Is individual practice in an immersive and interactive virtual reality application non-inferior to practicing with traditional equipment in learning systematic clinical observation? A randomized controlled trial

BMC Med Educ. 2020 Apr 22;20(1):123. doi: 10.1186/s12909-020-02030-7.


Background: The aim was to investigate if individual self-practice of the ABCDE approach (Airways, Breathing, Circulation, Disability, Exposure) in an immersive and interactive virtual reality (VR) application gave non-inferior learning outcome compared to using traditional equipment (TP) in first year medical and nursing students.

Methods: A non-inferior parallel group randomized controlled trial. The study was linked to a regular teaching program conducted in August and September 2019. All students participated in a 15-min ABCDE introduction session, before they self-practiced the ABCDE approach for 20 min in either a fully immersive and interactive VR application using hand controllers with some haptic feedback (Individual VR) or with blood pressure gauge, ear-thermometer and oximeter (Individual TP). The primary outcome was the number of students who documented all the eight predefined observations in the ABCDE approach in the correct order in a practical test on an advanced simulator manikin with a time limit of 5 min, done immediately after the self-practice. The predefined one-sided non-inferiority limit was 13% points.

Results: Of all eligible students, 84% participated in the study and randomly allocated to VR (n = 149) or TP (n = 140). The primary outcome showed non-inferiority of the VR application with 24.8% in individual VR doing all observations in correct order compared to 27.1% TP (absolute difference 2.3% points, one sided 95% CI 2.3 to 10.8). The secondary outcomes were similar between the groups, but more students in VR reported liking the way they practiced (absolute difference 46% points, 95% CI 36.5 to 56.6) and that it was a good way to learn (36.9% points, 95% CI 26.8 to 47). VR also scored high on the System Usability Scale (mean difference 6.4% points, 95% CI 2.8-10.1).

Conclusions: Individual self-practicing the ABCDE approach in VR was non-inferior to individual self-practicing with traditional equipment.

Keywords: ABCDE approach; Clinical skills; Immersive; Individual self-practice; Interactive; Interactive virtual reality; Simulation; Virtual reality.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Female
  • Humans
  • Male
  • Monitoring, Physiologic*
  • Observation*
  • Students, Medical
  • Students, Nursing
  • Teaching*
  • Virtual Reality*
  • Young Adult