TY  - GEN
ID  - heidok36941
CY  - Heidelberg
N2  - Well-trained medical first responders (MFRs) are essential to the management of mass casualty incidents (MCIs), where they must respond to more patients than their resources allow. However, real-life exercises (RLEs), the gold standard training method, remain infrequent due to the limited resources of MFR organizations. To fill this gap, MCI training in immersive virtual reality (iVR) and mixed reality (MR) has been gaining increasing attention. However, a thorough evaluation of the effectiveness of such training methods is essential to ensure adequate preparation of MFRs. This dissertation examines the potential of iVR and MR training for preparing MFRs for MCIs.
First, a systematic review was conducted on MCI and disaster training methods for MFRs as well as on the measurement of their effectiveness (Manuscript 1). Training methods from 55 (quasi-)experimental studies were evaluated. Most studies used written knowledge tests and subjective measures, while less than a third employed performance indicators. Two performance indicators that can be objectively and potentially automatically assessed were decision accuracy and speed. Technology-based methods mostly included learning on a computer screen. Three studies evaluated training with iVR and concluded that iVR was associated with similar learning satisfaction and similar or even higher performance than traditional methods. The review highlights a lack of evaluation studies on iVR and MR training, particularly MR with haptic feedback, and emphasizes the need to identify and validate objective performance indicators for iVR and MR MCI training.
Next, a study was conducted comparing MR MCI training with haptic feedback (n = 34) to the gold standard, RLEs with patient actors (n1 = 4, n2 = 14; Manuscript 2). The MR group reported similar stress, exhaustion, and self-efficacy scores as the RLE groups, but stress and exhaustion tended to be low in all groups. The MR group reported only slightly lower physical presence but considerably lower social presence. Open-ended responses suggested that this was mainly due to a lack of interaction opportunities with virtual patients. Perceived learning gains were moderate for the MR group and high for the RLE group. Participants reported that iVR/MR training had potential and could complement RLEs in a resource-efficient way. This study was the first to compare MR MCI training with RLEs and demonstrated the potential of such training while also identifying areas for improvement, such as incorporating more stressors (in both types of training) and enhancing virtual patient interaction.
To identify objective performance indicators that can be integrated in iVR/MR MCI training, a validation study on performance metrics for virtual training was conducted (Manuscript 3). Based on the known-groups approach, indicators identified in the systematic review as well as other medical education research were tested in their ability to differentiate between different levels of expertise. Seventy-six participants from the medical field completed five iVR MCI scenarios. While visual attention indicators did not distinguish between expertise levels, MFRs demonstrated significantly better triage accuracy, speed, and information transmission efficiency than non-MFRs. Triage accuracy also correlated positively with triage knowledge test scores. Self-rated performance did not correlate with any of the objective indicators. Immersive virtual MCI scenarios proved to be a valuable medium for assessing MFR performance, particularly in terms of accuracy, speed, and information transmission. The results suggest that immersive virtual training could be integrated into current MCI training curricula to provide frequent, objective performance assessments in a controlled environment.
In summary, this dissertation demonstrates that immersive virtual training has the potential to complement existing MCI training, thereby enhancing MFR preparation. Specifically, such training elicited similar psychological responses in several areas when compared to the gold-standard training and received positive trainee feedback. Additionally, immersive virtual MCI training can be used to assess MFR performance, and several performance indicators are recommended for the integration in iVR and MR training.
A1  - Baetzner, Anke Sabine
TI  - The Potential of Virtual and Mixed Reality for Training Medical First Responders
Y1  - 2025///
UR  - https://archiv.ub.uni-heidelberg.de/volltextserver/36941/
AV  - public
ER  -