A New Virtual World? The Future of Immersive Environments in Anesthesiology

Immersive virtual environments (IVEs), including virtual reality (VR) and augmented reality (AR), have gained immense popularity in medical education health care.1 Over the last 10 years, the expansion of gaming and development platforms, such as Unreal Engine and Unity, along with head-mounted displays (HMDs), has been fueled by major commercial interests, such as Meta, Microsoft, and Google, with huge investments in this immersive reality market. The immersive reality market is currently valued at 6.1 billion US dollars (USD) and is predicted to reach >20 billion USD by 2025.2 This commercial expansion has led to the rapid advancement of affordable, accessible, high-powered VR/AR technology and development tools supporting IVEs in medical education including anesthesia. IVEs date back to the early 19th century with the advent of the stereoscope. This ingenious device allowed 2 separate images, taken at slightly different angles, to be viewed as a single image with depth. The stereoscope led to the creation of a children’s toy: the View-Master (View-Master Ideal Group, Inc), a pioneer for modern-day VR. Subsequently, the invention of the microchip represented a significant leap, leading to a myriad of devices and technologies that make up IVEs today. Virtual environments have been described in 2 domains: immersive (HMD-based) and nonimmersive (desktop-based). Nonimmersive, desktop-based virtual environments do not use an HMD, but instead, the participant controls and manipulates the virtual environment on a screen with a traditional keyboard and mouse or a joystick.3,4 Playing a video game on one’s television screen using popular hardware such as the Sony PlayStation or the Microsoft Xbox is a basic example of desktop-based VR. In medical education, the American Society of Anesthesiologists (ASA) recently partnered with CAE Healthcare to create desktop-based virtual environments for managing anesthesia emergencies,5 which, when completed, fulfill the American Board of Anesthesiology Maintenance of Certification in Anesthesiology (MOCA) 2.0 Part 2 and 4 requirements.6 Although nonimmersive desktop-based virtual environments have been popular for decades and are an important part of our current medical education system, the focus of this article is on HMD-based IVEs. HMD-based IVEs have been described as “typically multi-modal in nature by providing a sense of immersion in the environment through 360° visuals by aid of an HMD, auditory stimulation through the use of earphones, and increasing the proprioception of limbs by way of controllers and tracking.”4 Using HMDs, IVEs “transport” users to alternate simulated environments while creating a sense of immersion. Imagine From the *Department of Anesthesia, Sunnybrook Health Sciences Centre and †Sunnybrook Simulation Centre, Toronto, Ontario, Canada; ‡Wilson Centre for Research in Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; §Canadian Anesthesiologists’ Society—Simulation and Education Section, Toronto, Ontario, Canada; ∥Collaborative Human ImmerSive Interaction Laboratory, Toronto, Ontario, Canada; and ¶Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; #Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.