Virtual Advancement of Learning for Operational Readiness in the Prehospital Setting (VALOR-PS): A Prospective, Controlled Multi-Center Trial of Virtual Reality and High Fidelity Manikin Simulation Across the Roles of Care

Background: High-fidelity manikin-based medical simulation training is one of the few evidence-based interventions demonstrated to reduce medical errors and improve trainee readiness. However, this modality does suffer from significant limitations. These limitations include both physical (i.e. inability to represent a diverse range of patients and presentations) and psychological challenges (i.e. inability to represent psychological and environmental dangers and distractors) of realism, as well as the cost and logistical complexity of high-fidelity simulation. Virtual reality medical simulation is a training modality with the potential to address these barriers; however, it presents other limitations of its own. Little research exists directly comparing the efficacy and efficiency of the two modalities for simulation training. Here, we describe our planned effort to comprehensively evaluate both approaches in a scientifically rigorous multi-center trial in the prehospital setting.

Methods: We plan a multi-center, prospective, controlled trial comparing virtual reality medical simulation (VRMS) to high-fidelity manikin simulation (HFMS) across three prehospital domains: 1) Chemical, Biological, Nuclear, Radiation, and high Explosive (CBRNE) disaster response, 2) Emergency Medical Services (EMS) ambulance en-route care, and 3) Advanced Resuscitative Care (ARC) for advanced prehospital trauma management in the field and aeromedical settings. Four scenarios from each domain will be selected, and training will be performed in VRMS using the SimX VR platform and HFMS using Laerdal and Gaumard manikin platforms. Scenarios will be replicated across modalities, and trainees will be randomized to VRMS or HFMS first, and then cross over to ensure equal training. Training sites will include the University of Alabama - Birmingham, Western Michigan University, and the US Air Force Special Operations Center for Medical Integration and Development.

Anticipated Results: We anticipate recruiting 50 participants from each site for an initial study cohort of 150 trainees, across the continuum of EMT-B, EMT-I, EMT-P and MD levels of training. The primary study measures will be collected through pre- and post- surveys, which will be used to measure outcomes in modality acceptance, proficiency in selected knowledge, skills, and abilities (KSAs), and cost and efficiency of execution. The secondary study measures will be direct measures of KSAs through measured simulation performance within VRMS and HFMS. Data will be collected across two time points, an initial training session, and a follow-up training session after a wash-out period in order to evaluate change in perceptions over time as well as knowledge decay. Both trainees and educators will be surveyed to provide a 360 degree view of the training modalities. Study data will be analyzed on a statistical non-inferiority basis between the two modalities.

Anticipated Conclusion: This study will be the first multi-center, randomized, controlled study comparing VRMS to HFMS for medical simulation training. We anticipate that our study will find non-inferiority between the two modalities on indirect (survey-based) KSA proficiency measures at the primary and secondary time points. Measures of cost, logistical complexity, and efficiency are likely to show benefit from VRMS training. VRMS training is likely to show benefits for physical, medical, and psychoenvironmental realism, while HFMS training is likely to show benefits for tactile and skills realism. Overall, we believe this study will provide a strong foundation for educators looking to optimize the selection of VRMS and HFMS training modalities to fit curricular needs and budgets through a detailed analysis of the strengths and weaknesses of both approaches, which will enable delivering more needed simulation training to those who need it.