Development and Validation of a Virtual Reality Circumcision Training Simulator: Simulator Sickness, User Experience, and Clinical Performance in Bali, Indonesia
I Gede Partha Sindu(1*), Ni Ketut Kertiasih(2), I Gede Surya Dinata(3), Putu Sugiartawan(4)
(1) Department of Informatics, FTK, Universitas Pendidikan Ganesha
(2) Department of Informatics, FTK, Universitas Pendidikan Ganesha
(3) Faculty of Medicine, Universitas Pendidikan Ganesha
(4) Postgraduate Program, Master of Informatics, INSTIKI
(*) Corresponding Author
Abstract
Virtual Reality (VR) is increasingly integrated into medical education, yet its application in Indonesia remains limited. This study developed and validated a VR-based circumcision simulator to evaluate simulator sickness, user experience, and clinical performance. A mixed-methods, repeated-measures design was conducted with 74 participants (25 Novices, 24 Intermediates, 25 Experts). Participants engaged in three simulation modes (Autonomous, Guided, Haptic). Instruments included SSQ, FMS, VRNQ, UEQ-S, Checklist, and OSATS. Analyses employed repeated-measures ANOVA, nonparametric tests, and Spearman correlations. Simulator sickness was highest in Autonomous Mode. User experience scores improved with expertise, showing positive correlations with performance and negative correlations with sickness. Experts consistently outperformed other groups, and skill improvements were retained for up to one month. The VR circumcision simulator demonstrated strong construct validity and educational impact. Instructional modes effectively reduced sickness, while haptic integration enhanced spatial orientation. Future studies should incorporate physiological measures and assess real-world skill transfer.
Keywords
Full Text:
PDFReferences
R. Firdaus, A. R. Tantri, and S. K. Manggala, “Factors Influencing Virtual Reality Sickness in Emergency Simulation Training,” Med Sci Educ, vol. 34, no. 6, pp. 1309–1315, Dec. 2024, doi: 10.1007/s40670-024-02102-z. [2] M. Mergen, M. Meyerheim, and N. Graf, “Reviewing the current state of virtual reality integration in medical education – a scoping review protocol,” Syst Rev, vol. 12, no. 1, 2023, doi: 10.1186/s13643-023-02266-6. [3] H. Jiang, S. Vimalesvaran, J. K. Wang, K. B. Lim, S. R. Mogali, and L. T. Car, “Virtual Reality in Medical Students’ Education: Scoping Review,” JMIR Med Educ, vol. 8, no. 1, 2022, doi: 10.2196/34860. [4] D. Mistry, C. A. Brock, and T. Lindsey, “The Present and Future of Virtual Reality in Medical Education: A Narrative Review,” Cureus, 2023, doi: 10.7759/cureus.51124. [5] C. Elendu et al., “The impact of simulation-based training in medical education: A review,” Jul. 05, 2024, Lippincott Williams and Wilkins. doi: 10.1097/MD.0000000000038813. [6] C. J. Clay, J. R. Budde, A. Q. Hoang, and A. Gushchyan, “An evaluation of the effectiveness of immersive virtual reality training in non-specialized medical procedures for caregivers and students: a brief literature review,” 2024, Frontiers Media SA. doi: 10.3389/frvir.2024.1402093. [7] S. S. Lie, N. Helle, N. V. Sletteland, M. D. Vikman, and T. Bonsaksen, “Implementation of Virtual Reality in Health Professions Education: Scoping Review,” 2023. doi: 10.2196/41589. [8] M. A. Minouei, A. Omid, A. Mirzaie, H. Mahdavifard, and A. Rahimi, “Effectiveness of virtual reality on medical students’ academic achievement in anatomy: systematic review,” BMC Med Educ, vol. 24, no. 1, Dec. 2024, doi: 10.1186/s12909-024-06402-1. [9] Y. M. Tang, K. Y. Chau, A. P. K. Kwok, T. Zhu, and X. Ma, “A systematic review of immersive technology applications for medical practice and education - Trends, application areas, recipients, teaching contents, evaluation methods, and performance,” Educ Res Rev, vol. 35, no. November 2021, p. 100429, 2022, doi: 10.1016/j.edurev.2021.100429. [10] B. M. Kyaw et al., “Virtual reality for health professions education: Systematic review and meta-analysis by the digital health education collaboration,” 2019. doi: 10.2196/12959. [11] H. Sung, M. Kim, J. Park, N. Shin, and Y. Han, “Effectiveness of Virtual Reality in Healthcare Education: Systematic Review and Meta-Analysis,” Oct. 01, 2024, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/su16198520. [12] A. Rubio-López, R. G. Carmona, L. Z. Román, A. R. Navas, A. González-Pinto, and P. Cardinal-Fernández, “Measuring Stress and Perceptions for a Virtual Reality–Based Pericardiocentesis Procedure Simulation for Medical Training: Usability Study,” JMIR Serious Games, vol. 13, Jan. 2025, doi: 10.2196/68515. [13] E. Jochmann, T. Jochmann, M. Weber, K. Weigel, and C. Klingner, “Impact of sensorimotor mismatch on virtual reality sickness and user experience: age-related differences in a randomized trial,” J Neuroeng Rehabil, vol. 22, no. 1, Dec. 2025, doi: 10.1186/s12984-025-01677-x. [14] J. H. Won, H. C. Na, and Y. S. Kim, “A New Training Method for VR Sickness Reduction,” Applied Sciences (Switzerland), vol. 14, no. 8, Apr. 2024, doi: 10.3390/app14083485. [15] T. Abu Selo, Z. Hussain, Q. Hussain, W. Alhajyaseen, S. Al-Quradaghi, and M. Y. Alqaradawi, “Exploring Simulation Sickness in Virtual Reality Pedestrian Scenarios: Effects of Gender, Exposure, and User Perceptions,” Safety, vol. 11, no. 3, p. 63, Jul. 2025, doi: 10.3390/safety11030063. [16] P. Kourtesis, J. Linnell, R. Amir, F. Argelaguet, and S. E. MacPherson, “Cybersickness in Virtual Reality Questionnaire (CSQ-VR): A Validation and Comparison against SSQ and VRSQ,” Virtual Worlds, vol. 2, no. 1, 2023, doi: 10.3390/virtualworlds2010002. [17] I. Arshad, P. De Mello, M. Ender, J. D. McEwen, and E. R. Ferre, “Reducing Cybersickness in 360-Degree Virtual Reality,” Multisens Res, vol. 29, 2021, doi: 10.1163/22134808-bja10066. [18] J. R. Abbas et al., “Virtual reality in simulation-based emergency skills training: A systematic review with a narrative synthesis,” Resusc Plus, vol. 16, p. 100484, Dec. 2023, doi: 10.1016/J.RESPLU.2023.100484. [19] A. Erbaş, E. Akyüz, and Ş. Ergöl, “The Effects of Virtual Reality Used in Healthcare Education on Cybersickness and Sense of Presence: A Systematic Review,” PRESENCE: Virtual and Augmented Reality, vol. 33, pp. 161–178, Jul. 2024, doi: 10.1162/pres_a_00414. [20] R. Walls et al., “Virtual reality as an engaging and enjoyable method for delivering emergency clinical simulation training: a prospective, interventional study of medical undergraduates,” BMC Med, vol. 22, no. 1, Dec. 2024, doi: 10.1186/s12916-024-03433-9. [21] D. Saredakis, A. Szpak, B. Birckhead, H. A. D. Keage, A. Rizzo, and T. Loetscher, “Factors associated with virtual reality sickness in head-mounted displays: A systematic review and meta-analysis,” Front Hum Neurosci, vol. 14, 2020, doi: 10.3389/fnhum.2020.00096. [22] S. Cossio et al., “Cybersickness and discomfort from head-mounted displays delivering fully immersive virtual reality: A systematic review,” Nurse Educ Pract, vol. 85, p. 104376, May 2025, doi: 10.1016/J.NEPR.2025.104376. [23] L. Simón-Vicente, S. Rodríguez-Cano, V. Delgado-Benito, V. Ausín-Villaverde, and E. Cubo Delgado, “Cybersickness. A systematic literature review of adverse effects related to virtual reality,” Neurología (English Edition), vol. 39, no. 8, pp. 701–709, Oct. 2024, doi: 10.1016/J.NRLENG.2022.04.007. [24] T. Tene, D. F. Vique López, P. E. Valverde Aguirre, L. M. Orna Puente, and C. Vacacela Gomez, “Virtual reality and augmented reality in medical education: an umbrella review,” 2024, Frontiers Media SA. doi: 10.3389/fdgth.2024.1365345.
Article Metrics
Refbacks
- There are currently no refbacks.
Copyright (c) 2025 IJCCS (Indonesian Journal of Computing and Cybernetics Systems)

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
View My Stats1







