Pediatrics · Medical Literature
Facilitator-guided vs self-guided debriefing in immersive virtual reality paediatric emergency training: a randomised pilot study on learning outcomes and feasibility.
Abstract
This study evaluated the feasibility and effectiveness of immersive virtual reality (VR)-based paediatric emergency training, comparing facilitator-guided with self-guided debriefing methods. In a single-blinded, randomised controlled pilot trial, 24 healthcare professionals (12 interprofessional dyads) were randomised to VR-based paediatric emergency training followed by either facilitator- or self-guided debriefing. Both groups received a standardised preparatory lecture and skills workshop. We collected data on the feasibility of the interventions and additional trial procedures. For pre- and post-performance assessment, all dyads were video-recorded whilst managing a mannequin-based paediatric emergency. Two independent, blinded raters assessed the dyads' teamwork, ABCDE adherence, and time to critical actions based on the videos. We also collected data on participants' cognitive load and perceived effectiveness of the two debriefing methods. The study demonstrated the feasibility of interprofessional VR-based paediatric emergency training with both facilitator- and self-guided debriefing in a clinical setting. Twenty-two healthcare professionals completed the intervention, and 20 completed follow-up. VR was acceptable and usable, though 46% of participants reported some cybersickness. Additional trial procedures were feasible but required substantial logistical coordination. VR training significantly improved teamwork (facilitator-guided mean 1.2, confidence interval (CI) 0.5 to 1.9, p = 0.005; self-guided mean 1.4, CI 0.8 to 2.0, p < 0.001) and ABCDE adherence (facilitator-guided mean 0.5, CI 0.1 to 1.0, p = 0.02; self-guided mean 0.5, CI 0.1 to 0.9, p = 0.01), with similar outcomes between the debriefing methods. However, participants perceived the facilitator-guided debriefing to be more effective (mean difference 1.4, CI 0.1 to 2.7, p = 0.04). Immersive VR-based paediatric emergency training with facilitator-guided and self-guided debriefing was feasible in a pilot context and yielded comparable performance outcomes. A larger, adequately powered trial is warranted to formally evaluate non-inferiority between debriefing methods. • Simulation-based paediatric emergency training improves clinical outcomes, but widespread implementation is limited by logistical challenges and high costs. • Immersive virtual reality (VR) may help overcome these barriers, yet evidence on its feasibility and effectiveness in this context is limited. • VR-based paediatric emergency training is feasible and effectively improves interprofessional performance. • Self-guided and facilitator-guided debriefing yielded comparable outcomes, highlighting the potential for scalable use.
Clinical relevance
In interprofessional healthcare teams undergoing immersive virtual reality (VR)-based paediatric emergency training, does facilitator-guided debriefing produce superior learning outcomes compared to self-guided debriefing, and is such a training programme feasible in a clinical setting? __SNAPSHOT__ {"studyDesign":"Single-blinded, randomised controlled pilot trial (parallel-group, pretest–posttest design)","setting":"Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark (single academic tertiary centre)","sampleSize":"n=24 enrolled (12 interprofessional dyads); n=22 completed the intervention; n=20 completed follow-up assessment","population":"Healthcare professionals working in pairs (interprofessional dyads); precise disciplines, experience levels, and seniority mix not reported in the abstract","intervention":"Immersive VR-based paediatric emergency simulation followed by facilitator-guided debriefing, plus a standardised preparatory lecture and skills workshop","comparator":"Identical VR-based paediatric emergency simulation followed by self-guided debriefing, plus the same standardised preparatory lecture and skills workshop","primaryOutcome":"Teamwork performance assessed by two independent blinded raters using the Clinical Teamwork Scale® (CTS) from video recordings of dyads managing a mannequin-based paediatric emergency at baseline and follow-up","followUp":"Single-day pre- and post-intervention assessment; exact interval between VR training and follow-up assessment not reported in the abstract","fundingSource":"Not reported in the abstract"}
Key findings
Both debriefing modalities produced statistically significant within-group improvements from baseline to follow-up. For teamwork (CTS), the facilitator-guided group improved by a mean of 1.2 points (95% CI 0.5–1.9; p=0.005) and the self-guided group by a mean of 1.4 points (95% CI 0.8–2.0; p<0.001). For ABCDE adherence, both groups improved by a mean of 0.5 points (facilitator-guided: 95% CI 0.1–1.0, p=0.02; self-guided: 95% CI 0.1–0.9, p=0.01). Objective learning outcomes (teamwork scores and ABCDE adherence) were similar between the two debriefing approaches; no between-group comparison statistic is reported in the abstract for these outcomes. However, participants perceived facilitator-guided debriefing as more effective (mean difference 1.4, 95% CI 0.1–2.7; p=0.04), as measured by the Debriefing Assessment for Simulation in Healthcare (DASH©). Usability, workload (NASA-TLX), and motivation were similar across groups. Results for time to critical actions are not reported in the abstract. The scale range for the CTS and ABCDE checklist (necessary to contextualise the magnitude of improvement) is not reported in the abstract, so the clinical importance of the observed mean differences cannot be fully determined. NNT/NNH: not calculable from available data. Adverse events related to VR use: 46% of participants reported some degree of cybersickness; no serious adverse events are described. Two of 24 enrolled participants (8.3%) did not complete the intervention, and 4 of 24 (16.7%) did not complete follow-up assessment.
Practice implications
This pilot study established that interprofessional VR-based paediatric emergency training, with either facilitator-guided or self-guided debriefing, is feasible in an academic clinical setting and is associated with statistically significant pre-to-post improvements in both teamwork and ABCDE adherence in both groups. Crucially, the study did not establish that facilitator-guided debriefing is superior to self-guided debriefing on objective performance outcomes; the observed improvements were comparable between arms. A notable and clinically relevant discordance exists: participants subjectively rated facilitator-guided debriefing as more effective, yet this preference was not reflected in measurable performance differences. This perception-performance gap warrants attention when designing future programmes, as learner preference may influence engagement and satisfaction but does not, in this study, predict superior learning. The findings apply primarily to interprofessional dyads of healthcare professionals in a tertiary paediatric academic centre; generalisability to community hospitals, other team sizes, different professional compositions, or resource-limited settings is unestablished. The pilot nature and very small sample (n=20–22 analysed) preclude definitive conclusions about equivalence or non-inferiority of self-guided debriefing. The cybersickness rate of 46%, while not preventing study completion, is a clinically important implementation consideration for VR-based training programmes. This review is based on the published abstract only, and additional methodological details (e.g., exact follow-up timing, CTS scale range, between-group statistical comparisons, demographic characteristics of participants, and time-to-critical-action results) are not available from this source. __LIMITATIONS__ Very small sample size (n=24 enrolled, n=20 at follow-up; 12 dyads total), underpowered for between-group superiority or non-inferiority conclusions,Pilot study design explicitly; not powered to detect statistically significant between-group differences on primary or secondary outcomes,Single-centre academic setting limits external generalisability,Interprofessional dyads only; findings may not generalise to larger team compositions or uni-professional teams,Exact professional composition, seniority mix, and baseline experience with VR or simulation training of participants are not reported in the abstract,Follow-up interval between VR training and post-assessment is not reported; durability of learning gains cannot be assessed,No active control without VR; cannot isolate VR contribution from the preparatory lecture and skills workshop,Performance outcomes are simulator-based (mannequin scenario) and are surrogate endpoints; transfer to real clinical performance and patient outcomes is unproven,Single-blinding only (raters were blinded; participants were aware of allocation); facilitator awareness and fidelity of self-guided debriefing not described,46% cybersickness rate may introduce differential attrition or performance bias; management strategy for cybersickness not described,Between-group statistical comparisons for primary and secondary performance outcomes are not reported in the abstract, preventing direct inferential comparison of the two arms,Scale ranges for CTS and ABCDE checklist not reported in the abstract, limiting interpretation of the clinical importance of mean differences,Time-to-critical-action results not reported in the abstract,Funding source not disclosed; potential conflicts of interest cannot be assessed __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This single-centre randomised pilot trial demonstrates that interprofessional VR-based paediatric emergency training is feasible and associated with significant improvements in teamwork and ABCDE adherence regardless of whether debriefing is facilitator-guided or self-guided, with no detectable difference in objective learning outcomes between the two modalities. Participants, however, perceived facilitator-guided debriefing as more effective, a discordance that warrants further investigation. Given the pilot design, very small sample, and single-centre setting, these findings are hypothesis-generating only; a fully powered non-inferiority trial is needed before self-guided VR debriefing can be adopted as an equivalent substitute for facilitator-guided debriefing in clinical training programmes.