Comparing the Effectiveness of Multimodal Learning Using Computer-Based and Immersive Virtual Reality Simulation-Based Interprofessional Education With Co-Debriefing, Medical Movies, and Massive Online Open Courses for Mitigating Stress and Long-Term Burnout in Medical Training: Quasi-Experimental Study.

BACKGROUND

Burnout among emergency room health care workers (HCWs) has reached critical levels, affecting up to 43% of HCWs and 35% of emergency medicine personnel during the COVID-19 pandemic. Nurses were most affected, followed by physicians, leading to absenteeism, reduced care quality, and turnover rates as high as 78% in some settings such as Thailand. Beyond workforce instability, burnout compromises patient safety. Each 1-unit increase in emotional exhaustion has been linked to a 2.63-fold rise in reports of poor care quality, 30% increase in patient falls, 47% increase in medication errors, and 32% increase in health care-associated infections. Burnout is also associated with lower job satisfaction, worsening mental health, and increased intent to leave the profession. These findings underscore the urgent need for effective strategies to reduce stress and burnout in emergency care.

OBJECTIVE

This study aimed to evaluate the effectiveness and effect size of a multimodal learning approach-Emergency Room Virtual Simulation Interprofessional Education (ER-VIPE)-that integrates medical movies, massive online open courses (MOOCs), and computer- or virtual reality (VR)-based simulations with co-debriefing for reducing burnout and stress among future health care professionals compared with approaches lacking co-debriefing or using only movies and MOOCs.

METHODS

A single-blind, quasi-experimental study was conducted at a university hospital from August 2022 to September 2023 using a 3-group treatment design. Group A (control) participated in a 3D computer-based, simulation-based interprofessional education (SIMBIE) without debriefing. Group B received the ER-VIPE intervention. Group C received the same as Group B, but the computer-based SIMBIE was replaced with 3D VR-SIMBIE. SIMBIE activities simulated a COVID-19 pneumonia crisis. Outcomes included the Dundee Stress State Questionnaire (DSSQ) and the Copenhagen Burnout Inventory, with trait anxiety as a behavioral control. Stress and burnout were measured at baseline, pre-intervention, postintervention, and 1-month follow-up. Generalized estimating equations were used to analyze group differences, with statistical significance set at P<.05.

RESULTS

We randomized 87 undergraduate students from various health programs into the 3 groups (n=29 each). Participants' mean age was 22 years, with 71% (62/87) as women. After the 1-month post-SIMBIE follow-up, adjusted analyses revealed positive trends in DSSQ-engagement across all groups, with Group B showing a significant increase compared with Group A (mean difference=3.93; P=.001). DSSQ-worry and DSSQ-distress scores decreased nonsignificantly across all groups. Burnout scores also improved across groups, with Group B having a significantly lower score than Group A (mean difference=-2.02; P=.02). No significant burnout differences were found between Group C and Groups A or B.

CONCLUSIONS

A multimodal learning approach combining medical movies, MOOCs, and 3D computer-based SIMBIE with co-debriefing effectively improved engagement, reduced stress, and lowered burnout among future health care professionals. This scalable educational framework may help enhance well-being and resilience in high-pressure clinical environments.