Currently submitted to: JMIR Serious Games
Date Submitted: Sep 3, 2026
Open Peer Review Period: Sep 7, 2026 - Nov 2, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Virtual Reality versus Computer-Based Serious Game Training to Improve ECG Acquisition and Electrode Placement Skills in Healthcare Professionals: A Randomized Pilot Study
ABSTRACT
Background:
The electrocardiogram (ECG) is crucial for diagnosing numerous cardiac conditions but depends on accurate electrode placement. Mispositioning often leads to diagnostic errors. Studies reveal frequent placement mistakes among healthcare workers, emphasizing the need for better training. Following AHA recommendations, we created an innovative serious game combining learning and assessment modes.
Objective:
We aimed to measure and to compare its relevance with two modalities: virtual reality (VR) with a headset and conventional computer.
Methods:
This randomized, single-center pilot study included 57 healthcare professionals, specifically nurses and nursing assistants, who were assigned to use our ECG training application either in VR or on a computer. Developed in Unity, the tool features learning and testing modes assessing electrode placement and ECG configuration. Performance was assessed using a score ranging from 0 to 20 before training, immediately after training, and at 3- and 6-month follow-up.
Results:
Both training modalities resulted in a significant and substantial improvement in ECG performance immediately following training (computer: 8.4 [7.7–9.8] to 17.4 [15.4–18.5]/20; VR : 8.2 [6.5–9.9] to 15.4 [12.6–18.1]/20; both p < 0.001), with no significant difference between groups at any time point (all p > 0.25). Precordial electrode placement showed the greatest improvement across all body types in both groups (all p < 0.001). A significant decline in performance was observed at 3 months in both groups (computer: p = 0.016; VR: p = 0.024), with scores stabilizing thereafter at approximately 11/20. Computer-based training was significantly faster (median 4.3 vs. 6.9 minutes; p < 0.001). User acceptability was excellent in both groups (overall Net Promoter Score: 77.1).
Conclusions:
Both formats effectively strengthen ECG acquisition skills, the computer-based version being faster and more scalable. These tools are a valuable complement to traditional training, but the skill decay seen at 3-6 months highlights the need for regular refreshers, easily delivered through the tool's autonomous, self-directed assessment mode.
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