Virtual Reality Based Rapid Cycle Deliberate Practice for Faculty Maintenance of Procedural Competency

Emergency Medicine faculty lack a consistent method to maintain procedural competency. Inadequate faculty proficiency negatively impacts patient safety and resident education. Practice within the clinical environment depends on patient presentation, which is unpredictable. When physicians do engage in procedural practice outside of their clinical duties, sessions may be at inconvenient times, and task trainers often lack durability. Virtual reality offers a solution to these obstacles and can provide automated, individualized feedback.

This pilot randomized trial (N = 15) compared improvement in procedural competency between faculty-mentored practice and virtual reality-mentored practice of the pericardiocentesis procedure. Baseline skills were assessed on a pericardiocentesis task trainer, and post-testing on the same task trainer was conducted 2-6 weeks later. We used analysis of covariance (ANCOVA) to estimate the adjusted mean difference in post-training scores between groups, controlling for baseline scores. A 95% confidence interval (CI) was constructed using 5,000 bootstrap samples.

Fifteen participants were randomized (n = 8 intervention, n = 7 control); 14 completed the study. Groups were similar at baseline. In permutation ANCOVA models adjusting for baseline scores, there was no significant difference in post-training scores comparing intervention and control (adjusted mean difference -0.15; 95% CI: -1.93-2.10; p = 0.87).

In this pilot study, observed differences between virtual reality-based deliberate practice and traditional mastery learning were small, consistent with noninferiority. Though the small sample size prevents definitive conclusions, the results suggest that virtual reality deliberate practice may be a feasible and effective way for faculty to maintain competency in rare, high-stakes procedures.