Using Real-Time Lung Visuals to Reduce Mental Strain and Improve Diagnosis Speed (VERDICT)

Effect of Real-Time Respiratory Mechanics Visualization ("Digital Twin") on Clinician Cognitive Workload and Diagnostic Latency: A Randomized Crossover Simulation Trial

The goal of this clinical simulation study is to learn if a "Digital Twin" graphical lung display reduce the mental workload of clinicians. The study also evaluates if this helps physicians diagnose and manage ventilator-related crises more effectively than standard ventilator screens.

The main questions it aims to answer are:

Does the Digital Twin display lower the cognitive stress (mental workload) experienced by clinicians during a crisis? Does the Digital Twin display reduce the time it takes for clinicians to identify specific respiratory complications? Does the use of real-time physiological visualization improve the accuracy of clinical decision-making? Researchers will compare the performance of clinicians using a standard ventilator display (the "Black Box" condition) to their performance when provided with an additional synchronized 3D lung and advanced waveform display (the "Digital Twin" condition).

Participants will:

Complete four randomized mechanical ventilation crisis scenarios using a high-fidelity lung simulator (ASL 5000).

Manage scenarios involving high airway resistance, low lung compliance, auto-PEEP, and patient-ventilator asynchrony.

Undergo a 14-day "washout" period between sessions to ensure no memory bias between the control and intervention groups.

Complete a NASA-TLX survey after each scenario to measure their perceived mental, physical, and temporal demand.

Study Overview

• Status: Not yet recruiting
• Conditions: Mechanical Ventilation; Self Concept; Clinical Competence; Education Curriculum
• Intervention / Treatment: Device: Real-time Graphical Lung Function Visualization (Digital Twin); Other: Standard Ventilator Waveform Monitoring

• Study Type: Interventional
• Enrollment (Estimated): 34
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Reng Ren, M.D.; Phone Number: 086-13486111524; Email: renreng1203@zju.edu.cn

Study Locations

• China
  • Zhejiang
    • Hangzhou, Zhejiang, China, 310029
      • Second Affiliated Hospital of Zhejiang University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Licensed physicians currently practicing in intensive care units (ICU), neuro-intensive care units (NICU), or respiratory departments.
• For the Junior Stratum: Physicians currently in a standardized residency training program or in their first two years of a sub-specialty fellowship. For the Senior Stratum: Senior attending physicians or senior fellows with more than 5 years of experience in intensive care medicine.
• Basic proficiency in operating the mechanical ventilators used in the study (e.g., Hamilton, Dräger, or Puritan Bennett).
• Willingness to participate in two simulation sessions separated by a 14-day interval.

Exclusion Criteria:

• Prior formal training or significant experience using the ASL 5000 / RespiSim "Digital Twin" or Aurora interface.
• Physical limitations that prevent the operation of a mechanical ventilator or the viewing of a digital monitor.
• Refusal to provide informed consent for video recording of the simulation session for data adjudication.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Digital Twin Intervention Group; Participants in this arm are provided with a "Digital Twin" visualization in addition to the standard ventilator display. This includes a secondary monitor displaying the RespiSim interface, featuring a synchronized 3D lung model (RespiView) and advanced physiological waveforms (Muscle Pressure, and the Equation of Motion parameters). Participants manage four simulated mechanical ventilation crises where the underlying pathophysiology is visually represented in real-time.	Device: Real-time Graphical Lung Function Visualization (Digital Twin); This intervention consists of a high-fidelity graphical display that translates raw simulator data into synchronized 3D animations and advanced physiological waveforms. It provides continuous visualization of, Muscle Pressure (Pmus), and the Equation of Motion components (Resistive vs. Elastic pressure) to assist in clinical diagnosis.
Active Comparator: Standard Monitoring Control Group (Black Box); Participants in this arm manage the same four simulated mechanical ventilation crises using only the information available on a standard mechanical ventilator display (e.g., airway pressure and flow-time waveforms). The secondary "Digital Twin" monitor is deactivated. Participants must rely on traditional clinical assessment and manual ventilator maneuvers (such as inspiratory and expiratory holds) to diagnose and manage the respiratory complications.	Other: Standard Ventilator Waveform Monitoring; This intervention represents the current standard of care in mechanical ventilation monitoring. Clinicians are limited to the pressure-time and flow-time waveforms provided by the mechanical ventilator interface. Diagnostic assessments of lung mechanics (Resistance and Compliance) must be performed using manual ventilator maneuvers, such as inspiratory and expiratory holds.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived Mental Workload (NASA Task Load Index)	The total workload score as measured by the NASA Task Load Index (NASA-TLX). This validated tool assesses six dimensions: mental demand, physical demand, temporal demand, performance, effort, and frustration level. Each dimension is scored on a scale of 0 to 100. The weighted average provides a "Global Workload Score." Higher scores represent a higher perceived cognitive burden.	Within 5 minutes following the completion of each 10-minute simulation scenario.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to Correct Diagnosis (Diagnostic Latency)	The duration (in seconds) from the initiation of a respiratory crisis (T=120s) until the participant accurately identifies the underlying pathophysiology (e.g., Bronchospasm, Atelectasis, Auto-PEEP, or Double Triggering). This is measured by an independent observer using a synchronized stopwatch. Lower times indicate higher diagnostic efficiency.	From the onset of the simulated respiratory crisis until the participant verbalizes the correct diagnosis, assessed during each 10-minute simulation scenario.
Diagnostic Accuracy Rate	The percentage of participants who correctly identify the respiratory complication within the allotted 10-minute scenario time. A diagnosis is marked "Correct" or "Incorrect" based on pre-defined criteria for each of the four scenarios.	Assessed at the conclusion of each 10-minute simulation scenario.

Collaborators and Investigators

• Sponsor: Second Affiliated Hospital, School of Medicine, Zhejiang University

Study record dates

Study Major Dates

• Study Start (Estimated): April 15, 2026
• Primary Completion (Estimated): July 31, 2026
• Study Completion (Estimated): July 31, 2026

Study Registration Dates

• First Submitted: March 30, 2026
• First Submitted That Met QC Criteria: March 30, 2026
• First Posted (Actual): April 6, 2026

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 6, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: mechanical ventilation; medical simulation; clinical competence; mental pressure load
• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders
• Other Study ID Numbers: 20260530

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data (including diagnostic latency times and NASA-TLX scores) will be made available upon reasonable request to qualified researchers for the purpose of meta-analysis or replication of results.

Drug and device information, study documents

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