The aim of this study was to explore chiropractic students’ perceptions of the Projection VR TM to assist in developing their radiographic skills and confidence in a laboratory setting. This study suggested that the simulation did improve students’ learning experience.
The Projection VR™ was previously incorporated into the Medical Imaging program in the School of Health and Biomedical Sciences (SHBS) at RMIT University with most technical complications being resolved by the time the simulation program was trialled with chiropractic students. In general, the program supported students’ skill development and enhanced confidence levels. Moreover, gender and age have been reported as possible barriers to using computer technology. In this study, differences in confidence levels were not associated with gender and age.
Another potential application of this program is remote access by students. The advantages of such access include the flexible delivery of learning and teaching, overcoming geographical barriers in terms of travel as well as students being able to acquire skills and knowledge at their own pace .
Students in this study identified that remote access to this simulation would be a beneficial change e.g. “simulation of practicals into computers makes practice easier and more accessible”, “make it readily available to practise at home” and “use of it at home via RMIT website, lists of views required for exam so we can practice”.
Given that there is variety in the reported levels of confidence, computer skills and abilities among students, the option of their being able to progress through simulation activities at their own pace is likely to facilitate the learning experience.
Confidence and skill development
In general, the introduction of Projection VR™ increased students’ confidence in patient positioning procedures and their ability to evaluate radiographic images. It has been reported that enhancing students’ clinical radiographic skills as they make the transition from their pre-clinical undergraduate education to clinical practice may help to alleviate the stress associated with this transition .
Having acquired the skills to confidently set up radiographic procedures and evaluate images, students have reported being able to better focus their energies on refining their communication and patient-interaction skills .
Students also described that participating in the Projection VR™ simulation positively influenced their ability to problem solve. These findings are consistent with other published reports that highlight the value of students critically reflecting on their perceived strengths and weaknesses as a step to solving future clinical challenges and contributing to a range of other important clinical and professional standards [20, 21].
Ninety-three percent of students identified that the simulation activity enhanced their understanding of the effect of changing radiographic exposure factors on patient dose. Chiropractors who perform radiography have a responsibility to select exposure parameters which minimise patient dose when producing clinically diagnostic images. Key parameters that a chiropractor controls and can manipulate for radiographic examinations include tube voltage (kVp), tube current and time (mAs) and source to image distance (SID). If SID is traditionally fixed at 150 cm for chiropractic planar imaging , then student chiropractors should develop a good understanding of 15% rule as a radiation dose reduction strategy. Projection VR™ simulation provides similar percent dose reduction measurements to direct dosimetry measurements when assessing application of the 15% rule . Student comments also highlighted the value of using this simulation to better understand technical factor selection for planar radiography “It helped me learn more about the technical side of medical imaging, such as kVp and dosages” and “gave us extra information on patient dose”. Projection VR™ is a useful educational tool to support student learning focussed on exposure parameters and dose reduction technique in planar radiography. Potential applications of the simulation program within the chiropractic curriculum may include:
a) assist in providing a blended learning approach to teaching radiographic positioning that includes the theoretical basis of radiography in chiropractic practice, face-to-face practicals and virtual radiography to complement and reinforce these more traditional approaches to teaching and learning;
b) help students to better understand how positioning influences radiation exposure (including factors such as skin dose and absorbed dose);
c) provide a cost-effective and efficient mechanism to 'practice' positioning;
d) assist in demonstrating how positioning influences radiographic anatomy;
e) currently none of the four chiropractic programs in Australia incorporate virtual radiography in their curricula and the preliminary findings of this study demonstrate the potential to incorporate virtual chiropractic radiography into their curricula as part of an effective blended learning approach to learning and teaching.
This study explored the students’ perceptions of virtual radiography in the undergraduate pre-clinical radiography course as part of a university chiropractic program.
Previous authors have noted that student performance may be influenced by a variety of factors [7, 19] and this interplay of factors may confound the ability to independently evaluate the role of specific potential enablers such as simulated teaching. This is particularly true when an innovative teaching tool or strategy is introduced into a new learning environment .
Documenting the student usage patterns of innovative teaching programs such as simulated radiography may also provide valuable information about how to best achieve flexibly delivered, clinical educational programs such as this in the future.