To see, or not to see... pathogens in virtual reality hand hygiene training

Abstract

Background: ViRTUE, a virtual reality (VR) hand hygiene trainer, offers users the option of visualizing pathogen transfers during virtual patient care either in real-time or at the end of a level as a summary visualization. In this study, we aimed to evaluate the effect of different timings of pathogen visualization (real-time vs summary) on in-trainer performance and user's immersion. Methods: The study included first-year medical students undergoing hand hygiene training with ViRTUE, randomized to one of three visualization set-ups: set-up 1 (on-off-off, with real-time visualization at the first level only, and summary visualization at level 2 and 3), set-up 2 (off-on-off), and set-up 3 (off-off-off). In-trainer performance was defined by number of pathogen transmission events (=contaminations) in level 3. The virtual experience of user's (among others: immersion) was assessed with a questionnaire. Results: 173 medical students participated in the study, with 58, 54, and 61 assigned to set-up 1, set-up 2, and set-up 3, respectively. Users assigned to set-up 3 with summary visualization at all levels, performed best with 1.02 (standard deviation (SD) +/- 1.86) contaminations, compared to 2.34 (SD +/- 3.09) and 2.07 (SD +/- 2.52) contaminations of users assigned to the other set-ups. Summary visualization at all levels also resulted in higher immersion of users. Conclusions: Real-time visualization of pathogen transmission during VR hand hygiene training with ViRTUE may negatively affect in-trainer performance and user immersion. This emphasizes the importance of pilot testing the effect of VR-based trainings in order to understand their impact on users.