January 14, 2020By HealthySimulation.com Writing Team

New Study Finds VR Effective for ACLS Training with 83% Cost Savings

A recent Mount Sinai HELPS Center study found that Virtual Reality ACLS simulation training was effective for assessing Advanced Cardiac Life Support competency, to the tune of 83% cost savings, 25% faculty requirements, and almost half the training time! Today we take a closer look at this upcoming research, AHA guidelines on addressing ACLS skills decay, and the new Virtual Reality system that is changing the game for VR ACLS training: Health Scholars.

Health Scholars, known for their VR simulations and cloud-based simulation management platform utilized for management, delivery, and analysis of clinical training, announced today the availability of the first Virtual Reality (VR) Advanced Cardiac Life Support (ACLS) training designed specifically for first responders. Looking at resuscitation skills decay studies from the AHA was a big reason why the company developed this new technology.

The company recently announced a $17M Series B funding round supported by Arboretum Ventures, Venture Investors, Capital Midwest Fund, OSF HealthCare, as well as key family office seed funders. “Closing our Series B financing is a huge vote of confidence from both the market and investor community of Health Scholars’ strategy and value, says Cole Sandau, Chief Executive Officer at Health Scholars. “Having $17M in new capital to expand our focus on patient safety and quality issues will provide our customers with truly transformative training and virtual simulation technologies that will drive improved patient outcomes,” he continues.

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Overcoming ACLS Skills Decay

The 2018 American Heart Association (AHA) Scientific Statement, “Resuscitation Education Strategies to Improve Outcomes from Cardiac Arrest,” stated that “when providers take resuscitation courses, whether online or in-person, their skills decay over time,” leading to poor survival outcomes. It also introduced concepts that can improve how well they learn and retain these skills: mastery learning and deliberate practice, spaced learning, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation.

These new concepts, along with the updated skills decay information, served as a catalyst for Health Scholars’ decision to create a head mounted display VR application for Advanced Cardiac Life Support (ACLS) training that allows hospitals to easily scale experiential ACLS education and enable deliberate practice with standardized refresher training.

Brian Gillett, MD, Health Scholars President & Chief Medical Officer shares that “Staying ahead of skills decay requires high-yield, deliberate, and frequent practice. In caring for patients with cardiopulmonary arrest, there is no room for error or delayed decision making because survival depends on clinicians’ ability to deliver precise and correct care without hesitation. Our communities entrust hospital staff with their lives; we must live up to this trust by committing to and assuring clinical readiness. Virtual reality is the ideal modality for enabling real-to-life training at the scale and frequency requisite to ensuring readiness for such critically ill individuals.”

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The Mount Sinai Study

To understand the potential impacts of VR-based simulation compared to high-fidelity medical simulation for ACLS training, Dr. Daniel Katz, MD, Vice Chair of Education for the Mount Sinai Department of Anesthesiology and Director of Operations for the Mount Sinai HELPS Center, conducted a research study utilizing Health Scholars’ ACLS virtual reality application. “Full study results will be released as part of abstract publications Spring 2020” with a current summary available on the Health Scholars website now.

The single centered non-inferiority cross-over study compared the performance of mannequin-based high-fidelity healthcare simulation for assessing ACLS competencies to that of a Virtual Reality in Medicine application with a cohort of 25 anesthesiology residents who:

Were of the same post-graduate year (CA-1)
Took the same ACLS course one year prior
Had the same preparation
Had similar educational experiences

Beginning in July 2019 the residents were randomized to either of the two assessment modalities. Two weeks later, the groups switched and underwent assessment with the alternative modality. The in-person skills examiners were also blinded as to whether or not the residents had been exposed to ACLS VR.

The Results

The study found that VR medical sim was predictive of clinicians’ overall performance in high-fidelity manikin -based clinical simulation and was 83% more cost effective. There was no statistically significant difference in assessing clinicians’ decision-making capabilities between VR and high-fidelity manikins -based simulation. Additionally, the rank order of the clinicians’ performance in VR correlated with their rank-order in high-fidelity simulation, indicating that VR can predict how clinicians will perform in real-life scenarios. This is because high-fidelity mannequin-based simulation has previously proven to be an effective surrogate for real life encounters in the resuscitation domain.

The study also demonstrated that Health Scholars’ ACLS VR application performed similarly to high-fidelity patient simulator -based simulation for assessing communication competencies. Effective team-based communication is critical to successfully resuscitating patients.

Enjoyability and perceived educational value is essential to achieving clinicians’ acceptance of training and assessment modalities. The study demonstrated that there was no statistically significant difference in the reported enjoyability of VR, the value of VR, or the desire to use VR as an ACLS certification pathway as compared to high-fidelity trauma manikin based simulation. Of note, the feedback received during high-fidelity human patient simulator based simulation was reported as being more useful than that in VR. The study also demonstrated that the majority of clinicians in this cohort would voluntarily use VR every six months on their own accord for refresher training.

Tying It All Together

Virtual reality offers a 100% objective, standardized, cost-effective, and highly repeatable modality for assessing Advanced Cardiopulmonary Life Support competencies. The study showed that VR can deliver true-to-life scenarios for assessing readiness and predicting clinical performance. High-fidelity mannequin-based simulation continues to be a vital training modality, particularly for team-based training and point-of-care assessments. However, this study suggests that VR may be an effective alternative for individualized deliberate practice and competency assessment.

Study Takeaways

The study showed that VR is highly cost-effective in terms of staff involvement, time, and cost:

Required Staff: High-Fidelity Manikin -based Simulation: 20 physician training proctors versus VR: 5 (not required to be a physician resource)
Average Time: High-Fidelity Simulator -based Simulation: 45 minutes versus VR: 25 minutes
Cost per Learner: High-Fidelity Patient Simulator -based Simulation: $193 versus VR: $89

The Mount Sinai study also demonstrated that VR is significantly less taxing on facilitators. Using the NASA TASLI mental demand model, Dr. Katz found that VR required far less mental, physical, and temporal demand on proctors. It also required less effort and resulted in less frustration. This is important because the operational workflows must be tenable in order to sustainably implement training or competency validation pathways in healthcare.

“Organizing the ACLS training for our department is extremely resource intensive. It’s a process that requires maintaining multiple schedules, and often one of the most challenging is making sure we have enough simulation instructors/operators to keep up with the demand. Moving to a virtual platform to refresh ACLS skills would allow us to meet our educational goals, while minimizing the demand and burnout of our simulation team.” – Daniel Katz, MD, Mount Sinai Vice Chair of Education for the Department of Anesthesiology & Director of Operations for the Mount Sinai HELPS Center.

Conclusions

With results indicating VR’s effectiveness – and cost savings up to 83% – VR is on its way to becoming a viable alternative to train and assess competencies at scale and a legitimate solution to preventing ACLS skills decay that contribute to poor survival outcomes. Learn more about the research here!

About Health Scholars

Health Scholars was founded by healthcare professionals who recognized the need to advance immersive education and clinical training effectiveness. Established in 2017, their mission is to advance healthcare simulation through virtualization, making experience-based training scaleable, accessible and affordable to both public health and safety professionals. Health Scholars is a cloud-based, VR-ready training platform with VR Simulations, Simulation Management, and Readiness Reporting solutions for the management, delivery and analysis of clinical training.

Their VR simulations extend physical simulation beyond the simulation center, enabling repeatable practice of proper workflows as well as critical soft skills like communications, situational awareness and critical thinking. Health Scholars is headquartered in Denver, Colorado and has clinical and support operations embedded in the world-class Jump Trading Simulation and Education Center on the OSF Campus in Peoria, Illinois. For more information about Health Scholars ACLS VR Training for Pre and In-Hospital, visit Health Scholars through the link below!

Designed in accordance with American Heart Association guidelines and input from local EMS partners, the new VR tool enables providers to play the role of the team lead running a mega code and are provided thirteen total scenarios that reflect cardiac and non-cardiac arrest scenarios. Using voice direction, providers identify rhythms and direct virtual team members to shock, give meds, and/or perform CPR as necessary. The emergency simulation provides extensive practice on communication, situational awareness, decision-making and competencies such as accurate hospital notification.