Not playing games: VR for medical training

Third-year medical students experiencing the immersive, experiential learning through PASS-IT.

Medical students from the NUS Yong Loo Lin School of Medicine are experiencing the process of patient safety and immersion in operating theatre procedures – all through the magic of virtual reality (VR).

Drawn into a simulated world through VR headsets and hand-held controllers, the students are able to learn about the entire flow of the peri-operative setting: from dental clearance to anaesthesia evaluation, to the handling of sharps during surgery and the safe conduct of operations.

The system, called PAtient Safety aS Inter-Professional Training (PASS-IT), is a digital gamified environment that allows students to learn about hands-on techniques in the operating theatre.

Due to COVID-19, access to the operating theatre (OT) is restricted, which means medical educators must balance practical learning experiences while ensuring the safety of their students.

The PASS-IT system also crucially helps to develop and hone students’ communication skills with one another.

Such “soft” communications skills – which are often overshadowed by the focus on core medical competencies – are normally honed in clinical settings when medical students are brought to a patient’s bedside to observe physicians at work. 

The VR environment enhances the teaching and learning of situational patient management, letting students observe the role that each healthcare worker performs and allowing them to gain a greater appreciation of each role.

“PASS-IT’s gamified style lets multiple learners be immersed in situations where they are given the opportunity to participate in what would usually be a highly restricted environment,” said Associate Professor Alfred Kow, a surgeon and Assistant Dean (Education) of NUS Medicine, who is one of the educators spearheading the initiative.

“With the COVID-19 situation, students have also been removed from these settings of practical learning due to the risk of exposing them to aerosol-generating procedures. This VR system is a good tool to help the students consolidate their learning despite increased clinical restrictions,” he added.

To enter the virtual training world, medical students don VR headsets and wield hand-held controllers to interact with each other in real-time. Their physical movements and actions are also tracked and displayed in real-time for visualisation and evaluation.

The tool allows students “to make mistakes, learn in a safe environment and ensure that they are competent before they enter actual clinical environment to care for patients”, according to Assoc Prof Kow.

The PASS-IT programme was piloted with a cohort of 36 third-year medical students who had just completed their clinical rotations in surgery, as well as 56 fourth-year medical students during their Phase IV Anaesthesia posting.

Students showed improved understanding of peri-operative patient safety after the training. Results also showed that the VR training had elevated the students’ appreciation for effective communication between healthcare workers, and the majority of students also spoke positively of the use of VR technology to enhance their knowledge of patient safety.

Third-year undergraduate Eleanor Loh said the VR training helped students get closer to what happens in the operating theatre.

“We are not allowed into the OT these days, so seeing something – even though it’s simulated – brings us a bit closer to what actually happens as compared to, say, a very edited YouTube video or just reading the textbook. We only get to see the patients post-op, and by then, they are already all sutured up. Getting to see some of the flow like checking dental carries, and the process of anaesthesia, really sticks and helps to form associations,” she shared.


Asst Prof Terry Pan from the NUS Department of Anaesthesia guiding a student with the PASS-IT simulation.

Assistant Professor Terry Pan from the Department of Anaesthesia at NUS Medicine said the introduction of the PASS-IT VR system has been timely as it gave the students “a unique opportunity to continue the operating theatre learning experience virtually in a safe and structured manner”.

“This innovative VR tool can certainly complement the operating theatre learning experience when the current restrictions are lifted,” he added.

Assoc Prof Kow said such experiential learning is “integral in helping to enhance and reinforce the didactic curriculum”, and added that dental students could also make use of the VR system in future.