Virtual Reality Simulation in Postgraduate Pediatric Critical Care Training Based on Trainee Perceptions in London: Exploratory Mixed Methods Study.

Background: Simulation-based training has established itself as integral to clinical education, particularly for high-stakes, low-frequency pediatric emergencies. Innovations incorporating virtual reality (VR) are rapidly gaining traction for offering scalable, repeatable, and immersive opportunities for scenario-based learning. Understanding its role and applicability in postgraduate pediatric training, however, remains limited, with further exploration required into how pediatric trainees perceive, conceptualize, and anticipate VR-based simulation within real-world training contexts. Objective: This study explored London-based pediatric trainees' perceptions of VR simulation as an adjunct for developing skills in recognizing and managing critically ill children. Methods: An exploratory mixed methods study was conducted among pediatric trainees across all training levels within the London School of Paediatrics between April 2024 and July 2024. Data were collected using a 35-item online questionnaire containing Likert-scale, categorical, and open-ended questions, alongside virtual semistructured interviews. The questionnaire explored current training practices; confidence and preparedness in managing critically ill children; familiarity and experience with VR; and perceived benefits, limitations, barriers, and facilitators to adoption. Quantitative data were analyzed descriptively, with exploratory Mann-Whitney U tests and Spearman correlations where appropriate. Internal consistency of key domains was assessed using Cronbach α. Qualitative data from open-ended responses and interviews were analyzed thematically using the Braun and Clarke reflexive approach. Quantitative and qualitative strands were integrated at the interpretation stage to contextualize survey patterns with illustrative qualitative insights. Results: Thirty trainees participated in the survey (30/450, 6.7%; female: 16/30, 53%), with participants spanning all 8 training years. Two senior trainees participated in interviews. Clinical exposure or experience and simulation training were identified as central to developing skills in managing pediatric emergencies. Trainees also described limited exposure to high-acuity scenarios; variable access to high-fidelity simulation; and constraints related to workload, supervision, and feedback. Most participants (21/30) had no prior VR exposure in a medical setting, while 17% (5/30) had used VR training, and all reported positive experiences. Despite limited exposure, 93% (28/30) of participants were willing to try VR simulation for exposure to rare scenarios, structured decision-making, and confidence-building. Key perceived barriers included high cost (24/30, 80%), technological literacy (17/30, 57%), infrastructure (15/30, 50%), and limited stakeholder familiarity or support (25/30, 83%). Participants suggested taster sessions, faculty advocacy, leadership engagement, and phased implementation as potential facilitators. Internal consistency of attitudinal survey items was good (Cronbach α=0.80). Conclusions: Despite limited exposure, pediatric trainees viewed VR simulation as a valuable adjunct to existing critical care training, particularly for those in earlier stages of training. However, these findings represent anticipatory perceptions rather than evidence of educational effectiveness. The implementation of VR will depend on addressing key infrastructural, organizational, educational, and equity-related barriers. Further multicenter studies are needed to evaluate the educational impact and feasibility, learning outcomes, and cost-effectiveness in postgraduate pediatric critical care training programs.