Teaching Mass Casualty Triage Skills Using Immersive Three‐dimensional Virtual Reality

Abstract

Objectives: Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy.Methods: Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training.Results: Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p < 0.001). Time to complete each scenario decreased significantly from A (8:10 minutes) to B (5:14 minutes; p < 0.001) and from B to C (3:58 minutes; p < 0.001). Self-efficacy improved significantly in the areas of prioritizing treatment, prioritizing resources, identifying high-risk patients, and beliefs about learning to be an effective first responder.Conclusions: Novice learners demonstrated improved triage and intervention scores, speed, and selfefficacy during an iterative, fully immersed VR triage experience.

Integrative review: Virtual disaster training

“…VRS is experientially reported to help learners achieve learning outcomes [11,19,[22][23][24] . Participants' self-report that these environments are realistic and not difficult to use [6,17] .…”

“…Knight, Carley, Tregunna, Smithies, deFreitas, Dunwell and Machway-Jones [23] discovered that triage tagging accuracy and triage step accuracy was significantly higher in a VRS training group than the group trained using a card sort exercise with no difference in time to triage (n = 91). Vincent et al [19] , found improvement in triage scores (mean=6.5, Std=.83 on a 7 point scale), speed and self-efficacy (p=.001) after fully immersive VRS. The use of student volunteers in this study may have resulted in more technically sophisticated participants and because student were used as their own controls the increase in the scores may have been due to repetition of the scenario.…”

“…Heinrichs, Youngblood, Harter, Kusumoto and Dev [17] report that participants felt immersed in a VRS emergency department (mean=3.47 with 5=high) and that VRS was useful for learning teamwork and clinical skills (mean=3.77). Vincent, Sherstyuk, Burgess, and Connolly [19] and Wilkerson et al [20] reported that participants gave high evaluation scores to VRS training (mean=6.5.Std=.61 on a 7 point scale). The participants in these studies represented a diverse group of healthcare workers.…”

“…Only one article sought to describe how knowledge was developed in the virtual environment. [19] This study explores the utility of immersive VRS for training first responders in a terrorism disaster scenario.…”

AFFECT: Altered-Fidelity Framework for Enhancing Cognition and Training

“…case study #2: Mass casualty Triage Vr Vincent et al (2008) developed an immersive VR system for teaching mass casualty triage skills. The system consisted of an HMD, stereo earphones, and three electromagnetic sensors for tracking the head and both hands.…”