A comparison between Immersive Virtual Reality Heart Saver and the Standardized Heart Saver Training amongst Non-Health Science Students.

When establishing the IVR HS training software program, the researcher and multimedia programmer first created a 360-degree heart-saver video in Arabic because all participants' mother tongue is Arabic. After establishing the recorded instruction for the IVR training in the demonstration part, the recorded instruction voice was in Arabic based on AHA HS instructions for Adult CPR with AED and guidelines. Secondly, the Information technology (IT) programmer created the new software based on AHA heart-saver contents in Arabic version; steps, criteria, guidelines, and heart-saver contents were provided to the IT programmer. The Heart Saver software program contains a 360-degree video, a training demonstration while listening to the recorded instructions to apply the HS Adult CPR and AED training through IVR, and an evaluation of the participant's performance, which is considered a performance exam. The duration time for each component in the experimental software program is as follows: the 360-degree video is 4:21 minutes, the demonstration takes 4 to 6 minutes, and the performance exam takes 2 minutes; the total range for that was around 12 minutes for each participant. Establishing the IVR HS software program took eight months, and the cost of this program was around 1500 USD dollars. It is worth mentioning that this program is provided in two languages, Arabic and English, as well as the same AHA content. Also, the AHA provides a heart-saver course in Arabic and English. Finally, testing the software program, this phase is essential before attending and applying to the study; in this phase, the testing was activated by the IVR HS program through the application to make sure the software is working accurately in a proper way without any deficit in the future. Around six people and two AHA instructors were invited to the testing program as shown in (Appendix P). After testing, the program needed some modifications, such as adding highlighters for the press location. The highlighter will enlarge when you press, grabbing hazardous objects requires you to touch them only to count, the microphone should hear the target better, and Check for breathing has a box to look at to be considered as "looking at the chest. All modification was done in the testing phase of IVR training before attending the pilot and research study to make this training program accurate, precise, feasible, and acceptable.
After obtaining ethical approval and all permissions to begin research and use the instruments, the sampling method was calculated and delivered to recruit the participants. First of all, the researcher invited the participants and explained its aims, content, and duration over email and phone calls, as well as; the researcher informed and texted them that, after participating in the study exempted 10 hours from the service community course as an incentive reward to them as agreed with the deanship of the student (Appendix N).
Furthermore, the consent form was assigned to participants who were eligible for this study and were willing to participate for each group when attending the VR lab or heart center also the researcher informed the participants that they could withdraw from the study at any time without giving reasons to ensure confidentiality (Appendix L, M). Then, the verbal and written explanation sheet and duration about the purpose of this study and study procedures was given and explained to the participants (Appendix J, K).
The participants in the experimental group were given a determined appointment at a specific attend time. The training for the experimental group was individual, the training for the experimental group was scheduled for one month, and the experimental training was conducted in a virtual reality lab at Arab American University. Each participant, before attending IVR heart saver training, was assigned the consent form after providing the explanation paper. After that, the pre-test written exam was administered to the participants before attending IVR HS training, and the pretest was considered as a baseline for the study. The amount of time for assigned consent, reading the explanation paper, and providing information related to the program, such as how to deal with new IVR technology and how to use it, and hall procedure before training took around 35 to 40 minutes. Then, the participants attended the IVR HS training by following the sequences by selecting from the list in front of them through oculus as shown in Figure (3.9.A) (watching a 360-degree video, demonstration, then performance evaluation by following the heart saver scenario respectively), as shown in Table (3.8), the amount of time ranged for training and evaluation from 12 minutes to 15 minutes for completing the procedure. After learning and performing their performance evaluation of the IVR Heart Saver Training, the participants did the post-exam immediately and filled out the satisfaction and self-confidence learner questionnaire; the total amount of time to do the post-test exam and fill out the questionnaire took 30 minutes. The total amount of time ranged from one to one and a half hour for completing the hall procedures for each participant because some of the participants were familiar with the VR technology, which is why they took one hour rather than someone unfamiliar with the technology.
The participants in the standardized HS group were split up into fourteen groups. The training was made up of six to seven students in each group, and an instructor and researcher led the courses. The standardized HS training was located in the Heart Centre at Arab American University, which uses the AHA heart-saver contents (Adult CPR, Rescue Breathing, and AED, respectively). Each participant, before attending standardized heart saver training, was assigned the consent form after providing the explanation paper. After that, the pre-test written exam was administered to the participants before attending the training, and the pretest was considered as a baseline for the study. The amount of time for assigned consent, reading explanation paper, and providing information related to the training, such as the importance of heart-saver. All procedures before attending the training took around 30 to 40 minutes.
After that, the standardized group conducted face-to-face heart-saver training by watching HS 2 digital videos, and after each video, the participants were trained on mannequins to perform adult CPR, rescue breathing, and AED while watching, which took around 40 to one hour. After training, the participants attended the performance evaluation immediately. The participants did the post-exam immediately and filled out the satisfaction and self-confidence learner questionnaire; the total amount of time to do the post-test exam and fill out the questionnaire was 30 minutes. The total amount of time ranged from two to three hours for each group to complete the hall procedures, as well as the permission to take pictures and use it while participant performing CPR for each group was obtain from the participants when attending to the training as shown in Figure (3.9.B).

In addition, it is worth mentioning that, related to standardized performance evaluation, the instructor and AHA instructor use the stopwatch to ensure and verify the accurate time for each component of the CPR checklist; however, concerning the IVR timer, it was calculated from the software program. Also, the cost of a heart saver for any person who would like to take this course depends on AHA prices for each country, and one instructor leads this course; the ratio of this training is one instructor to 6 at least and nine at maximum in each group.
To prevent contamination between the external and the standardized groups, the study was conducted as follows: the standardized group participated at the AHA center at a designated time other than the other group's time, which the researcher provided with an AHA observer. After completing the heart saver course training, the participants in the standardized group were assessed individually in performing adult CPR and AED skills. Further, the intervention group received heart-saver IVR training at a VR lab that the researcher provided with an AHA observer. After completing the heart-saver IVR training, the participants were immediately assessed individually in performing adult CPR and AED skills. After that, the two groups completed the satisfaction and self-confidence questionnaires. These sequences were done immediately to adjust for extraneous variables and ensure that skills were assessed immediately following the scenario (Table 3.9). Students were instructed not to discuss the scenario with others, To prevent any discussion related to the scenario, the participants in the standardized training were scheduled to attend the standardized groups at different times, and the participants in the IVR training were scheduled to participate at various times for each participant. As well, participants were told that their participation would not influence their evaluations. Then, the data collection was conducted using the following tools: a questionnaire, an American Heart Association pre- and post-exam, training on both VR for the interventional group and a demonstrative scenario for the control group, as well as using the heart server performance checklist for both groups after training to evaluate their performance skills. After that, the data was analyzed to conclude the findings. These results were used for Ph.D. research purposes.

2023-09-01

2023-10-31

Immersive virtual reality heart-saver training is more effective in terms of knowledge retention, performance, satisfaction, and self-confidence when compared with standardized methods of heart-saver training.

There are no differences between immersive virtual reality (IVR) heart-saver training and the standardized heart-saver training among no-health science students. However, the IVR HS is superior in performance compared to the standard.

The present study is grounded in an experimental framework, employing a randomized controlled trial (RCT) to meticulously examine and contrast the outcomes of immersive virtual reality heart-saver (IVR HS) training against those obtained through standardized heart-saver (Standardized HS) training methodologies. RCTs is a prospective, comparative, and quantitative experimental study performed under controlled conditions with random allocation of interventions to compare groups. RCT used in clinical and social science research, designed to assess the efficacy of interventions by randomly assigning participants to either a main intervention or a standardized group. Such randomization helps eliminating selection bias, ensuring that differences in outcomes between groups can be attributed to the intervention rather than other factors (Bhide et al., 2018). One of the primary strengths of RCTs is their ability to provide high-quality evidence on cause-and-effect relationships due to their rigorous design and control over variables, and shows the differences between groups. However, this design also has limitations, including high costs, ethical concerns, and sometimes limited generalizability if the study sample does not represent the broader population (Bhide et al., 2018). Despite these limitations, RCTs are used in this study because this design offers strong, credible results that can inform policy, clinical guidelines, and further research, ultimately contributing to evidence-based practice. The essence of conducting an RCT lies in its capacity to impartially assess the effectiveness of interventions, offering a robust mechanism to ascertain causal relationships between the educational interventions under investigation and the resultant learning outcomes among non-health science students at the Arab American University (AAUP).
The justification for selecting an RCT design is rooted in its unmatched ability to offer clear insights into cause-and-effect relationships, a feature that is indispensable for the evaluation of educational interventions. The RCT design employed in this study is particularly well-suited for assessing the efficacy of immersive virtual reality in CPR training—a burgeoning field with significant implications for educational methodology and learner outcomes. By directly comparing IVR HS training with the standardized HS approach, the study aims to contribute valuable empirical evidence to the ongoing discourse on the pedagogical merits of virtual reality in medical education.
At the core of this experimental inquiry is the deployment of a randomized control trial, a research design heralded for its unparalleled strength in elucidating causal inferences within the realm of educational interventions (Kesmodel, 2018; White et al., 2014). The RCT design segregates participants into two distinct cohorts: the experimental group, which engages with the novel IVR HS training, and the standardized group, which participates in the conventional Standardized HS training as delineated by the American Heart Association (AHA). This demarcation is pivotal, as it facilitates a direct, unbiased comparison between the innovative IVR intervention and the established standardized training methodology.
The experimental group is immersed in a three-steps IVR HS training regimen, commencing with an introductory 360-degree video demonstration of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) usage. This is followed by an interactive session within a virtual environment where participants are guided to perform CPR on adult victims, culminating in an evaluation phase where in participants' competencies are assessed via an embedded questionnaire within the IVR software as shown in Figure (). Notably, this study has developed the VR skill for certain aspects of the evaluation are automated, capturing nuanced data points that might elude standardized assessment methods. Which measured by initially sensed by VR machine and transformed to the computer system based on AHA criteria as shown in Appendix (Q).
Conversely, the standardized group is exposed to a standardized curriculum approved by the AHA, comprising theoretical and practical components of adult CPR and AED training. The curriculum is delivered through instructional videos, followed by a hands-on demonstration, and evaluation is conducted in alignment with the established AHA assessment criteria as shown in Appendix (Q).
The recruitment and randomization processes underpinning this study are meticulously crafted to ensure a representative sample of non-health sciences students from AAUP. The initial population is derived from the university's Deanship of Admission and Registration for selecting the sample size randomly for this study from the registry department list by SPSS software is employed to assign participants who presented determined their population, then invited the students to participate in this study to approach the students who welling to be a part in this study, after that, a randomized allocation mechanism was used to distributed the approached list manually by Excel sheet software is employed to assign participants manually to either the experimental or standardized group; the approached list was distributed manually by the first student was assigned to the experimental group and the second student was assigned to the standardized group till the finish the list. This randomization is critical, as it minimizes potential biases and ensures that any observed differences between groups post-intervention can be attributed with greater certainty to the intervention itself rather than extraneous variables.
The RCT's methodological rigor is further enhanced through the employment of randomized allocation sampling, a process meticulously outlined using an Excel sheet for unbiased group distribution. This methodological choice not only exemplifies the study's commitment to ensuring the internal validity of the research design but also underscores the randomized control trial's potency as the gold standard for comparative effectiveness research. The intrinsic value of an RCT in a study of this nature cannot be overstated, as it provides a robust framework for evaluating the differential impact of IVR versus standardized CPR training on key outcomes such as knowledge acquisition, skill proficiency, and self-confidence among participants.
In summary, the chosen research design and its meticulous implementation reflect a comprehensive and scientifically rigorous approach to investigating the comparative effectiveness of IVR HS and Standardized HS training programs. Through this experimental inquiry, the study aspires to shed light on the potential of immersive virtual reality as a transformative tool in CPR education, ultimately informing best practices and guiding future innovations in the field. The deliberate selection of an RCT, underscored by a systematic recruitment and randomization strategy, embodies the study's commitment to methodological excellence and its potential contribution to evidence-based educational policy and practice.

In the first step, we selected 250 non-health students randomly as a simple sample randomization from the department registry list out of 5,500 by using SPSS. after that, we approached 200 non-health science students who will be a part of this study. After that, we did the randomized allocation (assigned) for 200 students manually by using Microsoft Excel; we distributed the first student to the experimental group, then the second to the control group, until we finished the list.

In the first step, we selected 250 non-health students randomly as a simple sample randomization from the department registry list out of 5,500 by using SPSS. after that, we approached 200 non-health science students who will be a part of this study. After that, we did the randomized allocation (assigned) for 200 students manually by using Microsoft Excel; we distributed the first student to the experimental group, then the second to the control group, until we finished the list.

No

The power analysis calculation yielded a required sample size of 176 participants to achieve the desired power and effect size with the given alpha level. However, to account for potential dropouts—a common occurrence in longitudinal studies—a buffer of 10% was added to each group. This precautionary measure ensures that the final analysis retains its statistical power even with participant attrition, ultimately raising the total sample size to 200 participants, divided equally into 100 participants per group.
This meticulous approach to sample size calculation, supported by the theoretical underpinnings and statistical guidelines outlined in the literature (Cohen, 1988; Faul et al., 2007; Hedges & Rhoads, 2010), ensures that the study is well-positioned to make definitive conclusions about the comparative effectiveness of immersive virtual reality versus standardized CPR training. Moreover, the inclusion of a dropout buffer enhances the study's resilience to common research challenges, bolstering the reliability and validity of the anticipated findings. As well, this sample size accounts for the design's matched-pair nature, ensuring adequate statistical power to assess the interventions' effectiveness comprehensively.

200 non-health science students.

The total sample size was 200 non-health science students, we distributed 100 for the experimental group and 100 for the control group.

For the determination of the requisite sample size in this randomized control trial (RCT), the study utilized the G*power software application (version 3.0.10), an established statistical tool designed for power analysis across various experimental designs (Faul, Erdfelder, Lang, & Buchner, 2007). Employing a repeated measures ANOVA approach, the calculation was intricately designed to ascertain the optimal number of participants needed to detect statistically significant differences between the two groups (immersive virtual reality heart-saver training and standardized heart-saver training) with sufficient statistical power. The alpha (α) level, representing the probability of committing a Type I error, was conservatively set at 0.05. This standard threshold indicates a 5% risk of concluding a difference exists when, in fact, it does not, thus maintain the rigor of scientific inference (Cohen, 1988). Power (1-β error probability), which quantifies the study's ability to detect an actual effect if one exists, was ambitiously set at 0.95. This high level of power ensures a 95% probability of detecting a true effect, thereby reducing the risk of a Type II error, where a real difference is overlooked (Hedges & Rhoads, 2010). A crucial component of this calculation is the effect size, estimated at 0.25 based on preliminary research and theoretical considerations. An effect size of this magnitude is considered medium, according to Cohen's (1988) benchmarks, indicating a moderate yet meaningful difference expected between the intervention and control groups. This effect size was selected to ensure the study's sensitivity to detecting clinically significant differences that would warrant practical implementation of the findings. The power of 0.95, indicating an 95% chance of correctly rejecting the null hypothesis when it is false, strikes a balance between being sufficiently powered to detect real differences and the practical limitations of participant recruitment. This level of power is commonly accepted in social sciences research, providing a reasonable likelihood of detecting true effects while acknowledging the constraints of available resources (Cohen, 1992). An alpha level of 0.05 was chosen, setting a 5% risk of incorrectly rejecting the null hypothesis when it is true (Type I error). This threshold is standard in research, balancing the need to minimize false positives while allowing for a reasonable probability of detecting true effects (Cohen, 1992).