Rad education: how VR has changed the educational landscape for radiographers

By Marese O’Hagan, senior reporter

By Marese O’Hagan, senior reporter

Like all health sciences, the core tenets of radiography education have been set in stone for many years. These encompass learning in lecture theatres, classrooms and clinical settings, which many would argue are sufficient in setting learners up for success. But will learning through virtual reality (VR) – a mainstay in technological innovation – enhance the abilities of the newer generation of learners entering the profession?

Through programmes specifically designed to enhance clinical learning, learners are able to run interactive simulations repeatedly and experience that one-in-a-million case as many times as they like. Simulations can cover everything from interacting with anxious patients to performing scans or delivering radiotherapy treatment, and give learners insights that generations before never had.

Synergy set out to investigate how radiography education has evolved in the 21st century to include technological developments like VR, and explore whether the technology can fully replace hands-on clinical practice.

A safer learning environment

VR is increasingly common across healthcare education, offering risk-free simulations for learners to practise a variety of skills. By utilising head-mounted virtual reality headsets that immerse the user in a 3D virtual environment, radiography learners can practice delivering imaging techniques or radiotherapy treatment, improve skills such as patient interactions and expose themselves to less common situations that they may one day face in clinical practice.

So much of learning takes place in the clinical environment. To examine whether learners can benefit educationally from VR, we will first look at how they benefit from being able to replicate the clinical environment.

Dr Emma Hyde is the Society of Radiographers’ head of education and research. She sees the benefits of VR clearly – having used it herself when she worked in a university setting – and explains the safety aspects of VR as one of its most obvious upsides. “What it enables learners to do is practise their radiography techniques in a safe, supportive environment without the additional risk of an accidental or higher radiation exposure than there should be to the patient,” she says. “So learners can use the VR technology to simulate what it would be like to interact with a patient.

“And that could be simulating taking an X-ray if they're a diagnostic radiography learner, or delivering radiotherapy treatment if they're a therapeutic radiography learner.”

Using VR also means that learners can avoid the interruptions that might occur when working with a real patient in a clinical setting. “They can totally focus on the skill they are trying to practise without some of the other distractions that are in the clinical environment,” Emma continues. “And what that means is, when they get out into the clinical placement setting, they're actually far more prepared for that interaction with a patient. They've practised those skills in the VR and they are feeling more confident already from that experience, to then apply them directly to a real-life patient.”

Dr Emma Hyde, Society of Radiographers’ head of education and research

Revd Dr Mike Kirby

A more accessible approach

As an educator and an academic, the effects of VR on radiography learning – specifically radiotherapy learning – piqued the interest of Revd Dr Mike Kirby, a retired radiotherapy physicist. On top of a storied career in the NHS, Mike is an honorary lecturer in radiotherapy physics at the University of Liverpool’s School of Allied Health Professions and Nursing, and was previously a senior lecturer there. He still supervises postgraduate students at the university and, in September, he will become the next president of the British Institute of Radiology.

Mike’s case study, A blended approach to teaching Therapeutic Radiography students physics, was published in 2018. In it, Mike had learners use the Virtual Environment for Radiotherapy Training (VERT) software to help them master the physics needed to deliver radiotherapy treatment.

From a radiotherapy educator’s perspective, Mike says the VR was a different way of teaching the physics concepts integral to the science – an aspect many learners find tricky. “Whenever you ask prospective learners and those who've just started what they worry about most with the programme, it's usually going to be the physics and the science side of things,” he explains. “So, in essence, being able to teach in a slightly different way, one that's a bit more accessible, has proven to be really useful.” Ultimately, VR made the physics knowledge more understandable.

Solving real-world problems

Mike also found that using VR brought relevance to the clinic that the learners craved. “When you're teaching, our learners will ask: ‘What's the relevance of all of this compared to the clinic itself, really?’ And even more so with the physics and the science side of things – the raw physics problems,” he says.

Mike adds that, often, programme leaders can teach the science in a way that relates to everyday problems Therapeutic Radiographers might encounter. But the learning showcased in the case study was much more complex – and VERT was a helpful tool. “Those particular subjects within that case study – it was the fundamental science, and how to make it relevant is always difficult. So using VERT to make it relevant gives you just that extra bit of accessibility for our learners,” he explains. The learners involved in the study – as well as Mike’s colleagues – were very engaged with it and gave positive feedback.

The University of Liverpool is just one of many universities across the UK that makes use of VR for healthcare learners. The University of Bournemouth’s Pedagogical Innovation Lab has VR headsets, eye-tracking glasses and 360-degree cameras that bring innovative learning experiences to students.

First year pre-registration MSc therapeutic radiography students at the University of Liverpool using VERT in the university's simulation suite

First year pre-registration MSc therapeutic radiography students at the University of Liverpool using VERT in the university's simulation suite

The lab has produced 360-degree scenarios set within healthcare situations. Through the lab’s VR headsets, learners are given a front-row seat to situations that ultimately enhance their learning. “Scenarios involving first-person experiences immerse learners in the role of patient, with an internal monologue running throughout,” says the learning design team at the university. “Patient experiences such as dementia care help learners gain insight into the patient’s perspective, and scenarios involving sensory overload help learners understand conditions such as autism.

“The learning is designed to develop awareness of communication, empathy and decision making in complex situations.”

The VR facilities are offered to all faculties across the university, but are mainly used in midwifery, nursing and paramedic learning.

University of Bournemouth VR demonstration

VR vs hands on

We’ve established that VR can enhance radiography learning. Not only is it safer exposure wise, it can also be tailored to fit an exact situation a radiographer might encounter in their career – or, opposingly, a very rare case.

With just about everyone singing VR’s praises, could the technology end up replacing clinical work altogether? The consensus – not yet. In July last year, the College of Radiographers released guidance on the practice-based learning hours for pre-reg diagnostic radiography and therapeutic radiography courses. In it, the CoR advised that a minimum of 1,200 practice-based hours should be included in programmes for learners studying a standard pre-registration programme in the UK.

Emma believes that, as it stands currently, VR is perfect for preparing learners for clinical placement. “It's all about frontloading the skills so the learners have got the confidence before they set foot in a clinical department and try and undertake that particular imaging technique or deliver that radiotherapy treatment,” she explains. “So it's about preparing them for the clinical setting, and I don't think VR can replace the patient contact element of practice-based learning.”

“It's a really useful part of the learner's education,” she continues. “And I would say that, particularly in sonography, it's absolutely essential because of the hand-eye coordination that learners need to gain.

“So I think it has an important place within the overall programme of learning, but I don't think at this time it can replace practice-based learning hours.”

The CoR came to the 1,200 hours figure after a review of evidence into practice-based learning hours. But on top of this figure, it also recommends 120 hours of simulation-based education – like VR – based on work undertaken at the University of Bradford.

Reducing the risk

On VR potentially replacing clinical time, Mike has a similar view. While VR can open learners up to more in-depth learning opportunities, he believes it should be regarded as a supplement – not a replacement – for learning. “It's a great addition to [clinical time], it makes the teaching better in our view, and easier, but it very much is there to supplement what they do clinically,” he explains.

“So when you’re alongside a patient – say you're going to CT scan or you're going to treat on a linear accelerator – you can't look inside them and look at the anatomy at that time, and where the beams are going to go, and how it's going to be delivered, where that dose distribution is going to be. Whereas, in the VR world, you can.”

It’s not difficult to understand why the radiography profession has embraced VR. As SoR past president Tom Welton says, radiography is a “very pragmatic profession”. But what exactly has driven the shift to VR and modern technology in radiography education? And how will the role of a radiographer be impacted?

Tom is well placed to talk about VR. He is studying for his master's degree in practice development at Cumbria University, the research and proposal side of which centres on the use of VR in intensive care settings. He puts the recent shift towards VR down to changes in hands-on learning, accelerated by the Covid pandemic, and the normalisation of VR headsets like the Meta Quest. “I think because VR is quite commercially available now, and it's not some far-flung technology that we're trying to get in that’s expensive,” he muses. “It's readily available – something that people can see being used by Joe Public. That has prompted people to think, well, actually, what's the risk? There's not as much worry there.”

A rounded education

As for whether the job of a radiographer will be impacted by continuing technological breakthroughs, like VR technology, Tom believes the role will be improved in many ways, thanks to the adaptability of VR and how specific the scenarios can get. “By being able to bring [learning] through a virtual setting, it means that you're not waiting for that one-in-a-thousand patient who is going to teach you something,” he explains.

He gives the example of a VR learning situation he led that was set in a theatre, depicting a patient needing a hip replacement. “It was effectively from start-to-finish on a theatre case, but that you were a fly on the wall in the theatre,” he recalls. “So if you were to watch it, you could learn what we're doing and why. And that would be good for patients, and good for radiographers.”

X-ray technique was not the focus in this scenario. Instead, the depiction was about the theatre environment itself. “But what we did go in on is radiation protection. We did the patient getting anxious, because they were a bit delirious and were moving around, and people coming in and out of the theatre.”

This means that learners can also practise for scenarios that exist outside the immediate radiography education sphere. “Instead of waiting for that to go wrong on a theatre day, they can do that and ask, in that situation right there. So that works well.”

Tom Welton, SoR past president

What’s next for the future of radiography education?

It’s clear that integrating VR into modern radiography education truly improves outcomes. It widens the boundaries of learning and participation and emphasises the adaptability of the profession. Looking into a technology-laden future, the most obvious question is: what’s next?

Speaking as an educator, Tom believes the profession must allow for continued innovations, particularly in the realm of AI – and that universities must be prepared. “With AI and generative AI and all the different advancements within that area, universities have to evolve because you can't not expect a learner to use AI to support their writing,” he says. “And what that looks like – particularly from a plagiarism point of view – needs to be considered.”

Tom’s perspective can be boiled down to this: if AI can be used as a tool to improve learning and speed up information gathering, then learners should be allowed to utilise it. “Obviously from a clinical setting, we embrace AI as a learning tool now; we say if they can find information out very simply through AI, then crack on – it saves time,” he continues.

“If we can digitise and streamline traditional training methods so learners can pick up skills quickly, we can actually afford that time to really go in depth around other areas that we possibly haven't had time for in the past. In-depth, evaluative kinds of processes and constructive sort of processes.” But advances like these are not imminent, in Tom’s opinion – he predicts the profession is 10 or 15 years off that point.

The human aspect

For Emma, ongoing innovations in radiography are unsurprising because radiography is a constantly evolving profession. But it’s the human aspect of the practice that is ultimately important – something VR or AI cannot replicate. “Radiography is a profession that's constantly changing because of the fact that we are using such advanced medical technology,” she says. “And that's not going to slow down, that's only going to increase. For example, we're seeing more and more AI tools being deployed within clinical services.

“And I think the important thing for us to hold on to is the human touch that we provide, as the person taking the imaging or delivering the radiotherapy treatment. And it’s about always holding on to that – person-centred care is absolutely essential.”

As we’ve established, the use of VR in radiography education is generally supported by those in the profession. But we can’t know for sure what the effects of this will be on future radiographic workforce. Mike thinks the proof will be in the pudding – in this case, patient opinions on future staff once they enter the workforce. “Where some of these things, quite rightly, bring a better experience for the learner, and therefore the potential is that they learn better and deeper, the ultimate acid test is, well, how do our patients then find our newly qualified staff and our staff as they're coming in?” he says.

“Are they getting that patient-centred care? With all the bells and whistles, all the innovations, that’s the main reason that we're here. For that patient, first and foremost.”

More about CoR education approval

The College of Radiographers’ programme approval process ensures that all programmes in the UK that educate radiographers are of the highest quality. It works with clinical and academic departments to ensure that an excellent standard of learning is in place.

The CoR’s approval process is designed to work with internal approval and quality assurance structures in higher education institutions, clinical departments and the regulator, the Health and Care Professions Council. Among other duties, the CoR approvals process ensures that standards of clinical practice are aligned with the Education and Career Framework and support flexibility in the delivery of education.

Click here to learn more about CoR education approval.

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