Three-dimensional virtual environments are a viable and innovative tool to bring diverse healthcare students to learn together. The purpose of this study is to describe the development of a multiuser virtual environment and to evaluate healthcare students’ experiences of their collaborative learning in the environment. A mixed method study design was employed. Participants from six healthcare courses (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) were recruited from three institutions to form six interprofessional healthcare teams who participated in interdisciplinary team care via a virtual environment. Four focus groups were conducted with 27 healthcare students after they completed questionnaires to evaluate their perceived usability, the sociability of computer-supported collaborative learning, and senses of presence. Interview transcripts were analyzed using thematic analysis. Four themes emerged from the students’ experiences: “Bringing everyone together” to learn in the virtual platform was perceived as a valuable experience; “Feeling real”, whereby the students felt immersed in their own healthcare profession’s roles; learning in the virtual environment was perceived as “less threatening” compared to face-to-face interactions; and there were some “technical hiccups” related to sound quality and navigation. The participants reported positively on the usability (mean 3.48, SD 0.64) and feasibility (mean 3.39, SD 0.60) of the virtual environment in supporting collaborative learning. With a maximum score of 168, they also perceived a moderately strong sense of presence (mean 107.24, SD 17.78) in the environment. This study provides evidence for the acceptance of a virtual platform for collaborative learning in team care delivery. Given its flexibility, practicality, and scalability, this virtual platform serves as a promising tool for collaborative learning across different healthcare courses and institutions.

Background: The Generation Y students who enter our pharmacy course are technology-savvy and digitally focused. Our educators have a constant challenge to find innovative approaches to sustain students' interests in their modules, encourage peer learning and improve their practice skills. Furthermore, students face the challenge of not being able to integrate and apply what they have learnt to real-life practices. We developed an in-house role-playing game simulating various patient encounters in a futuristic post-apocalyptic world. Students played the game as pharmacist avatars to solve a "mystery". They had to communicate with virtual patients through series of questions in order to assess their medical conditions, and then provide therapeutically sound management plans.Methods: A cross-sectional study was conducted in October 2015 on a cohort of lower year pharmacy undergraduates. Students played the game prototype in one of their modules. After gameplay, they were asked to complete a self-administered survey to identify their experiences with the game. The survey obtained their preferences of various gaming elements in the prototype, and the effectiveness of the prototype in achieving its learning objectives.Results: Response rate was 95.2% (178/187 students). Majority agreed that the game was effective in the training of health communication (93.8%) and patient history taking skills (84.3%), extraction of drug information (85.4%) and knowledge of pharmacotherapy of drugs (83.7%). A quarter (25.3%) felt that the game was more effective than lectures in helping them meet the learning objectives. Over half agreed that the interactivity with virtual patients helped them understand how to take a patient's medical history (58.4%) and the appropriateness of the medication recommendation (56.2%). Most also preferred the adventurer storyline of the game (83.7%). The top in-game reward systems preferred by students were resources (83.7%), item grants (82.0%) and plot animations (82.0%); while vitality and life bars (64.0%) and experience points (57.9%) were the least preferred. Nearly two-thirds (62.4%) liked the three-dimensional first person perspective during gameplay. The proportion who liked the collaborative (84.3%) and cooperative aspects (82.6%) of the game was twice the proportion who liked its competitive aspect (43.3%). Almost half indicated that the fantasy elements in the game were fun and entertaining (48.9%). Majority agreed that the briefing and debriefing sessions before and after gameplay played an important role in enhancing their learning experience (71.3%) and their understanding of the learning objectives of the game (74.2%).Conclusion: Our in-house game prototype was well-received by pharmacy undergraduates. When complemented with appropriate briefing and debriefing, majority of students agreed that the game managed to enhance their learning experiences and pharmacy practice knowledge and skills. It is intended that this game be used to supplement our current methods of teaching in our clinical modules in the near future.