Katz Daniel, Shah Ronak, Kim Elizabeth, Park Chang, Shah Anjan, Levine Adam, Burnett Garrett
Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
City University of New York City Medical School, New York, NY, United States.
J Med Internet Res. 2020 Mar 12;22(3):e17425. doi: 10.2196/17425.
The incidence of cardiac arrests per year in the United States continues to increase, yet in-hospital cardiac arrest survival rates significantly vary between hospitals. Current methods of training are expensive, time consuming, and difficult to scale, which necessitates improvements in advanced cardiac life support (ACLS) training. Virtual reality (VR) has been proposed as an alternative or adjunct to high-fidelity simulation (HFS) in several environments. No evaluations to date have explored the ability of a VR program to examine both technical and behavioral skills and demonstrate a cost comparison.
This study aimed to explore the utility of a voice-based VR ACLS team leader refresher as compared with HFS.
This prospective observational study performed at an academic institution consisted of 25 postgraduate year 2 residents. Participants were randomized to HFS or VR training and then crossed groups after a 2-week washout. Participants were graded on technical and nontechnical skills. Participants also completed self-assessments about the modules. Proctors were assessed for fatigue and task saturation, and cost analysis based on local economic data was performed.
A total of 23 of 25 participants were included in the scoring analysis. Fewer participants were familiar with VR compared with HFS (9/25, 36% vs 25/25, 100%; P<.001). Self-reported satisfaction and utilization scores were similar; however, significantly more participants felt HFS provided better feedback: 99 (IQR 89-100) vs 79 (IQR 71-88); P<.001. Technical scores were higher in the HFS group; however, nontechnical scores for decision making and communication were not significantly different between modalities. VR sessions were 21 (IQR 19-24) min shorter than HFS sessions, the National Aeronautics and Space Administration task load index scores for proctors were lower in each category, and VR sessions were estimated to be US $103.68 less expensive in a single-learner, single-session model.
Utilization of a VR-based team leader refresher for ACLS skills is comparable with HFS in several areas, including learner satisfaction. The VR module was more cost-effective and was easier to proctor; however, HFS was better at delivering feedback to participants. Optimal education strategies likely contain elements of both modalities. Further studies are needed to examine the utility of VR-based environments at scale.
美国每年心脏骤停的发生率持续上升，但不同医院的院内心脏骤停存活率差异显著。当前的培训方法昂贵、耗时且难以规模化，这就需要改进高级心血管生命支持（ACLS）培训。在多个环境中，虚拟现实（VR）已被提议作为高保真模拟（HFS）的替代或辅助手段。迄今为止，尚无评估探讨VR程序检查技术和行为技能的能力以及成本比较。
本研究旨在探讨基于语音的VR ACLS团队领导者复习培训与HFS相比的效用。
这项在一所学术机构进行的前瞻性观察性研究纳入了25名二年级住院医师。参与者被随机分配到HFS或VR培训组，然后在为期2周的洗脱期后交叉分组。对参与者的技术和非技术技能进行评分。参与者还完成了关于各模块的自我评估。对监考人员的疲劳和任务饱和度进行评估，并根据当地经济数据进行成本分析。
25名参与者中有23名纳入评分分析。与HFS相比，熟悉VR的参与者较少（9/25，36%对25/25，100%；P<0.001）。自我报告的满意度和利用率得分相似；然而，更多参与者认为HFS提供了更好的反馈：99（四分位间距89 - 100）对79（四分位间距71 - 88）；P<0.001。HFS组的技术得分更高；然而，不同模式下决策和沟通的非技术得分无显著差异。VR课程比HFS课程短21（四分位间距19 - 24）分钟，监考人员的美国国家航空航天局任务负荷指数得分在每个类别中都较低，并且在单学习者、单课程模式下，VR课程估计成本低103.68美元。
在包括学习者满意度在内的几个方面，使用基于VR的团队领导者复习培训来进行ACLS技能培训与HFS相当。VR模块更具成本效益且监考更容易；然而，HFS在向参与者提供反馈方面表现更好。最佳教育策略可能包含两种模式的要素。需要进一步研究以大规模检验基于VR环境的效用。
