title: Teaching mass casualty triage skills using immersive three-dimensional virtual reality.
abstract: OBJECTIVE
  Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy.
  
  
  METHODS
  Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training.
  
  
  RESULTS
  Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p < 0.001). Time to complete each scenario decreased significantly from A (8:10 minutes) to B (5:14 minutes; p < 0.001) and from B to C (3:58 minutes; p < 0.001). Self-efficacy improved significantly in the areas of prioritizing treatment, prioritizing resources, identifying high-risk patients, and beliefs about learning to be an effective first responder.
  
  
  CONCLUSIONS
  Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, fully immersed VR triage experience.
authors.affiliation: Telehealth Research Institute, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA. dvincent@hawaii.edu
authors.forename: Dale S
authors.initials: DS
authors.lastname: Vincent
authors.forename: Andrei
authors.initials: A
authors.lastname: Sherstyuk
authors.forename: Lawrence
authors.initials: L
authors.lastname: Burgess
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Connolly
mesh_terms: D000328:Adult; D002983:Clinical Competence; D018961:Educational Technology; D006801:Humans; D054527:Mass Casualty Incidents; D016544:Patient Simulation; D013647:Task Performance and Analysis; D014218:Triage / Q000458:organization & administration*; D014584:User-Computer Interface