JMIR Publications

ABSTRACT

Background:

Burnout among emergency room healthcare workers (HCWs) has reached critical levels, with up to 43% of all HCWs and 35% of emergency medicine personnel affected during the COVID-19 pandemic. Nurses were the most impacted, followed by physicians, leading to absenteeism, diminished care quality, and high turnover rates—reaching 78% in some settings, such as Thailand. Beyond workforce instability, burnout significantly compromises patient safety. Each one-unit increase in emotional exhaustion has been associated with a 2.63-fold increase in reports of poor care quality, a 30% rise in patient falls, a 47% increase in medication errors, and a 32% increase in healthcare-associated infections. Burnout is also linked to declining job satisfaction, worsening mental health, and increased intent to leave the profession. These findings highlight the urgent need for effective strategies to reduce stress and burnout in emergency care settings.

Objective:

This study aimed to evaluate the effectiveness and effect size of a multimodal learning approach—Emergency Room Virtual Simulation Interprofessional Education (ER-VIPE)—which integrates medical movies, MOOCs, and computer- or VR-based simulations with co-debriefing, in improving self-reported stress levels and reducing burnout among future healthcare professionals, compared to alternative methods lacking co-debriefing or using only movies and MOOCs.

Methods:

A single-blinded quasi-experimental study was conducted at a university hospital from July 2022 to September 2023. A three-Group treatment design, Group A (control) participated in a 3D computer-based simulation-based interprofessional education (SIMBIE) without debriefing. Group B received a medical movie, MOOCs, a 3D computer-based SIMBIE, collectively referred to as ER-VIPE (Emergency Room Virtual Interprofessional Education). and an co-debriefing session. Group C received the same interventions as Group B, except the 3D computer-based SIMBIE was replaced with a 3D virtual reality SIMBIE. SIMBIE experiential learning activities involving a COVID-19 pneumonia crisis scenario. Outcome measures included the Dundee Stress State Questionnaire (DSSQ) and Copenhagen Burnout Inventory. Anxiety trait scores served as behavioral control. Self-reported stress and burnout levels were measured at baseline, pre-intervention, post-intervention, and one-month post-intervention. Generalized Estimating Equations (GEE) was employed to analyze variations in outcomes among the three groups. Statistical significance was set at P<.05.

Results:

Eighty-seven clinical undergraduate students from various professional programs participated in the study, with 29 students in each group (A, B, and C). Groups showed no significant differences in age, gender, or academic standing, with an average age of 21.87 years, and 71% female. Most nursing, radiological technology, and medical technology students were in their fourth year, while medical and pharmacy students were in their fifth and sixth years, respectively. After a 1-month post-SIMBIE follow-up, adjusted analyses revealed positive trends in DSSQ-engagement across all groups, with Group B showing a significant increase compared to Group A (mean difference=3.93; P=.001). DSSQ-worry and DSSQ-distress scores decreased non-significantly across all groups. Burnout scores also improved across groups, with Group B showing a significantly lower score than Group A (mean difference=−2.02; P=.02). No significant burnout differences were found between Group C and Groups A or B.

Conclusions:

This study highlights the effectiveness of a novel multimodal learning approach that integrates movie-based education, MOOCs, and a virtual 3D computer-based SIMBIE with co-debriefing in improving self-reported stress levels and reducing burnout among future healthcare professionals. By providing an interactive and scalable educational framework, this approach presents a viable strategy to enhance well-being and resilience in high-pressure clinical environments. Clinical Trial: -