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Regehr C, Birze A. Assessing the equivalency of face-to-face and online simulated patient interviews in an educational intervention. Adv Simul (Lond) 2024; 9:13. [PMID: 38581026 PMCID: PMC10998310 DOI: 10.1186/s41077-024-00286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/24/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND In adapting to COVID-19, many health professional training programs moved abruptly from in-person to online simulated patient interviews for teaching and evaluation without the benefit of evidence regarding the efficacy of this mode of delivery. This paper reports on a multi-methods research project comparing in-person and online simulated patient interviews conducted by allied health professionals as part of an educational intervention offered at a large university teaching hospital. METHODS Twenty-three participants conducted two 15-min interviews with simulated patients using previously validated scenarios of patients presenting with suicide risk. In order to assess the equivalency of the two modalities, physiological and psychological stress were measured using heart rate variability parameters and the State-Trait Anxiety Inventory respectively, and then were compared across cohorts using t-tests. Reflective interviews elicited qualitative impressions of the simulations that were subject to thematic qualitative analysis. RESULTS There were no statistical differences in measures of psychological stress or physiological arousal of participant health care professionals who engaged with in-person versus online simulated interviews, suggesting they were equally effective in eliciting reactions commonly found in challenging clinical situations. In reflective interviews, participants commented on the realism of both modalities of simulated patient encounters and that simulated interviews provoked emotional and physiological responses consistent with actual patient encounters. CONCLUSIONS These findings provide developing evidence that carefully designed online clinical simulations can be a useful tool for the education and assessment of healthcare professionals.
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Affiliation(s)
- Cheryl Regehr
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
| | - Arija Birze
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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Savino S, Mormando G, Saia G, Da Dalt L, Chang TP, Bressan S. SIMPEDVR: using VR in teaching pediatric emergencies to undergraduate students-a pilot study. Eur J Pediatr 2024; 183:499-502. [PMID: 37843614 PMCID: PMC10858116 DOI: 10.1007/s00431-023-05254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
The objective of this work was to provide pilot data on feasibility of using virtual reality (VR) to train undergraduate students in pediatric emergency scenarios. We staged VR sessions for a total of 45 medical and nursing students; in every session, each student managed two pediatric emergency virtual scenarios. At the end of the sessions, students completed a Technology Assessment Questionnaire to evaluate the perceived usefulness and perceived ease-of-use of their VR training experience and rated their perceived level of competence in managing the two clinical scenarios. The median perceived usefulness was 91.7/100 (interquartile range (IQR) 80.6-100), while the median perceived ease-of-use was 77.8/100 (IQR 63.9-88.9). The perceived level of competence increased from 2 (IQR 1-3) to 4 (IQR 3-4) on a 5-point Likert scale, for both scenarios (p < 0.001, Wilcoxon test for paired samples). Conclusions: The staged VR sessions had a good perceived usefulness and resulted in an increase in the perceived level of competence. The results on the ease-of-use, however, show that an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made; further work is required to ease the integration of VR into curricula. What is Known: • Virtual reality (VR) is a rising simulation training methodology in Pediatric Emergency Medicine (PEM), however little experience is reported about its use for undergraduate students What is New: • VR PEM trainiing was found useful by undergraduate students and its use increased their perceived level of competence, although ease-of-use received lower ratings. • Despite the young age, an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made.
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Affiliation(s)
- Sandro Savino
- Department of Medicine, University of Padua, Padua, Italy.
| | | | - Giorgia Saia
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Todd P Chang
- University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Silvia Bressan
- Department of Neurosciences, University of Padua, Padua, Italy
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Lietz A, Kraller J, Hoffelner A, Ritschl V, Berger A, Wagner M. Dose-response of virtual reality training of paediatric emergencies in a randomised simulation-based setting. Acta Paediatr 2023; 112:1995-2005. [PMID: 37195147 DOI: 10.1111/apa.16847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
AIM To determine the effect of different virtual reality training intervals on individual performance to facilitate the optimal implementation of medical virtual reality training. METHODS Emergency scenarios in virtual reality were performed by 36 medical students from the Medical University of Vienna. After baseline training, the participants were randomised into three groups of equal size and underwent virtual reality training at different time intervals (monthly, one training after 3 months, and no further training) before undergoing final assessment training after 6 months. RESULTS Group A, with monthly training exercises, improved their performance score significantly by 1.75 mean score points compared with Group B, who repeated baseline training after 3 months. Statistically significant difference was indicated when comparing Group A with Group C, which was not further trained and served as the control group. CONCLUSION One-month intervals are associated with statistically significant performance improvements compared with additional training after 3 months and to a control group without regular training. The results show that training intervals of 3 months or longer are insufficient to achieve high performance scores. Virtual reality training is a cost-effective alternative to conventional simulation-based training for regular practice.
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Affiliation(s)
- Andrea Lietz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Julian Kraller
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Alexander Hoffelner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
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Ivankovic J, Bahr N, Meckler GD, Hansen M, Eriksson C, Guise JM. Identifying high cognitive load activities during simulated pediatric cardiac arrest using functional near-infrared spectroscopy. Resusc Plus 2023; 14:100409. [PMID: 37424768 PMCID: PMC10323221 DOI: 10.1016/j.resplu.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Aim To identify specific activities associated with high cognitive load during simulated pediatric out-of-hospital cardiac arrest (POHCA) resuscitation using physiological monitoring with functional near-infrared spectroscopy (fNIRS). Methods We recruited teams of emergency medical services (EMS) responders from fire departments located throughout the Portland, OR metropolitan area to participate in POHCA simulations. Teams consisted of both paramedics and emergency medical technicians (EMTs), with one paramedic serving as the person in charge (PIC). The PIC was outfitted with the OctaMon to collect fNIRS signals from the prefrontal cortex. Signals reported changes in oxygenated and deoxygenated hemoglobin concentrations, which were used to determine moments of increased cognitive activity. Increased cognitive activity was determined by significant increases in oxygenated hemoglobin and decreases in deoxygenated hemoglobin. Significant changes in fNIRS signals were associated with specific concurrent clinical tasks recorded by two independent researchers using video review. Results We recorded cognitive activity of EMS providers in 18 POHCA simulations. We found that a proportion of PIC's experienced relatively high cognitive load during medication administration, defibrillation, and rhythm checks compared to other events. Conclusion EMS providers commonly experienced increased cognitive activity during key resuscitation tasks that were related to safely coordinating team members around calculating and administering medications, defibrillation, and rhythm and pulse checks. Understanding more about activities that require high cognitive demand can inform future interventions that reduce cognitive load.
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Affiliation(s)
- Jonathan Ivankovic
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA
| | - Nathan Bahr
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA
| | - Garth D Meckler
- Departments of Pediatrics and Emergency Medicine, University of British Columbia, 24-1160 Nicola Street, Vancouver, BC V6G 2E5, Canada
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, HRC 11D01, Portland, OR 97239, USA
| | - Carl Eriksson
- Department of Pediatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, CDRC 1231, Portland, OR 97239, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, East campus- Kirstein 3rd floor- OBGYN, 330 Brookline Ave, Boston, MA 02215, USA
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Harley JM, Bilgic E, Lau CHH, Gorgy A, Marchand H, Lajoie SP, Lavoie-Tremblay M, Fried GM. Nursing Students Reported More Positive Emotions about Training during COVID-19 After Using a Virtual Simulation Paired with an In-person Simulation. Clin Simul Nurs 2023:S1876-1399(23)00034-8. [PMID: 37360663 PMCID: PMC10150196 DOI: 10.1016/j.ecns.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background Virtual simulations (VS) are educational tools that can help overcome the limitations of in-person learning highlighted during the COVID-19 pandemic. Research has illustrated that VS can support learning, but little is known about the usability of VS as a distance learning tool. Research on students' emotions about VS is also scarce, despite the influence of emotions on learning. Methods A quantitative longitudinal study was conducted with undergraduate nursing students. 18 students participated in a hybrid learning experience involving a virtual simulation (VS) followed by an in-person simulation. Students completed questionnaires about their emotions, perceived success, and usability and received a performance score from the VS. Results Nursing students reported statistically significant improvements in their emotions about completing their program after completing both VS and in-person simulations compared to their emotions before the pair of simulations. Emotions directed toward the VS were weak-to-moderate in strength, but predominantly positive. Positive emotions were positively associated with nursing students' performance. Findings replicated "okay" approaching "good" usability ratings from a recent study with key methodological differences that used the same software. Conclusions VS can be an emotionally positive, effective, efficient, and satisfying distance learning supplement to traditional simulations.
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Affiliation(s)
- Jason M Harley
- Department of Surgery, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
- Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal Quebec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Elif Bilgic
- Department of Surgery, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
| | - Clarissa H H Lau
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Gorgy
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Hugo Marchand
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Susanne P Lajoie
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Mélanie Lavoie-Tremblay
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
| | - Gerald M Fried
- Department of Surgery, McGill University, Montreal, Quebec, Canada
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
- Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal Quebec, Canada
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Aiello S, Cochrane T, Sevigny C. The affordances of clinical simulation immersive technology within healthcare education: a scoping review. VIRTUAL REALITY 2023; 27:1-19. [PMID: 36686614 PMCID: PMC9840160 DOI: 10.1007/s10055-022-00745-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
Whilst clinical simulation is established as an effective education tool within the healthcare community, the inability to offer authentic educational learning environments remains problematic. Advances in technology such as immersive virtual reality offer new opportunities to enhance traditional practice to an extent that may transform learning. However, with traditional clinical simulation stress and anxiety can both hinder performance and learning, yet it is unknown what nuances are applicable within a clinical virtual simulation environment. Determining potential benefits, drawbacks (including related stress and anxiety) and affordances of immersive technology clinical simulation designs may help provide an understanding of its usefulness. The aim of this scoping review is to investigate the range and nature of evidence associated with immersive virtual reality clinical simulation and education design. In addition, the review will describe authentic immersive technology clinical simulation use and reported stress response measurements. A search of seven electronic database and grey literature was performed in accordance with the Joanna Briggs Institute methodology. A key term search strategy was employed with five themes identified and investigated: (1) Healthcare professionals, (2) Clinical simulation, (3) Immersive virtual reality, (4) Stress/anxiety and (5) Authentic learning design. Application of the search strategy resulted in a hit total of 212 articles. Twelve articles met inclusion criteria. With most literature focusing on procedural performance and non-transferable education needs, there was a paucity of research that specifically investigated immersive virtual reality clinical simulation education and related stress. Therefore, this scoping review contributes new understandings by providing valuable insight and potential research gaps into current immersive virtual reality clinical simulation, its relationship to stress and the education design models currently being utilised to develop these concepts.
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Affiliation(s)
- Stephen Aiello
- Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Thomas Cochrane
- Centre for the Study of Higher Education, The University of Melbourne, Melbourne, VIC Australia
| | - Charles Sevigny
- Department of Anatomy and Physiology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC Australia
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Price A, Lin YL, Levin AS, Tumietto F, Almeida R, Almeida A, Ciofi-Silva CL, Fontana L, Oliveira N, Parisi NF, Mainardi GM, Cordeiro L, Roselli M, Shepherd P, Morelli L, Mehrabi N, Price K, Chan W, Srinivas S, Harrison TK, Chu M, Padoveze MC, Chu L. Perceived Workload Using Separate (Filtering Facepiece Respirator and Face Shield) and Powered Air-Purifying Respirator and Integrated Lightweight Protective Air-Purifying Respirator: Protocol for an International Multisite Human Factors Randomized Crossover Feasibility Study. JMIR Res Protoc 2022; 11:e36549. [PMID: 36454625 PMCID: PMC9756122 DOI: 10.2196/36549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/26/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences. OBJECTIVE This study will assess whether the L-PAPR improves health care professionals' comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs. METHODS This is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user's perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types. RESULTS We expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time. CONCLUSIONS The design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/36549.
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Affiliation(s)
- Amy Price
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Anna S Levin
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Tumietto
- Unit of Antimicrobial Stewardship, Local Health Authority, City of Bologna, Bologna, Italy
| | | | - Ana Almeida
- Federal University of Itajubá, Minas Gerais, Brazil
| | | | | | - Naila Oliveira
- School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Paul Shepherd
- Animation and Media Arts Concentration, Academy of Film, Hong Kong Baptist University, Hong Kong, China
| | | | | | - Kathleen Price
- College of Health Sciences and Technology, St Thomas University, Miami, FL, United States
| | - Whitney Chan
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Shrinidhy Srinivas
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - May Chu
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | - Larry Chu
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Toohey S, Wray A, Hunter J, Waldrop I, Saadat S, Boysen-Osborn M, Sudario G, Smart J, Wiechmann W, Pressman SD. Comparing the Psychological Effects of Manikin-Based and Augmented Reality-Based Simulation Training: Within-Subjects Crossover Study. JMIR MEDICAL EDUCATION 2022; 8:e36447. [PMID: 35916706 PMCID: PMC9379786 DOI: 10.2196/36447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/27/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient simulators are an increasingly important part of medical training. They have been shown to be effective in teaching procedural skills, medical knowledge, and clinical decision-making. Recently, virtual and augmented reality simulators are being produced, but there is no research on whether these more realistic experiences cause problematic and greater stress responses as compared to standard manikin simulators. OBJECTIVE The purpose of this research is to examine the psychological and physiological effects of augmented reality (AR) in medical simulation training as compared to traditional manikin simulations. METHODS A within-subjects experimental design was used to assess the responses of medical students (N=89) as they completed simulated (using either manikin or AR) pediatric resuscitations. Baseline measures of psychological well-being, salivary cortisol, and galvanic skin response (GSR) were taken before the simulations began. Continuous GSR assessments throughout and after the simulations were captured along with follow-up measures of emotion and cortisol. Participants also wrote freely about their experience with each simulation, and narratives were coded for emotional word use. RESULTS Of the total 86 medical students who participated, 37 (43%) were male and 49 (57%) were female, with a mean age of 25.2 (SD 2.09, range 22-30) years and 24.7 (SD 2.08, range 23-36) years, respectively. GSR was higher in the manikin group adjusted for day, sex, and medications taken by the participants (AR-manikin: -0.11, 95% CI -0.18 to -0.03; P=.009). The difference in negative affect between simulation types was not statistically significant (AR-manikin: 0.41, 95% CI -0.72 to 1.53; P=.48). There was no statistically significant difference between simulation types in self-reported stress (AR-manikin: 0.53, 95% CI -2.35 to 3.42; P=.71) or simulation stress (AR-manikin: -2.17, 95% CI -6.94 to 2.59; P=.37). The difference in percentage of positive emotion words used to describe the experience was not statistically significant between simulation types, which were adjusted for day of experiment, sex of the participants, and total number of words used (AR-manikin: -4.0, 95% CI -0.91 to 0.10; P=.12). There was no statistically significant difference between simulation types in terms of the percentage of negative emotion words used to describe the experience (AR-manikin: -0.33, 95% CI -1.12 to 0.46; P=.41), simulation sickness (AR-manikin: 0.17, 95% CI -0.29 to 0.62; P=.47), or salivary cortisol (AR-manikin: 0.04, 95% CI -0.05 to 0.13; P=.41). Finally, preexisting levels of posttraumatic stress disorder, perceived stress, and reported depression were not tied to physiological responses to AR. CONCLUSIONS AR simulators elicited similar stress responses to currently used manikin-based simulators, and we did not find any evidence of AR simulators causing excessive stress to participants. Therefore, AR simulators are a promising tool to be used in medical training, which can provide more emotionally realistic scenarios without the risk of additional harm.
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Affiliation(s)
- Shannon Toohey
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Alisa Wray
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - John Hunter
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Ian Waldrop
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Megan Boysen-Osborn
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Gabriel Sudario
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Jonathan Smart
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Warren Wiechmann
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, United States
| | - Sarah D Pressman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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Wood J, Ebert L, Duff J. Implementation Methods of Virtual Reality Simulation and the Impact on Confidence and Stress When Learning Patient Resuscitation: An Integrative Review. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Croghan IT, Hurt RT, Aakre CA, Fokken SC, Fischer KM, Lindeen SA, Schroeder DR, Ganesh R, Ghosh K, Bauer BA. Virtual Reality for Health Care Professionals During a Pandemic: A Pilot Program. J Prim Care Community Health 2022; 13:21501319221086716. [PMID: 35352605 PMCID: PMC8972930 DOI: 10.1177/21501319221086716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: The purpose of this pilot study was to evaluate the safety and use of a nature-based virtual reality (VR) experience among health care providers (HCP) during a pandemic. Methods: Twenty-four frontline HCP participated in this crossover pilot where the viewing order of the experiences were randomized. All participants attended in-person consent, baseline, and end-of-study visits. The intervention consisted of viewing 2 nature-based scenes (“walk in the woods” and “forest of focus”) through 3-D VR and with computer 4K graphic imagery. Randomization took place with regards to the viewing order (VR vs 4K computer video, scene 1 and 2). Outcomes measured were safety, acceptability and changes in intensity of anxiety feelings, resilience, emotional distress, cognitive function, and self-efficacy. Results: Among the 26 HCP expressing interest in the study, 24 enrolled in this study. The majority were male (58.3%), white (66.7%) and of an average age of 46.3 ± 10.5 years (standard deviation (SD)). End of the study survey showed that almost all participants (96%) would participate in the study again and recommend it to others. Twenty-three of the 24 participants also felt relaxed after seeing the imagery. With respect to anxiety (as measured by the STAI Y1), the VR “walk in the woods” had the greatest reduction from pre to post (6.4 points, SD = 5.98) followed by VR “forest of focus” (5.8 points, SD = 9.29), computer screen “forest of focus” (5.0 points, SD = 8.89), and computer screen “walk in the woods” (4.1 points, SD = 6.22). All 4 sessions had a significant decrease in score from pre to post (P-values ≤.005), but there was no significant difference in the change from pre- to post-session between the 4 groups (P-value = .5835). Conclusion: The use of the VR among HCP has promise for reducing stress among health care providers during a high stress period, such as a pandemic but much larger studies are needed.
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Chang TP, Hollinger T, Dolby T, Sherman JM. Development and Considerations for Virtual Reality Simulations for Resuscitation Training and Stress Inoculation. Simul Healthc 2021; 16:e219-e226. [PMID: 33273419 DOI: 10.1097/sih.0000000000000521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Resuscitation simulations immerse learners into the complexity of emergency patient management. Head-Mounted Display Virtual Reality (VR) has been used for stress inoculation therapy for phobias and posttraumatic stress disorder. However, VR for stress inoculation in resuscitation leadership training has not been studied. We sought to develop VR simulation for stress inoculation, as exposure therapy training, for resuscitations. METHODS We explain the conceptual design, development, production, and initial evaluation process for 2 VR simulations in infant status epilepticus and pediatric anaphylactic shock. We further describe deliberate game mechanic choices to maximize psychological fidelity. In-virtual reality performance data for time-to-critical actions and stress physiology markers (heart rate, salivary cortisol) were collected from expert pediatric emergency physicians and novice pediatric residents. Data were analyzed to examine differences between the 2 groups for both outcome types to determine the extent of stress response or performance deficit the VR induced. RESULTS Multiple difficulties and distractions were designed for the 2 scenarios; we evaluated the highest difficulty and environmental distraction versions. Between 19 expert physicians and 15 novice physicians, no performance differences were found in typical airway, breathing, and circulation actions. Residents preferred more lorazepam first-line antiepileptics than attendings (P = 0.003) and performed a cricothyrotomy later than attendings (P = 0.02). Residents, however, manifested higher salivary cortisol levels than attendings (+0.07 μg/dL, 95% confidence interval = 0.03-0.12, P = 0.001). CONCLUSIONS A VR resuscitation simulation manifested expected stress physiology changes in physicians. Further evaluation is needed to determine the effect of VR simulation as longitudinal stress inoculation for healthcare providers.
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Affiliation(s)
- Todd P Chang
- From the Division of Emergency Medicine, Keck School of Medicine, University of Southern California (T.P.C.), and Division of Emergency and Transport Medicine (T.H.), Children's Hospital Los Angeles, Los Angeles, CA; A.i.Solve, Ltd (T.D.), Luton, United Kingdom; and PM Pediatrics (J.M.S.), Los Angeles, CA
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Abulfaraj MM, Jeffers JM, Tackett S, Chang T. Virtual Reality vs. High-Fidelity Mannequin-Based Simulation: A Pilot Randomized Trial Evaluating Learner Performance. Cureus 2021; 13:e17091. [PMID: 34527478 PMCID: PMC8432415 DOI: 10.7759/cureus.17091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/05/2022] Open
Abstract
Background Virtual Reality (VR) simulation has been found to be useful in learning technical and non-technical skills. However, empirical data about its efficacy in clinical education are limited. This pilot study compares the efficacy of VR to mannequin-based simulation for learners managing status epilepticus (SE). Methods Pediatric and emergency medicine interns at an academic tertiary care referral center were randomized to either VR (intervention, using an Oculus RiftⓇ (Occulus from Facebook, Facebook Inc., USA)) or mannequin-based (control) simulation for the same SE scenario. The control group participated in two mannequin-based simulation sessions while the intervention group had a VR session followed by a mannequin-based session. Sessions were one-one with an instructor and held three months apart. Performance was assessed by measuring the time-to-critical actions during the second session. Results Of 42 interns, 22 were in the intervention group and 20 in the control group. There was no statistical difference in time-to-critical 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, 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. We did not find a significant difference between the two groups in learner performance. Larger studies are needed to corroborate our findings, investigate the best applications of VR in clinical training, and determine if it could lead to more rapid learning at a lower cost.
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Affiliation(s)
- Maher M Abulfaraj
- Pediatric Emergency Medicine, Taibah University School of Medicine, Madinah, SAU
| | - Justin M Jeffers
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, USA
| | - Todd Chang
- Emergency Medicine, Children's Hospital of Los Angeles, Los Angeles, USA
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Leary M, McGovern SK, Balian S, Abella BS, Blewer AL. A Pilot Study of CPR Quality Comparing an Augmented Reality Application vs. a Standard Audio-Visual Feedback Manikin. Front Digit Health 2020; 2:1. [PMID: 34713015 PMCID: PMC8521903 DOI: 10.3389/fdgth.2020.00001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/10/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Guidelines-based cardiopulmonary resuscitation (CPR) during in-hospital cardiac arrest is a significant predictor of survival, yet the quality of healthcare provider (HCP) CPR (e.g., nurses, physicians etc.) has been shown to be poor. Studies have found that providing HCPs with simulated CPR refresher trainings can improve their CPR quality, however, no studies have compared the use of an augmented reality (AR) CPR refresher training with a standard audio-visual (AV) feedback manikin to improve HCP training. Objectives: In our pilot study, HCPs were randomized to a refresher CPR simulation training with either our AR CPR training application (CPReality) or a standard AV feedback manikin. All subjects completed 2 min of CPR on their respective CPR training modalities, followed by an additional 2 min post-simulation CPR evaluation with no feedback. We hypothesized that the AR CPR training application would confer improved CPR quality defined as chest compression rate and depth compared with the standard AV feedback training. Results: Between January 2019 and May 2019, 100 HCPs were enrolled (50 in the CPReality cohort and 50 in the standard AV manikin cohort). The mean chest compression (CC) rate for all subjects during the intervention was 118 ± 15 cpm, and CC depth was 50 ± 8; post-intervention the CC rate was 120 ± 13 and CC depth was 51 ± 8. The mean CC rate for those trained with CPReality was 121 ± 3 compared with the standard CPR manikin training which was 114 ± 1 cpm (p < 0.006); CC depth was 48 ± 1 mm vs. 52 ± 1 (p = 0.007), respectively. Post-simulation CPR quality with no feedback showed a mean CC rate for the CPReality application at 122 ± 15 cpm compared with the standard CPR manikin at 117 ± 11 cpm (p = 0.09); depth was 49 ± 8 mm vs. 52 ± 8 (p = 0.095), respectively. In the post-survey, 79% of CPReality subjects agreed that the AR application provided a realistic patient presence compared with 59% (p = 0.07) of subjects in the standard CPR manikin cohort. Conclusions: In a randomized trial of an AR CPR training application compared with a standard CPR manikin training, the AR CPR application did not improve the quality of CPR performed during a CPR refresher training compared with the standard training in HCPs. Future studies should investigate the use of this and other digital technologies for CPR training and education.
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Affiliation(s)
- Marion Leary
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States.,School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Shaun K McGovern
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Steve Balian
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Benjamin S Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
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