Virtual Reality in Medical Training: Usability and Stress Measurements for a Pericardiocentesis Procedure Simulation (Preprint)
Authors: Rubio-López Alberto , García Carmona Rodrigo , Zarandieta Laura , Rubio Alejandro , González-Pinto Angel , Cardinal-Fernández Pablo 
Published: November 2024

BACKGROUND

Virtual Reality (VR) has experienced a surge in use for medical education, offering immersive environments where students can practice high-risk procedures such as pericardiocentesis safely and easily. This life-saving intervention is associated with high cognitive and emotional stress for the practitioner, making it crucial to evaluate not only the usability of a VR simulation of it, but also the physiological stress responses of its users. Heart Rate Variability (HRV) provides an objective measure of stress and can therefore be used to evaluate it. Finally, prior experience with VR can affect this stress response.

OBJECTIVE

This study aimed to (1) assess the usability of VR simulations for pericardiocentesis, (2) examine correlations between physiological stress, measured through HRV, and usability perceptions; and (3) investigate whether prior VR experience influences usability scores and stress levels

METHODS

Final-year medical students (N = 119) performed a VR-based pericardiocentesis simulation. Usability was evaluated using the System Usability Scale (SUS), Post-Study System Usability Questionnaire (PSSUQ), Simulator Sickness Questionnaire (SSQ), and Presence Questionnaire (PQ). Physiological stress was assessed via HRV parameters (rMSSD, PNN20, PNN50, LF/HF ratio, SD1/SD2, Poincaré Area). Prior VR experience was recorded, and data were analyzed using descriptive statistics, Spearman correlations, and Mann-Whitney U tests to examine relationships between usability, stress, and experience

RESULTS

Usability assessments showed moderate to high usability across all participants. SSQ scores indicated mild simulator sickness, primarily in the nausea and oculomotor dimensions. Significant negative correlations were observed between HRV parameters (rMSSD, PNN50, Poincaré Area) and SSQ scores (p < 0.05), suggesting that higher physiological stress during the experience is linked to more pronounced simulator sickness symptoms. Prior VR experience was associated with higher SUS scores and lower simulator sickness, though no significant impact on HRV responses was found

CONCLUSIONS

VR simulations for high-risk procedures like pericardiocentesis are generally well received by medical students in terms of usability. However, physiological stress, as indicated by HRV, correlates with increased simulator sickness, highlighting the need for optimizing VR design to reduce discomfort. Prior VR experience enhances usability perceptions and reduces simulator sickness but does not significantly affect physiological stress markers. Future research should focus on balancing immersive learning with user comfort in medical VR applications, particularly for stress-inducing scenarios. Simulations without any interactions not already present in the real scenario simulated (teleportation, heads-up displays, etc.) are appropriate as first-time VR experiences for users