Virtual reality (VR) technology has transformed various industries which includes healthcare and medical education, to allow professionals to practice skills in a safe, controlled environment. With VR, medical students, nurses, surgeons, and emergency responders can rehearse complex procedures and high-stress scenarios without patient endangerment. Despite the benefits, VR comes with specific challenges, notably cybersickness—a condition characterized by nausea, dizziness, headaches, disorientation, and fatigue that results from VR exposure (Stanney et al., 2020). This HealthySimulation.com article by Tiffani Chidume, DNP, RN, CHSE-A, CHSOS, will explore the dangers of cybersickness in VR, the impact on healthcare simulation, and the importance of prebriefing by facilitators to mitigate the effects.
What is Cybersickness and The Causes
Cybersickness, also referred to as VR motion sickness, arises from a discrepancy between visual stimuli and the body’s sensory perceptions. In healthcare simulation, these effects are of particular concern as they can compromise clinical skill acquisition and patient safety training. This inconsistency leads to discomfort and is influenced by several factors (Rebenitsch & Owen, 2021). Latency and refresh rate issues in virtual reality systems with low refresh rates or significant input lag can induce dizziness and nausea (Chang et al., 2020). A visual-vestibular mismatch occurs when users experience visual motion without physical movement correspondence, which results in sensory conflict and symptoms similar to motion sickness. This may be especially problematic for trainees learning ambulatory care or patient transport procedures.
The field of view (FOV) and motion sensitivity also play a role; while a broad FOV enhances immersion, it can exacerbate motion sickness, particularly if the movement within the VR simulation is abrupt or unnatural. Additionally, prolonged exposure to VR can intensify cybersickness symptoms, especially for inexperienced users. Comprehension of these causes is essential for the mitigation of cybersickness and the enhancement of virtual reality design to reduce discomfort. Healthcare simulation-specific factors that may exacerbate cybersickness include the precise nature of medical procedures, the stress inherent in healthcare scenarios, and the cognitive load associated with clinical decision-making with the adaption simultaneously to VR environments.
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The Impact of Cybersickness on Healthcare Training
VR is widely used in healthcare simulation for training purposes, which includes procedural interventions, emergency response, patient interaction, and therapeutic communication. However, cybersickness presents unique challenges that can affect learning outcomes. Research by Biniok et al. (2024) indicates that approximately 22-80% of healthcare students experience some degree of cybersickness in VR-based clinical simulations, with higher rates in scenarios that involve rapid patient movements or complex visual environments like those found in emergency departments or operating rooms.
Cybersickness presents unique challenges in healthcare simulation education that may undermine the effectiveness of simulation-based training. Symptoms such as dizziness and disorientation can impair a trainee’s clinical performance and decision-making abilities, which can potentially reinforce incorrect clinical habits. Additionally, healthcare students who experience cybersickness may develop anxiety about future simulations and reduce their willingness to engage fully in essential clinical skill development.
Cybersickness can also disrupt team-based training, particularly in interprofessional simulations like trauma team responses, where individual members that experience symptoms may compromise team dynamics and communication training critical for patient safety. Inconsistent learning experiences arise when some students must exit simulations due to symptoms, can create disparities in exposure to critical clinical scenarios among cohorts. To address cybersickness effectively is essential to ensure students benefit from immersive training without compromise to their well-being (Kardong-Edgren et al., 2019).
The Role of Prebriefing: How to Prepare Students for Potential Cybersickness
Facilitators must adequately prepare students before they engage in VR simulations to minimize the risks associated with cybersickness. A well-structured prebrief session should include education on common symptoms like nausea, headaches, dizziness, eye strain, and disorientation. Additionally, facilitators should offer practical strategies to reduce these symptoms. A few suggestions are to start with shorter VR sessions, focus on stable reference points, and practice deep breathing exercises.
Orientation sessions that utilize the sandbox feature, where students can assess VR opportunities and limitations, may also be beneficial (Chidume, 2023). Adjust VR settings for comfort, which includes the FOV, refresh rate, and movement mechanics, which is also essential. Encourage students to be self-aware and communicate any discomfort they experience, which will aid in the management of cybersickness. Furthermore, facilitators should consider alternative educational methods, such as augmented reality (AR) or screen-based simulations, for students particularly susceptible to cybersickness. With the implementation of a thorough prebriefing process, facilitators can help students better prepare for VR training and reduce disruptions related to cybersickness.
How to Manage Cybersickness During and After VR Sessions
Even with proper preparation, some students may experience cybersickness during VR sessions. Facilitators should have a clear plan to manage these symptoms during and after these sessions. An essential practice is to encourage students to take breaks and hydrate as they step out of the VR environment, which may alleviate discomfort. Healthcare simulation programs should provide a stable and safe physical space– students may need to sit down if they feel unsteady.
The VR area should also be free of obstacles. Acclimatization techniques can help because they gradually increase exposure to VR environments to reduce the susceptibility to cybersickness. Post-session debriefing is important to check in with students about their experiences and any symptoms they encountered. If severe cybersickness symptoms persist beyond the VR session, advise students to seek medical advice. Proactive management strategies ensure that VR training remains a valuable and accessible tool for all students.
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Future Directions and Additional Research Needed on Cybersickness
The field of VR in healthcare simulation continues to evolve rapidly. Future research should focus on several key areas to enhance its efficacy and user experience. First, develop more comprehensive metrics that predict and monitor cybersickness in real time, which could significantly improve training outcomes. Additionally, explore individual susceptibility factors such as age, gender, and prior experience with VR, as these can help tailor training methods to better suit different users. Innovations in VR technology, such as adaptive field of view and motion smoothing technologies, can further reduce cybersickness and enhance user comfort.
Integrate multimodal feedback combining visual, auditory, and haptic elements in simulations, which may also create more stable and immersive environments, to potentially mitigate the incidence of cybersickness (Chang et al., 2020). As these areas are addressed, educators and developers can continue to improve the effectiveness and comfort of VR-based healthcare training to ensure the VR modality remains a valuable tool for medical education.
Cybersickness presents a significant challenge in VR-based healthcare simulations, which may affect both learning experiences and overall well-being. This is an issue that is crucial to the maximization of the benefits of immersive healthcare simulations. Facilitators play a pivotal role in preparing students for potential side effects through effective prebriefing, symptom recognition, and preventive measures. Proper management strategies during and after VR sessions can help minimize cybersickness’s impact and improve students’ engagement in VR-based learning. Student comfort and well-being are the priority as healthcare educators ensure that VR remains a safe, effective, and widely adopted tool in healthcare simulation preparation.
As healthcare education adoption of immersive technologies is on the rise, comprehension of cybersickness becomes essential for effective clinical training. Evidence-based prebriefing strategies, thoughtful simulation design, and continuous research are imperative. This balanced approach ensures that healthcare trainees benefit from immersive learning without a compromise to their welfare or educational outcomes to ultimately enhance patient care through more effective healthcare simulation-based training.
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References:
- Biniok, M., Forbrig, T. A., Gellert, P., & Gräske, J. (2024). Analysis of cybersickness in virtual nursing simulation: a German longitudinal study. BMC nursing, 23(1), 187. https://doi.org/10.1186/s12912-024-01833-z
- Chang, E., Kim, H. T., & Yoo, B. (2020). Virtual reality sickness: A review of causes and measurements. International Journal of Human-Computer Interaction, 36(17), 1658-1682.
- Kardong-Edgren, S., Farra, S. L., Alinier, G., & Young, H. M. (2019). A call to unify definitions of virtual reality. Clinical Simulation in Nursing, 31, 28-34.
- Rebenitsch, L., & Owen, C. (2021). Review on cybersickness in applications and visual displays. Virtual Reality, 25, 1153-1170.
- Saredakis, D., Szpak, A., Birckhead, B., Keage, H. A., Rizzo, A., & Loetscher, T. (2020). Factors associated with virtual reality sickness in head-mounted displays: A systematic review and meta-analysis. Frontiers in Human Neuroscience, 14, 96.
- Stanney, K. M., Lawson, B. D., Rokers, B., Dennison, M., Fidopiastis, C., Stoffregen, T., & Fulvio, J. M. (2020). Identifying causes of and solutions for cybersickness in immersive technology: Reformulation of a research and development agenda. International Journal of Human-Computer Interaction, 36(19), 1783-1803.
