Virtual reality (VR) is an expanding area within medical education, accelerated by the COVID-19 pandemic. Use of VR has been explored within multiple areas but there is limited evidence relating its use in teaching clinical decision-making (medical ‘expert-thinking’) to medical students . Before VR, the most realistic patient-less simulation environments utilised high-fidelity manikins (HFSim). These are effective in teaching management of numerous medical and surgical presentations, but limited by cost and logistics . This is the first study to assess the efficacy of VR, compared to HFSim, in teaching medical students’ clinical decision-making.
This ethically approved study utilised mixed methods to investigate:
Whether VR is as effective as HFSim at increasing students’ clinical decision-making competence and confidence;
The perceived value and experience of each; and
Where VR training should be placed temporally in relation to HFSim.
Sub-analyses explored whether outcomes were influenced by gender.
Students were randomly allocated to experience a simulated scenario in either VR or HFSim. After consenting, participants:
1. Completed baseline assessments of competence and confidence;
2. Received sepsis revision and familiarisation with the relevant environment;
3. Individually undertook an acute sepsis scenario with debriefing;
4. Completed follow-up confidence and competence assessments;
5. Undertook a second scenario in the alternate environment; and
6. Completed questionnaires regarding experiences of VR and HFSim, and preferred initial environment.
The collated data was analysed using the t-test in Excel®.
The study recruited 50 participants. Key findings were:
1. No difference in baseline confidence between VR and HFSim groups;
2. Statistically equal increase in confidence and competence regarding decision-making (confidence after VR +17% and HFSsim +19%, competence after VR +17% and HFSsim +15%). See Figure 1;
3. Participants’ preference was for HFSim (71%, due to greater realism; increased pressure; and verbal communication);
4. Participants’ preference was to undertake VR before HFSim (80%, because less stressful and useful earlier in training); and
5. 100% recommended both environments (complement each other and different knowledge gained from each).
Sub-analysis revealed same outcomes with gender aggregation.
Interim results suggest, regardless of gender, equivalent increases in confidence and competence are achieved in teaching clinical decision-making with either VR or HFSim. VR appears to have a natural place in the progression of teaching between theory and HFSim. Evidence suggests that teaching ‘expert-thinking’ should begin early in training . VR simulation is a safe and more moderate technique through which this can be introduced.
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