Virtual reality simulation with eye-tracking feedback versus mannequin-based training for situational awareness in trauma management under simulated emergency department interruptions in Iran: a pilot randomized controlled trial.

PURPOSE: To primarily examine the feasibility of implementing eye-tracking-based feedback within a virtual reality (VR) trauma simulation with realistically simulated emergency department interruptions, and to explore preliminary changes in situational awareness (SA) (primary outcome), Advanced Trauma Life Support (ATLS) performance, and trauma-management errors (exploratory outcomes) compared with conventional mannequin-based simulation. METHODS: In this pilot randomized pretest-posttest study, 35 medical interns were assigned to VR training with eye-tracking heatmap feedback (n=17) or mannequin-based training with instructor verbal feedback (n=18). SA (modified Situation Awareness Global Assessment Technique), ATLS checklist performance, and trauma-management error scores were measured before and after the intervention. Within-group changes were tested with the Wilcoxon signed-rank test, and between-group differences were compared using the Mann-Whitney U test on change scores (Δ=post-pre), with effect sizes reported as r. RESULTS: Baseline pretest performance did not differ significantly between the groups. Both groups improved in SA and ATLS performance (all P<0.001) and reduced error scores (VR: P=0.004; mannequin: P<0.001). In exploratory between-group comparisons, the VR group showed numerically greater improvements in SA (mean change 6.59 vs. 3.11; P=0.006, r=0.46), ATLS performance (22.12 vs. 8.22; P=0.003, r=0.48), and error reduction (-9.36 vs. -3.61; P=0.005, r=0.47). Given the pilot design, these differences should be interpreted as preliminary signals. CONCLUSION: In this pilot study, both training modalities were associated with improved SA and ATLS performance and with fewer errors, with point estimates favoring the VR condition. These preliminary signals suggest that VR with eye-tracking feedback may be a promising option for trauma training in interruption-rich, emergency department-like settings and warrants further evaluation in larger studies.