Anna Tonda

BACKGROUND Orotracheal intubation is a high-risk procedure that requires repetitive practice to achieve technical proficiency while ensuring patient safety. Immersive virtual reality (VR) serious games offer a promising alternative to traditional simulation by enabling standardized, repeatable, and accessible procedural training. However, evidence supporting the initial validation of immersive VR systems for airway management, particularly regarding usability, educational value, and objective performance assessment, remains limited. OBJECTIVE This study aimed to perform an initial validation of an immersive VR serious game for direct laryngoscopy-guided orotracheal intubation through subjective questionnaires, objective performance metrics, and qualitative feedback from healthcare professionals. METHODS A cross-sectional validation study was conducted with 23 healthcare professionals from different clinical backgrounds. Participants independently completed a guided VR intubation training session using a Meta Quest 3 headset. Objective performance metrics, including total completion time and procedural phase durations, were automatically recorded through timestamped application event logs. Participants subsequently completed the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), Simulator Sickness Questionnaire (SSQ), a Pedagogical Value Questionnaire, and a Simulator Construction Quality Questionnaire. Internal consistency was assessed using Cronbach α. Associations between questionnaire scores and objective performance were examined using Spearman correlation coefficients, and performance differences according to previous intubation experience were evaluated using Mann-Whitney U tests with Cliff δ effect sizes. Open-ended responses were analyzed using inductive thematic analysis. RESULTS All 23 participants completed the training session without technical interruptions. The immersive VR serious game achieved good usability (SUS mean 73.4, SD 13.4), high perceived pedagogical value (mean 4.08/5, SD 0.97), and high construction quality (mean 4.20/5, SD 0.85). Simulator sickness remained low (SSQ total mean 13.66, SD 13.70), whereas NASA-TLX results indicated a moderate workload characterized primarily by mental demand and effort. Positive correlations were observed between usability, pedagogical value, and construction quality (ρ=0.535-0.665; all P<.01). No significant associations were found between subjective evaluations and objective performance measures (P>.05). Automatic event logging successfully characterized users' procedural performance, showing that the intubation phase required longer completion times than the oxygenation phase. Qualitative feedback highlighted the educational usefulness of the system while identifying interaction fidelity and procedural realism as the principal areas for improvement. CONCLUSIONS The findings provide initial validation evidence supporting the usability, educational value, and feasibility of this immersive VR serious game for orotracheal intubation training. The combination of positive user evaluations, low simulator sickness, automated performance logging, and feedback from healthcare professionals suggests that the system is a promising educational tool for introductory airway management training. Future studies should establish effectiveness for improving learning outcomes, skill retention, and transfer to clinical practice through controlled educational evaluations. CLINICALTRIAL Not applicable.

This study investigates the pedagogical effectiveness of three instructional formats for teaching block-based programming: an immersive virtual reality (VR) environment, a tactile board game (BG), and a traditional digital manual. Two interactive prototypes (VR and BG) were developed and validated to ensure functional and educational reliability. A three-way experimental design was employed to evaluate learner engagement, conceptual understanding, and satisfaction. Results revealed that both VR and BG significantly outperformed the traditional digital format across all metrics, with VR showing slightly higher engagement due to its immersive features. However, the BG demonstrated comparable learning outcomes and stronger accessibility. These findings validate the study’s hypotheses, emphasizing the value of interactivity in education. The BG emerges as an effective, low-tech alternative in contexts where VR access is limited, reinforcing the importance of well-designed physical tools in programming education.

Aircraft maintenance is a highly relevant procedure in many industries, yet obtaining qualified personnel to carry it out is a difficult task. Training in such techniques is complex and requires access to facilities and materials that are not readily available. Virtual reality can be a tool to improve this situation. This paper presents the whole process of design, development, and evaluation of a virtual environment that allows users to perform some of the main tasks required in aircraft maintenance after landing or for take-off. By following a user-centered design methodology and the Octalysis framework to apply motivation and engagement techniques, a gamified virtual environment was developed that allows the user to practice specific aircraft maintenance techniques. The environment was tested by users of different profiles who answered questionnaires to evaluate the perceived gamification, usability, and the feeling of sickness from the experience. The analysis of the data corroborates the good performance of the VR environment in these fields.