Cincinnati Children's Hospital
Purpose: Respiratory distress is the most common cause of hospital admission during the 1st year of life. Identification of respiratory distress is critical for escalation of care, relying upon exam skills which are often under-developed in medical students. Our objective was to develop and assess the impact of an immersive virtual reality (VR) curriculum on medical student competence in assessment of respiratory distress.
Method: A randomized, controlled, prospective study was initiated at a large, academic children’s hospital in July 2017. All 3rd year medical students on the pediatric rotation were eligible. All medical students received standard didactic training on respiratory distress through didactics, mannequin simulation, and inpatient instruction. The intervention group additionally underwent an independent 20-minute VR curriculum with three simulations: 1) infant in no distress, 2) respiratory distress, and 3) impending respiratory failure.
The VR environment, experienced through an Oculus Rift™ headset, was created to replicate an inpatient room. A facilitator controlled VR preceptor guided the medical student through the simulation. The VR patient portrayed exam findings (i.e. retractions, breath sounds, mental status) with corresponding vital signs on the VR monitor. A post-session survey included retrospective pre-post self-assessment of competence and questions regarding attitudes towards the VR environment and VR education.
At the end of each rotation, all students completed a free response clinical assessment requiring evaluation of videos of 3 patients (included patient findings, vital sign data, and audio of breath sounds) that was coded utilizing rubrics developed by 6 clinical experts (Emergency Medicine and Critical Care faculty) via a modified Delphi approach.
Results: 42 intervention and 46 control students participated through December 2017. 94% of intervention showed improvement in self-assessed competence (95% CI [80.8-99.3], p<0.001). A significant majority of intervention highly rated the effectiveness and immersion of the VR training and rated VR as equally or more effective than many teaching modalities. A significant difference between intervention and control was demonstrated on the video-based exam for consideration of mental status (p<0.001), recognition of respiratory distress (p=0.02), and recognition of a need for escalation of care (p<0.001).
Conclusions: This study represents a novel application of an immersive VR-based simulation curriculum targeting clinical assessment skills. This modality was well received, represents a unique approach to clinical training and was successful in leading to improved self-assessed competence as well as an objective difference in competence at the assessment of respiratory distress and recognition of the need for an escalation of care, a key skill to ensure the safety of patients.
