JMIR Publications

ABSTRACT

Background:

Orotracheal intubation is a high-risk procedure that requires repetitive practice to achieve technical proficiency while ensuring patient safety. Immersive virtual reality (VR) serious games offer a promising alternative to traditional simulation by enabling standardized, repeatable, and accessible procedural training. However, evidence supporting the initial validation of immersive VR systems for airway management, particularly regarding usability, educational value, and objective performance assessment, remains limited.

Objective:

This study aimed to perform an initial validation of an immersive VR serious game for direct laryngoscopy-guided orotracheal intubation through subjective questionnaires, objective performance metrics, and qualitative feedback from healthcare professionals.

Methods:

A cross-sectional validation study was conducted with 23 healthcare professionals from different clinical backgrounds. Participants independently completed a guided VR intubation training session using a Meta Quest 3 headset. Objective performance metrics, including total completion time and procedural phase durations, were automatically recorded through timestamped application event logs. Participants subsequently completed the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), Simulator Sickness Questionnaire (SSQ), a Pedagogical Value Questionnaire, and a Simulator Construction Quality Questionnaire. Internal consistency was assessed using Cronbach α. Associations between questionnaire scores and objective performance were examined using Spearman correlation coefficients, and performance differences according to previous intubation experience were evaluated using Mann-Whitney U tests with Cliff δ effect sizes. Open-ended responses were analyzed using inductive thematic analysis.

Results:

All 23 participants completed the training session without technical interruptions. The immersive VR serious game achieved good usability (SUS mean 73.4, SD 13.4), high perceived pedagogical value (mean 4.08/5, SD 0.97), and high construction quality (mean 4.20/5, SD 0.85). Simulator sickness remained low (SSQ total mean 13.66, SD 13.70), whereas NASA-TLX results indicated a moderate workload characterized primarily by mental demand and effort. Positive correlations were observed between usability, pedagogical value, and construction quality (ρ=0.535-0.665; all P<.01). No significant associations were found between subjective evaluations and objective performance measures (P>.05). Automatic event logging successfully characterized users' procedural performance, showing that the intubation phase required longer completion times than the oxygenation phase. Qualitative feedback highlighted the educational usefulness of the system while identifying interaction fidelity and procedural realism as the principal areas for improvement.

Conclusions:

The findings provide initial validation evidence supporting the usability, educational value, and feasibility of this immersive VR serious game for orotracheal intubation training. The combination of positive user evaluations, low simulator sickness, automated performance logging, and feedback from healthcare professionals suggests that the system is a promising educational tool for introductory airway management training. Future studies should establish effectiveness for improving learning outcomes, skill retention, and transfer to clinical practice through controlled educational evaluations. Clinical Trial: Not applicable.