Evaluating a basic life support and defibrillation XR system with healthcare professionals: the role of feedback on knowledge and skill gain and the effects of refresh training

Abstract Extended Reality (XR) has recently been introduced for Basic Life Support and Defibrillation (BLSD) training. The medical literature shows that feedback enhances real-world performance in BLSD, but it is unclear whether it could also be effective during XR training. This is the first study to explore the effect of the combined real-time (rt-FB) and post-performance feedback (pp-FB) in a BLSD XR system: we compared two groups of doctors and nurses trained with (G1) or without feedback (G2), and we assessed their performance immediately after training and one month later (retention). We also assessed the performance of the trainees after a refresh training with rt-FB and pp-FB in both groups. We analyzed the number of correct steps, compressions (frequency, depth, release, hand position, overall correctness), and participants’ perception of the XR system (usability, satisfaction, ease of learning and use, willingness to use). Eighty participants attended the first training session (G1: n=41, G2: n=39). Immediately after training, G1 performed better in terms of correct compressions and depth difference. Fifty participants attended the second session a month later. A differential 37.5% dropout prevented comparisons between groups in this session. Retention assessment revealed an expected natural decay in correct steps in both groups. Refresh training consistently improved correct steps and depth difference in both groups, as well as correct compressions in G1 and in G1+G2. Compared to the post-training performance of the first session, refresh training consistently improved correct steps and depth difference in both groups, as well as frequency difference in G2 and in G1+G2. Participants described the XR system as useful, easy to learn and use, and satisfactory. Most participants assigned the highest score to their willingness to use it. Results suggest that providing rt-FB and pp-FB enhances the efficacy of XR training. Refresh training is effective at improving BLSD performance and is well-received among doctors and nurses. This paves the ground for future regular use of XR-based refresh training in BLSD.