Is individual practice in an immersive and interactive virtual reality application non-inferior to practicing with traditional equipment in learning systematic clinical observation? A randomized controlled trial

Helen Berg,Aslak Steinsbekk

doi:10.1186/s12909-020-02030-7

Abstract

BackgroundThe aim was to investigate if individual self-practice of the ABCDE approach (Airways, Breathing, Circulation, Disability, Exposure) in an immersive and interactive virtual reality (VR) application gave non-inferior learning outcome compared to using traditional equipment (TP) in first year medical and nursing students.MethodsA non-inferior parallel group randomized controlled trial. The study was linked to a regular teaching program conducted in August and September 2019. All students participated in a 15-min ABCDE introduction session, before they self-practiced the ABCDE approach for 20 min in either a fully immersive and interactive VR application using hand controllers with some haptic feedback (Individual VR) or with blood pressure gauge, ear-thermometer and oximeter (Individual TP). The primary outcome was the number of students who documented all the eight predefined observations in the ABCDE approach in the correct order in a practical test on an advanced simulator manikin with a time limit of 5 min, done immediately after the self-practice. The predefined one-sided non-inferiority limit was 13% points.ResultsOf all eligible students, 84% participated in the study and randomly allocated to VR (n = 149) or TP (n = 140). The primary outcome showed non-inferiority of the VR application with 24.8% in individual VR doing all observations in correct order compared to 27.1% TP (absolute difference 2.3% points, one sided 95% CI 2.3 to 10.8). The secondary outcomes were similar between the groups, but more students in VR reported liking the way they practiced (absolute difference 46% points, 95% CI 36.5 to 56.6) and that it was a good way to learn (36.9% points, 95% CI 26.8 to 47). VR also scored high on the System Usability Scale (mean difference 6.4% points, 95% CI 2.8–10.1).ConclusionsIndividual self-practicing the ABCDE approach in VR was non-inferior to individual self-practicing with traditional equipment.

Highlights

The aim was to investigate if individual self-practice of the ABCDE approach (Airways, Breathing, Circulation, Disability, Exposure) in an immersive and interactive virtual reality (VR) application gave non-inferior learning outcome compared to using traditional equipment (TP) in first year medical and nursing students
We only found two experimental studies investigating the effect of serious game where the ABCDE skills were one of the outcome measures, and these found the results to be similar as other training [19, 20]
Recruitment and baseline characteristics Overall 689 first year medical and nursing students were eligible in the larger study and 289 participated in this study

Summary

Introduction

The aim was to investigate if individual self-practice of the ABCDE approach (Airways, Breathing, Circulation, Disability, Exposure) in an immersive and interactive virtual reality (VR) application gave non-inferior learning outcome compared to using traditional equipment (TP) in first year medical and nursing students. The best way to learn the ABCDE approach is through simulation-based training [5,6,7]. They have found both high-fidelity and low-fidelity simulations with actors, advanced and simple manikin simulators and interactive elearning courses to be effective. VR may benefit to reduce the use of critical resources like lecturers, time, cost and traveling [12]

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