Virtual Reality (VR) and other modern technologies are increasingly becoming part of educational programmes at an accelerated rate (Baxter & Hainey, 2018). Although VR is not a new concept, more recent developments and improvements in the impressiveness of the technology has allowed VR to become increasingly used and considered for use across multiple disciplines in higher education (Radianti, Majchrzak, Fromm, & Wohlgenannt, 2020; Ravipati, 2017). It is clear to see why VR is attractive to educators as it has the ability to replicate various scenarios, which allows the students to immerse themselves within a specific environment. For example, undergraduate students have previously suggested it has a potential use in areas such as education, healthcare, and science (Baxter & Hainey, 2018). Further, more recent studies have gone on to prove this and found VR is a valuable educational tool for both medicine and healthcare studies, as well as additional skills such as enhancing communication (Gout et al., 2020; Liaw et al., 2020; Tidbury, Bridge, & Jarvis, 2020).
The current generation of undergraduate students have been exposed to a wide range of advancing technology in daily life from a relatively early age. Technology has shown to be introduced into curricula from primary to higher levels of education (Domingo & Gargante, 2016). Therefore, it is often easy to assume that the introduction of advanced technologies will be advantageous to their learning or enhance student experience. Previous research has demonstrated that game-based learning aids the learning of students. However, it is not always clear what constitutes game-based learning, as at times simulation, computer games, and VR can all be considered a ‘game-based’ learning platform (Hainey et al., 2013). The inconsistency in defining these learning methods may be the reason why more recently the pedagogy surrounding game-based learning - specifically VR - has been questioned (Fowler, 2015). For the purpose of this paper VR is defined as the ability to create an illusion of being in another place, i.e. immersed in another environment. However, it must be acknowledged that the immersiveness of the virtual experience is reliant on the specific technology utilized.
Johnston (2018) proposed a theory, that to implement new technologies, such as VR, into education the pedagogical foundations need to be well understood (Johnston, 2018). Understanding these foundations will allow educators to better integrate the VR systems into the curriculum effectively. Therefore, the initial step in building these foundations is preparation (
The process of implementing a new technology into the curriculum (Johnston, 2018).
During the exploration of the pedagogical background, it is important to consider learning and teaching theories to help determine how this new technology will aid student learning. Fowler (2015) argues that one can assume that most VR educational technologies have an element of experiential learning, which provides students with a deeper insight and allows them to apply their knowledge to practice (Fowler, 2015; Kolb, 1984). Experiential learning involves four processes: concrete experience, reflective observation, abstract conceptualization, and active experimentation (Kolb, 1984). The step that must be emphasized here with VR is ‘concrete experience’ which symbolizes a new experience. The VR system could enable learners to encounter experiences within an artificial environment. Students may be able to experience virtual scenarios that may potentially be logistically difficult or impossible to experience in a usual academic setting, for example specific clinical environments. However, it must be acknowledged that the experience must be immersive and a highly realistic environment relating to the real world to allow students to feel the virtual experience as a real experience (Kwon, 2019).
Other researchers propose constructivist principles are fundamental during learning within a VR environment (Huang, Rauch, & Liaw, 2010). Constructivist theory believes learners actively construct useful knowledge from individual experiences, which can include those in a virtual environment. As quoted by Jonassen: ‘constructivists emphasize the design of learning environments rather than instructional sequences’ (Jonassen, 1994, p. 35). Furthermore, the theory aims to lessen the gap between knowledge as a concept and real-life experience (Huang et al., 2010). This can easily be applied to VR in education as the educator is aiming to provide virtual environments and scenarios based on a real-world environment.
Overall, learning could either be defined as experiential which provides the student with an immersive virtual scenario that relates to the ‘real world’, or the learning could be experimental in which the student learns through practice (Aithal, 2016). The relevant learning theory appears to be very much dependent on the content developed. Therefore, dependent on what is developed, the educator needs to be aware of the appropriate theory to enable them to understand how the students may learn using the VR, to ultimately ensure the system is developed and delivered efficiently.
Although many studies have shown great value in using in VR in education and training (Kavanagh, Luxton-Reilly, Wuensche, & Plimmer, 2017), the potential difficulties and logistical challenges surrounding the implementation must also be acknowledged. Recent literature has already identified some significant flaws. Firstly, the price of the equipment is costly, so if this level of technology is going to be implemented in education, the pedagogical gain behind it is important to consider (Wolwort, n.d.). Secondly, researchers and educators should be aware of the physiological effects of VR, such as cyber sickness. These sort of side effects can reduce inclusivity within the classroom setting (Martirosov & Kopecek, 2017). Lastly, other potential challenges are the lack of subject-specific content available, public perception of it being a ‘novelty’, and not being aware of the potential advantages of VR within education (Wolwort, n.d.).
With little empirical research undertaken surrounding the learning effects of VR, it seems plausible to explore the potential uses from the beginning. Previous studies that have researched the use of VR in education have often found that exploration of VR in education has had unexpected findings and results due to student feedback and technological difficulties (Vesisenaho et al., 2018). Therefore, referring back to Johnston’s (2018) approach of ‘preparing’ to integrate VR into education it seems reasonable to initially consider students’ perceptions of VR for use in education. Insight from student groups will aid in exploration of this topic and the possibilities of further development. Therefore, the aim of this study is to ascertain students’ perceptions of the use of VR within their undergraduate studies.
Undergraduate orthoptic students at the University of Liverpool were surveyed through an online questionnaire. Convenience sampling was used to select participants (Sedgwick, 2013). Students participating in the study were selected from years one, two, and three of the programme. Students were selected based on the following inclusion criteria:
enrolled on the Orthoptic BSc (Hons).
The survey incorporated both quantitative and qualitative elements via the inclusion of Likert-scale questions and free text comments. The free text answers allowed the students to expand on the meaning of previous answers and provide any additional relevant information for the research. Questions were based around students’ understanding of VR, their experience of teaching methods in higher education, and the value of VR in learning and teaching. The questionnaire was disseminated online via Survey Monkey. Ethical permission was granted by the University of Liverpool. Student consent to take part was sought. All responses were anonymous, no ethical issues arose.
Data was initially analysed via Survey Monkey, as this provided some descriptive statistics from the students’ answers. Further data was extrapolated from Survey Monkey and analysed using Microsoft Excel.
Free text responses were analysed thematically. Thematic analysis involved searching the data for patterns and themes to generate insights into the topic of VR in higher education (Glesne, 2011). Some themes were anticipated due to reading and current knowledge surrounding the topic. Therefore, some themes were identified deductively (Elo & Kyngas, 2008). When all of the themes had been identified, a list of codes emerged. For further analysis of the free text answers a framework approach was utilized to enable the researcher to summarize and compare the categories (Gale, Heath, Cameron, Rashid, & Redwood, 2013). Once this framework was finished, the exploratory analysis of the free text answers was considered complete.
Results and discussion
Fifty undergraduate (thirty-five female; fifteen male) orthoptic students completed the online survey. Age distribution of students can be found in
Participant age range
|Age range (years)||Number||Percentage (%)|
Results showed that students had access to higher levels of technology, with 100% of those surveyed having access to a smartphone and a high percentage having access to a laptop (
Technologies that students already have access to (%).
Over 50% of students were found to be either ‘non-gamers’ or only played games online between zero to five hours a week (zero hours: 45%; one to five hours: 39%; five to ten hours: 10%; ten to twenty hours: 4%; twenty plus hours: 2%). VR use amongst the students was limited, with 92% of students having experience between zero to ten times. The reasons for not accessing VR or having limited experience are highlighted in
Reasons for students not accessing VR at home or for education at this moment in time
|It is too expensive||49|
|The technology is not that good||4|
|Not enough content||27|
|I do not like wearing the headset||24|
|I get motion sickness/cyber sickness||14|
|The experience is not immersive enough||4|
|None of my friends use it||18|
Students were asked to identify what teaching methods they had been exposed to so far as an undergraduate orthoptic student. The students had been exposed to all teaching methods identified within the question. Traditional methods of teaching delivery were recognized by all, but alternative delivery methods, or methods utilizing different resources or technology were not always recognized (
Teaching methods students were aware had been utilized on the orthoptic programme so far.
Word cloud to highlight students differing understanding of what virtual reality is or means.
Analysis of the Likert question, which asked about the value of VR in higher education, highlighted students overall were unsure or agreed there may be a use for VR in education (
Likert responses about the value of VR as a teaching resource
|Strongly disagree (1)||Disagree (2)||Unsure (3)||Agree (4)||Strongly agree (5)|
|Virtual reality has a valuable use in learning and teaching in higher education||2%||8%||35%||43%||12%|
Students were asked for further information regarding this point and asked to answer as a free text response. After exploratory analysis of the free text responses, the following themes emerged:
Virtual reality could be a valuable resource to enable students to visualize concepts and support the transition from academia to clinical practice
Virtual reality in education is useful to allow students to visualize concepts and processes that traditional media would not allow them to do. Having a resource that allows students to see ‘abnormal results’ and anatomical features will support students’ transition from academia to clinical practice.
VR may not support all students leaning due to personal preferences and individual learning styles
It must be acknowledged students have individual learning styles. Therefore, learning via VR may not be as useful to some as it is to others. In addition, students may have additional reasoning as to why they do not support the use of VR in education, e.g. cyber sickness (
The value of VR in education is dependent on the content that is accessible
VR is only useful to support education if the content is applicable and engaging. Students reported, both in the free text and previous questions, that they did not always see a use of VR in orthoptic education due to the limited content.
Students require more support and direction when using VR technology in an educational setting
If VR is to be incorporated into a programme, delivery needs to be carefully executed. Due to students coming from a range of diverse backgrounds, an introductory session detailing the aims and logistics may be valuable. When delivering the actual session, students preferred the session to be directly delivered by the academic, and not left to learn individually.
VR is better utilized as an additional resource, not to replace traditional media
Due to the differing learning styles and individual preferences, VR is not to replace traditional teaching methods. It is instead seen of value when used in addition to previous teaching and to help support the transition from academia to clinical practice.
Interpretation of results
It is clear from the results that most undergraduate students in the institution surveyed were unfamiliar with VR in general, not just within the context of education. Some students were not even aware that VR had already been utilized as a teaching method within the programme (
Exploratory analysis of free text responses revealed that students would possibly benefit from having an immersive resource where they could ‘see’ a virtual patient. As an academic, it is clear that students do often struggle with the transition from an educational setting to a clinical setting; therefore, something bridging this gap may support many students, particularly kinaesthetic learners (Richardson, 1985). Previous studies have supported this claim when looking at simulation in other formats as a teaching resource. It was found that simulation and virtual simulation can in fact increase the perceived relevance and interest of educational activities within medicine (Makransky et al., 2016; Miller, 2014). It has also been shown to increase confidence and self-motivation which could ultimately improve and enhance the quality of the future workforce. (Makransky et al., 2016). This has also been found by a previous study specifically looking at the use of VR in medical education. Results showed that providing students with an environment in which they can explore without risk increases perceived confidence. Also, the sense of layers within the VR environment, i.e. the realism and the addition of educational material within the software adds much more to the learning experience than other media resources (Sattar et al., 2020). Therefore, creating a risk-free environment may enhance learning and confidence.
In addition to this, it must be acknowledged that due to differing learning styles, the implementation of VR within the educational setting may not aid all students’ learning. It was clear from the results of some individuals that there was a lack of engagement surrounding the use of VR in education. This lack of engagement has been highlighted before in previous studies, finding that a number of students expressed a dissatisfaction (Hsieh, Wu, & Ma, 2010). Although the number who were unsatisfied was small, it still has to be respected that not all students may benefit from the activity as much as others. Part of the onus of this is on the academic to ensure that the platform is immersive and user friendly, but also to ensure that educators do not rely solely on VR to facilitate student engagement with a topic (Kavanagh et al., 2017). To support this point, research has shown that advanced VR programmes may be associated with higher student engagement (Sattar et al., 2020). Therefore, ultimately it should be ensured that the VR programme is well designed, but also that it should be seen as an additional resource to enhance experience and increase confidence rather than a resource to replace traditional teaching methods.
Students who were unsure of the usefulness of VR in education or who were unfamiliar also reported the lack of content an issue. It is clear that students will not engage in the novelty of VR if the content is somewhat lacking. Previous studies have reported issues surrounding the realism of the virtual experience (Kavanagh et al., 2017). When the experience is insufficiently realistic, a lack of engagement has been reported (Huang et al., 2010). Within any form of medical education, a realistic experience is important to ensure it reflects the clinical practice. Therefore, after implementing an immersive and realistic experience to students, views may possibly change on the overall usefulness of the VR in education.
With a realistic and immersive environment comes an increase in the need for academics and students to possess technological skills. This can pose issues surrounding staff and student confidence. In particular students did report that they would prefer support with the use of VR. Previous studies which have looked at the use of VR in education have often found that usability issues are the most commonly reported problem (Kavanagh et al., 2017). Some of these usability issues may be due to the unfamiliarity with the technology, which is what the orthoptic students in this study also reported (Falah et al., 2014; Huang et al., 2010). The unfamiliarity is a valid point for academics to take on board and can be addressed with additional academic support. However, another issue may be due to a poorly designed virtual environment which needs to be addressed by academics, clinicians, and software developers. Huang et al. (2010) have previously found issues with usability and poorly designed virtual environments. Therefore, the design of the environment as well as the additional student support is important to increase confidence and engagement with the activity.
Ensuring that a highly immersive, user friendly, well-designed virtual platform is implemented creates problems of its own. The biggest issue here is the overheads. To address all students’ concerns is costly. Funds will be required to purchase VR systems in addition to the programmes and the software, as well as additional staff training. This is an extremely valid point to address, particularly as adult learners are shown to have high expectations (Keskitalo, 2012). Therefore, if appropriate investment cannot be made to develop a highly functioning resource that provides a sufficient amount of realism to help bridge the gap between theoretical and clinical practice, then it appears it would be better to not implement VR at all.
It is important to note that this study did have its flaws. Responses were limited to students’ experiences and opinions from one particular programme at one institution. Participants were not representative of the diverse background and student population on the programme. It may be more useful to attain views from all diverse student groups to get a clearer overall picture of the perceptions surrounding VR in education. However, it would make more sense to continue obtaining data from medical students, health science students, or other clinical programmes. The rationale behind this is that VR has been shown to be of better use in occupational training where professionals and students can be exposed to differing scenarios that are often difficult to simulate in a classroom setting (Sattar et al., 2020).
Overall, this research aimed to ascertain orthoptic student perceptions of the use of VR in a higher education setting. The results provided some useful information surrounding perceptions and expectations of the use of VR in education. Findings were mainly positive (55%) or showed a degree of uncertainty (35%) in terms of whether students viewed VR as a valuable teaching resource in higher education. It could be argued that those with more experience or more gaming experience favoured the use of VR more so; however, there were not enough ‘gamers’ included in the study to draw complete conclusions. The main issues identified were lack of content and unfamiliarity, cost, cyber sickness, and disinterest.
Although baseline data has been retrieved, due to the positive results, as well as the uncertainty, it would be useful to explore this topic further, particularly surrounding specific content. Exploratory analysis and interpretation of results has identified that if VR is going to be successful in this area, then a significant amount of financial investment will be necessary to ensure the VR platform is highly functioning and user friendly. Therefore, to progress to the next stage, it would be useful to interview a number of students or conduct a focus group within each year group to explore possible content that could be taught or delivered via a blended learning approach, to include VR. In addition to this, once content has been refined, it would be useful to reflect critically on the pedagogy behind the use of VR specifically in orthoptic education. Ultimately, further future research would be valued surrounding academic performance. To justify the expense of the implementation of VR in orthoptic education, it would be desirable to demonstrate enhanced student performance, confidence, and experience after undertaking teaching sessions delivered via VR.