Virtual reality training for postpartum uterine balloon insertion - a multi-center randomized controlled trial.

ABSTRACT

BACKGROUND: Virtual reality provides users a unique opportunity to learn through a fully immersive platform that may be beneficial in postgraduate medical education. OBJECTIVE: The primary objective of the study was to assess the feasibility of virtual reality in the training of obstetrics and gynecology residents in the insertion of a postpartum balloon for management of postpartum hemorrhage. STUDY DESIGN: A multi-center randomized control trial involving obstetric residents (n=40) from two tertiary level perinatal centers - The National Maternity Hospital & The Rotunda, Dublin, Ireland from July 3rd to July 6th 2023. Participants were randomly assigned to an intervention group (n=21) and a control group (n=19). All participants filled in a pre-study survey assessing knowledge, experience in postpartum hemorrhage management, confidence levels, experience of virtual reality and thoughts on its use in medical education. The intervention group received a virtual reality immersive tutorial whilst the control group received no teaching. The decision not to offer the control group any teaching was to reflect the current situation in our hospitals where there is no regular formal teaching on insertion of postpartum balloon prior to night or weekend duty on the labor ward. The use of VR in this scenario provides residents with a new opportunity for accessible simulation training. Both groups were then tested on insertion of a postpartum uterine balloon in a model pelvis. Residents were timed and insertion technique was objectively marked, in line with manufacturer guidelines. Following insertion on the model, participants completed a survey including assessment of knowledge, confidence levels, satisfaction, side effects & benefits of virtual reality. The primary outcome was a structured objective assessment of the residents on the insertion technique of the balloon in a pelvic model. Secondary outcomes were time taken to complete the task, knowledge and confidence levels and any side effects of virtual reality. We calculated descriptive statistics such as frequency and percentage for categorical data. The paired t-test was used to compare mean scores before and after the intervention, both for the multiple choice questionnaire and confidence levels. Statistical significance was defined as a p-value of <0.05. RESULTS: The intervention group scored significantly better in the objective technique assessment post learning experience compared to the control group (9.29/10 vs 7.26/10, P<0.001). The median time for task completion in the intervention group was significantly less than that of the control group (3minutes vs 4 minutes, P=0.012) and resident confidence improved more in the intervention VR group (0.42 vs 0.62, P<0.001). Both groups scored better in the multiple-choice questionnaire post learning experience, however there was no significant difference between them. CONCLUSION: Virtual reality is beneficial to residents for teaching insertion of a postpartum balloon, in terms of technique, time taken and confidence levels.