Facilitator-guided vs self-guided debriefing in immersive virtual reality paediatric emergency training: a randomised pilot study on learning outcomes and feasibility

Clinical Snapshot

Key Findings

• P Value: Teamwork: facilitator-guided p=0.005, self-guided p<0.001; ABCDE adherence: both groups p≤0.02

• Effect Size: Teamwork improvement: facilitator-guided mean 1.2, self-guided mean 1.4; ABCDE adherence improvement: both groups mean 0.5

• Primary Outcome: Teamwork performance and ABCDE adherence both significantly improved in both groups

• Nnt Or Sensitivity: Not calculable from available data; pilot study focused on feasibility rather than definitive efficacy

• Confidence Interval: Teamwork facilitator-guided CI 0.5-1.9, self-guided CI 0.8-2.0; ABCDE adherence both groups CI 0.1-0.9/1.0

Clinical Application

Demonstrated feasibility but requires substantial logistical coordination; 46% cybersickness rate may limit widespread adoption Highly relevant to Australian paediatric emergency training; could support RACGP emergency medicine training requirements and complement existing simulation programs in major hospitals Interprofessional healthcare teams in paediatric emergency departments, intensive care units, and emergency medicine training programs

Abstract

UNLABELLED: This study evaluated the feasibility and effectiveness of immersive virtual reality (VR)-based paediatric emergency training, comparing facilitator-guided with self-guided debriefing methods. In a single-blinded, randomised controlled pilot trial, 24 healthcare professionals (12 interprofessional dyads) were randomised to VR-based paediatric emergency training followed by either facilitator- or self-guided debriefing. Both groups received a standardised preparatory lecture and skills workshop. We collected data on the feasibility of the interventions and additional trial procedures. For pre- and post-performance assessment, all dyads were video-recorded whilst managing a mannequin-based paediatric emergency. Two independent, blinded raters assessed the dyads' teamwork, ABCDE adherence, and time to critical actions based on the videos. We also collected data on participants' cognitive load and perceived effectiveness of the two debriefing methods. The study demonstrated the feasibility of interprofessional VR-based paediatric emergency training with both facilitator- and self-guided debriefing in a clinical setting. Twenty-two healthcare professionals completed the intervention, and 20 completed follow-up. VR was acceptable and usable, though 46% of participants reported some cybersickness. Additional trial procedures were feasible but required substantial logistical coordination. VR training significantly improved teamwork (facilitator-guided mean 1.2, confidence interval (CI) 0.5 to 1.9, p = 0.005; self-guided mean 1.4, CI 0.8 to 2.0, p < 0.001) and ABCDE adherence (facilitator-guided mean 0.5, CI 0.1 to 1.0, p = 0.02; self-guided mean 0.5, CI 0.1 to 0.9, p = 0.01), with similar outcomes between the debriefing methods. However, participants perceived the facilitator-guided debriefing to be more effective (mean difference 1.4, CI 0.1 to 2.7, p = 0.04). CONCLUSION: Immersive VR-based paediatric emergency training with facilitator-guided and self-guided debriefing was feasible in a pilot context and yielded comparable performance outcomes. A larger, adequately powered trial is warranted to formally evaluate non-inferiority between debriefing methods. WHAT IS KNOWN: • Simulation-based paediatric emergency training improves clinical outcomes, but widespread implementation is limited by logistical challenges and high costs. • Immersive virtual reality (VR) may help overcome these barriers, yet evidence on its feasibility and effectiveness in this context is limited. WHAT IS NEW: • VR-based paediatric emergency training is feasible and effectively improves interprofessional performance. • Self-guided and facilitator-guided debriefing yielded comparable outcomes, highlighting the potential for scalable use.

References

1. 1.Sohlin, A. M., Hoffmann, I. M., Poulsen, A., Gjærde, L. K., Chang, T. P., Lee, J. Y., Overbeck, G., Lund, S., Sørensen, J. L., & Kjærgaard, J. (2026). Facilitator-guided vs self-guided debriefing in immersive virtual reality paediatric emergency training: a randomised pilot study on learning outcomes and feasibility. European Journal of Pediatrics. https://doi.org/10.1097/SIH.0000000000000745