Recent emergence and commercialization of immersive virtual reality (VR) shows great promise in its application to medical education. While the technology is rapidly developing, we don't yet know how we learn in an immersive environment. As a result, this study will investigate how medical students at the University of Toronto learn from immersive 360-degree video (i.e. VR) when compared to standard 2D video. The task to learn will be hospital (i.e. Toronto Western Hospital) navigation.

The recent emergence and commercialization of immersive virtual reality (VR) shows great promise in its application to medical education. While several surgical, critical care, and procedural 'virtual reality simulators' are described, very few immersive VR experiences that use 360-degree videos have been described (Alakar et al., 2016; Zhu et al., 2014). 360-degree video is a form of virtual reality that shows video content in a globe creating a sense of immersion and realism that is not possible in standard 2D-videos. The videos are viewed using a virtual reality headset capable of displaying the 360-degree content. Among the few studies that do describe immersive learning experiences in medical training, very few have explored the modality from a pedagogical perspective (Barsom et al., 2017; Cha et al, 2006). It is still unclear whether learning via an immersive experience through 360-degree videos is better than traditional methods such as 2D videos.

The use of traditional 2D video is quite well established in medical education as it enhances knowledge transfer, communication skills, attitude formation, and appeals to learners with various learning styles (Abraham et al, 2011; de Leng et al., 2007). Videos are commonly used for clinical skills training as they provide standardized and consistent learning experiences (Flores et al., 2010; Knowles et al., 2001). They can also be used as resources for 'just-in-time' learning, where students preview content by watching videos before attending didactic or hands-on sessions. Patient case videos allow for rare clinical scenarios to be available to students in perpetuity (Gagliano, 1988). The use of video has allowed for the delivery of educational content in both asynchronous and synchronous (i.e. live or real-time) formats allowing for streaming of video to distant locations with real-time dialogue at all sites (Bridge et al., 2009; Gandsas et al., 2004). These advantages of video have enabled the rapid expansion of some medical schools to multiple hospitals. As medical students rotate through these sites during their clinical years, they often face the challenge of adjusting to unfamiliar environments. Anecdotal as well as survey feedback from our site suggests that unfamiliarity with a new environment induces anxiety among trainees and may result in some 'false' starts on the first day of the rotations. Furthermore, the unfamiliarity may cause students to get lost and arrive late to their clinical assignments. Current solutions include text-based directions for way-finding and orientation, which are at times are supplemented by photographs and standard 2-dimensional video. The realism of 360-degree videos may provide a sense of direction with better wayfinding skills because it will allow the learner to explore and 'experience' the depicted location. To date, there is no study reported comparing 2D with 360-degree video on wayfinding and the orientation experience for medical students.

The use of video to assist with wayfinding and orientation exists but is not currently reported in the literature. Spofford et al. (2012) conducted a randomized controlled trial to evaluate the utility of standard lecture and 2D video in orienting students to the anesthesia machine and the operating room setup. The orientation 2D video group performed significantly better with higher post-test scores but scored lower on satisfaction as students preferred the traditional lecture. The study did not assess the utility of orientation videos for wayfinding. Furthermore, the efficacy in improving spatial orientation, reducing anxiety, or enhancing the orientation process is not well known.

Hypothesis: 360-degree videos will enhance spatial orientation of medical students by:

1. Improving way-finding and sense of orientation
2. Conferring a sense of presence
3. Increasing level of satisfaction with the learning experience
4. Decreasing anxiety with a new environment

Methods:

This will be a prospective randomized controlled trial. Pre-clerkship (year 1 and 2) medical students from the University of Toronto Faculty of Medicine will be recruited to take part in the study. Participants will complete a baseline questionnaire collecting data quantifying key potentially confounding factors such as previous 360 videos, previous visits to Toronto Western Hospital, physical gait disability, and navigation experience.

Students will be randomized to two groups (see below) and given video orientation for each route. It takes approximately 4 minutes to walk each one.

Route 1: Conference room 2nd floor to the Day Surgery Unit on the 4th floor. Route 2: Anesthesia lounge on 2nd floor to preoperative assessment clinic on the ground floor to the operating rooms on the 2nd floor

The goal of having each group complete different routes is to assess internal validity within each group when given traditional vs. VR instructions. Group 1 and 2 will also be compared to assess which learning method is superior.

Inclusion Criteria:

• Pre-clerkship (year 1 and 2) medical students from the University of Toronto Faculty of Medicine.

Exclusion Criteria:

• Any medical students who have had experience visiting Toronto Western Hospital for personal reasons or previous coursework, shadowing, research, or clinical rotations.

Individual participant data will not be shared to preserve student privacy and confidentiality throughout the course of the study and the feedback they share at the end of the study. The students however will be provided access to both the VR and the traditional 2D hospital orientation videos once the study is complete.