216 - Differences between 1-player and 2-player Virtual Reality Training for Neonatal Resuscitation Program (NRP) Skills: a quasi-randomized comparison trial

Publication Number: 216.4141

Todd Chang, Children's Hospital Los Angeles, Los Angeles, CA, United States; Maurizio P. Escobar, Children's Hospital Los Angeles, Los Angeles, CA, United States; Joong Wan Park, Seoul National University Hospital, La Canada Flintridge, CA, United States; Nehemie P. Jules, Children's Hospital Los Angeles, LosAngeles, CA, United States; Laquanda Knowlin, Children's Hospital Los Angeles, Los Angeles, CA, United States; Branae Rollins, Children's Hospital Los Angeles, Los Angeles, CA, United States; Marcella Christine. Bernstein, Children's Hospital Los Angeles, Los angeles, CA, United States; Satchel Clendenin, Children's Hospital Los Angeles, West Hollywood, CA, United States; Troy Zeier, Children's Hospital Los Angeles, Los Angeles, CA, United States; Jaeyun Jung, Seoul National University Children’s Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Elmer David, Children's Hospital Los Angeles, Los Angeles, CA, United States; Courtney Washington, Children's Hospital Los Angeles, Los Angeles, CA, United States; Rebecca Martinez-Hannon, Children's Hospital of Los Angeles, Los Angeles, CA, United States

Background: High-fidelity Neonatal Resuscitation Program (NRP) simulations require substantial costs. Virtual Reality NRP improves cognitive and problem-solving but were initially 1-player simulations. 2-player modes enabling human communication appear to improve teamwork and reduce deviations from protocols. It is unknown if 2-player NRP VR training has advantages in compared to 1-player versions.

Objective: To determine whether a 2-player NRP VR simulation is superior to a 1-player simulation in improving knowledge and performance.

Design/Methods: This is a quasi-randomized controlled trial using a VR headset and a SOMAReality NRP training software (Figure 1). Eligible physicians, advanced providers, nurses, and respiratory therapists were allocated to 1- or 2-player groups. Participants completed the initial NRP scenario 3 times. Then they returned 1-2 weeks later for an assessment session wherein each participant was tested with a standardized 2nd player in the VR software environment. Performance data were evaluated. Demographic and VR use data were collected. Primary outcomes were collected during the assessment sessions and included number of critical actions completed. Cybersickness, perceived team function and workload were measured. Data were analyzed using univariate statistics and multiple linear regression.

Results: 14 participants were allocated to 1-player and 20 were allocated to 2-player; final data were available for 13 and 16 participants, respectively. There were no impactful demographic differences between groups demographics (Table 1, p>0.16). There were no differences in video game or VR familiarity between groups (p>0.65). The 2-player participants were statistically older but not clinically: 32 (IQR 31.25,33) vs 36.5 (IQR 32.75,43.5). With univariate statistics, outcome variables for performance were not significantly different between groups (Table 01). In multiple linear regression, we found 4 factors that influenced performance (Adjusted R2 0.12). Three factors demonstrated weak, non-significant relationships between better performance and: 1) more resuscitation experience, 2) recent NRP certification, 3) having completed a 2-player VR session. Better performance was associated with less VR familiarity (p=0.01). No differences in cybersickness, team function, or workload were found between groups (Table 2).

Conclusion(s): We found no significant differences in VR performance for NRP skills between 1-player vs. 2-player learning modes. Single player VR may be an effective method of teaching basic resuscitation skills in a VR setting.

Figure 01 - Virtual Reality NRP
A 1-player version of the SOMAReality NRP Training software. The participant is using a PICO Neo 03 headset with controllers and adjusting the FiO2 and PIP of the NeoPuff device.

Table 01 - Demographics and Performance Data
Participants were generally similar between group allocation between 1-player and 2-player. There was a statistically significant difference in age, but this was unlikely to have clinically or educationally significant effect. No key differences in performance during the standardized assessment session was found between groups.

Table 02 - Simulator Sickness Questionnaire, NOTECHS Teamwork Scale, NASA-TLX Workload Scale
No substantial differences were found between groups in either the initial VR session or the assessment sessions. SSQ measures the sum total of 16 body sensations corresponding to simulator sickness (0-3 each), NOTECHS is a 5-item (0-5 each) score on leadership and teamwork function, and NASA-TLX tests 6 domains (-10 to 10 each) on different perceptions of workload.

Figure 01 - Virtual Reality NRP
A 1-player version of the SOMAReality NRP Training software. The participant is using a PICO Neo 03 headset with controllers and adjusting the FiO2 and PIP of the NeoPuff device.

Table 01 - Demographics and Performance Data
Participants were generally similar between group allocation between 1-player and 2-player. There was a statistically significant difference in age, but this was unlikely to have clinically or educationally significant effect. No key differences in performance during the standardized assessment session was found between groups.

Table 02 - Simulator Sickness Questionnaire, NOTECHS Teamwork Scale, NASA-TLX Workload Scale
No substantial differences were found between groups in either the initial VR session or the assessment sessions. SSQ measures the sum total of 16 body sensations corresponding to simulator sickness (0-3 each), NOTECHS is a 5-item (0-5 each) score on leadership and teamwork function, and NASA-TLX tests 6 domains (-10 to 10 each) on different perceptions of workload.