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Development and Evaluation of a Virtual Reality Module for Emergency Front-of-Neck Access Training
Caoimhe C Duffy1, Hyun Kim, Dani Weber
1Department of Anesthesiology and Critical Care (C.C.D., J.H.A.); Perelman School of Medicine (H.K.); Department of Surgery (D.W., D.B., N.W., K.D.); Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine (G.A.B.); and Penn Center for Immersive Simulation (C.C.D., H.K., D.W., D.B., J.H.A., N.W., K.D.), University of Pennsylvania, Philadelphia, PA.
Background:
Emergency front-of-neck access is a high-acuity, low-occurrence procedure in "can't intubate, can't oxygenate" events. Training opportunities are limited, and confidence declines without repeated practice. Virtual reality (VR) offers standardized rehearsal without the logistical requirements of cadaveric or task-trainer models. We evaluated an immersive VR emergency front-of-neck access module by collecting validity evidence related to content, presentation, and learner experience.
Methods:
We conducted a prospective study at a quaternary academic medical center. Sixty-one participants completed the module, including 21 expert clinicians across airway-related specialties and forty postgraduate year-1 surgical interns. A structured survey assessed usability, realism, immersion, effectiveness, and clinical relevance. Experts completed a content validity assessment using item-level and scale-level indices. Automated metrics captured completion time and accuracy. Ordinal data were summarized as medians with interquartile ranges, and group comparisons used the Mann-Whitney U test.
Results:
Participants rated the module highly for usefulness and relevance. Novices reported higher ease-of-use scores. Experts reported greater preparedness for a can't intubate, can't oxygenate scenario after completing the module. Content validity assessment showed good agreement, with a scale-level index of 0.844. Procedural-sequence and anatomical-fidelity items had the highest agreement, while decision-making cues had lower agreement. Experts completed the module in a median of 14.3 minutes. Free-text responses highlighted accessibility, realism, and suitability for repeated practice, with anticipated limitations related to absent haptic feedback.
Conclusions:
In this preliminary evaluation, we collected favorable validity evidence to face, content, and usability across disciplines. Immersive VR may offer an additional modality to support rehearsal of this high-acuity, low-occurrence procedure; however, its impact on procedural performance and patient outcomes remains to be established.
