Materials and methods

Creation, design, and implementation of the VR experience

Through collaboration with Pediatric Emergency Medicine education leadership and a medical education innovations team, the authors designed and created a VR experience utilizing a 360-degree video camera (Insta360 ONE X2; Shenzhen, China) to record a simulated pediatric trauma resuscitation. The video recording featured an interprofessional Pediatric Emergency Medicine resuscitation team (attending physician, fellow, residents, nurses, patient care technicians) managing a simulated pediatric trauma patient (SimJunior mannequin, Laerdal; Stavanger, Norway) in the pediatric trauma bay of the authors’ institution. The primary perspective of the video is from an observer.

The scenario depicted the initial resuscitation of a pediatric patient with blunt abdominal trauma and emphasized both clinical management and non-technical skills, including role clarification and closed-loop communication. Interactive “access points” were embedded throughout the 360-degree video recording using video editing software (FinalCut ProX; Cupertino, California) to allow learners to pause the scenario and access additional supplemental educational content. These modules included the use of equipment specific to pediatric patient care (such as the Broselow tape, airway supplies, intraosseous devices) and Advanced Trauma Life Support (ATLS) concepts such as the primary survey, use of adjunct tests, imaging, and the secondary survey.

The complete VR experience required approximately 25 minutes to complete, including a 10-minute immersive simulation and recorded debrief and 15 minutes of supplemental educational content. Learners were able to navigate freely through the simulation and supplemental educational content with ability to pause and replay videos. A workflow diagram of the VR experience is shown in Figure 1.

Figure 1: Virtual reality experience content and workflowImage credit: Created by the authors using Lucidchart (Lucid Software Inc., South Jordan, Utah, US).

The experience was completed independently without real-time faculty facilitation or debriefing; however, faculty were available for technical support if needed. A representative screenshot of the VR experience demonstrating an embedded “Primary Survey” access point is shown in Figure 2.

Figure 2: Screenshot of the virtual reality experience

Pediatric and EM residents completing their Pediatric Emergency Medicine rotation viewed the experience using Oculus (Meta Quest; Menlo, California) VR headsets. Upon completion of the VR experience, residents completed anonymous evaluations of the education experience.

Study design, setting and population

This was a descriptive mixed-methods study testing a new educational intervention. NYU Langone Health Institutional Review Board's approval was obtained prior to this study (approval no. i19-01009_CR6). The study was conducted at an academic Pediatric Emergency Department and Level 2 Pediatric Trauma Center. Study participants were Pediatric and Emergency Medicine residents at all levels of post-graduate training. Subjects were approached via email for study participation and provided informed consent for the semi-structured interviews after completing the VR experience. Recruitment took place between September 2020 and April 2021.

Feasibility and acceptability outcomes

After completion of the VR experience, learners completed a brief, anonymous questionnaire administered through REDCap (Nashville, Tennessee) to capture their initial impressions of the experience as part of the educational evaluation. The questionnaire was developed by the study team to evaluate this educational intervention and underwent iterative review and refinement by faculty with expertise in Pediatric Emergency Medicine, medical education, and simulation to establish content validity.

The questionnaire evaluated learner preferences for educational modalities and perceptions of the VR experience, including comfort, ease of use, relevance of information, perceived knowledge acquisition, overall satisfaction, and perceived value compared with traditional educational approaches. Participants also provided feedback regarding potential incorporation of the VR experience into residency curricula. At the end of the survey, residents could provide additional free-text comments and critiques.

Study protocol

A study co-investigator (DB) who did not play a role in the evaluation of residents during their Pediatric Emergency Medicine rotations approached potential participants via email after completion of the education and obtained informed consent for the interviews. The authors created, piloted, and revised a semi-structured guide of open-ended questions based on participant feedback (Appendix A). Using this guide, the study co-investigator conducted interviews over an online conference platform (Zoom; San Jose, California) to gather participant perspectives while maintaining their anonymity. Interviews lasted approximately 20-30 minutes. Interview audio was recorded digitally over Zoom and transcribed with a third-party professional service (Transcription Outsources, LLC; Denver, Colorado) for use in data analysis. No personal identifiable information was collected during the audio recording or transcription process.

Data analysis

Quantitative survey data were summarized using descriptive statistics. Responses to the five-point Likert scale items describing comfort, ease of use, usefulness, and applicability were reported as frequencies and percentages. Microsoft Excel (Microsoft Corp., Redmond, WA, USA) was used to generate graphical representations of the results.

Qualitative data from free-text survey responses and semi-structured interview transcripts were analyzed using descriptive thematic analysis. Initial coding was performed independently by the first author (MB), followed by review of the coding framework by two additional investigators (KC and JA) with prior qualitative research experience. Differences in code interpretation were resolved through discussion until consensus was reached. Codes were subsequently grouped into broader themes that reflected participants’ experiences and perceptions of the VR curriculum.

Because only two semi-structured interviews were completed, thematic saturation was not formally assessed. Interview findings were therefore interpreted alongside free-text survey responses to provide additional contextual understanding of learner perceptions rather than as a comprehensive qualitative analysis.