Real Francis J, Whitehead Monica, Ollberding Nicholas J, Rosen Brittany L, Meisman Andrea, Crosby Lori E, Klein Melissa D, Herbst Rachel
Department of Pediatrics, University of Cincinnati College of Medicine (FJ Real, M Whitehead, NJ Ollberding, BL Rosen, LE Crosby, MD Klein, and R Herbst), Cincinnati, Ohio; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (FJ Real and MD Klein), Cincinnati, Ohio.
Department of Pediatrics, University of Cincinnati College of Medicine (FJ Real, M Whitehead, NJ Ollberding, BL Rosen, LE Crosby, MD Klein, and R Herbst), Cincinnati, Ohio; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center (M Whitehead, LE Crosby, and R Herbst), Cincinnati, Ohio.
Acad Pediatr. 2023 Jan-Feb;23(1):185-192. doi: 10.1016/j.acap.2022.07.011. Epub 2022 Jul 21.
Effective educational strategies to train and assess residents' skills in behavioral health competencies have been limited. We hypothesized that a training curriculum using virtual reality (VR) simulations would enhance residents' evidence-based skills related to behavioral health anticipatory guidance (BHAG) and motivational interviewing (MI).
We conducted a randomized controlled pilot trial of our curriculum within an urban academic clinic. Intervention and control groups received four 15-minute, monthly didactics on BHAG and MI followed by VR simulations to 1) deliberately practice delivering BHAG by verbally counseling avatars, who responded real-time (intervention group) or 2) assessing pediatric respiratory distress (control group). Two months post-VR training, all residents participated in a unique VR behavioral health scenario which was recorded and coded by pediatric psychologists via an observation instrument to assess residents' skills. Differences in BHAG and MI competencies were assessed via independent samples t tests for continuous variables and Fisher's exact tests for categorical variables.
Sixty-six percent (n = 55) of eligible residents completed all study protocols comprising 35 intervention and 20 control participants. Intervention participants demonstrated an increase in BHAG skills (P = .002), percentage of open-ended questions asked (P = .04), and percentage of MI adherent behaviors (P = .04) when compared to the control group.
VR may be an effective educational strategy for residents to acquire BHAG and MI skills though deliberate practice. Next steps will focus on assessing the generalizability of the VR curriculum as well as exploring the opportunities to enhance its scalability through artificial intelligence.
用于培训和评估住院医师行为健康能力技能的有效教育策略一直有限。我们假设,使用虚拟现实(VR)模拟的培训课程将提高住院医师与行为健康预期指导(BHAG)和动机性访谈(MI)相关的循证技能。
我们在一家城市学术诊所内对我们的课程进行了一项随机对照试验。干预组和对照组每月接受四次15分钟的关于BHAG和MI的教学,随后进行VR模拟,以1)通过对实时回应的虚拟角色进行口头咨询来刻意练习提供BHAG(干预组),或2)评估小儿呼吸窘迫(对照组)。VR培训两个月后,所有住院医师都参与了一个独特的VR行为健康场景,儿科心理学家通过观察工具对其进行记录和编码,以评估住院医师的技能。通过独立样本t检验评估连续变量的BHAG和MI能力差异,通过Fisher精确检验评估分类变量的差异。
66%(n = 55)符合条件的住院医师完成了所有研究方案,其中35名干预组参与者和20名对照组参与者。与对照组相比,干预组参与者在BHAG技能(P = .002)、开放式问题提问百分比(P = .04)和MI依从行为百分比(P = .04)方面有所提高。
通过刻意练习,VR可能是住院医师获得BHAG和MI技能的有效教育策略。下一步将重点评估VR课程的可推广性,以及探索通过人工智能提高其可扩展性的机会。