The Comparative Effectiveness of Virtual Reality Versus E-Module on the Training of Donning and Doffing Personal Protective Equipment: A Randomized, Simulation-Based Educational Study

Abstract

Introduction Preventing errors in donning and doffing of personal protective equipment (PPE) is critical for limiting the spread of infectious diseases. Virtual reality (VR) has demonstrated itself as an effective tool for asynchronous learning, but its use in PPE training has not been tested. The objective of this study was to compare donning and doffing performance between VR and e-module PPE training. Methods A prospective randomized open-blinded controlled trial was conducted to determine differences in donning and doffing performance after VR and e-module PPE training among medical staff and medical students at a single institution. The primary outcome was donning and doffing performance with real PPE, assessed using a 64-point checklist. The secondary outcome was participant preparedness and confidence level after training. Results Fifty-four participants were randomized, mostly consisting of medical students (n=24 {44%}) or emergency medicine and otolaryngology residents (n=19 {35%}). The VR group (n=27 {50%}) performed better than the control in the overall PPE scores but this was not statistically significant (mean {SD}, VR: 55.4 {4.4} vs e-module: 53.3 {8.1}; p = 0.40). VR participants also reported higher levels of preparedness and confidence after training. Residents as a subgroup achieved the highest increases after VR training compared to their counterparts in the control training group (mean {SD}, VR: 55.6 {4.9} vs e-module 48.4 {5.5}, p = 0.009). Conclusion In this randomized trial, VR training was found to be non-inferior to e-module for asynchronous PPE training. Our results suggest that in particular residents may benefit most from VR PPE training. Additionally, VR participants felt more confident and prepared to don and doff PPE after training compared to e-module participants. These findings are particularly relevant given the ongoing coronavirus disease 2019 (COVID-19) pandemic. Future studies need to focus on VR integration into residency curriculum and monitoring for long-term skill retention.

Keywords: donning and doffing; personal protective equipment (ppe); simulation in medical education; virtual reality in medical education; virtual reality simulation.

Figure 1. Study flow diagram of control (e-module) and intervention (VR) groups.

PPE: personal protective equipment

Figure 2. Training mode allows for guided, repetitive practice of donning and doffing (A). In testing mode, users demonstrate their skills for a score (B).

Figure 3. Visual comparison of the average performance in overall PPE score between virtual reality (VR) and control (module) groups.

Scores are represented for the whole study sample (A), residents alone (n = 19) (B), medical students alone (n = 24) (C), and all other participants (n = 9) (D). Residents in the VR group on average demonstrated higher overall PPE scores compared to non-residents in the VR group. *P-value < 0.05. PPE: personal protective equipment

Figure 4. Training time differences among subgroups

Visual comparison of the average training time among subgroups between virtual reality (VR) and control (e-module) groups. Residents in the e-module group spent significantly less time training compared to medical students and other participants (p < 0.05). However, there was no significant difference in VR training time among the three subgroups.