How does virtual reality simulation compare to simulated practice in the acquisition of clinical psychomotor skills for pre-registration student nurses? A systematic review.

INTRODUCTION: Simulated practice, both face-to-face and computer-based, is well established within healthcare education, allowing rehearsal and refinement of clinical skills. Virtual reality is a new and relatively untested method of delivering simulation learning. AIMS: This project aims to systematically review, critically appraise and synthesise the published evidence in order to answer the question 'How does virtual reality simulation compare to simulated practice in the acquisition of clinical psychomotor skills for pre-registration student nurses?'
METHODS: The databases CINAHL, Medline, Psychinfo, PubMed and the University of Portsmouth 'Discover' database were searched between 4th June 2018 and 7th July 2018 using the terms; pre-registration, pre-licensure, "pre-registration", "pre licensure", trainee, student, students, nurs*, virtual-reality, VR, "virtual reality", "augmented reality", clinical, skil*, competenc* and mastery. Inclusion and exclusion criteria relating to type of paper, population, intervention, comparison and outcome were applied. Selected articles were appraised using the Centre for Reviews and Dissemination guidelines. As clinical psychomotor skill mastery requires the application of theoretical knowledge to a motor skill in a range of contexts, outcomes relating to these elements (namely knowledge, cognitive gain, skill performance, skill success and time to complete) were analysed.
FINDINGS: Nine studies were included in the review. All studies employed a quasi-experimental design but were of mixed methodological quality. There was significant heterogeneity in methods and missing data, limiting synthesis and precluding meta-analysis. Virtual reality groups performed favourably in comparison to simulation groups in posttest knowledge scores, cognitive gain, skill performance scores and skill success rate. There was divergence of results in relation to time taken to complete the skill. DISCUSSION: Whilst the results are generally favourable for virtual reality, variation in devices, data collection tools and outcome measurements mean that caution must be used in their interpretation. Outcomes relating to psychomotor skill performance support the use of virtual reality as an educational intervention. Time taken to undertake and complete the skill is questioned as a valid outcome measurement due to the potential to forgo skill accuracy in favour of speed.
CONCLUSION: Virtual reality is an emerging technology with a limited body of evidence, which is of variable methodological quality. It appears that virtual reality leads to educational outcomes similar or superior to traditional simulated practice. Consensus in definitions is needed along with further research to advance knowledge of this developing area of practice. Such research is needed to justify the cost of investing in this new technology.