Study design
angulation
During the study, both groups were taught the same 31 radiographic views (see Table Radiography views.Participants in the group assigned to VR simulation used Virtual Medical Coaching's radiography software for their simulation tutorial. See Figure Student performing VR simulation.Participants in the group assigned to physical simulation used physical equipment for their simulation tutorials. The equipment comprised a Phillips digital X‐ray room with a ceiling‐mounted X‐ray tube, erect detector and table, with a manikin for positioning. The group were given training and time to familiarise themselves with the operation of the equipment.Following the 25‐week teaching and learning programme, the learning of both groups was examined in end of semester OSCE examinations.The OSCE examinations involved physical X‐ray equipment and actors for patients. 39 student volunteers from a non‐healthcare degree with no ability to ‘help’ the learner under evaluation were employed to act as the patients. Each actor was given the same instructions to facilitate consistency. In the OSCE, each student was required to perform the same radiographic projections starting from the same initial environment in terms of X‐ray tube position, bed height, control panel settings and detector positions. Sixteen clinical radiographers with previous experience of assessing students in clinical departments evaluated the students during the OSCE. Neither the assessing radiographers nor the patient actors had any knowledge of whether a student was from the VR cohort or the physical simulation cohort, and the students themselves were instructed not to disclose this.The OSCE assessment criteria were objectively specified to facilitate consistency across different assessors. The criteria groups were:The duration of the OSCEThe length of time each student took to perform the required projections was timed with a stopwatch.Frequency of machinery movementThis criterion evaluated movement of the X‐ray tube, table or detector in the x, y or z plane; rotation or angulation of the X‐ray tube or detector; and collimation opening, closing and field rotation. A movement was defined as any point where the student made contact with and moved the machinery until they had finished that specific movement.Frequency of incorrect machinery movementThis criterion also evaluated movement of the X‐ray tube, table or detector in the x, y or z plane; rotation or angulation of the X‐ray tube or detector; and collimation opening, closing and field rotation. Incorrect movement was defined as any movement of the machinery that the student reversed.Frequency of radiographic exposure errorsThis criterion evaluated selection of Source to Image Distance (SID), kVp and mAs. Errors in radiographic exposure were defined as a selection that the assessor considered to be exposure settings that would create a diagnostic exposure. This was a difficult criterium to measure as with a digital system many errors in exposure will produce a diagnostic image, as will an incorrect SID.Frequency of patient positioning errorsThis criterion evaluated the position of the body part under examination relative to the detector. Errors in patient positioning were defined as any position which the assessor would alter prior to exposure in a clinical setting.The assessment criteria were measured and recorded in real time by the assessors using a tick box format form and an area for additional observations.