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Virtual reality in medical education
Virtual reality (VR)-based education is a promising avenue to not only integrate peripheral nerve system-
focused content into medical school curricula, but also promote sustained knowledge. Educational VR
technology provides a powerful environment for meaningful learning, enhances retention of existing
[22]
curriculum, and encourages active participation over passive lecture experiences . The use of VR
technology within medical education has repeatedly been found to improve learning experiences and
performance on examinations, and increase student confidence in their skills [23-26] . For example, VR-based
anatomical education has been repeatedly found to improve examination performance over traditional
prosection-based learning . Given the multitude of benefits demonstrated by VR-based education, we
[26]
sought to develop a VR rather than lecture-based curriculum on the peripheral nervous system to provide
medical students with a reusable virtual learning environment. Additionally, as a study by Bartlett et al.
[27]
found that the use of surgical VR simulations made surgical residency more appealing to students , we
hope integrating this content into medical schools will encourage medical students to explore and
ultimately pursue nerve surgery-related fields. We partnered with BioDigital Systems LLC to create an
immersive, user-friendly peripheral nerve education virtual reality platform dubbed the “Virtual Peripheral
Nerve Academy (VPNA),” which enables virtually any healthcare student or provider to easily learn about
the peripheral nervous system and gain competency in treating real-life nerve pathologies. BioDigital
Systems, LLC has a history of successful collaborations in healthcare education, including anatomical
modules at the Johns Hopkins School of Nursing and surgical simulations with the New York University
Langone Medical Center Department of Reconstructive Plastic Surgery [28-31] . Studies have found that the use
of VR modules based on the BioDigital platform significantly improves knowledge of the procedure and
increases trainee confidence [29,30] . Herein, we will discuss how VPNA is being developed at the Johns
Hopkins School of Medicine.

THE VIRTUAL PERIPHERAL NERVE ACADEMY
General description
VPNA is an immersive, reusable virtual learning platform to provide medical students with a
comprehensive education on peripheral nerve disorders and associated treatment. The VPNA curriculum is
module-based and uses a variety of media, including still and animated graphics, motion video, and text.
The VPNA is designed to be entirely virtual and can be integrated into existing medical school curricula led
by experienced practitioners.

Trainees are first introduced to the VPNA historical timeline, which denotes significant figures like Santiago
Ramon y Cajal of Spain (Nobel Prize, 1906), for his work on neuroanatomy, and Hanno Millesi of
Germany, for his introduction of interfascicular interposition nerve grafting (1974), and Rita Levi-
Montalcini of Italy (Nobel Prize 1986), for her discovery of nerve growth factor. This introduction serves
both to set the foundation for the basics of the peripheral nervous system as well as the concepts that drive
modern treatments.

After completing the introduction, trainees first learn about the components and inner workings of nerves
at a cellular level. They can view the processes underlying normal synaptic transmission as well as the
pathophysiology of nerve disorders and injury [Figure 1]. Trainees then learn how to classify nerve injuries
into the Seddon and Sunderland classifications related to the degree of disruption of the neural structure.

Trainees then explore the nerves within the human body through a virtual rendering and can dissect layer
by layer to locate individual nerves and branches [Figure 2]. Natural variations in nerve location are
described. Users can observe normal motor function and sensory innervation through a physical exam with