JMIR Publications

ABSTRACT

Background:

Patient simulators are an increasingly important and prominent part of medical training. They have been shown to be effective in teaching procedural skills, medical knowledge and clinical decision making. More recently, virtual and augmented reality simulators are being produced, but there is no research on whether these more realistic experiences cause problematic and greater stress responses as compared to standard manikin simulators.

Objective:

The purpose of this research was to examine the psychological and physiological effects of augmented reality (AR) in medical simulation training as compared to traditional manikin simulations.

Methods:

A within-subjects experimental design was used to assess the psychological and physiological responses of medical students (N=89) as they completed emergency simulations (using either manikin or AR) on pediatric resuscitation and subsequent death of the patient. Baseline measures of psychological well-being, salivary cortisol, and galvanic skin response (GSR) were taken before the simulations began. Continuous GSR assessments throughout and after the simulations were captured along with follow-up measures of emotion and cortisol. Participants also wrote freely about their experience with each simulation, and narratives were coded for emotional word use.

Results:

Thirty-seven (43.0%) male and 49 (57.0%) female medical students with a mean age of 25.2 (SD=2.09, 22-30) and 24.7 (SD=2.08, 23-36) respectively, participated in the study. Both simulations were associated with increased GSR (p< 0.001). GSR was higher in manikin group (p=0.009) adjusted for day, sex and medications taken by the participants. Negative affect and self-reported stress increased with both simulations (p < .001) but the difference between simulation types was not significant. Simulation stress, and percentage of positive emotion words used to describe the experience, were higher on the first versus the second day of simulation (p= 0.030 & 0.021 respectively); however, the difference between simulation types was not statistically significant. Further, there was not a statistically significant difference between simulation types in terms of the percentage of negative emotion words used to describe the experience, simulation sickness, or salivary cortisol. Finally, pre-existing levels of post-traumatic stress disorder, perceived stress, and reported depression were not tied to physiological responses to AR.

Conclusions:

Augmented reality simulators elicited similar stress responses to currently used manikin-based simulators and we did not find an evidence of AR simulators causing excessive stress to participants. Therefore, AR simulators are a promising tool to be used in medical training that can provide more realistic scenarios without risk of additional harm. Clinical Trial: n/a