Feasibility of Virtual Reality-Based Simulation for Neonatal Resuscitation Training: A Pilot Study at an International Site

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Building on prior research conducted in the United States, we evaluated the feasibility of deploying a VR-based neonatal resuscitation training model in an international setting. Methods Healthcare providers at Ho Chi Minh City Children's Hospital in Vietnam participated in VR-based training for neonatal resuscitation. Training included a knowledge review, platform orientation, and a simulated resuscitation scenario based on the Neonatal Resuscitation Program. Participants completed post-training surveys assessing satisfaction, perceived realism, and challenges encountered. Results Among 28 participants, 100% recommended VR training, and 86% found it more realistic than traditional methods. The mean usefulness score was 4.3/5. Challenges included language barriers and technical issues. Conclusions VR-based neonatal resuscitation training is feasible and well-received internationally, demonstrating potential for expanding specialized medical education to resource-limited settings. Enhancements addressing implementation challenges are warranted. Scientific community and society/Developing world Health sciences/Health care/Patient education Figures Figure 1 Figure 2 INTRODUCTION Neonatal resuscitation is a critical skill for healthcare providers who attend newborn deliveries, as approximately 10% of newborns require assistance to initiate breathing at birth. 1 Effective resuscitation in these high-pressure scenarios significantly impacts immediate and long-term neonatal outcomes. 2 – 4 Consequently, ensuring that healthcare providers possess the necessary competencies is essential, with simulation-based training forming the cornerstone of education in neonatal resuscitation programs worldwide. 5 Traditional training methods, including manikin-based simulations, have proven effective but are not without limitations. High-fidelity manikins, while valuable, struggle to fully replicate the immersive, variable, and dynamic nature of real-life clinical scenarios. Additionally, the high cost, space requirements, and resource-intensive setup of these simulations limit their accessibility, especially in resource-constrained settings. These barriers underscore the need for innovative approaches to complement or, in some cases, replace traditional methods. Virtual reality (VR), augmented reality, and mixed reality have emerged as transformative tools in medical education, offering equal knowledge acquisition compared to traditional methods while significantly enhancing learner satisfaction, engagement, and self-efficacy​. 6 VR enhances neonatal resuscitation training by providing immersive, customizable simulations that improve procedural skills, decision-making, and learner confidence while offering a scalable and accessible solution for diverse healthcare settings. 7 A systematic review by Kyaw et al. demonstrated that VR improves post-intervention knowledge retention and cognitive skill acquisition, with a large effect size (Standardized Mean Difference = 1.12; 95% CI 0.81–1.43). 8 This evidence underscores VR's capacity to simulate procedural and decision-making tasks effectively, making it a valuable tool for training healthcare professionals in high-stakes settings like neonatal resuscitation. However, the application of VR in neonatology remains underexplored, with limited studies evaluating its effectiveness, feasibility, and scalability across diverse cultural and healthcare settings. Building on prior research conducted in the United States (U.S.), 9 this study sought to extend the use of VR-based neonatal resuscitation training to an international context, specifically in Ho Chi Minh City, Vietnam. The objectives were to assess the feasibility, acceptance, and challenges of implementing this training model in a resource-constrained setting and to identify areas for refinement to improve its effectiveness. By expanding VR training beyond its initial development setting, this study contributes to the growing body of evidence supporting the integration of advanced technologies in medical education. METHODS Study Design, Setting, and Participants This was a cross-sectional pilot study evaluating the feasibility and participant reception of a VR-based neonatal resuscitation training program in Ho Chi Minh City, Vietnam. The study was conducted at the Neonatal Intensive Care Unit (NICU) of Ho Chi Minh City Children’s Hospital, a tertiary care center serving a diverse patient population. Participants included healthcare providers involved in neonatal care, recruited via in-person announcements and electronic communication. Inclusion criteria were active clinical involvement in neonatal resuscitation and willingness to participate in the study. A total of 28 healthcare providers participated, including neonatologists, pediatric residents, nurses, and allied health professionals. Written informed consent was obtained from all participants prior to the study. Ethical approval was secured from the Institutional Review Board of the University of Wisconsin-Madison and the local ethics committee in Vietnam. Virtual Reality Model Development The VR training platform was developed using Acadicus (Arch Virtual, Madison, WI, USA) in collaboration with a multidisciplinary team of neonatologists, VR developers, and simulation experts. The training model simulated a 30-week neonate experiencing respiratory distress, with scenarios aligned to the Neonatal Resuscitation Program® (NRP) 8th edition guidelines. 10 The virtual neonate exhibited key clinical features, including chest rise, retractions, and changes in vital signs, providing real-time dynamic feedback during the resuscitation scenario. Participants engaged with the virtual environment using the Meta Quest 2 head-mounted displays (Meta Platforms, Inc., Menlo Park, CA, USA) and handheld controllers, as shown in Fig. 1 . The training maintained consistency with our previously published U.S. pilot study, 9 while incorporating adaptations to accommodate local contextual factors in Vietnam. This study utilized a group-based training approach with enhanced nursing representation, allowing nurses and allied health professionals to train alongside physicians, mirroring the team-based structure of traditional NRP education. The training environment was designed as a fully equipped virtual resuscitation room, providing participants with an immersive and interactive experience. Within this environment, participants were guided through essential tasks such as mask ventilation, implementing corrective steps, and providing post-resuscitation care. The corrective steps, known as MR. SOPA, include specific interventions to improve ventilation: Mask adjustment, Repositioning the airway, Suctioning the mouth and nose, Opening the mouth, increasing Pressure, and using an Alternative airway if necessary. The VR platform featured pre-recorded instructions that facilitated navigation and interaction with virtual equipment, allowing participants to complete key steps in the resuscitation process. Intervention The training sessions were conducted over two weeks in April 2023 and consisted of four group sessions, each involving 6–8 participants. Each session followed a structured format with four key components. The first component was an introduction and orientation led by a study team member and co-author (G.T.), who was based at the University of Wisconsin–Madison but was onsite in Vietnam for the duration of the study. G.T. facilitated the sessions, providing an overview of the training objectives and logistics, and utilized her fluency in Vietnamese to ensure effective communication with participants. To further support the sessions, an onsite team member assisted with translation and technical troubleshooting. Participants then completed a virtual environment orientation module, which included a guided walkthrough to familiarize them with navigation techniques and the use of virtual tools. This preparation was designed to build participants' confidence and competence before engaging in the simulation. With each training session, a remote study team member (R.M.), based at the University of Wisconsin–Madison, greeted participants via Zoom® (Zoom Video Communications, Inc. San Jose, CA) and subsequently joined them in the virtual environment to guide the simulation scenario. In the third component, participants managed a case of a 30-week neonate with respiratory distress. Within the virtual environment (Fig. 2 ), participants performed critical MR. SOPA corrective steps. The scenario, aligned with the NRP algorithm, included pre-programmed clinical changes that required participants to perform critical interventions such as positive pressure ventilation and corrective actions. Each session concluded with a debriefing and feedback phase. During this phase, participants engaged in a facilitated discussion to reflect on their performance, share insights, and receive constructive feedback. Following the debriefing, participants completed a post-training survey to evaluate the session’s effectiveness and provide suggestions for improvement. Survey Development The post-training survey used in this study was adapted from the survey developed for our prior U.S. study in collaboration with the University of Wisconsin Survey Center. 9 To ensure linguistic and cultural accuracy, the survey underwent a two-step translation process. It was first translated from English to Vietnamese by professional translators recommended by UW-Madison, followed by an independent back-translation into English to verify accuracy (see Appendix for the survey tool). A team member (G.T.) then conducted a final review to refine linguistic precision and cultural relevance. The survey was administered electronically using the Qualtrics platform and assessed primary outcomes, including participant satisfaction, perceived realism, and the usefulness of the VR model. Secondary outcomes included reports of adverse effects associated with VR use (e.g., dizziness, nausea) and implementation challenges. Additionally, open-ended questions captured qualitative feedback for thematic analysis, providing deeper insight into participant experiences and areas for improvement. Data Analysis Quantitative data were analyzed using descriptive statistics, with categorical variables presented as frequencies and percentages and continuous variables as means with standard deviations. Subgroup analyses were performed to examine differences in VR ratings by role, prior VR experience, and years of NICU experience. Comparative analysis with the prior U.S. study was conducted using chi-square or t-tests as appropriate. Qualitative data from open-ended survey responses were analyzed using thematic analysis to identify recurring themes and subthemes. RESULTS Participant Demographics A total of 28 healthcare providers participated in the VR-based neonatal resuscitation training in Vietnam (Table 1 ). Participants included pediatric residents (11%), NICU hospitalists (29%), neonatologists (4%), nurses (18%), and other healthcare professionals (18%). Most participants were female (70%) and had 3–5 years of NICU experience (39%), while 28% had less than three years of NICU experience. Only 22% of participants had American NRP certification, highlighting a relative lack of formal resuscitation training within the cohort. Table 1 Participant Demographics (Vietnam Cohort) Demographic Variable N (%) Role Pediatric Resident 3 (11%) NICU Hospitalist 8 (29%) Neonatologist 1 (4%) Nurse 5 (18%) Other 11 (39%) Gender Female 20 (70%) Male 8 (30%) Years of NICU Experience Less than 3 years 8 (28%) 3–5 years 11 (39%) More than 5 years 9 (33%) Prior VR Exposure Had used VR before 9 (32%) Owned a VR headset 5 (18%) VR Familiarity and Training Experience Prior VR exposure was limited among participants, with only 32% reporting prior use of a VR headset, and 18% owning one. All participants successfully completed the VR orientation module and simulation scenario, with 79% indicating a desire to revisit the orientation module before future sessions. The training program included a combination of virtual walkthroughs, simulation exercises, and debriefing, ensuring a structured and immersive learning experience. Satisfaction and Perceived Usefulness Participant satisfaction with the VR training was positive. All participants (100%) stated they would recommend VR training to colleagues, and 86% rated the VR simulation as more realistic than traditional training methods. The average usefulness score for the VR platform was 4.3 out of 5 (standard deviation: 0.9), reflecting high perceived value among users (Table 2 ). Table 2 Statistical Comparison of Key Outcomes Group Mean Usefulness Score (SD) P-Value Role Pediatric Resident 3.4 (0.6) 0.0728* NICU Hospitalist 4.3 (0.5) 0.0728* Neonatologist 1.0 (0.0) 0.0728* NICU Experience Less than 3 years 4.2 (1.3) 0.8753 3–5 years 4.1 (0.4) 0.8753 More than 5 years 4.0 (0.5) 0.8753 * P-values : Statistical comparisons were conducted using a significance threshold of p < 0.05. Comparison with U.S. Cohort Compared to a prior U.S.-based cohort (Table 3 ), the Vietnamese participants reported higher recommendation rates (100% vs. 95%) and higher perceived realism (86% vs. 70.3%). Furthermore, VR-related discomfort, such as dizziness or nausea, was reported by only 28.6% of Vietnamese participants, compared to 40.5% of the U.S. cohort. Table 3 Comparison of Feedback Between U.S. and Vietnam Cohorts Feedback Metric U.S. Cohort (N = 38) Vietnam Cohort (N = 28) Would recommend VR training to colleagues 95% 100% Found VR more realistic than traditional methods 70.3% 86% Reported VR-related discomfort 40.5% 28.6% Average usefulness score (Likert 1–5) 4.5 4.3 Challenges and Qualitative Feedback Participants identified several challenges during the training, including language barriers, unfamiliarity with the NRP algorithm, and intermittent internet connectivity. Despite these obstacles, participants appreciated the novelty and potential of the VR platform. Thematic analysis of open-ended survey responses revealed key areas for improvement, including a desire for greater scenario realism and clinical variability, increased opportunities for practice, and more stable technology. Additionally, participants valued the teamwork facilitated by the VR training and emphasized the importance of safe practice environments that do not pose risks to real patients. DISCUSSION This study demonstrates the feasibility and positive reception of a VR-based neonatal resuscitation training program in an international setting, specifically in Vietnam. Building on prior research conducted in the U.S., 9 this pilot study confirms the adaptability of the VR platform across diverse healthcare environments and highlights its potential as an innovative training tool for neonatal resuscitation. Comparison with Traditional Training Methods The Vietnamese participants reported high satisfaction with the VR training, with 86% rating it as more realistic than traditional training methods. This aligns with previous findings that VR offers an immersive learning environment, enabling repeated exposure to high-stakes clinical scenarios in ways that traditional manikin-based training may not, though some learners perceive limitations in realism and patient interaction. 11 The dynamic and interactive nature of the VR platform allowed participants to engage with a simulated 30-week neonate, providing valuable opportunities to practice critical interventions such as positive pressure ventilation and corrective steps. These features are particularly relevant in settings with limited access to high-fidelity manikins or formal neonatal resuscitation training. A key distinction between this study and our previous VR-based neonatal resuscitation training study 9 was the adoption of a group-based training approach with enhanced nursing and allied health representation. Unlike the prior study, which focused on individualized training, this study mirrored the team-based structure of traditional NRP education by allowing nurses, respiratory therapists, and other allied health professionals to train alongside physicians. This modification not only improved the realism of the training but also emphasized the critical role of interdisciplinary teamwork in neonatal resuscitation. Given that effective neonatal resuscitation relies on coordinated efforts among multiple providers, incorporating a team-based model better prepares participants for real-world clinical scenarios. Additionally, this approach fosters collaborative decision-making, role clarity, and communication skills, which are essential for optimizing neonatal outcomes. These findings suggest that VR-based training can be effectively expanded beyond individual skill acquisition to enhance team dynamics, an aspect that warrants further exploration in future studies. International Adaptability and Cultural Considerations This study highlights the international adaptability of VR-based training. Compared to the U.S. cohort, the Vietnamese participants expressed higher perceived realism and comfort with the VR platform, despite lower baseline familiarity with VR technology. This suggests that VR can potentially bridge gaps in training quality in resource-constrained settings. However, unique challenges were encountered, including language barriers and limited familiarity with the NRP algorithm. Future iterations of the program should incorporate bilingual instruction and region-specific clinical guidelines to further enhance accessibility and relevance. Implementation Challenges and Potential Improvements Despite the overwhelmingly positive reception, several implementation challenges were noted. Language barriers required the presence of an onsite translator, which, while effective, added logistical complexity. Unstable internet connections occasionally disrupted the immersive experience, emphasizing the need for robust technical infrastructure to support remote training sessions. Additionally, participants expressed a desire for increased scenario variability and more opportunities for practice to enhance skill mastery. Addressing these challenges in future implementations could improve the scalability and effectiveness of the program. Virtual Environment Familiarity and Adaptation One important consideration when deploying VR-based neonatal resuscitation training is the potential adjustment period required for participants to familiarize themselves with a virtual environment that may differ from their actual clinical setting. The layout of virtual resuscitation rooms, positioning of equipment, and user interfaces may not precisely mirror participants' real-world work environments. This discrepancy could lead to an initial learning curve, requiring additional time to orient participants to the virtual space before they can fully engage in resuscitation tasks. Future research should evaluate the extent to which this familiarization process impacts training efficiency, skill acquisition, and overall learning outcomes. Optimizing the design of virtual environments to reflect local clinical settings may help minimize disorientation and enhance the realism and relevance of the simulation experience. Flexibility to Accommodate Multiple Resuscitation Algorithms While the VR training platform in this study was designed according to the NRP 8th edition guidelines, there are several neonatal resuscitation algorithms currently in use across different regions and institutions. A key advantage of VR technology is its adaptability; virtual scenarios can be tailored to reflect various protocols and guidelines, thereby supporting widespread applicability. However, certain procedural elements—such as endotracheal intubation and chest compressions—may currently lack the tactile realism provided by advanced haptic feedback systems, which remain in early stages of development. Despite this limitation, VR offers an effective modality for practicing cognitive elements of neonatal resuscitation, including algorithm adherence, clinical decision-making, and team coordination. Psychological Impact of Training in a Virtual Environment Another important consideration is the psychological experience of participants during VR-based simulations. Ideally, these environments promote psychological safety so learners can engage fully, take risks, and learn from mistakes without fear of embarrassment or judgment. This sense of safety supports critical behaviors such as asking questions, reflecting on performance, and openly acknowledging uncertainty—behaviors that are foundational to simulation-based education. 12 Psychological safety is especially important in unfamiliar learning environments like VR, where the novelty of the interface can heighten anxiety. Effective strategies to foster this safety begin before the simulation itself. A structured pre-briefing that clarifies learning objectives, roles, expectations, and evaluation methods can help reduce ambiguity and support learner engagement. As described by Rudolph et al., the pre-briefing also establishes a “fiction contract,” a mutual agreement that acknowledges the simulation’s limitations while encouraging learners to interact with the scenario as if it were real. 13 This contract normalizes performance variability and invites participants to focus on learning rather than scenario appearance. In VR contexts, where the simulated experience may feel isolating or immersive in unfamiliar ways, facilitator support plays an important role in encouraging curiosity and demonstrating respect for the learner’s perspective. Future research should explore how psychological safety influences learning outcomes in VR-based training and identify effective, culturally adaptable strategies for creating safe learning environments across diverse settings. Cybersickness and VR-Related Discomfort Across Cohorts While VR can serve as a valuable adjunct to traditional manikin-based neonatal resuscitation simulations, challenges such as cybersickness warrant consideration. Cybersickness, which is characterized by symptoms like dizziness, nausea, and disorientation, is a frequently reported side effect of VR use. 14 , 15 Previous studies have shown that a significant proportion of users experience these symptoms, with rates as high as 49% among midwifery students 16 and 23% among medical students receiving VR-based trauma education. 17 In our study, 28.6% of participants reported VR-related discomfort, a lower incidence compared to our U.S. cohort( 40.5%), 9 yet still notable. This reduction may reflect differences in session structure, participant demographics, or prior VR exposure. Regardless, the overall occurrence of discomfort highlights the need for mitigation strategies, such as improved hardware, stable internet connectivity, and structured orientation. Strategies such as limiting session lengths to one hour, as recommended by Holla and Berg, 17 and incorporating gradual acclimation to the VR environment could mitigate these effects. In addition to motion sickness, prolonged VR use may lead to oculomotor strain, although both symptoms may diminish with repeated exposure. 18 Addressing these challenges through user preparation and technological refinements may help optimize the effectiveness and accessibility VR-based training programs. Further research is needed to understand the contributing factors to cybersickness and oculomotor strain, including how these issues vary across educational backgrounds and experience levels. Strengths and Limitations A major strength of this study is its demonstration of VR training’s feasibility in a resource-limited international setting. The study design allowed for structured evaluation of participant attitudes and challenges, providing valuable insights for future adaptations. However, several limitations warrant discussion. First, the reliance on self-reported survey data introduces potential response bias, as participants may have been inclined to provide favorable feedback. Second, the absence of a control group limits the ability to directly compare VR training outcomes with those of traditional methods. Finally, the small sample size and limited representation of certain professional roles, such as nurses and allied health professionals, may affect the generalizability of the findings. Future Directions Future research should focus on addressing identified challenges and expanding the scope of evaluation. Comparative studies with larger, more diverse samples are needed to rigorously assess the effectiveness of VR training relative to traditional methods. Objective outcome measures, such as skill retention and clinical performance, should complement participant feedback to provide a more comprehensive understanding of the program’s impact. Additionally, integration of emerging technologies, such as artificial intelligence, could enhance the adaptability and interactivity of VR-based training. Features such as real-time feedback, automated performance assessment, and multilingual support have the potential to address current limitations and further optimize training outcomes. Conclusion This pilot study demonstrates that VR-based neonatal resuscitation training is a feasible, effective, and well-received approach in an international setting. By providing immersive, realistic, and accessible training experiences, VR has the potential to transform neonatal resuscitation education, particularly in resource-limited contexts. Addressing implementation challenges and conducting rigorous evaluations will be critical to unlocking the full potential of this innovative training tool. Declarations Competing Interests The authors declare no competing interests. Funding Source: No funding was secured for this study. Financial Disclosure : The authors have no financial relationships relevant to this article to disclose. Conflict of Interest : The authors have no conflicts of interest to disclose. Clinical Trial Registration : Not applicable Author Contributions: R.M. conceived the study and developed the VR model. G.T. and R.M. designed the survey in consultation with experts from the University of Wisconsin Survey Center. G.T. and R.M. coordinated the planning, recruitment, and training sessions. B.H. helped coordinate training sessions at Ho Chi Minh City Children’s Hospital, Vietnam. All authors participated in the analysis and interpretation of the results and contributed to the writing and revision of the final manuscript. Acknowledgments We extend our sincere appreciation to the team at ArchVirtual for their technical assistance, which was instrumental to the successful completion of this project. Additionally, we thank the Survey Center at the University of Wisconsin-Madison for their valuable contribution in designing the post-training survey. References Aziz K, Lee HC, Escobedo MB, et al. 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The Impact of Virtual Reality Content Characteristics on Cybersickness and Head Movement Patterns. Sensors (Basel). Jan 2 2025;25(1)doi: 10.3390/s25010215 Ryan G, Callaghan S, Rafferty A, et al. Virtual reality in midwifery education: A mixed methods study to assess learning and understanding. Nurse Educ Today. Dec 2022;119:105573. doi: 10.1016/j.nedt.2022.105573 Holla M, Berg MVD. Virtual reality techniques for trauma education. Injury. Nov 2022;53 Suppl 3:S64-S68. doi: 10.1016/j.injury.2022.08.067 Takata R, Kanehira M, Kato Y, et al. Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: A prospective observational study. BMC Med Educ. Sep 21 2021;21(1):498. doi: 10.1186/s12909-021-02872-9 Additional Declarations There is NO conflict of interest to disclose. Supplementary Files VietnamVRSurvey.pdf Participant Survey Cite Share Download PDF Status: Published Journal Publication published 20 Aug, 2025 Read the published version in Journal of Perinatology → Version 1 posted Editorial decision: revise 12 May, 2025 Review # 2 received at journal 09 May, 2025 Reviewer # 2 agreed at journal 21 Apr, 2025 Review # 1 received at journal 14 Apr, 2025 Reviewer # 1 agreed at journal 03 Apr, 2025 Reviewers invited by journal 02 Apr, 2025 Submission checks completed at journal 01 Apr, 2025 Editor assigned by journal 31 Mar, 2025 First submitted to journal 31 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6346639","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":437493948,"identity":"d9df3b26-86f9-49ea-b41d-5842d1171152","order_by":0,"name":"Ryan McAdams","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-9579-1698","institution":"University of Wisconsin-Madison","correspondingAuthor":true,"prefix":"","firstName":"Ryan","middleName":"","lastName":"McAdams","suffix":""},{"id":437493949,"identity":"b081a10b-25a3-4b7e-8c93-3c69c11ee2f8","order_by":1,"name":"GiaKhanh Trinh","email":"","orcid":"https://orcid.org/0000-0002-6498-9829","institution":"Altru Hospital","correspondingAuthor":false,"prefix":"","firstName":"GiaKhanh","middleName":"","lastName":"Trinh","suffix":""},{"id":437493950,"identity":"8c1971ca-3762-474d-a025-ef7c80902816","order_by":2,"name":"Binh Ho T.T.","email":"","orcid":"","institution":"City Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Binh","middleName":"Ho","lastName":"T.T.","suffix":""},{"id":437493951,"identity":"64cef234-fff8-4b6d-987b-ab5246c60c16","order_by":3,"name":"Jens Eickhoff","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Jens","middleName":"","lastName":"Eickhoff","suffix":""}],"badges":[],"createdAt":"2025-03-31 16:35:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6346639/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6346639/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41372-025-02382-2","type":"published","date":"2025-08-20T04:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81931325,"identity":"0fd5fc16-b51f-408c-a7d5-26a2f6ab1e9f","added_by":"auto","created_at":"2025-05-05 05:29:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":247787,"visible":true,"origin":"","legend":"\u003cp\u003eHealthcare providers at Ho Chi Minh City Children’s Hospital participating in virtual reality (VR)-based neonatal resuscitation training. (A) Two participants wear VR head-mounted displays and handheld controllers, engaging in simulated resuscitation scenarios designed to reinforce neonatal resuscitation protocols. (B) A participant navigates the VR simulation while a nearby laptop displays the virtual environment for facilitator observation and feedback. The VR-based platform offers immersive, interactive training to enhance cognitive and team-based skills in neonatal resuscitation.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6346639/v1/453eb787507f3088d8122630.jpg"},{"id":81931324,"identity":"8f896361-45a0-41f9-8348-5ceecdd5ee78","added_by":"auto","created_at":"2025-05-05 05:29:16","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":387027,"visible":true,"origin":"","legend":"\u003cp\u003eScreenshot of the virtual reality (VR) neonatal resuscitation training environment used in the pilot study at Ho Chi Minh City Children’s Hospital. The immersive scenario depicts a simulated neonatal resuscitation room with a preterm infant on a radiant warmer. Participants, represented by avatars, are shown performing bulb suctioning of the infant’s mouth as part of the MR. SOPA algorithm for ventilation corrective steps. During this session, Vietnamese healthcare provider participants were joined by co-author R.M., located remotely in Madison, Wisconsin, and co-author G.T., who was onsite in Ho Chi Minh City providing real-time translation of R.M.’s instructions. The VR platform enabled interdisciplinary and international collaboration, simulating neonatal resuscitation procedures in accordance with Neonatal Resuscitation Program® guidelines. Interactive equipment, including a resuscitation warmer, ventilation devices, and laryngoscope tools, allowed participants to practice cognitive decision-making and team-based communication skills in a realistic, immersive, and safe training space.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6346639/v1/8ae0fc55038b87fbecee4ee6.jpg"},{"id":89545642,"identity":"0e9d2341-b8ee-439c-881d-65ec87775b9d","added_by":"auto","created_at":"2025-08-21 07:19:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1481868,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6346639/v1/4b56d412-3a7e-4b64-be4d-1000af447667.pdf"},{"id":81931319,"identity":"35736172-bfb5-4d91-9986-09f9967b838f","added_by":"auto","created_at":"2025-05-05 05:29:16","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":209903,"visible":true,"origin":"","legend":"Participant Survey","description":"","filename":"VietnamVRSurvey.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6346639/v1/9d8c60a0a33bc1ecc131b6fc.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Feasibility of Virtual Reality-Based Simulation for Neonatal Resuscitation Training: A Pilot Study at an International Site","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNeonatal resuscitation is a critical skill for healthcare providers who attend newborn deliveries, as approximately 10% of newborns require assistance to initiate breathing at birth.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Effective resuscitation in these high-pressure scenarios significantly impacts immediate and long-term neonatal outcomes.\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Consequently, ensuring that healthcare providers possess the necessary competencies is essential, with simulation-based training forming the cornerstone of education in neonatal resuscitation programs worldwide.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTraditional training methods, including manikin-based simulations, have proven effective but are not without limitations. High-fidelity manikins, while valuable, struggle to fully replicate the immersive, variable, and dynamic nature of real-life clinical scenarios. Additionally, the high cost, space requirements, and resource-intensive setup of these simulations limit their accessibility, especially in resource-constrained settings. These barriers underscore the need for innovative approaches to complement or, in some cases, replace traditional methods.\u003c/p\u003e \u003cp\u003eVirtual reality (VR), augmented reality, and mixed reality have emerged as transformative tools in medical education, offering equal knowledge acquisition compared to traditional methods while significantly enhancing learner satisfaction, engagement, and self-efficacy​.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e VR enhances neonatal resuscitation training by providing immersive, customizable simulations that improve procedural skills, decision-making, and learner confidence while offering a scalable and accessible solution for diverse healthcare settings.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e A systematic review by Kyaw et al. demonstrated that VR improves post-intervention knowledge retention and cognitive skill acquisition, with a large effect size (Standardized Mean Difference\u0026thinsp;=\u0026thinsp;1.12; 95% CI 0.81\u0026ndash;1.43).\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e This evidence underscores VR's capacity to simulate procedural and decision-making tasks effectively, making it a valuable tool for training healthcare professionals in high-stakes settings like neonatal resuscitation. However, the application of VR in neonatology remains underexplored, with limited studies evaluating its effectiveness, feasibility, and scalability across diverse cultural and healthcare settings.\u003c/p\u003e \u003cp\u003eBuilding on prior research conducted in the United States (U.S.),\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e this study sought to extend the use of VR-based neonatal resuscitation training to an international context, specifically in Ho Chi Minh City, Vietnam. The objectives were to assess the feasibility, acceptance, and challenges of implementing this training model in a resource-constrained setting and to identify areas for refinement to improve its effectiveness. By expanding VR training beyond its initial development setting, this study contributes to the growing body of evidence supporting the integration of advanced technologies in medical education.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design, Setting, and Participants\u003c/h2\u003e \u003cp\u003e This was a cross-sectional pilot study evaluating the feasibility and participant reception of a VR-based neonatal resuscitation training program in Ho Chi Minh City, Vietnam. The study was conducted at the Neonatal Intensive Care Unit (NICU) of Ho Chi Minh City Children\u0026rsquo;s Hospital, a tertiary care center serving a diverse patient population. Participants included healthcare providers involved in neonatal care, recruited via in-person announcements and electronic communication. Inclusion criteria were active clinical involvement in neonatal resuscitation and willingness to participate in the study.\u003c/p\u003e \u003cp\u003eA total of 28 healthcare providers participated, including neonatologists, pediatric residents, nurses, and allied health professionals. Written informed consent was obtained from all participants prior to the study. Ethical approval was secured from the Institutional Review Board of the University of Wisconsin-Madison and the local ethics committee in Vietnam.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVirtual Reality Model Development\u003c/h3\u003e\n\u003cp\u003eThe VR training platform was developed using Acadicus (Arch Virtual, Madison, WI, USA) in collaboration with a multidisciplinary team of neonatologists, VR developers, and simulation experts. The training model simulated a 30-week neonate experiencing respiratory distress, with scenarios aligned to the Neonatal Resuscitation Program\u0026reg; (NRP) 8th edition guidelines.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e The virtual neonate exhibited key clinical features, including chest rise, retractions, and changes in vital signs, providing real-time dynamic feedback during the resuscitation scenario.\u003c/p\u003e \u003cp\u003eParticipants engaged with the virtual environment using the Meta Quest 2 head-mounted displays (Meta Platforms, Inc., Menlo Park, CA, USA) and handheld controllers, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The training maintained consistency with our previously published U.S. pilot study,\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e while incorporating adaptations to accommodate local contextual factors in Vietnam. This study utilized a group-based training approach with enhanced nursing representation, allowing nurses and allied health professionals to train alongside physicians, mirroring the team-based structure of traditional NRP education.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe training environment was designed as a fully equipped virtual resuscitation room, providing participants with an immersive and interactive experience. Within this environment, participants were guided through essential tasks such as mask ventilation, implementing corrective steps, and providing post-resuscitation care. The corrective steps, known as MR. SOPA, include specific interventions to improve ventilation: Mask adjustment, Repositioning the airway, Suctioning the mouth and nose, Opening the mouth, increasing Pressure, and using an Alternative airway if necessary. The VR platform featured pre-recorded instructions that facilitated navigation and interaction with virtual equipment, allowing participants to complete key steps in the resuscitation process.\u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eThe training sessions were conducted over two weeks in April 2023 and consisted of four group sessions, each involving 6\u0026ndash;8 participants. Each session followed a structured format with four key components. The first component was an introduction and orientation led by a study team member and co-author (G.T.), who was based at the University of Wisconsin\u0026ndash;Madison but was onsite in Vietnam for the duration of the study. G.T. facilitated the sessions, providing an overview of the training objectives and logistics, and utilized her fluency in Vietnamese to ensure effective communication with participants. To further support the sessions, an onsite team member assisted with translation and technical troubleshooting. Participants then completed a virtual environment orientation module, which included a guided walkthrough to familiarize them with navigation techniques and the use of virtual tools. This preparation was designed to build participants' confidence and competence before engaging in the simulation.\u003c/p\u003e \u003cp\u003eWith each training session, a remote study team member (R.M.), based at the University of Wisconsin\u0026ndash;Madison, greeted participants via Zoom\u0026reg; (Zoom Video Communications, Inc. San Jose, CA) and subsequently joined them in the virtual environment to guide the simulation scenario. In the third component, participants managed a case of a 30-week neonate with respiratory distress. Within the virtual environment (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), participants performed critical MR. SOPA corrective steps. The scenario, aligned with the NRP algorithm, included pre-programmed clinical changes that required participants to perform critical interventions such as positive pressure ventilation and corrective actions.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eEach session concluded with a debriefing and feedback phase. During this phase, participants engaged in a facilitated discussion to reflect on their performance, share insights, and receive constructive feedback. Following the debriefing, participants completed a post-training survey to evaluate the session\u0026rsquo;s effectiveness and provide suggestions for improvement.\u003c/p\u003e\n\u003ch3\u003eSurvey Development\u003c/h3\u003e\n\u003cp\u003eThe post-training survey used in this study was adapted from the survey developed for our prior U.S. study in collaboration with the University of Wisconsin Survey Center.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e To ensure linguistic and cultural accuracy, the survey underwent a two-step translation process. It was first translated from English to Vietnamese by professional translators recommended by UW-Madison, followed by an independent back-translation into English to verify accuracy (see Appendix for the survey tool). A team member (G.T.) then conducted a final review to refine linguistic precision and cultural relevance.\u003c/p\u003e \u003cp\u003eThe survey was administered electronically using the Qualtrics platform and assessed primary outcomes, including participant satisfaction, perceived realism, and the usefulness of the VR model. Secondary outcomes included reports of adverse effects associated with VR use (e.g., dizziness, nausea) and implementation challenges. Additionally, open-ended questions captured qualitative feedback for thematic analysis, providing deeper insight into participant experiences and areas for improvement.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data were analyzed using descriptive statistics, with categorical variables presented as frequencies and percentages and continuous variables as means with standard deviations. Subgroup analyses were performed to examine differences in VR ratings by role, prior VR experience, and years of NICU experience. Comparative analysis with the prior U.S. study was conducted using chi-square or t-tests as appropriate. Qualitative data from open-ended survey responses were analyzed using thematic analysis to identify recurring themes and subthemes.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Demographics\u003c/h2\u003e \u003cp\u003eA total of 28 healthcare providers participated in the VR-based neonatal resuscitation training in Vietnam (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants included pediatric residents (11%), NICU hospitalists (29%), neonatologists (4%), nurses (18%), and other healthcare professionals (18%). Most participants were female (70%) and had 3\u0026ndash;5 years of NICU experience (39%), while 28% had less than three years of NICU experience. Only 22% of participants had American NRP certification, highlighting a relative lack of formal resuscitation training within the cohort.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant Demographics (Vietnam Cohort)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRole\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatric Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU Hospitalist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of NICU Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrior VR Exposure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHad used VR before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOwned a VR headset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVR Familiarity and Training Experience\u003c/h3\u003e\n\u003cp\u003ePrior VR exposure was limited among participants, with only 32% reporting prior use of a VR headset, and 18% owning one. All participants successfully completed the VR orientation module and simulation scenario, with 79% indicating a desire to revisit the orientation module before future sessions. The training program included a combination of virtual walkthroughs, simulation exercises, and debriefing, ensuring a structured and immersive learning experience.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSatisfaction and Perceived Usefulness\u003c/h2\u003e \u003cp\u003eParticipant satisfaction with the VR training was positive. All participants (100%) stated they would recommend VR training to colleagues, and 86% rated the VR simulation as more realistic than traditional training methods. The average usefulness score for the VR platform was 4.3 out of 5 (standard deviation: 0.9), reflecting high perceived value among users (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStatistical Comparison of Key Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Usefulness Score (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatric Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.4 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0728*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU Hospitalist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.3 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0728*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0728*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNICU Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.2 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.0 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*\u003cem\u003eP-values\u003c/em\u003e: Statistical comparisons were conducted using a significance threshold of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComparison with U.S. Cohort\u003c/h2\u003e \u003cp\u003eCompared to a prior U.S.-based cohort (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), the Vietnamese participants reported higher recommendation rates (100% vs. 95%) and higher perceived realism (86% vs. 70.3%). Furthermore, VR-related discomfort, such as dizziness or nausea, was reported by only 28.6% of Vietnamese participants, compared to 40.5% of the U.S. cohort.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Feedback Between U.S. and Vietnam Cohorts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeedback Metric\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eU.S. Cohort (N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVietnam Cohort (N\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWould recommend VR training to colleagues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFound VR more realistic than traditional methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReported VR-related discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage usefulness score (Likert 1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eChallenges and Qualitative Feedback\u003c/h2\u003e \u003cp\u003e Participants identified several challenges during the training, including language barriers, unfamiliarity with the NRP algorithm, and intermittent internet connectivity. Despite these obstacles, participants appreciated the novelty and potential of the VR platform. Thematic analysis of open-ended survey responses revealed key areas for improvement, including a desire for greater scenario realism and clinical variability, increased opportunities for practice, and more stable technology. Additionally, participants valued the teamwork facilitated by the VR training and emphasized the importance of safe practice environments that do not pose risks to real patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study demonstrates the feasibility and positive reception of a VR-based neonatal resuscitation training program in an international setting, specifically in Vietnam. Building on prior research conducted in the U.S.,\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e this pilot study confirms the adaptability of the VR platform across diverse healthcare environments and highlights its potential as an innovative training tool for neonatal resuscitation.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComparison with Traditional Training Methods\u003c/h2\u003e \u003cp\u003eThe Vietnamese participants reported high satisfaction with the VR training, with 86% rating it as more realistic than traditional training methods. This aligns with previous findings that VR offers an immersive learning environment, enabling repeated exposure to high-stakes clinical scenarios in ways that traditional manikin-based training may not, though some learners perceive limitations in realism and patient interaction.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The dynamic and interactive nature of the VR platform allowed participants to engage with a simulated 30-week neonate, providing valuable opportunities to practice critical interventions such as positive pressure ventilation and corrective steps. These features are particularly relevant in settings with limited access to high-fidelity manikins or formal neonatal resuscitation training.\u003c/p\u003e \u003cp\u003eA key distinction between this study and our previous VR-based neonatal resuscitation training study\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e was the adoption of a group-based training approach with enhanced nursing and allied health representation. Unlike the prior study, which focused on individualized training, this study mirrored the team-based structure of traditional NRP education by allowing nurses, respiratory therapists, and other allied health professionals to train alongside physicians. This modification not only improved the realism of the training but also emphasized the critical role of interdisciplinary teamwork in neonatal resuscitation. Given that effective neonatal resuscitation relies on coordinated efforts among multiple providers, incorporating a team-based model better prepares participants for real-world clinical scenarios. Additionally, this approach fosters collaborative decision-making, role clarity, and communication skills, which are essential for optimizing neonatal outcomes. These findings suggest that VR-based training can be effectively expanded beyond individual skill acquisition to enhance team dynamics, an aspect that warrants further exploration in future studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eInternational Adaptability and Cultural Considerations\u003c/h2\u003e \u003cp\u003eThis study highlights the international adaptability of VR-based training. Compared to the U.S. cohort, the Vietnamese participants expressed higher perceived realism and comfort with the VR platform, despite lower baseline familiarity with VR technology. This suggests that VR can potentially bridge gaps in training quality in resource-constrained settings. However, unique challenges were encountered, including language barriers and limited familiarity with the NRP algorithm. Future iterations of the program should incorporate bilingual instruction and region-specific clinical guidelines to further enhance accessibility and relevance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eImplementation Challenges and Potential Improvements\u003c/h2\u003e \u003cp\u003eDespite the overwhelmingly positive reception, several implementation challenges were noted. Language barriers required the presence of an onsite translator, which, while effective, added logistical complexity. Unstable internet connections occasionally disrupted the immersive experience, emphasizing the need for robust technical infrastructure to support remote training sessions. Additionally, participants expressed a desire for increased scenario variability and more opportunities for practice to enhance skill mastery. Addressing these challenges in future implementations could improve the scalability and effectiveness of the program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eVirtual Environment Familiarity and Adaptation\u003c/h2\u003e \u003cp\u003eOne important consideration when deploying VR-based neonatal resuscitation training is the potential adjustment period required for participants to familiarize themselves with a virtual environment that may differ from their actual clinical setting. The layout of virtual resuscitation rooms, positioning of equipment, and user interfaces may not precisely mirror participants' real-world work environments. This discrepancy could lead to an initial learning curve, requiring additional time to orient participants to the virtual space before they can fully engage in resuscitation tasks. Future research should evaluate the extent to which this familiarization process impacts training efficiency, skill acquisition, and overall learning outcomes. Optimizing the design of virtual environments to reflect local clinical settings may help minimize disorientation and enhance the realism and relevance of the simulation experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFlexibility to Accommodate Multiple Resuscitation Algorithms\u003c/h2\u003e \u003cp\u003e While the VR training platform in this study was designed according to the NRP 8th edition guidelines, there are several neonatal resuscitation algorithms currently in use across different regions and institutions. A key advantage of VR technology is its adaptability; virtual scenarios can be tailored to reflect various protocols and guidelines, thereby supporting widespread applicability. However, certain procedural elements\u0026mdash;such as endotracheal intubation and chest compressions\u0026mdash;may currently lack the tactile realism provided by advanced haptic feedback systems, which remain in early stages of development. Despite this limitation, VR offers an effective modality for practicing cognitive elements of neonatal resuscitation, including algorithm adherence, clinical decision-making, and team coordination.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePsychological Impact of Training in a Virtual Environment\u003c/h2\u003e \u003cp\u003eAnother important consideration is the psychological experience of participants during VR-based simulations. Ideally, these environments promote psychological safety so learners can engage fully, take risks, and learn from mistakes without fear of embarrassment or judgment. This sense of safety supports critical behaviors such as asking questions, reflecting on performance, and openly acknowledging uncertainty\u0026mdash;behaviors that are foundational to simulation-based education.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Psychological safety is especially important in unfamiliar learning environments like VR, where the novelty of the interface can heighten anxiety. Effective strategies to foster this safety begin before the simulation itself. A structured pre-briefing that clarifies learning objectives, roles, expectations, and evaluation methods can help reduce ambiguity and support learner engagement. As described by Rudolph et al., the pre-briefing also establishes a \u0026ldquo;fiction contract,\u0026rdquo; a mutual agreement that acknowledges the simulation\u0026rsquo;s limitations while encouraging learners to interact with the scenario as if it were real.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e This contract normalizes performance variability and invites participants to focus on learning rather than scenario appearance. In VR contexts, where the simulated experience may feel isolating or immersive in unfamiliar ways, facilitator support plays an important role in encouraging curiosity and demonstrating respect for the learner\u0026rsquo;s perspective. Future research should explore how psychological safety influences learning outcomes in VR-based training and identify effective, culturally adaptable strategies for creating safe learning environments across diverse settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eCybersickness and VR-Related Discomfort Across Cohorts\u003c/h2\u003e \u003cp\u003eWhile VR can serve as a valuable adjunct to traditional manikin-based neonatal resuscitation simulations, challenges such as cybersickness warrant consideration. Cybersickness, which is characterized by symptoms like dizziness, nausea, and disorientation, is a frequently reported side effect of VR use.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Previous studies have shown that a significant proportion of users experience these symptoms, with rates as high as 49% among midwifery students\u003csup\u003e16\u003c/sup\u003e and 23% among medical students receiving VR-based trauma education.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e In our study, 28.6% of participants reported VR-related discomfort, a lower incidence compared to our U.S. cohort( 40.5%),\u003csup\u003e9\u003c/sup\u003e yet still notable. This reduction may reflect differences in session structure, participant demographics, or prior VR exposure. Regardless, the overall occurrence of discomfort highlights the need for mitigation strategies, such as improved hardware, stable internet connectivity, and structured orientation. Strategies such as limiting session lengths to one hour, as recommended by Holla and Berg,\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and incorporating gradual acclimation to the VR environment could mitigate these effects. In addition to motion sickness, prolonged VR use may lead to oculomotor strain, although both symptoms may diminish with repeated exposure.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Addressing these challenges through user preparation and technological refinements may help optimize the effectiveness and accessibility VR-based training programs. Further research is needed to understand the contributing factors to cybersickness and oculomotor strain, including how these issues vary across educational backgrounds and experience levels.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eA major strength of this study is its demonstration of VR training\u0026rsquo;s feasibility in a resource-limited international setting. The study design allowed for structured evaluation of participant attitudes and challenges, providing valuable insights for future adaptations. However, several limitations warrant discussion. First, the reliance on self-reported survey data introduces potential response bias, as participants may have been inclined to provide favorable feedback. Second, the absence of a control group limits the ability to directly compare VR training outcomes with those of traditional methods. Finally, the small sample size and limited representation of certain professional roles, such as nurses and allied health professionals, may affect the generalizability of the findings.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eFuture research should focus on addressing identified challenges and expanding the scope of evaluation. Comparative studies with larger, more diverse samples are needed to rigorously assess the effectiveness of VR training relative to traditional methods. Objective outcome measures, such as skill retention and clinical performance, should complement participant feedback to provide a more comprehensive understanding of the program\u0026rsquo;s impact. Additionally, integration of emerging technologies, such as artificial intelligence, could enhance the adaptability and interactivity of VR-based training. Features such as real-time feedback, automated performance assessment, and multilingual support have the potential to address current limitations and further optimize training outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis pilot study demonstrates that VR-based neonatal resuscitation training is a feasible, effective, and well-received approach in an international setting. By providing immersive, realistic, and accessible training experiences, VR has the potential to transform neonatal resuscitation education, particularly in resource-limited contexts. Addressing implementation challenges and conducting rigorous evaluations will be critical to unlocking the full potential of this innovative training tool.\u003c/p\u003e"},{"header":"Declarations","content":" \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Source:\u003c/h2\u003e \u003cp\u003eNo funding was secured for this study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFinancial Disclosure\u003c/b\u003e: The authors have no financial relationships relevant to this article to disclose.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConflict of Interest\u003c/b\u003e: The authors have no conflicts of interest to disclose.\u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical Trial Registration\u003c/b\u003e: Not applicable\u003c/p\u003e\u003ch2\u003eAuthor Contributions:\u003c/h2\u003e \u003cp\u003eR.M. conceived the study and developed the VR model. G.T. and R.M. designed the survey in consultation with experts from the University of Wisconsin Survey Center. G.T. and R.M. coordinated the planning, recruitment, and training sessions. B.H. helped coordinate training sessions at Ho Chi Minh City Children\u0026rsquo;s Hospital, Vietnam. All authors participated in the analysis and interpretation of the results and contributed to the writing and revision of the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe extend our sincere appreciation to the team at ArchVirtual for their technical assistance, which was instrumental to the successful completion of this project. Additionally, we thank the Survey Center at the University of Wisconsin-Madison for their valuable contribution in designing the post-training survey.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAziz K, Lee HC, Escobedo MB, et al. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Oct 20 2020;142(16_suppl_2):S524-S550. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/CIR.0000000000000902\u003c/span\u003e\u003cspan address=\"10.1161/CIR.0000000000000902\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamath-Rayne BD, Berkelhamer SK, Kc A, Ersdal HL, Niermeyer S. Neonatal resuscitation in global health settings: an examination of the past to prepare for the future. Pediatr Res. 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Simul Healthc. Dec 2014;9(6):339\u0026ndash;49. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SIH.0000000000000047\u003c/span\u003e\u003cspan address=\"10.1097/SIH.0000000000000047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaredakis D, Szpak A, Birckhead B, Keage HAD, Rizzo A, Loetscher T. Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis. Front Hum Neurosci. 2020;14:96. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fnhum.2020.00096\u003c/span\u003e\u003cspan address=\"10.3389/fnhum.2020.00096\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark SY, Koo DK. The Impact of Virtual Reality Content Characteristics on Cybersickness and Head Movement Patterns. Sensors (Basel). Jan 2 2025;25(1)doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/s25010215\u003c/span\u003e\u003cspan address=\"10.3390/s25010215\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyan G, Callaghan S, Rafferty A, et al. Virtual reality in midwifery education: A mixed methods study to assess learning and understanding. Nurse Educ Today. Dec 2022;119:105573. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.nedt.2022.105573\u003c/span\u003e\u003cspan address=\"10.1016/j.nedt.2022.105573\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolla M, Berg MVD. Virtual reality techniques for trauma education. Injury. Nov 2022;53 Suppl 3:S64-S68. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.injury.2022.08.067\u003c/span\u003e\u003cspan address=\"10.1016/j.injury.2022.08.067\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakata R, Kanehira M, Kato Y, et al. Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: A prospective observational study. BMC Med Educ. Sep 21 2021;21(1):498. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-021-02872-9\u003c/span\u003e\u003cspan address=\"10.1186/s12909-021-02872-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6346639/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6346639/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVirtual reality (VR) offers immersive training experiences that can address limitations of traditional neonatal resuscitation training. Building on prior research conducted in the United States, we evaluated the feasibility of deploying a VR-based neonatal resuscitation training model in an international setting.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e Healthcare providers at Ho Chi Minh City Children's Hospital in Vietnam participated in VR-based training for neonatal resuscitation. Training included a knowledge review, platform orientation, and a simulated resuscitation scenario based on the Neonatal Resuscitation Program. Participants completed post-training surveys assessing satisfaction, perceived realism, and challenges encountered.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 28 participants, 100% recommended VR training, and 86% found it more realistic than traditional methods. The mean usefulness score was 4.3/5. Challenges included language barriers and technical issues.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eVR-based neonatal resuscitation training is feasible and well-received internationally, demonstrating potential for expanding specialized medical education to resource-limited settings. Enhancements addressing implementation challenges are warranted.\u003c/p\u003e","manuscriptTitle":"Feasibility of Virtual Reality-Based Simulation for Neonatal Resuscitation Training: A Pilot Study at an International Site","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 05:29:11","doi":"10.21203/rs.3.rs-6346639/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-05-12T07:18:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-05-09T20:13:15+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-04-21T23:17:08+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-04-14T14:59:32+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-04-03T15:07:13+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-04-02T14:22:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T10:40:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-31T16:31:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Perinatology","date":"2025-03-31T16:31:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3f6b1d6c-0200-4bb3-8b51-fa48a2ba0be3","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":46584873,"name":"Scientific community and society/Developing world"},{"id":46584874,"name":"Health sciences/Health care/Patient education"}],"tags":[],"updatedAt":"2025-08-21T07:19:50+00:00","versionOfRecord":{"articleIdentity":"rs-6346639","link":"https://doi.org/10.1038/s41372-025-02382-2","journal":{"identity":"journal-of-perinatology","isVorOnly":false,"title":"Journal of Perinatology"},"publishedOn":"2025-08-20 04:00:00","publishedOnDateReadable":"August 20th, 2025"},"versionCreatedAt":"2025-05-05 05:29:11","video":"","vorDoi":"10.1038/s41372-025-02382-2","vorDoiUrl":"https://doi.org/10.1038/s41372-025-02382-2","workflowStages":[]},"version":"v1","identity":"rs-6346639","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6346639","identity":"rs-6346639","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}