Background: Simulation-based Advanced Cardiac Life Support (ACLS) or Advanced Life Support (ALS) training for health care professionals is important worldwide for saving lives. Virtual reality (VR)–based serious gaming can be an alternative modality to be used as a part of simulation-based ALS training. Objective: The aim of this study is to investigate whether a VR-based ALS serious game module can replace classroom-based ALS lectures, the latter being part of existing conventional ALS training protocols in addition to skills training. Methods: Participants were students from Acibadem Mehmet Ali Aydinlar University’s Vocational School for Anesthesiology (N=29) randomly divided into 2 groups with 15 (conventional training group) and 14 (VR-based training group) participants each. Participants in the conventional training group had to complete the pretest consisting of multiple-choice questions at the beginning of the study. Afterward, they took part in an interactive classroom-based ALS lecture. The next step involved skills training with task trainers to teach them compression skills. Following this, the conventional training group was divided into Code Blue teams, each consisting of 5 participants for the simulation session. Two independent instructors evaluated video recordings in terms of technical and nontechnical skills. The score acquired from the manikin-based simulation session was considered the main performance indicator in this study to measure the learning outcome. A similar workflow was used for the VR-based training group, but this group was trained with the VR-based ALS serious game module instead of the theoretical lecture. The final stage of the study involved completing the posttest consisting of multiple-choice questions. A preference survey was conducted among the study participants. Mann-Whitney U and Wilcoxon signed-rank tests were used to analyze the 2 groups’ performances in this study. Results: The improvement in posttest results compared with pretest results was significant in the conventional training group (P=.002). Hands-on technical scores of the conventional training group were higher than those of the VR-based training group during manikin-based simulation, but total scores, including those for technical and crisis resource management skills, acquired from the manikin-based simulation session did not reveal any significant difference between the 2 groups. The results of the VR preference survey revealed that the majority of the participants prefer VR-based serious game–based training instead of classroom lectures. Conclusions: Although hands-on technical scores of the conventional training group during the manikin-based simulation session were higher than those of the VR-based training group, both groups’ total performance scores, including those for technical and crisis resource management skills, did not differ significantly. The preference survey reveals that the majority of the participants would prefer a VR-based ALS serious gaming module instead of lecture-based training. Further studies are required to reveal the learning outcome of VR-based ALS serious gaming. Trial Registration: ClinicalTrials.gov NCT05798910; https://clinicaltrials.gov/study/NCT05798910

Background: Virtual reality (VR) modules are commonly used for health care training, such as adult advanced cardiac life support (ACLS), due to immersion and engagement. The metaverse differs from current VR serious gaming by enabling shared social connections, while current VR modules focus on computer-based content without social interaction. Educators in the metaverse can foster communication and collaboration during training sessions. Objective: This study aimed to compare learning outcomes of VR-based, machine-guided training with educator-guided, VR-based training in the metaverse environment. Methods: A total of 62 volunteered students from Acibadem Mehmet Ali Aydinlar University Vocational School for Anesthesiology were randomly divided into 2 groups of 31 participants each: one group received VR-based training with machine guidance (MG), and the other received VR-based training with educator guidance (EG) in the metaverse. The members of both groups undertook VR-based basic training for ACLS. Afterward, the MG group was trained with a VR-based advanced training module, which provides training with full MG, whereas the EG group attended the VR-based, educator-guided training in the metaverse. The primary outcome of the study was determined by the exam score of the VR-based training module. Descriptive statistics defined continuous variables such as VR exam scores and time spent on machine- or educator-guided training. The correlation between training time and VR exam scores was assessed with the Spearman rank correlation, and nonnormally distributed variables were compared using the Mann-Whitney U test. Statistical significance was set at P<.05, with analyses executed by MedCalc Statistical Software (version 12.7.7). Results: Comparing the VR test scores between the MG and EG groups revealed no statistically significant difference. The VR test scores for the EG group had a median of 86 (range 11-100). In contrast, the MG group scores had a median of 66 (range 13-100; P=.08). Regarding the correlation between the duration of machine-guided or educator-guided training and VR-based exam scores, for the MG group, =0.569 and P=.005 were obtained. For the EG group, this correlation was found to be =0.298 and P=.10. While this correlation is statistically significant for the MG group, it is not significant for the EG group. The post hoc power analysis (80%), considering the correlation between the time spent on training and exam scores, supported this finding. Conclusions: The results of this study suggest that a well-designed, VR-based serious gaming module with MG could provide comparable learning outcomes to VR training in the metaverse with EG for adult ACLS training. Future research with a larger sample size could explore whether social interaction with educators in a metaverse environment offers added benefits for learners. Trial Registration: ClinicalTrials.gov NCT06288087; https://clinicaltrials.gov/study/NCT06288087

Background: Serious game–based training modules are pivotal for simulation-based health care training. With advancements in artificial intelligence (AI) and natural language processing, voice command interfaces offer an intuitive alternative to traditional virtual reality (VR) controllers in VR applications. Objective: This study aims to compare AI-supported voice command interfaces and traditional VR controllers in terms of user performance, exam scores, presence, and confidence in advanced cardiac life support (ACLS) training. Methods: A total of 62 volunteer students from Acibadem Mehmet Ali Aydinlar University Vocational School for Anesthesiology, aged 20-22 years, participated in the study. All the participants completed a pretest consisting of 10 multiple-choice questions about ACLS. Following the pretest, participants were randomly divided into 2 groups: the voice command group (n=31) and the VR controller group (n=31). The voice command group members completed the VR-based ACLS serious game in training mode twice, using an AI-supported voice command as the game interface. The VR controller group members also completed the VR-based ACLS serious game in training mode twice, but they used VR controllers as the game interface. The participants completed a survey to assess their level of presence and confidence during gameplay. Following the survey, participants completed the exam module of the VR-based serious gaming module. At the final stage of the study, participants completed a posttest, which had the same content as the pretest. VR-based exam scores of the voice command and VR controller groups were compared using a 2-tailed, independent-samples t test, and linear regression analysis was conducted to examine the effect of presence and confidence rating. Results: Both groups showed an improvement in performance from pretest to posttest, with no significant difference in the magnitude of improvement between the 2 groups (P=.83). When comparing presence ratings, there was no significant difference between the voice command group (mean 5.18, SD 0.83) and VR controller group (mean 5.42, SD 0.75; P=.25). However, when comparing VR-based exam scores, the VR controller group (mean 80.47, SD 13.12) significantly outperformed the voice command group (mean 66.70, SD 21.65; P=.005), despite both groups having similar time allocations for the exam (voice command group: mean 18.59, SD 5.28 minutes and VR controller group: mean 17.3, SD 4.83 minutes). Confidence levels were similar between the groups (voice command group: mean 3.79, SD 0.77 and VR controller group: mean 3.60, SD 0.72), but the voice command group displayed a significant overconfidence bias (voice command group: mean 0.09, SD 0.24 and VR controller group: mean –0.09, SD 0.18; P=.002). Conclusions: VR-based ACLS training demonstrated effectiveness; however, the use of voice commands did not result in improved performance. Further research should explore ways to optimize AI’s role in education through VR. Trial Registration: ClinicalTrials.gov NCT06458452; https://clinicaltrials.gov/ct2/show/NCT06458452

Giriş: Simülasyona dayalı eğitimlerin etkinliğinin değerlendirilmesinde, simülasyon eğitimi sonrası memnuniyet ve özgüven düzeylerinin belirlenmesi önemlidir. Amaç: Simülasyona dayalı hemşirelik oryantasyon eğitiminin hemşirelerin memnuniyetine ve hemşirenin kendine olan güvenine etkisinin belirlenmesi amaçlanmıştır. Yöntem: Tanımlayıcı retrospektif tipte olan bu çalışmada 2018-2019 yıllarında gerçekleştirilen oryantasyon eğitimi alan 313 hemşireye anket gönderildi ve ankete yanıt veren 209 hemşire ile çalışma gerçekleştirildi. Veriler, 9 sorudan oluşan bireysel özellikler formu ve 13 sorudan oluşan “Öğrenci Memnuniyeti ve Öğrenmede Kendine Güven Ölçeği” ile toplandı. Anketler katılımcılara elektronik posta yoluyla gönderildi. Bulgular: Simülasyonda kullanılan öğretim yöntemleri yararlı ve etkiliydi (4.43 ± 0.676) maddesi en yüksek ortalamaya sahip olup, en fazla olumlu yanıtın verildiği memnuniyet ölçeği maddesi olarak belirlendi. Ölçeğin memnuniyet alt boyut puanı: (Min: 5- Max: 25), kendine güven alt boyut puanı (Min: 18- Max: 40) olup, ölçeğin toplam puanı (Min: 23- Max: 65) ‘tir. Sonuç: Simülasyona dayalı hemşirelik eğitimi hemşirelerin kendilerine olan güvenlerini ve memnuniyetini artırmaktadır.