Development and Pilot Implementation of TACTICS VR: A Virtual Reality-Based Stroke Management Workflow Training Application and Training Framework

Abstract

Delays in acute stroke treatment contribute to severe and negative impacts for patients and significant healthcare costs. Variability in clinical care is a contributor to delayed treatment, particularly in rural, regional and remote (RRR) areas. Targeted approaches to improve stroke workflow processes improve outcomes, but numerous challenges exist particularly in RRR settings. Virtual reality (VR) applications can provide immersive and engaging training and overcome some existing training barriers. We recently initiated the TACTICS trial, which is assessing a “package intervention” to support advanced CT imaging and streamlined stroke workflow training. As part of the educational component of the intervention we developed TACTICS VR, a novel VR-based training application to upskill healthcare professionals in optimal stroke workflow processes. In the current manuscript, we describe development of the TACTICS VR platform which includes the VR-based training application, a user-facing website and an automated back-end data analytics portal. TACTICS VR was developed via an extensive and structured scoping and consultation process, to ensure content was evidence-based, represented best-practice and is tailored for the target audience. Further, we report on pilot implementation in 7 Australian hospitals to assess the feasibility of workplace-based VR training. A total of 104 healthcare professionals completed TACTICS VR training. Users indicated a high level of usability, acceptability and utility of TACTICS VR, including aspects of hardware, software design, educational content, training feedback and implementation strategy. Further, users self-reported increased confidence in their ability to make improvements in stroke management after TACTICS VR training (post-training mean ± SD = 4.1 ± 0.6; pre-training = 3.6 ± 0.9; 1 = strongly disagree, 5 = strongly agree). Very few technical issues were identified, supporting the feasibility of this training approach. Thus, we propose that TACTICS VR is a fit-for-purpose, evidence-based training application for stroke workflow optimisation that can be readily deployed on-site in a clinical setting.

Implementation of Virtual Reality in Health Professions Education: Scoping Review

“…Being able to move freely in the system using an active avatar provided a sense of reality and improved the sense of participation [ 34 ]. Such interactive elements promote user engagement and maximize the benefits of using virtual reality technology [ 36 ]. Students could practice examining patients, analyzing scenarios, and interacting with others in clinical situations in a virtual reality environment [ 33 ].…”

“…Faculty availability during virtual reality use was also mentioned as being critical. On-site coordinators or facilitators for providing assistance in using the virtual reality system (address questions, brief students, and provide continuous feedback) were described as crucial to successful virtual reality implementation, both in preparation and actual use [ 34 , 36 ]. Moreover, using virtual reality in small tutorial groups rather than during lectures was advised [ 35 ].…”

“…Technological problems and usability difficulties were mentioned as significant barriers to successful virtual reality implementation [ 30 , 35 , 36 ]. People’s IT skills (or lack thereof) and unfamiliarity with virtual reality hinder its use.…”

“…It contains the results from the initial literature search conducted in January and February 2022 as well as those from the additional search conducted in November 2022. We included 7 (1.4% of the total 498 records screened) papers [30][31][32][33][34][35][36], and the key information from these papers is presented in Table 1.…”

Comparing approaches for selection, development, and deployment of extended reality (XR) teaching applications: A case study at The University of Newcastle Australia

“…In universities, educators are developing their own XR applications, typically driven by motivated individuals, departments, or specific funding initiatives which are tested as pilot applications. Diverse disciplines are generating VR and AR teaching applications in a range of areas, particularly in engineering and health/medicine (Bouaicha et al, 2020;Falah et al, 2015;Garfjeld Roberts et al, 2017;Hernandez-de-Menendez et al, 2020;Hood et al, 2021;Nicholson et al, 2006;Vieira et al, 2017). Similarly, some companies are providing subscription services of standardised VR and AR software applications for undergraduate education and other training.…”