Effect of Gamification of a Virtual Reality Trainer used for Regional Anaesthesia on Educational Outcomes of Novice Participants

Background: This randomised controlled trial is investigating if a gamified virtual reality (VR) trainer performs superior to the VR trainer without gamification. The VR trainer is being used to train clinicians in needling procedural skills necessary for competency in ultrasound-guided regional anaesthesia (UGRA) techniques. Gamification refers to purposefully designed educational software that is integrated with elements derived from computer game software. Examples of gamification in this context include: leaderboards, stars for achievements, and accumulated points for reaching competency levels. Participants: 60 Medical students and Clinicians (junior medical doctors – interns, residents, and registrars) in the Departments of Anaesthesia in Liverpool, Campbelltown and Fairfield Hospitals. The participants are all novices (defined as having < 10 attempts at URGA). All participants are de-identified. Groups: Participants will be divided into 2 equal groups (n=30 each) into Gamified VR training (intervention arm) and Original VR training (comparator arm). Equipment: The virtual reality training software will be installed on a gaming laptop with a dedicated NVIDIA graphics card capable of rendering high resolution graphics without lag. These specifications will exceed the minimum hardware requirements of the tethered Oculus Rift S or Oculus Quest 2 head mounted display with dual hand controllers, ensuring smooth VR experience for participants (ie. minimums of > 60Hz refresh rates, < 20 millisecond latencies, 1080x1440 resolution, occlusive headset, and > 90 degrees field of view). Procedure: 1. Baseline demographics: At the point of recruitment, the following demographic data for each participant will be collected: age, gender, years of video game use, including gaming using virtual reality, and site of recruitment (Liverpool/Campbelltown/Fairfield Hospital). 2. Baseline testing of needling skill: Each participant is then placed in an isolated room, free from distractions. In the room will be a pork meat phantom embedded with bovine tendon adjacent to an ultrasound machine, which is used as the standardised model for all in vitro testing. Each participant will be asked to perform an ultrasound-guided needling attempt, steering the needle to the top (12 o’clock) and bottom (6 o’clock) above and below the target tendon structure. Participants are limited to a maximum of 300 seconds to perform this procedure (they may practice this needling attempt 3 times). 3. Virtual reality training: After an initial orientation, each participant will then experience a 30 minute session (Session 1) of training. This will consist of an initial 10 minutes using the VR trainer (either the Gamified VR or Original VR trainer, depending on their group allocation), followed by a 10 minute rest break during which face-to-face feedback will be provided, and then a further 10 minutes of VR training. The VR trainer teaches the needling techniques necessary for UGRA. The participant has unlimited attempts at practice using the software. A member of the teaching faculty (not involved in assessment or data collection during the study) will inspect the participant’s performance using the metrics produced by the VR trainer software and provide targeted feedback. The participant will then undergo a second 30 minute VR session (Session 2), of the same structure to Session 1, to integrate the feedback and practice further. Both sessions and the feedback will occur within a one week period separated by a minimum of 1 day, and organised pragmatically around the participant’s shiftwork and clinical duties. 4. Final testing of needling skill: At the end of the week of Session 1 and 2 training, each participant will be invited back into an isolated room set up as per the baseline testing. They will be asked to repeat the performance of an ultrasound-guided nerve block on the pork with bovine tendon in vitro model. The performance will be video recorded and edited as previously described. A maximum of 300 seconds will be allowed for the entire procedure. As the sessions are conducted with a researcher present, adherence is not applicable.