High-fidelity simulation and virtual reality: a mixed-methods crossover study evaluating medical students’ experiences as observers

Active observers can benefit vicariously from the experience of hands-on learners in simulation. Kolb’s experiential learning cycle and vicarious learning theory form the theoretical basis for directed observation during simulation teaching, although little is known about the impact of different simulation technologies on the observer experience. This mixed-methods crossover study compared student experiences as observers using a high-fidelity manikin and immersive virtual reality (VR) software. Forty-nine final-year medical students were divided into two groups, undertaking and observing scenarios using either the manikin or VR before switching to the other form of simulation. Forty-eight questionnaires comprising Likert items were completed and analysed, with 11 students participating in focus groups. As observers, the students reported similar experiences with regards to engagement and reflection, with no statistically significant difference between the two technologies. However, the manikin scored higher in domains such as realism, enjoyment, clinical reasoning, usefulness and improved confidence. Students found that ‘participating’ is a more useful experience than ‘observing’ in both technologies. Thematic analysis revealed themes such as skills development, learning experience and technology. Students valued observing their colleagues completing scenarios within both technologies, highlighting the benefits of observation in focus groups. The high-fidelity manikin scored higher for several domains; however, there was no difference between VR and high-fidelity simulation on perceived observation experience regarding engagement and self-reflection. This suggests VR may have a useful role in observational learning, without the need for a simulation suite.