A Comparison Between Physical and Virtual Simulation: A Randomized Controlled Trial

Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Study

Nurse-physician communication skills can be improve through inter-professional team training. Simulation is often used to conduct these training. However, constraints to conduct these sessions such as scheduling and logistic arrangements have been widely reported. Thus with the advancement of technology in education, the use of virtual environment to conduct the team training is being explored and evaluated.

Study Overview

• Status: Completed
• Conditions: Interdisciplinary Communication
• Intervention / Treatment: Other: Create Real-life Experience And Teamwork In Virtual Environment (CREATIVE)

Detailed Description

All recruited participants underwent a 3-hour nurse-physician communication training prior to the simulation session. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum and pre-learning videos were introduced to the participants. Pre-test questionnaires were administered after the training. Participants were then randomized to the control (live simulation) or intervention group (virtual simulation).

Intervention group participants will undergo a virtual simulation session training via the multi-user virtual world by logging in into the 3D virtual environment while participants in the control group performed the simulations in a physical simulated ward setting. Each pair of 1 medical student and 1 nursing student participate in two role-playing simulation scenarios (15-20 minutes each) along with a facilitator who will provide a debrief (30-minutes). Prior to the simulation, participants were given a smart-watch to monitor their physiological parameters such as heart rate. Post-test questionnaires were administered after the simulation sessions.

After the simulation training, a 30-minutes team-based assessments were conducted based on a inter-professional bedside care scenario in pairs of one medical and one nursing student within their randomized group. The assessments were video recorded for evaluation by assessors who are blinded to the groupings. All participants were then invited to complete a follow-up questionnaire 2 months after the simulation training.

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Singapore
  • Singapore, Singapore
    • National University of Singapore

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

i) Full time students undertaking National University of Singapore's

• Third or fourth year Bachelor of Science (Nursing)
• Third or fourth year Bachelor of Medicine & Bachelor of Surgery

ii) Completed acute care management modules

Exclusion Criteria:

i) Does not voluntarily agree to join the study

ii) Does not want their performance to be video-recorded

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Virtual Reality; 3D avatar in a virtual simulation environment	Other: Create Real-life Experience And Teamwork In Virtual Environment (CREATIVE); 3D virtual hospital environment where participants can perform physical and social interaction and presence using avatars.
NO_INTERVENTION: Live Simulation; Live-based simulation in a simulation ward

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Demographics	Collection of participant demographic data.	Baseline
Communication skill performance	Participants nurse-doctor communication skill was measured using a validated team communication scale that was self-developed. It is a 7-item checklist with a 5-point scale. The score ranges from 5 to 35 with higher score indicating better nurse-doctor communication performance.	Post-test (immediately after simulation assessment)
Baseline (Attitudes Toward Interprofessional Health Care Team)	Measurement of participants' attitudes towards working in interprofessional care team using the 14-item Attitudes Toward Interprofessional Health Care Team questionnaire using a 5-point scale. The scores ranges from 14 to 70 with higher score indicating more positive attitudes.	Pre-test
Post-test (Change of Attitudes Toward Interprofessional Health Care Team from baseline)	Measurement of participants' attitudes towards working in interprofessional care team using the 14-item Attitudes Toward Interprofessional Health Care Team questionnaire using a 5-point scale. The scores ranges from 14 to 70 with higher score indicating more positive attitudes.	Post-test (immediately after simulation training)
Follow-up (Change of Attitudes Toward Interprofessional Health Care Team from baseline and post-test)	Measurement of participants attitudes towards working in interprofessional care team using the 14-item Attitudes Toward Interprofessional Health Care Team questionnaire using a 5-point scale. The scores ranges from 14 to 70 with higher score indicating more positive attitudes.	Follow-up (2-months after simulation training)
Baseline (Interprofessional Socialization and Valuing Scale)	Measurement of participants behaviors, beliefs and attitudes in interprofessional socialization using the 24-item Interprofessional Socialization and Valuing Scale questionnaire using a 7-point scale (1= not at all ; 7= to a very great extent; "not applicable" response is also available). The score ranges from 24 to 168 with higher score indicating greater presence of the attributes measured.	Pre-test
Post-test (Change of Interprofessional Socialization and Valuing Scale from baseline)	Measurement of participants behaviors, beliefs and attitudes in interprofessional socialization using the 24-item Interprofessional Socialization and Valuing Scale questionnaire using a 7-point scale (1= not at all ; 7= to a very great extent; "not applicable" response is also available). The score ranges from 24 to 168 with higher score indicating greater presence of the attributes measured.	Post-test (immediately after simulation training)
Follow-up (Change of Interprofessional Socialization and Valuing Scale from baseline and post-test)	Measurement of participants behaviors, beliefs and attitudes in interprofessional socialization using the 24-item Interprofessional Socialization and Valuing Scale questionnaire using a 7-point scale (1= not at all ; 7= to a very great extent; "not applicable" response is also available). The score ranges from 24 to 168 with higher score indicating greater presence of the attributes measured.	Follow-up (2-months after simulation training)
Pulse rate	Stress measurement parameter using a continuous monitoring smart watch	Pre-test
Pulse rate (Change of parameter from baseline)	Stress measurement parameter using a continuous monitoring smart watch	Post-test (immediately after simulation training)
Blood pressure (diastolic & systolic)	Stress measurement parameter using a sphygmomanometer	Pre-test
Blood pressure (diastolic & systolic) (Change of parameter from baseline)	Stress measurement parameter using a sphygmomanometer	Post-test (immediately after simulation training)
Baseline (State-Trait Anxiety Inventory)	Measurement of participants state anxiety were measured using the 20-items State-Trait Anxiety Inventory questionnaire using a 4 point likert scale (almost never-almost always). The score ranges from 20 to 80 with higher score indicating higher sense of anxiety.	Pre-test
Post-test (Change of State-Trait Anxiety Inventory from baseline)	Measurement of participants state anxiety were measured using the 20-items State-Trait Anxiety Inventory questionnaire using a 4 point likert scale (almost never-almost always). The score ranges from 20 to 80 with higher score indicating higher sense of anxiety.	Post-test (immediately after simulation training)
Baseline (Confidence and self-efficacy)	Measurement of participants confidence and self-efficacy was measured using a 5-items self-efficacy questionnaire through a 10-point likert scale ranging from scores ranging from 5 to 50 with higher score indicating better self-efficacy in their ability in contributing to patient-centered care in a multidisciplinary team.	Pre-test
Post-test (Change of Confidence and self-efficacy from baseline)	Measurement of participants confidence and self-efficacy was measured using a 5-items self-efficacy questionnaire through a 10-point likert scale ranging from scores ranging from 5 to 50 with higher score indicating better self-efficacy in their ability in contributing to patient-centered care in a multidisciplinary team.	Post-test (immediately after simulation training)
Baseline (Student Stereotype Rating)	Measurement of participants stereotype towards other health disciplines was measured using the 9-items Student Stereotype Rating Questionnaire through a 5-point Likert scale (1=very low to 5= very high). The score ranges from 9 to 45 with higher scores indicating higher perceived ability of the particular healthcare discipline by the other discipline.	Pre-test
Post test (Change of Student Stereotype Rating from baseline)	Measurement of participants stereotype towards other health disciplines was measured using the 9-items Student Stereotype Rating Questionnaire through a 5-point Likert scale (1=very low to 5= very high). The score ranges from 9 to 45 with higher scores indicating higher perceived ability of the particular healthcare discipline by the other discipline.	Post-test (immediately after simulation training)
Follow up (Change of Student Stereotype Rating from baseline and post test)	Measurement of participants stereotype towards other health disciplines was measured using the 9-items Student Stereotype Rating Questionnaire through a 5-point Likert scale (1=very low to 5= very high). The score ranges from 9 to 45 with higher scores indicating higher perceived ability of the particular healthcare discipline by the other discipline.	Follow-up (2-months after simulation training)

Collaborators and Investigators

• Sponsor: National University, Singapore

Publications and helpful links

General Publications

• Liaw SY, Sutini, Chua WL, Tan JZ, Levett-Jones T, Ashokka B, Te Pan TL, Lau ST, Ignacio J. Desktop Virtual Reality Versus Face-to-Face Simulation for Team-Training on Stress Levels and Performance in Clinical Deterioration: a Randomised Controlled Trial. J Gen Intern Med. 2023 Jan;38(1):67-73. doi: 10.1007/s11606-022-07557-7. Epub 2022 May 2.
• Liaw SY, Ooi SW, Rusli KDB, Lau TC, Tam WWS, Chua WL. Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes. J Med Internet Res. 2020 Apr 8;22(4):e17279. doi: 10.2196/17279.

Study record dates

Study Major Dates

• Study Start (ACTUAL): July 1, 2018
• Primary Completion (ACTUAL): December 31, 2019
• Study Completion (ACTUAL): December 31, 2019

Study Registration Dates

• First Submitted: March 26, 2020
• First Submitted That Met QC Criteria: March 30, 2020
• First Posted (ACTUAL): April 2, 2020

Study Record Updates

• Last Update Posted (ACTUAL): April 3, 2020
• Last Update Submitted That Met QC Criteria: April 1, 2020
• Last Verified: April 1, 2020

More Information

Terms related to this study

• Keywords: simulation; virtual reality; team training; nurse-physician communication
• Other Study ID Numbers: S-17-107

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No