360-degree projection simulation versus traditional simulation in undergraduate paramedicine education: a pilot randomised controlled trial.

Introduction: Simulation is considered a mainstay for teaching and assessment in various clinical fields, including paramedicine. Simulation fidelity in educational practice is constantly changing to accommodate the integration of extended realities (XRs), such as augmented, mixed and virtual realities. However, little research has been undertaken to directly compare these newer, technology-enhanced methods, such as 360-degree projection simulation, with the traditional methods used in undergraduate education. The purpose of this research was to provide a direct comparison, exploring their effect on ratings of self-perceived performance in second-year paramedicine students. Methods: Using a single-site, parallel randomised controlled, non-blinded trial, participants were randomly allocated to a three-day intensive 360-degree projection (intervention) or traditional (control) simulation programme. Ratings of self-perceived performance were collected using the Seattle University Simulation Evaluation tool at three different time points: after participants' first simulation as 'lead paramedic' on Day 1 of the intensive programme (Rating 1), after their final simulation on Day 3 of the intensive programme (Rating 2) and after their final simulation in a follow-up programme after a nine-week washout period (Rating 3). Results: Out of the 37 participants randomly allocated, 20 fulfilled the study requirements, with 11 in the 360-degree projection group and nine in the traditional simulation group. Participants consistently reported higher ratings of self-perceived performance in the traditional simulation group, in comparison to the 360-degree projection simulation group (p = 0.04). While no difference was seen between groups after the intensive programme (Rating 2), a notable difference was observed between groups at Rating 3 in favour of the traditional simulation group (p = 0.02). Conclusion: This pilot study suggested that measures of self-perceived performance were lower when using 360-degree projection simulation spaces. While there may be some benefit to this form of simulation as an adjunct to current traditional methods used, further research, including studies that are appropriately powered and include objective outcome measures, is needed to understand the measure of effectiveness in a practical setting and to inform future educational interventions.