Mixed reality versus manikins in basic life support simulation-based training for medical students in France: the mixed reality non-inferiority randomized controlled trial

Abstract

Purpose: To compare the effectiveness of mixed reality with traditional manikin-based simulation in basic life support (BLS) training, testing the hypothesis that mixed reality is non-inferior to manikin-based simulation. Methods: A non-inferiority randomized controlled trial was conducted. Third-year medical students were randomized into 2 groups. The mixed reality group received 32 minutes of individual training using a virtual reality headset and a torso for chest compressions (CC). The manikin group participated in 2 hours of group training consisting of theoretical and practical sessions using a low-fidelity manikin. The primary outcome was the overall BLS performance score, assessed at 1 month through a standardized BLS scenario using a 10-item assessment scale. The quality of CC, student satisfaction, and confidence levels were secondary outcomes and assessed through superiority analyses. Results: Data from 155 participants were analyzed, with 84 in the mixed reality group and 71 in the manikin group. The mean overall BLS performance score was 6.4 (mixed reality) vs. 6.5 (manikin), (mean difference, -0.1; 95% confidence interval [CI], -0.45 to +∞). CC depth was greater in the manikin group (50.3 mm vs. 46.6 mm; mean difference, -3.7 mm; 95% CI, -6.5 to -0.9), with 61.2% achieving optimal depth compared to 43.8% in the mixed reality group (mean difference, 17.4%; 95% CI, -29.3 to -5.5). Satisfaction was higher in the mixed reality group (4.9/5 vs. 4.7/5 in the manikin group; difference, 0.2; 95% CI, 0.07 to 0.33), as was confidence in performing BLS (3.9/5 vs. 3.6/5; difference, 0.3; 95% CI, 0.11 to 0.58). No other significant differences were observed for secondary outcomes. Conclusion: Mixed reality is non-inferior to manikin simulation in terms of overall BLS performance score assessed at 1 month.