Christian Moro, Bond University, Australia 

https://doi.org/10.36866/pn.119.46

Over the past decade, a large portion of my time has been spent working on integrating technology into physiology teaching. It has been an enjoyable and rewarding journey, especially learning how to create virtual models of organ systems and anatomical structures for students to navigate through using devices such as virtual, augmented and mixed reality. In March 2020, when social distancing was enforced and teaching conducted online, our team immediately thought it would be fantastic to convert the virtual reality lessons into online sessions to engage students within their homes. However, we soon realised that although technology can theoretically allow for learning at any time in any place, this often needs to be a specific goal during the lesson’s creation. Only one of my students owned a virtual reality headset, and no-one had access to the mixed reality device I’d been planning to use, the Microsoft HoloLens, rendering these lessons unusable. As such, we had a completely virtual, engaging and interactive series of laboratories and physiology learning sessions that were completely unusable outside of the laboratory environment (Figure 1).

Figure 1: Students in Christian’s class using virtual reality to explore the structures of the spine.

The need to run classes off-campus certainly helped to motivate the conversion of many teaching resources into entirely online delivery. I am very grateful to have received the 2019 David Jordan Teaching Award to help share as many physiological resources and online learning tools as possible, and this placed me in good stead for creating a wide range of online physiology curricula. I have now been teaching through a variety of modes which are entirely free for students, such as using Instagram (@physiologywithchristian) to run informative sessions, YouTube for video content (Physiology with Dr Christian), and trialling different forms of educational media, such as converting my Physiology and Anatomy adventure game into a completely free fully online platform (https://www.physiologywithchristian.com/game – check it out!!).

As integrating virtual, augmented and mixed reality into our physiology classes has been a recent highlight for teaching, I thought it might be helpful in this article to explore these terms and their use in the literature.

What is virtual, augmented and mixed reality?

One of the most confusing things to comprehend when entering the technology-enhanced space is the terminology used. Virtual reality, augmented reality, mixed reality, extended reality, and cross-reality are all widely contested terms. The most helpful source from the literature to decode some of these terms is an article by Milgram and Kishino (1994). Here, the authors describe the use of a “Reality-Virtuality Continuum”. In their model, one end of the spectra is the real environment, with the other end the virtual environment (i.e. virtual reality). Augmented reality fits in the middle, while mixed reality is employed as a somewhat umbrella term encompassing the entire spectra. With the introduction of new devices explicitly marketed as “mixed reality”, this definition may be ageing, so I’ve done my best to summarise these terminologies below:

Virtual reality: The user’s senses (sight, hearing and motion) are fully immersed in a synthetic environment that mimics the properties of the real world through high resolution, high refresh rate (constantly-updating) head-mounted displays, stereo headphones and motion-tracking systems (Moro, Stromberga, & Stirling, 2017).

Augmented reality: Using a camera and screen (i.e. smartphone or tablet) digital models are superimposed onto the real-world. The user is then able to interact with both the real and virtual elements of their surrounding environment (Moro, Stromberga, Raikos, & Stirling, 2017).

Mixed reality: While augmented reality overlays digital information onto real-world elements, mixed reality allows for an additional layer of interactivity. Virtual objects placed within a mixed reality environment can be interacted with as if they were real objects. The user’s hand and feet, as well as other people, become part of the environment in which all objects, real and virtual, are fully interactable (Birt, Stromberga, Cowling, & Moro, 2018).

Figure 2: Students in Christian’s class using augmented reality to learn about the physiology of the brain and central nervous system.

There remains some overlap between augmented and mixed reality, and as such, other contemporary umbrella terms have been increasingly present in the literature. In particular, the use of “XR” is a modern way to group all the modes together, even if the acronym’s components remain contended. XR may represent: cross-reality; extended reality; or simply ‘X’-reality; but either way, having a single term to discuss these modes has been useful.

Which “reality” mode is best for physiology teaching?

This question is tricky to answer, as each mode is unique and holds its own benefits. Virtual reality provides a fully digital environment, placing the user’s eyes, ears, hands and body within a completely artificial space (Kuehn, 2018). For example, virtual reality has allowed me to create a large pair of lungs that enables students to walk inside and see the features surrounding them. On the other hand, augmented reality can be beneficial if you wish to add interactive features, such as a beating heart, to silicon models or laboratory resources. Recently, I’ve developed a real interest in exploring mixed reality, with this current semester set to mark the introduction of lessons using the Microsoft HoloLens. This is a new device capable of blending the benefits of both virtual and augmented reality in a head-mounted computer (Figure 3). While this rollout has currently been delayed due to world events, once we are all back on campus, I’m very excited to see whether this technology is effective for learning.

Figure 3: Students in Christian’s class using the Microsoft HoloLens, a head-mounted mixed reality device, to learn the physiology of the cardiovascular and pulmonary systems.

Christian Moro is the Science Lead of the Bond University Medical Program and a urological researcher, investigating the physiology of the lower urinary tract. Christian also develops & researches evidence-based resources for medical and health sciences, such as the use of Instagram (@physiologywithchristian) and YouTube (Physiology with Dr Christian) for physiology education.

References

Birt, J., Stromberga, Z., Cowling, M., & Moro, C. (2018). Mobile Mixed Reality for Experiential Learning and Simulation in Medical and Health Sciences Education. Information, 9(2), 31. https://doi.org/10.3390/info9020031.

Kuehn, B. M. (2018). Virtual and Augmented Reality Put a Twist on Medical Education. JAMA, 319(8), 756-758. https://doi.org/10.1001/jama.2017.20800.

Milgram, P., & Kishino, F. (1994). A Taxonomy of Mixed Reality Visual Displays. IEICE Trans. Information Systems, vol. E77-D, no. 12, 1321-1329. 

Moro, C., Stromberga, Z., Raikos, A., & Stirling, A. (2017). The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ, 10(6), 549-559. https://doi.org/10.1002/ase.1696.

Moro, C., Stromberga, Z., & Stirling, A. (2017). Virtualisation devices for student learning: Comparison between desktop-based (Oculus Rift) and mobile-based (Gear VR) virtual reality in medical and health science education. Australasian Journal of Educational Technology, 33(6). https://doi.org/10.14742/ajet.3840.