Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study

Abstract

Background: Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation.

Objective: This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills.

Methods: Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant's total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups' mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX).

Results: We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups' standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach α of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21).

Conclusions: This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment.

Keywords: Messick framework; assessment, acute medicine; emergency; emergency medicine; head-mounted display; medical education; medical student; simulation-based education; undergraduate medical education; virtual reality.

Figure 1

Snapshots from the anaphylaxis and COVID-19 scenarios. The patient is in the middle of the picture, the junior doctor on the left, and the nurse on the right. Left: Screenshot from the anaphylaxis scenario. The patient's next of kin sits behind the junior doctor. The controllers are illustrated in the VR environment as 2 hands. An MCQ pauses the scenario: “Q11 What do you do now? Use an oxygen catheter in the nose, 3 L/min; Put on an inhalation mask with Beta2 agonist, 6 L/min; Continue to C (circulation)." Right: Screenshot from the COVID-19 scenario. A participant wearing a VR head-mounted display is shown as a picture in a picture with the experienced scenario. MCQ: multiple-choice question; VR: virtual reality.

Figure 2

360MedQuest score (mean total test score) for the 3 groups, including mean and SD. *P<.001, **P<.001, and ***P=.04.

Figure 3

A pass-or-fail score of 19 points (68% of the maximum possible score of 28) was established by contrasting groups’ method. Blue curve: novice group; orange curve: experienced group. 360MedQuest score: mean total test score.

Figure 4

The groups’ experienced performance according to the NASA-TLX workload questionnaire. The groups with greater scores experienced more failure in their performance. Multiple pairwise comparisons between groups were conducted with the Wilcoxon rank-sum test with continuity correction. *P<.001, **P=.02, and ***P=.11. The experienced group rated their performance significantly higher than the intermediate and novice groups. NASA-TLX: National Aeronautics and Space Administration Task Load Index.