Using Virtual Reality to Assess Residents' Clinical Assessments During and After COVID-19

Pediatric hospitalizations for respiratory illnesses declined during the SARS-CoV-2 (COVID-19) pandemic, reducing clinical exposure for trainees. A study conducted during this time period demonstrated low skills among pediatric interns related to the assessment and management of impending respiratory failure as measured via performance during a screen-based virtual reality (VR) simulation. However, a key limitation in interpreting the results was a lack of performance data from periods of exposure to normal clinical volumes. The objective of this study is to complete a follow-up to the initial study to assess pediatric intern performance in the same VR simulation during time periods in which interns were exposed to normalized clinical volumes.

This cross-sectional observational study was conducted at a large, free-standing academic children's hospital. Three cohorts of convenience samples of interns completed the VR simulation. Performance was assessed via video review. Statistical differences among groups were examined through Fischer's exact test.

A total of 22, 11, and 24 interns participated in cohorts 1 (January-May 2021), 2 (January-May 2022), and 3 (April-June 2024), respectively. There were no statistical differences among the performances of cohorts 1, 2, or 3 with regards to identification of altered mental status, impending respiratory failure, or a need for escalation of care.

Although there were no statistically significant differences in the recognition of respiratory failure or proposing an escalation of career among the cohorts of interns across periods of variable clinical volumes, these data prompt further investigation to explore when and how residents gain these critical clinical assessment skills and the role of VR for objectively assessing competency.