P0524 - Virtual Reality vs. High-fidelity manikin-based simulation: A randomized comparison trial on case leadership skills

Background:
Virtual Reality (VR) is gaining popularity because it can engage multiple mental processes, that should improve learning; however, empiric data are limited. We conducted this pilot study to determine the feasibility of VR for clinical simulation and compare learner performance following VR and standard simulation practice sessions.


Methods:
All pediatric and emergency medicine interns in a large academic center were randomized to either VR or standard simulation for the same status epilepticus (SE) scenario. The standard simulation used a high-fidelity manikin in our simulation center. VR groups used a standard headset (Oculus Rift) and cases were designed to mimic an actual case in the critical care bay. The player can interact with staff, examine the patient and perform certain tasks using the controllers. After randomization, each participant completed two 30-minute sessions (video recorded) individually with an instructor. The initial session had an orientation to learning objectives and their respective simulation equipment followed by practice with the SE case. After VR use, a modified system usability scale (Bangor 2009) using an 11-item survey with a 5-point Likert scale was filled. Approximately, three months later, each participant led a manikin-based SE simulation that was similar to the scenario of the initial session. Time-to-actions were measured by reviewing the video records and analyzed using a t-test.

Results:
Of 42 interns, 22 participated in the VR and 20 in the standard simulation groups. 19/22 (86%) felt that the overall user-friendliness of VR was good to excellent and only 1 participant had symptoms of cybersickness. There was no difference in time-to-actions for VR vs. standard groups; for example, VR times (in seconds) compared to standard times were 18.1 (SD 10.5) and 18.9 (SD 15.8) (p=.90) for oral suction, 34.1 (SD 17.9) and 34.1 (SD 13.9) (p=.74) for non-rebreather order, and 61.6 (SD 24.8) and 62.8 (SD 26.9) (p=.82) for IV lorazepam completion.


Conclusion:
This pilot trial suggests that VR is feasible for clinical simulation and can be as effective as standard simulation. Larger studies should corroborate our findings, investigate the best applications of VR simulation in clinical training, and determine if VR could lead to more rapid learning at a lower cost.