title: Collaborative virtual reality based advanced cardiac life support training simulator using virtual reality principles.
abstract: BACKGROUND
  Advanced Cardiac Life Support (ACLS) is a series of team-based, sequential and time constrained interventions, requiring effective communication and coordination of activities that are performed by the care provider team on a patient undergoing cardiac arrest or respiratory failure. The state-of-the-art ACLS training is conducted in a face-to-face environment under expert supervision and suffers from several drawbacks including conflicting care provider schedules and high cost of training equipment.
  
  
  OBJECTIVE
  The major objective of the study is to describe, including the design, implementation, and evaluation of a novel approach of delivering ACLS training to care providers using the proposed virtual reality simulator that can overcome the challenges and drawbacks imposed by the traditional face-to-face training method.
  
  
  METHODS
  We compare the efficacy and performance outcomes associated with traditional ACLS training with the proposed novel approach of using a virtual reality (VR) based ACLS training simulator. One hundred and forty-eight (148) ACLS certified clinicians, translating into 26 care provider teams, were enrolled for this study. Each team was randomly assigned to one of the three treatment groups: control (traditional ACLS training), persuasive (VR ACLS training with comprehensive feedback components), or minimally persuasive (VR ACLS training with limited feedback components). The teams were tested across two different ACLS procedures that vary in the degree of task complexity: ventricular fibrillation or tachycardia (VFib/VTach) and pulseless electric activity (PEA).
  
  
  RESULTS
  The difference in performance between control and persuasive groups was not statistically significant (P=.37 for PEA and P=.1 for VFib/VTach). However, the difference in performance between control and minimally persuasive groups was significant (P=.05 for PEA and P=.02 for VFib/VTach). The pre-post comparison of performances of the groups showed that control (P=.017 for PEA, P=.01 for VFib/VTach) and persuasive (P=.02 for PEA, P=.048 for VFib/VTach) groups improved their performances significantly, whereas minimally persuasive group did not (P=.45 for PEA, P=.46 for VFib/VTach). Results also suggest that the benefit of persuasiveness is constrained by the potentially interruptive nature of these features.
  
  
  CONCLUSIONS
  Our results indicate that the VR-based ACLS training with proper feedback components can provide a learning experience similar to face-to-face training, and therefore could serve as a more easily accessed supplementary training tool to the traditional ACLS training. Our findings also suggest that the degree of persuasive features in VR environments have to be designed considering the interruptive nature of the feedback elements.
authors.affiliation: Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, United States. Electronic address: prabalkhanal@gmail.com.
authors.forename: Prabal
authors.initials: P
authors.lastname: Khanal
authors.affiliation: Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, United States.
authors.forename: Akshay
authors.initials: A
authors.lastname: Vankipuram
authors.affiliation: Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, United States.
authors.forename: Aaron
authors.initials: A
authors.lastname: Ashby
authors.affiliation: HP Labs, Palo Alto, CA, United States.
authors.forename: Mithra
authors.initials: M
authors.lastname: Vankipuram
authors.affiliation: Department of Management, University of Tennessee Chattanooga, TN, United States.
authors.forename: Ashish
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Banner Health SimET Center, Phoenix, AZ, United States.
authors.forename: Denise
authors.initials: D
authors.lastname: Drumm-Gurnee
authors.affiliation: Banner Health SimET Center, Phoenix, AZ, United States.
authors.forename: Karen
authors.initials: K
authors.lastname: Josey
authors.affiliation: Banner Health SimET Center, Phoenix, AZ, United States.
authors.forename: Linda
authors.initials: L
authors.lastname: Tinker
authors.affiliation: Banner Health SimET Center, Phoenix, AZ, United States.
authors.forename: Marshall
authors.initials: M
authors.lastname: Smith
mesh_terms: D022561:Advanced Cardiac Life Support / Q000193:education* / Q000706:statistics & numerical data*; D003194:Computer-Assisted Instruction / Q000379:methods* / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D004521:Educational Measurement; D016544:Patient Simulation; D014584:User-Computer Interface
keywords: Advanced cardiac life support; Computer applications in medicine; Computer uses in education – collaborative learning; Medical team training; Multimedia information systems – virtual reality; Serious games