Impact of an Immersive Virtual Reality Curriculum on Medical Students’ Clinical Assessment of Infants With Respiratory Distress*

Abstract

Objective: To determine whether exposure to an immersive virtual reality curriculum on pediatric respiratory distress improves medical students’ recognition of impending respiratory failure. Design: Randomized, controlled, prospective study conducted from July 2017 to June 2018. Evaluators blinded to student groupings. Setting: Academic, free-standing children’s hospital. Participants: All third-year medical students (n = 168) were eligible. The standard curriculum was delivered to all students during their pediatric rotation with optional inclusion of research data per Institutional Review Board review. A randomized selection of students was exposed to the virtual reality curriculum. Intervention: All students received standard training on respiratory distress through didactics and high-fidelity mannequin simulation. Intervention students underwent an additional 30-minute immersive virtual reality curriculum, experienced through an OculusRift headset, with three simulations of an infant with 1) no distress, 2) respiratory distress, and 3) impending respiratory failure. Measurements and Main Results: The impact of the virtual reality curriculum on recognition/interpretation of key examination findings, assignment of an appropriate respiratory status assessment, and recognition of the need for escalation of care for patients in impending respiratory failure was assessed via a free response clinical assessment of video vignettes at the end of the pediatric rotation. Responses were scored on standardized rubrics by physician experts. All eligible students participated (78 intervention and 90 control). Significant differences between intervention and control were demonstrated for consideration/interpretation of mental status (p < 0.01), assignment of the appropriate respiratory status assessment (p < 0.01), and recognition of a need for escalation of care (p = 0.0004). Conclusions: Exposure to an immersive virtual reality curriculum led to improvement in objective competence at the assessment of respiratory distress and recognition of the need for escalation of care for patients with signs of impending respiratory failure. This study represents a novel application of immersive virtual reality and suggests that it may be effective for clinical assessment training.

Establishing Objective Measures of Clinical Competence in Undergraduate Medical Education Through Immersive Virtual Reality

“…The VR scenario's development and content including a simulated inpatient environment with virtual patient and preceptor avatars, vital signs monitor, and room décor along with functionality (visual and auditory cues including patients’ breath sounds) has been previously described in Academic Pediatrics 15 ( https://drive.google.com/file/d/1m-1j7hbxvIu-dK1jdgz9MRQYcubS6-IS/view?usp=sharing ) with demonstrated effectiveness as a teaching tool. 16 To establish our competency standards, we focused on a case of impending respiratory failure during which the virtual infant displayed altered mental status, increased work of breathing, abnormal breath sounds, tachycardia, tachypnea, and hypoxia - consistent with a need for escalation of clinical care. 15 , 16 …”

“… 16 To establish our competency standards, we focused on a case of impending respiratory failure during which the virtual infant displayed altered mental status, increased work of breathing, abnormal breath sounds, tachycardia, tachypnea, and hypoxia - consistent with a need for escalation of clinical care. 15 , 16 …”

“…The videos were also reviewed by a second group of physicians (FR, DY) using a structured observable behavior checklist ( Figure 1 ), which had been developed for a previous VR study using a modified Delphi approach. 16 Two sample scenarios were graded independently by the two reviewers, followed by a debriefing session to compare scores and reach consensus to enhance reliability. A key grading perspective established during this debriefing was that students who required prompting to state that the patient required an escalation of care would still receive credit for a correct response due to having an accurate interpretation of the clinical scenario.…”

“…VR has successfully been used for training in various contexts, such as performing procedures, 11 learning empathy, 12 addressing vaccine hesitancy, 13 , 14 and performing a clinical assessment. 15 , 16 , 17 However, VR has yet to be leveraged for the establishment of competency standards or formal assessment of performance. To address this gap, our study aimed to establish competency standards related to student recognition of impending respiratory failure using an immersive VR platform, using the clinical scenario of an infant admitted with bronchiolitis.…”

Recent Advances in Simulation for Pediatric Critical Care Medicine

“…Evidence of its efficacy, however, is only starting to emerge. Topics such as airway intubation, patient monitoring, and infant respiratory distress have been taught through this technique, with positive results [ 33 , 42 – 46 ]. In the case of VR/AR simulations, feedback is given through a computer program; there is often no human instructor used for debriefing.…”