Graphics Programs Reference
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sequences normally associated with mistakes or
failure. Both desktop and immersive VR clinical
simulations have been used in healthcare training
for a variety of teaching and learning purposes,
such as teaching facts, principles, and concepts;
assessing the student's progress or competency
with a certain skill, integrating the use of technol-
ogy in the learning experience and developing
problem solving and diagnostic reasoning skills
in a safe, non-threatening environment (Waltz,
Strickland, & Lenz, 2004; Jeffries, 2006; Lee et
al., 2007; Taber, 2008).
VR simulations also reduce the potential
risks involved in training nurses and can help
develop standards and streamline and optimize
procedures. In Engum et al.'s (2003) article on
intravenous catheter training system, they report
on a randomized experiment using a desktop VR
simulation of an IV catheter for third year medi-
cal and baccalaureate nursing students. The study
compared the effectiveness of this interactive
multimedia simulation with a traditional labora-
tory experience of teaching IV venipuncture skills
to both nursing and medical students. The control
group was exposed to a traditional method of in-
struction involving a scripted self-study module
which involved a 10-minute videotape, instructor
demonstration, and hands-on-experience using
plastic mannequin arms. The experimental group
was exposed to an interactive multimedia catheter
simulator program utilizing virtual reality. Pre-
test and post-test feedback found a significant
improvement in cognitive gains, student satisfac-
tion, and documentation of the procedure with the
traditional laboratory group as compared with
the computer catheter simulator group. While
study results supported the traditional-learning
methods as superior in five areas evaluated, the
authors concluded that both groups were similar
in their ability to demonstrate the skill correctly
and the experimental group enjoyed the use of
VR simulation in the learning process.
In a similar study conducted by Jeffries, Woolf,
and Linde (2003) the researchers investigated the
effectiveness of an interactive virtual simulation
compared with traditional methods for teaching
the skill of performing a 12-lead ECG (an elec-
trical recording of the heart which is used in the
investigation of heart disease). The study used a
randomized pre-test/post-test experimental design
involving 77 baccalaureate nursing students. The
control group (n = 32) was exposed to a traditional
method of a brief lecture, demonstration and hands
on experience using a plastic mannequin with a
real 12-lead ECG machine. The experimental
group (n = 45) was exposed to the same content
but used an interactive multimedia CD-ROM who
obtained experience through embedded virtual
reality activities. The study found a significant
improvement (p < 0.0001) in the pre-test/post-
test scores for both groups. However there was
no significant difference between the two groups
cognitive gains; with the control group having
a pre-test mean of 14.6 and a post-test mean of
19.8, and the experiment group having pre-test
mean of 13.6 and a post-test mean of 20.3 (p
< 0.05). The two groups also displayed similar
satisfaction with their instructional methods and
ability to demonstrate the skill correctly on a live,
simulated patient, suggesting that a skill learned
from a computer-simulated experience can be
similar to a skill learned via traditional methods.
These results also imply that a healthcare student's
experience from a computer simulation can be
effectively transferred into the real world.
Interactive instructional tools that involve re-
alistic environments and incorporate constructive
learning are increasingly being used to supplement
real practical training. A study by Mili, Barr, Har-
ris, and Pittiglio (2008) investigated the benefits
of Virtual training simulations from a pedagogi-
cal perspective as they identified a problem with
controlling what the student is exposed to and
what feedback they are provided with hospital-
based learning. The study found that healthcare
educators perceived that virtual simulation could:
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