Impact of a virtual reality-based simulation training for shoulder dystocia on human and technical skills among caregivers: A randomized-controlled trial

Abstract

Abstract Background:This study analyzed the adherence to the modified Advanced Life Support in Obstetrics (ALSO) algorithm (HELP-RER) for handling shoulder dystocia (SD)using a virtual reality (VR) training modality. Secondary outcomes were improvements in the post-training diagnosis-to-delivery time, human skills factors (HuFSHI), and perceived task-load index (TLX). Methods:Prospective, case-control, single-blind, 1:1 randomized crossover study. Participants were shown a 360-degree VR video of SD management. The control group was briefed theoretically. Both groups underwent HuFSHI and HELP-RER score assessments at baseline and after the manikin-based training. The TLX questionnaire was then administered. After a washout phase of 12 weeks, we performed a crossover, and groups were switched. Results:There were similar outcomes between groups during the first training session. However, after crossover, the control group yielded significantly higher HELP-RER scores [7 vs. 6.5; p=0.01)], with lower diagnosis-to-delivery-time [85.5 vs. 99 seconds; (p=0.02)], and TLX scores [57 vs. 68; (p=0.04)]. In the multivariable linear regression analysis, VR training was independently associated with improved HELP-RER scores (p=0.003). The HuFSHI scores were comparable between groups. Discussion:Our data demonstrated the feasibility of a VR simulation training of SD management for caregivers. Considering the drawbacks of common high-fidelity trainings, VR-based simulations offer new perspectives.