Rubio-López Alberto, García Carmona Rodrigo, Zarandieta Román Laura, Rubio Navas Alejandro, González-Pinto Angel, Cardinal-Fernández Pablo
Intensive Care Unit, Hospital Universitario HM Montepríncipe, HM Hospitales, Avda Montepríncipe, Boadilla del Monte, Madrid, 28660, Spain, 34 656316182.
Facultad de Medicina, Universidad San Pablo CEU, Madrid, Spain.
JMIR Serious Games. 2025 May 7;13:e68515. doi: 10.2196/68515.
Virtual reality (VR) is increasingly used in medical education, providing immersive environments for training in high-risk procedures such as pericardiocentesis. This lifesaving procedure requires technical precision and induces cognitive and physiological stress. Evaluating both usability and stress responses in a VR-based pericardiocentesis simulation is essential. Heart rate variability (HRV) serves as an objective stress marker, while prior VR experience may influence usability and stress perception.
This study aimed to assess the usability of a VR-based pericardiocentesis simulation, examine the relationship between usability perceptions and physiological stress (HRV), and determine the impact of prior VR experience on usability scores and stress responses.
A total of 119 final-year medical students participated in a VR pericardiocentesis simulation. Usability was evaluated using the System Usability Scale (SUS), the Post-Study System Usability Questionnaire, the Presence Questionnaire, and the Simulator Sickness Questionnaire. Physiological stress was assessed through HRV parameters, including the root-mean-square of successive differences (rMSSDs), percentage of differences greater than 50 ms (PNN50), low-frequency to high-frequency ratio, and nonlinear HRV indices (SD1/SD2 ratio, Poincaré area). Statistical analyses included descriptive statistics, Spearman correlations, and Mann-Whitney U tests to explore relationships between usability, stress, and prior VR experience.
The VR simulation received a mean SUS score of 75.00 (SD 6.41; 95% CI 73.42-76.58), exceeding the general usability threshold of 68 (P=.002). The mean Post-Study System Usability Questionnaire score of 2.92 (SD 1.83; 95% CI 2.55-3.29) indicated moderate satisfaction, while the mean Presence Questionnaire score of 109.46 (SD 9.12; 95% CI 107.88-111.04) reflected strong immersion. Simulator sickness symptoms were mild (mean Simulator Sickness Questionnaire score 12.43, SD 15.41; 95% CI 9.28-15.58), although novice users reported significantly higher nausea levels (P=.02). Physiological stress analysis revealed a mean rMSSD of 281.27 (SD 98.99; 95% CI 259.45-303.09) ms and PNN50 of 56.85% (SD 19.70%; 95% CI 52.23%-61.47%), indicating moderate autonomic balance. A significant negative correlation was observed between HRV parameters (rMSSD and PNN50) and simulator sickness (P=.04; Spearman ρ=-0.23), suggesting that higher physiological stress was associated with increased simulator sickness symptoms. Prior VR experience was linked to higher usability scores (SUS +5.2; 95% CI 3.12-7.28; P=.03) and lower simulator sickness symptoms (P=.02) but did not significantly affect HRV markers.
VR-based simulations for high-risk medical procedures are effective training tools with high usability (SUS=75) and strong immersion. Simulator sickness correlated with physiological stress, emphasizing the need for design refinements to improve user comfort. Prior VR experience improved usability and reduced simulator sickness but did not significantly impact HRV markers. Future research should refine VR interfaces to balance immersion with minimized cognitive and physical discomfort.
虚拟现实（VR）在医学教育中的应用日益广泛，为诸如心包穿刺术等高风险操作的培训提供了沉浸式环境。这种挽救生命的操作需要技术精准度，并会引发认知和生理压力。评估基于VR的心包穿刺术模拟中的可用性和压力反应至关重要。心率变异性（HRV）是一种客观的压力标志物，而先前的VR体验可能会影响可用性和压力感知。
本研究旨在评估基于VR的心包穿刺术模拟的可用性，研究可用性感知与生理压力（HRV）之间的关系，并确定先前的VR体验对可用性得分和压力反应的影响。
共有119名医学专业最后一年的学生参与了VR心包穿刺术模拟。使用系统可用性量表（SUS）、研究后系统可用性问卷、临场感问卷和模拟器晕动症问卷评估可用性。通过HRV参数评估生理压力，包括逐次差值的均方根（rMSSD）、差值大于50毫秒的百分比（PNN50）、低频与高频比值以及非线性HRV指数（SD1/SD2比值、庞加莱面积）。统计分析包括描述性统计、斯皮尔曼相关性分析和曼-惠特尼U检验，以探索可用性、压力和先前VR体验之间的关系。
VR模拟的SUS平均得分为75.00（标准差6.41；95%置信区间73.42 - 76.58），超过了一般可用性阈值68（P = 0.002）。研究后系统可用性问卷的平均得分为2.92（标准差1.83；95%置信区间2.55 - 3.29），表明满意度中等，而临场感问卷的平均得分为109.46（标准差9.12；95%置信区间107.88 - 111.04）反映出强烈的沉浸感。模拟器晕动症症状较轻（模拟器晕动症问卷平均得分12.43，标准差15.41；95%置信区间9.28 - 15.58），尽管新手用户报告的恶心程度显著更高（P = 0.02）。生理压力分析显示，rMSSD的平均值为281.27（标准差98.99；95%置信区间259.45 - 303.09）毫秒，PNN50为56.85%（标准差19.70%；95%置信区间52.23% - 61.47%），表明自主神经平衡适中。观察到HRV参数（rMSSD和PNN50）与模拟器晕动症之间存在显著的负相关（P = 0.04；斯皮尔曼ρ = -0.23），表明较高的生理压力与模拟器晕动症症状增加有关。先前的VR体验与较高的可用性得分（SUS增加5.2；95%置信区间3.12 - 7.28；P = 0.03）和较低的模拟器晕动症症状（P = 0.02）相关，但对HRV标志物没有显著影响。
基于VR的高风险医疗操作模拟是有效的培训工具，具有高可用性（SUS = 75）和强烈的沉浸感。模拟器晕动症与生理压力相关，强调需要进行设计改进以提高用户舒适度。先前的VR体验提高了可用性并减少了模拟器晕动症，但对HRV标志物没有显著影响。未来的研究应改进VR界面，以在沉浸感与最小化认知和身体不适之间取得平衡。
