VR-based Competence Training at Scale: Teaching Clinical Skills in the Context of Virtual Brain Death Examination

Teaching medical practical and soft skills in clinical routines is increasingly difficult, and manikin or actor-based simulations have gained popularity in the last decades. These simulations, however, hardly scale with the demand, are commonly insufficient to train crucial clinical competencies, and cannot portray complex visual and dynamic symptomatologies as required in, for example, brain death examinations. In this paper, we explore the requirements and challenges of integrating a large-scale high-throughput VR setup into a real medical curriculum and describe our approaches and implementation. Therefore we extend and evaluate an interactive virtual reality-based simulation for training brain death diagnostics in a virtual intensive care environment, featuring a fully reactive simulated patient. To enable the required scalability we integrated the simulation into a dedicated hardware and software framework, enabling 12 simultaneous VR trainings which are controlled by a centralized server system. Using this setup we continuously collected feedback on the application's usability and realism from hundreds of students to gain first insights into the applicability of large-scale VR-based learning systems in real course designs. After integrating this feedback, we conducted a controlled curricular study in which we compared the virtual brain death simulation with the classical manikin-based training approach. Our results indicate that the immersive learning experience is perceived to be more realistic and engaging and is overall preferred by the students while also providing the same learning effect as the alternatives.