XR Educational Classrooms for Health Sciences

Introduction

Immersive technologies such as Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR) – known together as Extended Reality (XR) – are moving from a source of entertainment into a new technology for education. The University of Utah is a leader in this effort with 16 departments across campus conducting cutting-edge research in fostering new ways of teaching and learning using XR technologies. For example, the School of Dentistry uses VR to simulate implant dentistry that allows for continuous tracking of hand movements with sub-millimeter accuracy during practical learning. The Trauma Code Resuscitation VR Platform brings trainees into one of two real-life scenarios where decisions they make have direct impact on patient care. The College of Health has a VR Lab that effectively manipulates mobility-related anxiety while maintaining participant safety in the real world. Since the creation of an XR learning community began in 2018 and with the COVID-19 pandemic creating a heightened use of virtual scenarios for teaching, there has been an increased demand by instructors for modules that help students learn. This is especially true for health sciences education, where hands-on, experiential learning is essential to their professional training. However, in the larger education community, there are relatively few examples of deploying XR modules into the physical classroom space. A unique opportunity exists to design a dedicated XR classroom that will allow for easy deployment of XR education modules in health sciences courses. This report will review the literature and interview managers of existing XR classrooms to examine best practices and ways of addressing potential challenges in designing a classroom hosting this technology.

Methods

Literature review

The librarian conducted a literature search in IEEE Xplore (ieeexplore.org, 1988-2021), Scopus (scopus.com, 1970-present), and Academic Search Ultimate (Ebscohost, 1965-present). Inclusion criteria included a designated physical classroom with head-mounted display (HMD) technology, such as VR, AR, and MR. Two reviewers screened title/abstract and then a team screened the full text articles and extracted data into Microsoft Excel Online. Extracted data included citation, institution, location, XR classroom dimensions, XR equipment, other equipment, furniture, room set-up, instructors, students, educational content, study design, outcomes, recommendations, reservation system, security, staff maintenance, funding model, cleaning/sanitizing, media, and URLs.

Interviews with existing XR spaces

            A list of existing XR spaces was created by way of interviewing Roger Altizer and crowdsourcing names from the University of Utah’s VRplus listserv members. After securing a list of universities and institutions with designated XR spaces, the authors invited leaders to participate in a virtual interview on Zoom. The interview questions posed to the XR space leaders are listed in Table A.

Table A: Questions asked of XR space leaders that responded to an invitation.

Table A: Questions asked of XR space leaders that responded to an invitation.

Results

Literature review

Our search returned 113 unique results after the duplicates were removed in EndNote (Clarivate). Following title and abstract screening, we reviewed 28 full-text articles for relevancy. Four studies met our criteria; 2 articles and 2 conference proceedings. See Appendix A for full data extraction, including location, classroom dimensions, XR equipment, furniture, room set-up, and funding model.

Interviews with existing XR spaces

            Nine XR space leaders responded to the invitation to discuss their XR space. Many of the spaces are multifunctional, serving as research labs and production studios, with a few using HMD technology to instruct students. Appendix B includes short descriptions and websites about each space.

Discussion

Leveraging collected data from 13 XR spaces, including nine XR space leader interviews and four articles, best practices and challenges to XR classrooms were identified. The first section lists the best practices, which focus on space and support. The latter section identifies the four major challenges for educational XR classrooms with possible solutions and considerations.

Best practices when designing an XR classroom

            From the data collected, the authors determined best practices (and things to avoid) when designing effective XR classrooms. A summary of those best practices is listed below:

Provide an area for discovery and priming before engaging in classroom activity. Since XR is a newer educational technology, it may be the first time a student is using and experiencing this technology. They need an opportunity to discover the applicability of it before introducing the educational experience. Posters and video tutorials introducing people to the space would be helpful, as well as a headset to practice fit and comfort adjusting. Weekly open hours for people to come and visit the space also helps prime individuals interested in this technology.

The space should be multifunctional and modular. Having flexibility in how the room is structured is best. Many XR experiences happen in a collaborative and social space, which may occur after a discussion in a standard lecture-format classroom. Many of the spaces researched have multiple areas (small conference rooms to medium-sized development rooms with computers). Having one large open space is difficult as equipment tracking will often get in the way of multiple students and different size play spaces are better for different applications.

There should be ample room for moving around and safety should be emphasized. Using XR technologies is a physical endeavor and space accommodations should be met. The standard space per individual is 6 by 6 square feet, but it is better to provide more space to reduce injury or interference among students. VR games designed for interactions tend to be action-packed and require students to move around and produce rapid, sudden movements.

In designing the space, it’s important to balance need and demand. The space is not going to be everything to everybody. Instructors and students will dictate how the space is used and which equipment is needed. Some may find it easier to have their own equipment and run their own XR space. It is good to focus on how to best meet the largest demand. Having a reserve fund available can continue to address needs and keep up with technology advancement throughout the initial few years of use.

A technology-based classroom requires ease of use and available support to be successful. It should be simple for a student to obtain the hardware needed (headset and controllers) and access content. On-site support is preferred, especially during a person’s first visit or during open visiting times. It’s important to take a consistent approach in supporting students using the space while also balancing staff availability and tutorial content. Most XR spaces also provided a check-out service for equipment.

Challenges when designing an XR classroom

There are four major challenge areas when designing and implementing an XR classroom. This section presents the challenges with their associated questions and then the recommendations based off gathered data.

Assessing XR modules in the marketplace. When a new XR idea is proposed, what is currently available for free or what is for cost? Is there a current database that captures this information? If not, how might a database be created for available XR Modules that describe the educational content and purpose of the module?

            There is no database currently used to package and assess educational XR modules. In order to locate existing XR experiences, one must employ a variety of discovery methods, including:

Instructors and students should explore a variety of existing XR content to identify what best meets their learning objectives or needs. A commercially available XR module may be preferred because it will have more built-in support and ease, compared to a custom-developed module created for a class or research project, which is costly and takes a lengthy period of time to develop. A person will need to reach out to those XR module creators and ask if they will share the code for implementation at their institution.

When searching for existing and relevant XR modules, the searcher should consider the different audiences: gamers, educators, and discipline-specific groups. For example, an article about an educational virtual reality game for autistic children could be published in a gaming, education, or medical journal. Considering these multiple audiences means multiple searches, time, and patience. Those inquiring about search strategies should reach out to a librarian for assistance.

If an institution wants to create a database of XR modules, there are two existing digital collections at the University of Utah worth looking into. Previous work and findings from these can be used to craft and consider viability of an XR module collection. The two digital collections which contain some VR/AR materials are the EAE Archive (2010-present) and The GApp Lab (2014-2018). These two collections contain wrap kits of games, containing packages of materials like code, artwork and production materials of varying level of detail, since the author determines what is presented (e.g. description vs. code). In 2018-2019, Anne Morrow and Tallie Casucci received a grant from the Institute of Museum and Library Services to research and provide practical recommendations for complex, born-digital scholarly works, such as games. Their final report is available at https://collections.lib.utah.edu/ark:/87278/s61z92q4. The findings of this report can be applied to VR module database/collection.

            Another potential avenue for database creation would be to develop a national effort through a group or organization. Potentially, the National Library of Medicine, IEEE-VR, or AAMC’s MedEdPORTAL could be potential partners. Oculus, Valve, or other emerging XR companies may also be interested in partnering to create an education-specific database. Existing online education platforms like Khan Academy, Coursera, or EdX may also express interest.

Demonstration collection and repository

Should XR educational modules be collected? If yes, what are the details of collecting, managing, and providing access to these modules? How is this collection shared among multiple students simultaneously?  

Questions around a shared demo collection or repository have been the hardest to answer through the data collected. XR spaces seem to be divided in whether or not they provide a collection of XR games and applications for students. There is a current lag in content sharing ability for the major commercial players in the XR arena, which forces classroom space managers to decide if it’s better to have students manage their own content or take on the responsibility themselves. This is especially true for commercial content, where the major player, Facebook’s Oculus, requires individual logins per headset. If a student signs into Oculus with their personal Facebook account, they are requested to logout and reset the device before leaving the space. Concerns for requiring students to login to a device using their personal Facebook account included student privacy issues and the inability to have a shared library. Facebook’s attempted solution to this is an Oculus Business license, which space leaders reported as being underwhelming – it’s expensive ($180 per device per year) and requires a Facebook Workplace (which still captures data and is hard to access). The interviewed managers said Facebook Workspace does not meet the demands of an educational setting. Instead, some spaces decided to create “distribution” Facebook accounts where a single login belonging to the space can be shared across multiple devices. This has been a temporary measure until Facebook and other companies develop and release a long-term solution available to educators.

Sharing content among multiple students from commercial stores does help with engagement in the space. The Marriott Library has 10 STEAM accounts that manage applications and games for devices. Common applications or games first purchased include discovery games (First Steps, Beat Saber and Google Earth), anatomy education (ShareCare and Organon 3D), art-related applications (Tiltbrush and MasterpieceVR), and storytelling experiences (Google Spotlight Stories and 360-degree video stories like Traveling While Black). Custom-developed XR modules are also shared among XR spaces with each having their own management system. GitHub is the most popular way to store developed educational and research games and applications after they’re built in the Unity or Unreal Game Engines. Some choose to invest in headsets which don’t require login information, like the Pico Neo 2, but these devices lack the same marketplace for popular games and applications faculty and students want to use. To get a sense of what XR devices require logins, the Creativity and Innovation Services team at the Marriott Library at the University of Utah developed an XR Headset Summary Cheat Sheet

The best way to meet both a demand for commercially-made content and the ability to share custom-developed modules may be to invest in a combination of devices and in a device management system. To manage devices, while having the ability to build a library of applications and push content to headsets, some spaces invested in a management software. Software companies like ArborXR, SpringBoardVR, or GroveXR, are considerably cheaper than an Oculus Business license (around $40 per device) and seem much more robust in their transferability to an educational setting. Regardless of the combination of devices and content, it’s important to be forward thinking in ways of managing devices and what they’ll need to support relevant content.

Education and training

How can faculty be taught to use XR technology as part of their teaching? How can campus education support and training groups be involved? How about including faculty who teach the instructional design curriculum?   

            Hands-on workshops and lectures are necessary to expose professors and instructors to VR for their teaching. Within the literature there are several case reports of successful workshops for teachers and professors, such as Young and Manson’s (2018) pre-conference workshop for K-12 teachers. Seed funding that helps faculty projects get off the ground like those coming from the University of Michigan’s XR Initiative and events and speaker-series like those happening at University of Rochester’s StudioX are prime examples of engaging educators. Locally, it is worth continuing the VR Symposium that the University of Utah libraries hosted in 2019 and become more involved with national conversations and organizations, such as the Frameless Symposium at the Rochester Institute of Technology.

Many interviewees discussed the role that discoverability and play have to expose faculty to XR technology for use in the classroom. They suggested weekly open classroom hours to invite those interested to come and discover the space and technology for themselves. Dr. Grace Ahn from University of Georgia commented that most VR devices that are bought are plug and play, and don’t require any technological prowess. On-boarding programs built in the app store are plentiful and help students take their first steps in VR and teach them about how to use the controllers, move around in the space, etc.

At health sciences schools and colleges, there are many potential partners for increasing educational XR usage and implementation on campus. In addition to the library’s XR-related offerings, other partners to consider include a health sciences-focused educators symposium, a faculty center, learning with technologies center, and instructional design or teaching with technology programs. Many interviewees emphasized the importance of presenting to teaching conferences and symposiums within the institution to expose faculty to XR technology.

            When commercial options are not available, there are several options for creating local content. It might be worth reaching out to a video game development or computer science program on campus. At the University of Utah, The GApp Lab is the ideal lab for creating health-related VR games, since it brings together game development students, content experts, and Electronic Arts and Entertainment (EAE) faculty. EAE or computer science students can be hired directly as well, but it is highly recommended to involve EAE faculty member(s) for project guidance and field expertise.

Support model for XR classrooms

What should customer service look like for an XR Classroom to make sure equipment is charged and in working order for the next class? What cleaning and sanitizing needs to be done? Who should be on call when classes are in session and technology breaks down?

            The support model for an XR classroom is most vital to ensure success of the space. The interviewed managers all emphasized the importance of having staff on hand for technical assistance and ensuring classroom readiness. Different staffing models existed amongst the XR spaces, but most have a dedicated manager who keeps an inventory of hardware, updates software, and repairs technology. Technology malfunctioning doesn’t happen often and part-time student workers help prevent or troubleshoot possible errors. An instructor and their students should be able to get help quickly and most managers have an office in or near the classroom spaces. Some institutions used endowment funds to support student or faculty fellows doing projects in the space and holding informational workshops that utilize XR technology. Specified areas for equipment storage with charging stations should be available. For example, the Marriott Library has 3D printed controller stations, that keeps everything charged and organized (Sams & Leither 2021). Another example is a hidden wall of cabinets and movable walls with charging stations in the Digital Innovation Lab at the Rehabilitation Hospital at the University of Utah. Wireless networking infrastructure is also essential so that wi-fi access points that connect to wireless headsets can be controlled by staff.

            Safety and security should also be of utmost importance in developing the XR classroom. Safety protocols should be developed and posted visibly in the room. It is preferred that the space equal 10 by 10 square feet per individual, and at minimum 6 by 6 feet should be met. Cords and equipment should be off the ground and its helpful to have padded floors for stability. Seated VR is another common way to experience games and applications, especially for those with lower-limb injuries, and swivel chairs should be made available in the space. StudioX at the University of Rochester and GAVEL at University of Georgia provide small and medium conference rooms to provide spaces for private sessions. The Digital Innovation Lab at the University of Utah has frosted glass panes that can be turned on and off for privacy. Sanitizing dispensers and wipes should be on hand to promote good sanitation with ultraviolet light cleaning boxes for headset and controller cleanliness. There are also add-ons to headsets to substitute cloth fabrics with soft plastic that can be easily wiped clean. If someone is not physically in the space and equipment is not secured, the space should be locked. Card access for equipment or room reservations also helps secure equipment. The Marriott Library’s VR classrooms provide a permanent reservable space with the equipment provided.

Conclusion

XR has the potential to transform education. Personal observation suggests that students and educators are asking for XR technologies to explore. Instead of a portable option, Picker (2020) found that students want “a dedicated VR room in every [K-12] school… for learning.” Of course, this can be applied to the higher education setting as well. There are plenty of opportunities for future growth, including:

  • developing an open access software repository for educational content,
  • investing in a device management system to help collect and push content,
  • partnering to create training workshops for teaching and content creation,
  • hosting consistent open houses to orient new users, and
  • supporting research and educational outcomes using XR hardware and supported software.

Challenges still present themselves, and include:

  • lack of clear hardware leaders,
  • lack of support from the industry to develop for educational purposes,
  • challenge in creating XR content from scratch, and
  • access to paid applications in stores and how to share them with multiple students simultaneously.

It’s important to be realistic in balancing future growth opportunities while addressing the challenges. Early adoption means that changes may happen frequently, so it is important to stay nimble about the process and remain flexible in creating and maintaining an XR Classroom. The Eccles Health Sciences Library has begun creating a temporary XR Classroom in the Eccles Health Sciences Education Building to begin experimenting with room setup and support. Using this report as a backbone, one can identify and meet with instructors that would utilize an XR classroom space for their teaching and start developing solutions for their institution. Staying current on the newest XR technology, while maintaining a space that can be depended upon by educators, will take a fine balance. There is crucial need for those managing the XR classroom to stay abreast to the latest happenings in the field through professional conferences and organizations, continuous professional development, and industry product demonstrations and trainings. Intentional industry partnerships could supply spaces with the newest technologies, similar to film schools’ partnership with camera companies. There is a lot of growth potential and areas for exploration.

Acknowledgement

The authors would like to thank fellow XR task force members for their assistance in the creation of the original white paper on XR classrooms. The authors also thank the VRplus interest group and the XR classroom managers for their time and expertise on these topics.

References

Pirker, J., Holly, M., & Gütl, C. (2020, 21-25 June 2020). Room Scale Virtual Reality Physics Education: Use Cases for the Classroom. Paper presented at the 2020 6th International Conference of the Immersive Learning Research Network (iLRN).

Sams, A., & Leither, L. (2021). Toward new creative services: a case study in building a virtual reality classroom in an academic library. College & Undergraduate Libraries, 1-13. doi:10.1080/10691316.2021.1898511

Young, A., & Manson, R. (2018). Pre-Conference Workshop – Creating XR Experiences for the Classroom. 2018 IEEE International Conference on Teaching, Assessment, and Learning for Engineering (TALE), 2018, pp. 1217-1218, doi: 10.1109/TALE.2018.8615379.



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XR Educational Classrooms for Health Sciences by Brandon Patterson, MA, MSI & Tallie Casucci, MLIS