A Comparison Study of Virtual Reality Versus Mannequin-Based Simulations for Educating Trainees in the Pediatric Cardiac Critical Care Unit

Background: Traditional mannequin-based simulation has been previously demonstrated to be a versatile and effective modality for the education of trainees in the pediatric cardiac intensive care unit (CICU). Unfortunately, creating and maintaining high-fidelity mannequin simulations is resource-intensive. Virtual reality (VR) is an emerging alternative to traditional high-fidelity mannequin simulation for medical education. A previous pilot study by these authors delineated the feasibility of VR in the CICU for the diagnosis and management of patients with hemodynamic compromise. This study sought to compare VR to classic mannequin simulations. Methods: This prospective, single-center study was approved by the Institutional Review Board (IRB) of a quaternary pediatric center and conducted from September to December of 2021. Four common CICU patient scenarios were developed for both VR and mannequins, including supraventricular tachycardia (SVT), postoperative hypotension after a Norwood procedure, pulmonary hypertensive crisis, and apnea with bradycardia. The VR logic was created by the authors, and the programming was completed by SimX (Mountain View, California, USA). Pediatric cardiology and advanced cardiac critical care fellows completed the first two simulations using either VR or mannequins and then crossed over to complete the last two simulations on the other modality. Fellows were assessed on their completion of a critical action checklist for each scenario as well as by an eight-question post-simulation knowledge test. The average number of checklist items completed was calculated for both mannequin and VR-based scenarios, stratified by type of simulation and year of fellowship. Results: A total of 14 fellows completed the study. Overall, the average number of checklist items completed and post-test score increased with each postgraduate year. When comparing the overall number of checklist items completed for all of the simulations between mannequin and VR, there was no significant difference in the means (p = 0.463). On average, fellows completed two to three out of five critical actions, and the average post-test score was 87%. Fellow questionnaires reflected an interest in VR, a lack of previous VR experience, and a general feeling that VR was more immersive than mannequin simulation. The most common complaint by participants was mild nausea. Conclusion: Using VR, multiple common CICU scenarios were designed to accurately reflect complex physiologic changes in real-time, creating an immersive and highly realistic simulation environment. Trainees performed no differently with VR simulations as compared to high-fidelity mannequin simulations in the pediatric CICU. Further investigation is required to demonstrate how VR compares to traditional simulation modalities for long-term knowledge retention.