Virtual vs. Traditional CPR Training: Effects on Stress

Not Applicable

Recruiting

• Conditions: Heart Rate Variability, Biomarker of Stress; Stress and Anxiety

• Registration Number: NCT07147322
• Lead Sponsor: Oulu University Hospital

Brief Summary

This medical education study investigates stress levels among undergraduate medical students during basic life support (BLS) training. It compares traditional face-to-face teaching session with virtual reality (VR) training simulating a resuscitation scenario in a public place. We will measure heart rate, heart rate variability, and self-reported stress to assess acute stress responses. The study also examines physical sensations related to VR, the realism of the virtual environment, and the suitability of VR for BLS training.

Detailed Description

Cardiac arrest is a major cause of mortality, with survival depending heavily on timely and effective cardiopulmonary resuscitation (CPR). Basic life support (BLS) training teaches recognition of cardiac arrest, calling for help, providing chest compressions and ventilations, and using an automated external defibrillator (AED). For healthcare students, regular BLS training is essential but often limited by time, resources, and staff availability. Simulation-based training provides safe practice opportunities, but traditional methods can be resource-intensive.

Virtual reality (VR) offers an alternative, enabling immersive, interactive training with lower resource requirements. VR can simulate realistic resuscitation scenarios in varied environments, potentially increasing engagement, situational awareness, and learning outcomes. However, VR may also induce physical symptoms such as nausea or dizziness, and its effectiveness compared with conventional training remains under investigation.

This pilot study compares conventional face-to-face BLS training with VR-based training delivered via head-mounted displays simulating a public cardiac arrest. The primary objective is to evaluate stress responses between the two methods, measured physiologically by heart rate variability (HRV) and psychologically by validated stress and workload questionnaires. Secondary objectives are to assess VR-related physical symptoms, the perceived realism and usability of the VR environment, and its suitability as a BLS teaching method.

The VR environment replicates a public setting with bystanders and distractions. Compressions are performed on a manikin mapped to a virtual patient, with real-time feedback on depth and rate. A virtual AED is integrated into the simulation.

Sixty first- or second-year medical students will be randomized to VR-based or conventional manikin-based BLS training (30 per group). Exclusion criteria include pregnancy, prior healthcare experience, and BLS training within the past six months. Previous VR experience will be recorded.

Physiological stress will be recorded using a three-lead surface ECG (Bittium Faros 180, Finland), providing continuous heart rate and HRV data. Approximately three hours of data will be collected, including baseline rest, training, and post-session recovery.

Participants will complete pre- and post-session questionnaires (STAI (state anxiety; NASA-TLX (task load); System Usability Scale (SUS); Simulation Sickness Questionnaire (SSQ); Simulation Design Scale (SDS): Credibility/Presence measures) All surveys will be completed electronically. A standard debrief follows each session.

The study is approved by the regional ethics committee and conducted under GDPR and the Declaration of Helsinki. Participation is voluntary with informed consent. VR may cause mild symptoms such as nausea or dizziness; sessions will be stopped if symptoms become limiting. Data are pseudonymized and securely stored.

Study Timeline

• Status Verified: 2025-08
• Study First Submitted: 2025-08-12
• Study Start: 2025-08-13
• Study First Submitted QC: 2025-08-21
• Last Update Submitted: 2025-08-21
• Study First Posted: 2025-08-29
• Last Update Posted: 2025-08-29
• Primary Completion: 2026-08-31
• Study Completion: 2026-08-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• Volunteers (18-30 years old) will be recruited from first- and second-year medical students
• Participants must be healthy young individuals with no known heart disease, normal physical performance capacity, and no current physical limitations that would affect the ability to perform chest compressions.

Exclusion Criteria

• Pregnant individuals will not be included
• Individuals with previous healthcare experience will not be included.
• Participants must not have received basic life support training within the past six months.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Stress and Workload Compared Between Two Basic Life Support Training Environments	During training session (approximately 2 hours, including pre/post questionnaires)	To determine whether basic life support training in a virtual environment causes more stress and workload than conventional training. Stress will be measured using heart rate variability (HRV), and perceived mental workload will be assessed with validated questionnaires (STAI, NASA-TLX).
Physiological Stress (Heart Rate Variability, HRV)	During training session (approximately 2 hours/participant)	Physiological Stress (Heart Rate Variability, HRV). Continuous three-lead ECG recording using skin-surface electrodes with the Bittium Faros 180 device.; Parameters: Standard HRV indices (time-domain: SDNN, RMSSD; frequency domain: LF, HF, LF/HF ratio).; Interpretation: Lower HRV (e.g. higher LF/HF ratio) indicates greater physiological stress.
Stress (State-Trait Anxiety Inventory, STAI) questionary	Immediately after training	Description: Stress levels assessed using the State-Trait Anxiety Inventory (STAI).; Range: 20-80.; Interpretation: Higher scores indicate greater situational anxiety/stress.
Perceived Workload (NASA Task Load Index)	Immediately after training	Questionnaire assessing workload across six dimensions (mental, physical, temporal demand, performance, effort, frustration).; Range: 0-100.; Interpretation: Higher scores indicate greater perceived workload.

Secondary Outcome Measures

Name	Time	Method
Simulation Design Quality (Simulation Design Scale, SDS)	Immediately after training	20-item questionnaire evaluating simulation design (objectives, support, problem-solving, feedback, fidelity), rated 1-5.; Range: 20-100 total.; Interpretation: Higher scores indicate stronger agreement that the simulation was well designed.
Evaluation of physical symptoms caused by virtual environment - Simulation Sickness (Simulation Sickness Questionnaire, SSQ)	Immediately after training	The SSQ is a validated tool to assess simulator-related adverse effects (e.g., nausea, oculomotor strain, disorientation).; Scoring: Items rated and combined into subscales (Nausea, Oculomotor, Disorientation) and a total score.; Range: Scores scaled; higher scores indicate greater severity of simulation sickness.; Interpretation: Higher total and subscale scores indicate stronger symptoms of simulator sickness.
Suitability of virtual environment for Basic life support training - System Usability (System Usability Scale, SUS)	Immediately after training	To explore the suitability of a virtual learning environment for resuscitation training. 10-item questionnaire on usability, scored on a 5-point Likert scale and converted to a 0-100 scale.; Range: 0-100.; Interpretation: Higher scores indicate better usability
Sense of Presence (Slater-Usoh-Steed Questionnaire)	Immediately after training	Questionnaire measuring the feeling of "being there" in a virtual reality environment.; Range: 1-7 per item; mean score calculated.; Interpretation: Higher scores indicate a stronger sense of presence in VR.

Trial Locations

Locations (1)

Knoppi - Clinical Skills Centre, Faculty of Medicine, University of Oulu; 🇫🇮 Oulu, North Ostrobothnia, Finland