Background: The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time. Objective: This study aims to investigate the feasibility of using an intervention comprising a VR scenario and an educational video to examine MD among health care workers during the COVID-19 pandemic and to use our mobile app for longitudinal monitoring of stress, MD, and MI after the intervention. Methods: We recruited 15 participants for a compound intervention consisting of a VR scenario followed by an educational video and a repetition of the VR scenario. The scenario portrayed a morally challenging situation related to a shortage of life-saving equipment. Physiological signals and scores of the Moral Injury Outcome Scale (MIOS) and Perceived Stress Scale (PSS) were collected. Participants underwent a debriefing session to provide their impressions of the intervention, and content analysis was performed on the sessions. Participants were also instructed to use a mobile app for 8 weeks after the intervention to monitor stress, MD, and mental health symptoms. We conducted Wilcoxon signed rank tests on the PSS and MIOS scores to investigate whether the VR scenario could induce stress and MD. We also evaluated user experience and the sense of presence after the intervention through semi–open-ended feedback and the Igroup Presence Questionnaire, respectively. Qualitative feedback was summarized and categorized to offer an experiential perspective. Results: All participants completed the intervention. Mean pre- and postintervention scores were respectively 10.4 (SD 9.9) and 13.5 (SD 9.1) for the MIOS and 17.3 (SD 7.5) and 19.1 (SD 8.1) for the PSS. Statistical analyses revealed no significant pre- to postintervention difference in the MIOS and PSS scores (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. However, content analysis revealed feelings of guilt, shame, and betrayal, which relate to the experience of MD. On the basis of the Igroup Presence Questionnaire results, the VR scenario achieved an above-average degree of overall presence, spatial presence, and involvement, and slightly below-average realism. Of the 15 participants, 8 (53%) did not answer symptom surveys on the mobile app. Conclusions: Our study demonstrated VR to be a feasible method to simulate morally challenging situations and elicit genuine responses associated with MD with high acceptability and tolerability. Future research could better define the efficacy of VR in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies. Trial Registration: ClinicalTrails.gov NCT05001542; https://clinicaltrials.gov/study/NCT05001542 International Registered Report Identifier (IRRID): RR2-10.2196/32240

Background: Stress, anxiety, distress, and depression are high among health care workers during the COVID-19 pandemic, and they have reported acting in ways that are contrary to their moral values and professional commitments that degrade their integrity. This creates moral distress and injury due to constraints they have encountered, such as limited resources. Objective: The purpose of this study is to develop and show the feasibility of digital platforms (a virtual reality and a mobile platform) to understand the causes and ultimately reduce the moral distress of health care providers during the COVID-19 pandemic. Methods: This will be a prospective, single cohort, pre- and posttest study examining the effect of a brief informative video describing moral distress on perceptual, psychological, and physiological indicators of stress and decision-making during a scenario known to potentially elicit moral distress. To accomplish this, we have developed a virtual reality simulation that will be used before and after the digital intervention for monitoring short-term impacts. The simulation involves an intensive care unit setting during the COVID-19 pandemic, and participants will be placed in morally challenging situations. The participants will be engaged in an educational intervention at the individual, team, and organizational levels. During each test, data will be collected for (1) physiological measures of stress and after each test, data will be collected regarding (2) thoughts, feelings and behaviors during a morally challenging situation, and (3) perceptual estimates of psychological stress. In addition, participants will continue to be monitored for moral distress and other psychological stresses for 8 weeks through our Digital intervention/intelligence Group mobile platform. Finally, a comparison will be conducted using machine learning and biostatistical techniques to analyze the short- and long-term impacts of the virtual reality intervention. Results: The study was funded in November 2020 and received research ethics board approval in March 2021. The study is ongoing. Conclusions: This project is a proof-of-concept integration to demonstrate viability over 6 months and guide future studies to develop these state-of-the-art technologies to help frontline health care workers work in complex moral contexts. In addition, the project will develop innovations that can be used for future pandemics and in other contexts prone to producing moral distress and injury. This project aims to demonstrate the feasibility of using digital platforms to understand the continuum of moral distress that can lead to moral injury. Demonstration of feasibility will lead to future studies to examine the efficacy of digital platforms to reduce moral distress.

The current coronavirus disease (COVID-19) pandemic has shifted traditional educational approaches in health professions education (HPE) from in-person to remote learning. Although pedagogical strategies have been developed and implemented rapidly to support cognitive and affective domains of learning in HPE, less progress has occurred in psychomotor skills acquisition. Psychomotor skills, referred to as technical skills training, are underpinned by educational theories and conceptual frameworks. Considering the widening gap in learning domains, this editorial provides an overview and recommendations for developing and implementing remote training supported by educational theories, such as deliberate practice, and conceptual frameworks in technical skills acquisition in HPE. We begin by discussing the unique curricular needs for remote psychomotor skills in medical teaching-learning contexts and subsequently present a theory-driven and evidence-based model for remote psychomotor skills acquisition.

Serious games, that is, games whose primary purpose is education and training, are gaining widespread popularity in higher education contexts and have been associated with increased learner memory retention, engagement, and motivation even among learners with special needs. Despite these benefits, serious games have fixed scenarios that cannot be easily modified, leading to predictable and dull experiences that can reduce user engagement. Therefore, there is a demand for tools that allow educators to create new modifications and customize serious game scenarios, and avoid the fixed-scenario problem and a one-size-fits-all approach. Here, we present and detail our novel virtual serious games authoring platform called Moirai, which uses a no-code approach to allow educators who may have limited (or no) prior programming experience to use a diagram-based interface to author and customize serious games focused on decision and communication skills development. We describe two case studies, each of which involved creating serious games for nursing education (one for mental health education and the other for internationally educated nurses). The usability of both games was qualitatively evaluated using the system usability scale (SUS) questionnaire and achieved above-average usability scores.

The adoption of consumer-level mobile devices and head-mounted displays (HMDs) has caused an increased consumption of 360° video content. This trend has led to accessible and immersive content creation for training and education in health and safety amongst other areas. Although 360° videos can provide realistic content, they often lack interactivity. We hypothesize that integrating interactive elements into 360° videos will affect its perceived immersion, engagement, and usability. In this paper, we present a framework for adding interactions to 360° videos composed of an editor and a video player. The Editor allows adding interactive content in the form of panels containing information, quizzes, pictures, and 3D models. A three-stage study was conducted with participants from the Ontario Tech University (n=45) to evaluate our VR framework's usability and engagement compared to a non-interactive 360° video by applying the SUS (System Usability Scale) and the GEQ (Game Experience Questionnaire) surveys. Results indicate that the interactions add tension, higher negative affect, and lower positive affect than non-interactive videos that led to higher perceived usability with the non-interactive version. We believe that this is caused by the need to locate and interact with elements while the video is playing.