Validation of a Virtual Simulator With Haptic Feedback for Endotracheal Intubation Training

Abstract

Introduction: Endotracheal intubation (ETI) is a procedure that varies in difficulty because of patient characteristics and clinical conditions. Existing physical simulators do not encompass these variations. The Virtual Airway Skills Trainer for Endotracheal Intubation (VAST-ETI) was developed to provide different patient characteristics and high-fidelity haptic feedback to improve training. Methods: We demonstrate the effectiveness of VAST-ETI as a training and evaluation tool for ETI. Construct validation was evaluated by scoring the performance of experts (N = 15) and novices (N = 15) on the simulator to ensure its ability to distinguish technical proficiency. Convergent and predictive validity were evaluated by performing a learning curve study, in which a group of novices (N = 7) were trained for 2 weeks using VAST-ETI and then compared with a control group (N = 9). Results: The VAST-ETI was able to distinguish between expert and novice based on mean simulator scores (t[88] = −6.61, P < 0.0005). When used during repeated practice, individuals demonstrated a significant increase in their score on VAST-ETI over the learning period (F[11,220] = 7206, P < 0.001); however when compared with a control group, there was not a significant interaction effect on the simulator score. There was a significant difference between the simulator-trained and control groups (t[12.85] = −2.258, P = 0.042) when tested in the operating room. Conclusions: Our results demonstrate the effectiveness of virtual simulation with haptic feedback for assessing performance and training of ETI. The simulator was not able to differentiate performance between more experienced trainees and experts because of limits in simulator difficulty.

Simulation: past, present, and future

“…SBHE educational paradigms, such as rapid cycle deliberate practice [ 27 ], virtual simulation [ 24 ], and simulation at a distance, must leverage the expanding portfolio of simulation devices and other SBHE enabling technologies to enhance healthcare learner outcomes and educational systems’ effectiveness. Optimizing existing and future technologies including fully immersive environments using augmented reality (AR) and VR displays, interactions in the metaverse, airway haptics [ 28 ], and olfactory stimuli [ 17 ] will require research into many fundamentally unanswered questions regarding pedagogies, assessment, and outcomes. The Society for Simulation in Healthcare (SSH) recently established the top ten questions and priorities for healthcare simulation research, including uncovering best research designs to investigate simulation effectiveness, studying the dose response relationship between simulation training and patient care outcomes, effective approaches to patient safety, and the impact of learning strategies [ 13 ].…”