Virtual Reality Versus In-Person Simulation of Sepsis for Medical Students: Randomized Comparative Pilot Study

Virtual reality (VR) simulation-using head-mounted displays to present a computer-generated, 3D, interactive environment-may be a cost-effective alternative to in-person (IP) medical simulation training. However, studies directly comparing learning outcomes have demonstrated mixed results and mainly focused on knowledge or skill acquisition rather than integrated practice.

This randomized comparative pilot study aimed to evaluate the effectiveness of VR versus IP simulation in developing sepsis management skills among final-year medical students, addressing a gap in medical education evidence.

Final-year medical students at Great Western Hospital, United Kingdom, participated in both IP and VR simulation sessions featuring sepsis scenarios. Session order was randomized, determining study group assignment. Participants underwent an additional video-recorded "assessment" IP simulation of septic shock management either between or after both scheduled sessions. Questionnaires were completed between scenario completion and debriefing across all sessions. Performance was evaluated using a modified Queen's Simulation Assessment Tool (mQSAT) by facilitating study authors across all sessions, with the assessment simulation additionally evaluated by blinded assessors. The primary outcomes included mQSAT scores, recognition of septic shock, and identification of critical care needs. Analysis of covariance was conducted to detect differences in mQSAT scores between the groups, with simulation modality as the independent variable and the number of simulations or debriefs prior to assessment as the covariate. Binary outcomes between the groups were analyzed using binomial tests.

A total of 32 participants were recruited and allocated to 1 of 4 groups based on completed simulation sessions prior to assessment: IP only (IP-Assess, n=10), VR only (VR-Assess, n=6), IP then VR (IP-VR-Assess, n=11), and VR then IP (VR-IP-Assess, n=5). No statistically significant differences in mQSAT scores were detected between any groups for any domain nor for the recognition of septic shock. For the recognition of need for critical care, participants who completed VR simulation only prior to assessment were more likely to recognize need for critical care than those who completed IP simulation only (3/5 vs 1/7; P=.01).

This study demonstrates the feasibility of the proposed trial method and provides insight into likely effect sizes for the design of further studies. The measured learning outcomes were similar across the groups, regardless of which simulation modalities were used prior to assessment. Our study found no statistically significant differences for VR simulation versus IP simulation for the measured educational outcomes, which is reassuring for the ethical conduct of further studies comparing VR and IP simulation.