CICU Attending Children's National Hospital Washington, District of Columbia, United States
Abstract: HYPOTHESIS Traditional manikin-based simulation has been previously demonstrated to be a versatile and effective modality for the education of trainees in the pediatric CICU. Unfortunately, creating and maintaining high-fidelity manikin simulations is resource intensive. Virtual reality (VR) is an emerging alternative to traditional high-fidelity manikin simulation for medical education. A previous pilot study by these authors delineated the feasibility of VR in the CICU for diagnosis and management of patients with hemodynamic compromise. This study sought to compare VR to classic manikin simulations.
METHODS This prospective, single center study was approved by the IRB at a quaternary pediatric center and conducted from September to December of 2021. Four common CICU patient scenarios were developed for both VR and manikins, including supraventricular tachycardia, postoperative hypotension after a Norwood procedure, pulmonary hypertensive crisis, and hypoxia with bradycardia. The VR logic was created by the authors, and programming was completed by SimX (Palo Alto, CA). Pediatric cardiology and advanced cardiac critical care fellows completed the first two simulations using either VR or manikins, and then crossed over to complete the last two simulations using the other modality. Fellows were assessed on their completion of a critical action checklist for each scenario, as well as by a post-simulation knowledge test. The average number of checklist items completed was calculated for both manikin and VR-based scenarios, stratified by type of simulation as well as year in fellowship.
RESULTS A total of 14 fellows completed the study. Overall, the average number of checklist items completed as well as post-test score increased with each post-graduate year. When comparing the overall number of checklist items completed for all of the simulations between manikin and VR, there was no significant difference in the means (p = 0.463). On average, fellows completed 2 to 3 out of 5 critical actions, and the average post-test score was 87%. Fellow questionnaires reflected an interest in VR, a lack of previous VR experience, and a general feeling that VR was more immersive than manikin simulation. The most common complaint by participants was mild nausea.
CONCLUSION Trainees perform no differently with VR simulations as compared with high-fidelity manikin simulations in the pediatric CICU. Using VR, multiple common CICU scenarios were designed to accurately reflect complex physiologic changes in real-time, creating an immersive and highly realistic simulation environment. Most fellows had no prior experience using VR but were able to be oriented quickly with minimal training. While a few fellows experienced some minor discomfort, many reported an interest in using VR for simulation in the future. VR holds significant promise as a teaching tool in the pediatric CICU, with realistic simulations that are low cost to maintain and readily reset for flexible learning. Further study is required to demonstrate how VR compares with traditional simulation modalities for long-term knowledge retention.
