Introduction: The increase in doctors undergoing specialist training has limited exposure to critical patients, particularly in pediatrics, making simulation essential for acquiring management skills. Virtual reality (VR) simulation is widespread, but optimizing learning through this technology remains unclear. Primary Objective: To evaluate the effectiveness of two modes of delivering VR simulation as a training technology for managing pediatric emergency scenarios. Materials and Methods: A quasi-randomized crossover pilot study included doctors in the first two years of their pediatric specialization at the University Hospital of Padua. Participation was voluntary and based on inclusion/exclusion criteria. In Phase I, participants were divided into two groups: Debriefing, involving a single VR session managing a pediatric emergency (Status Epilepticus) followed by facilitated debriefing, and Non-Debriefing, which had two VR sessions (basic and advanced) with automatic feedback. Effectiveness was assessed a month later in high-fidelity simulations, with participants divided into teams within the same group. Video recordings of high-fidelity simulation scenarios were used to evaluate non-technical management performance using the validated NOTECHS scale (primary outcome). The time taken for stabilization interventions in the high-fidelity scenario (via video recordings), subjective preference for one of the proposed VR delivery modes (via VR Questionnaire), and perceived ease of use and usefulness of VR (using the Technology Acceptance Model questionnaire - TAM) were also evaluated as secondary outcomes. Phase II, conducted a year later, involved reversing the two study arms to perform the same procedures as Phase I but with a case of Anaphylaxis. Results: The study included 80 doctors in specialist training, with 77 participating in Phase I and 63 in Phase II. In both phases, the Debriefing arm achieved a higher overall score on the NOTECHS scale compared to the control (13.5 [13 - 18] and 12 [11 - 14]; 18 [15.5 19] and 12.5 [10.5 – 15] respectively for the Debriefing and Non-Debriefing groups in the first and second phases of the study). The clinical evaluation and stabilization interventions were similar in both groups in both study phases. However, Group D showed greater speed in executing clinical and stabilization actions. 80% of participants preferred the VR mode followed by group debriefing. The ease of use of VR was rated sub-optimally in both phases (66.7%), while perceived utility remained high (94.5% and 91.7%). Conclusions: Although pilot and with a small sample size, our study highlighted that simulation of pediatric emergency scenarios through VR, accompanied by debriefing, appears to have superior, albeit modest, effectiveness in acquiring management skills and team dynamics in a high-fidelity simulation setting. This delivery mode was preferred by the majority of participants. However, despite the perceived high utility of VR simulation, the assessment of technology ease of use remained sub-optimal, indicating the need for further strategies to improve it.
Introduzione: L'aumento dei medici in formazione specialistica ha limitato l'esposizione al paziente critico, soprattutto in pediatria, rendendo essenziale potenziare la simulazione per acquisire competenze gestionali. La simulazione virtuale (VR) è diffusa, ma l'ottimizzazione dell'apprendimento tramite questa tecnologia rimane poco chiara. Obiettivo primario dello studio: Valutare l'efficacia di due modalità di erogazione della simulazione tramite realtà virtuale (VR) utilizzata come tecnologia di formazione per la gestione di scenari di emergenza pediatrica. Materiali e Metodi: Studio pilota quasi randomizzato cross-over a due bracci che ha incluso medici in formazione specialistica della Scuola di Specializzazione in Pediatria dell’Azienda Ospedale-Università di Padova, nel primo biennio della loro formazione, in due distinte fasi di studio. La partecipazione è stata volontaria e basata su criteri di inclusione/esclusione. Nella Fase I, i partecipanti sono stati divisi in due gruppi: Debriefing, che comprendeva una singola sessione VR gestendo un'emergenza pediatrica (Stato di Male Epilettico) seguita da debriefing con facilitatore, e Non Debriefing, che ha avuto due sessioni VR (di base ed avanzata) con feedback automatico. L'efficacia delle modalità è stata valutata un mese dopo le sessioni VR in simulazioni ad alta fedeltà, con partecipanti divisi in squadre appartenenti allo stesso gruppo. Dalle video registrazioni degli scenari di simulazione ad alta fedeltà sono state valutate la performance di gestione non tecnica mediante l’utilizzo della scala validata NOTECHS (outcome primario). Sono stati inoltre valutati i tempi necessari agli interventi di stabilizzazione nello scenario ad alta fedeltà (tramite le video registrazioni), la preferenza soggettiva di una delle due modalità di erogazione della VR proposte (tramite VR Questionnaire) e la valutazione di percepita facilità d’uso ed utilità della VR (con il Technology Acceptance Model questionnaire - TAM) quali outcome secondari. La Fase II - a distanza di un anno - ha previsto l’inversione tra i due bracci di studio che hanno eseguito le medesime procedure della Fase I, ma su un caso di Anafilassi. Risultati: Lo studio ha coinvolto 80 medici in formazione specialistica, 77 di questi hanno partecipato alla Fase I dello studio, 63 alla Fase II. In entrambe le fasi il braccio Debriefing (D) ha ottenuto un punteggio globale maggiore sulla scala NOTECHS rispetto al controllo (13.5 [13 - 18] e 12 [11 - 14]; 18 [15.5 19] e 12.5 [10.5 – 15] rispettivamente per il gruppo Debriefing e Non Debriefing nella prima e nella seconda fase dello studio); anche il punteggio attribuito alle voci della scala NOTECHS singolarmente, per alcuni domini è risultato maggiore per il braccio D, sebbene non in maniera statisticamente significativa. La valutazione clinica e gli interventi per la stabilizzazione sono stati simili in entrambi i gruppi nelle due fasi dello studio. Tuttavia, il Gruppo D ha mostrato una maggiore rapidità nell'esecuzione delle azioni cliniche e di stabilizzazione. L'80% dei partecipanti ha preferito la modalità VR seguita da debriefing di gruppo. La facilità d'uso della VR è stata valutata come sub-ottimale in entrambe le fasi (66.7%), mentre la percepita utilità è rimasta alta (94.5% e 91.7%). Conclusioni: Il nostro studio ha evidenziato che la simulazione di scenari di urgenze-emergenze pediatriche tramite VR, accompagnata da debriefing, sembra avere un'efficacia superiore, seppur modesta, nell'acquisizione di abilità gestionali e dinamiche di squadra in un contesto di simulazione ad alta fedeltà. Questa modalità di erogazione è stata preferita dalla maggior parte dei partecipanti. Tuttavia, nonostante l'elevata utilità percepita della simulazione in VR, la valutazione della facilità d'uso della tecnologia è rimasta non ottimale, indicando la necessità di ulteriori strategie per migliorarla.
Simulazione virtuale per la formazione nelle emergenze pediatriche: due modalità di erogazione a confronto
MENARDO, FRANCESCO MARIA
2023/2024
Abstract
Introduction: The increase in doctors undergoing specialist training has limited exposure to critical patients, particularly in pediatrics, making simulation essential for acquiring management skills. Virtual reality (VR) simulation is widespread, but optimizing learning through this technology remains unclear. Primary Objective: To evaluate the effectiveness of two modes of delivering VR simulation as a training technology for managing pediatric emergency scenarios. Materials and Methods: A quasi-randomized crossover pilot study included doctors in the first two years of their pediatric specialization at the University Hospital of Padua. Participation was voluntary and based on inclusion/exclusion criteria. In Phase I, participants were divided into two groups: Debriefing, involving a single VR session managing a pediatric emergency (Status Epilepticus) followed by facilitated debriefing, and Non-Debriefing, which had two VR sessions (basic and advanced) with automatic feedback. Effectiveness was assessed a month later in high-fidelity simulations, with participants divided into teams within the same group. Video recordings of high-fidelity simulation scenarios were used to evaluate non-technical management performance using the validated NOTECHS scale (primary outcome). The time taken for stabilization interventions in the high-fidelity scenario (via video recordings), subjective preference for one of the proposed VR delivery modes (via VR Questionnaire), and perceived ease of use and usefulness of VR (using the Technology Acceptance Model questionnaire - TAM) were also evaluated as secondary outcomes. Phase II, conducted a year later, involved reversing the two study arms to perform the same procedures as Phase I but with a case of Anaphylaxis. Results: The study included 80 doctors in specialist training, with 77 participating in Phase I and 63 in Phase II. In both phases, the Debriefing arm achieved a higher overall score on the NOTECHS scale compared to the control (13.5 [13 - 18] and 12 [11 - 14]; 18 [15.5 19] and 12.5 [10.5 – 15] respectively for the Debriefing and Non-Debriefing groups in the first and second phases of the study). The clinical evaluation and stabilization interventions were similar in both groups in both study phases. However, Group D showed greater speed in executing clinical and stabilization actions. 80% of participants preferred the VR mode followed by group debriefing. The ease of use of VR was rated sub-optimally in both phases (66.7%), while perceived utility remained high (94.5% and 91.7%). Conclusions: Although pilot and with a small sample size, our study highlighted that simulation of pediatric emergency scenarios through VR, accompanied by debriefing, appears to have superior, albeit modest, effectiveness in acquiring management skills and team dynamics in a high-fidelity simulation setting. This delivery mode was preferred by the majority of participants. However, despite the perceived high utility of VR simulation, the assessment of technology ease of use remained sub-optimal, indicating the need for further strategies to improve it.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/63124