Justification for research
Virtual reality (VR) technologies have been advancing in many fields, including medical education. This study was to verify whether a VR simulator can be equally used in the medical education curriculum by achieving comparable outcomes for students.
To study weather trauma management self-learning in VR setting is non-inferior to the traditional instructor-lead simulation by using manikin patient simulator.
Manikin simulation-based group teaching (control) is superior to VR simulation-based self-learning (intervention)
VR simulation-based self-learning is non-inferior to the manikin simulation-based group teaching.
Study design: randomized controlled simulation based trial
Population: medical students, volunteers
Trauma score (“Trauma simulator”, Exonicus, Inc.; point range 0-199);
The examination simulation with manikin will be recorded. The video data was stored for review and deleted afterward. During the exam, students was examined by the expert team consisting of facilitator and confederate.
Randomization: manikin simulation-based group teaching (control) and VR simulation-based self-learning (intervention) 1:1. Groups were randomized by using the Research Randomizer tool.
Sample size: Sample size calculation was done by using Seal Envelope Power Calculator based on pilot study results, where among medical 31 students Trauma score was 84.13 (11.95 SD). If there is truly no difference between the standard and experimental treatment, then 36 (18 per group) students are required to be 80% sure that the lower limit of a one-sided 95% confidence interval (or equivalently a 90% two-sided confidence interval) will be above the non-inferiority limit of -10. Estimated severe motion (“cyber”) sickness is 5%. Accounting for other reasons of drop out, 20 students in each group (40 in total) will be enrolled.
40 participants participated in the study over 5 days, i.e. 8 students per day, September 2020. On each study day, a total of eight students received the welcome and orientation (10 min), followed by a video lecture covering essential advanced trauma life support principles (40 min). The students were randomized into two groups (4 and 4): the VR group and the manikin simulation (SIM) group.
The VR group was trained in the learning mode for 60 minutes. There were 3 VR headsets provided.
The SIM group received the simulation orientation and instructor-led training (all four students simultaneously) in a specially equipped room that visually looks as alike as possible to the VR scenario. Both groups did undergo a simulation-based assessment of the same scenario.
The students received pre and post–surveys (See Annex 2). The surveys are structured to evaluate students’ experiences before and after the training. As a reference, the evaluation tools are made, based on Bangor et al. 2009 and Kennedy et al. 1993; 
Virtual reality sickness questionnaire (included in the post-survey) provided a motion sickness measurement index in a virtual reality environment;
After performing the VR exam an exported Excel table of individual detailed scores from the Trauma Simulator software was available for further analysis.
Proportions was compared by using Chi square test and continuous data by using t-test. Significance is assumed when p<0,05. Statistical tests will be carried out by using SPSS v23.0.
The research team was composed of Rigas Stradins University academic staff, researchers, MDs, IT specialists, students, project managers, lawyers, and other field experts.