Remote Augmented Reality Versus Traditional Simulation for Team Leader Assessment in a Cardiac Arrest Scenario: Noninferiority Randomized Controlled Trial.

Remote AR simulation was noninferior to traditional in-person simulation for team leader checklist performance in a ventricular fibrillation cardiac arrest scenario.

• Mean checklist scores were 41.6 (SD 6.2) in the remote AR group and 42.6 (SD 5.8) in the traditional in-person group.
• The AR group's 95% CI (38.9–44.4) was above the prespecified 20% noninferiority threshold of 34.1.
• The checklist instrument was adapted and validated for cognitive leadership assessment.
• 42 of 50 enrolled participants fully completed study procedures (remote AR group: n=22; traditional in-person group: n=20).

Remote AR simulation was noninferior to traditional in-person simulation across all assessed outcomes, including behavioral performance measured by the Behaviorally Anchored Rating Scale (BARS).

• Both checklist-based cognitive leadership and observational behavioral measures (BARS) were evaluated.
• The AR group demonstrated noninferior performance 'across all outcomes.'
• Participants were randomized using a noninferiority randomized controlled trial design.
• The study was conducted across two continents, with remote instruction provided from Stanford University (USA) to participants at UNICAMP, Brazil.

AR participants reported high usability and low ergonomic burden associated with headset use.

• Usability and ergonomics were 'favorably reported by most participants' in the remote AR group.
• Participants indicated 'comfortable headset use' in ergonomic evaluations.
• Usability and ergonomics were assessed as secondary outcomes.
• These findings suggest low barriers to adoption of the AR technology among health care professionals.

The study enrolled 50 health care professionals who were randomized to remote AR simulation or traditional in-person simulation, with 42 completing the full protocol.

• 25 participants were randomized to the remote AR group and 25 to the traditional in-person group.
• 8 participants did not fully complete study procedures (remote AR: n=3 incomplete; traditional: n=5 incomplete), leaving 22 and 20 per group respectively.
• All participants completed an identical ventricular fibrillation cardiac arrest case as team leaders.
• The trial was conducted at the State University of Campinas (UNICAMP), Brazil.

Access to high-fidelity in-person simulation is frequently limited by geographic, logistical, and financial constraints, motivating investigation of remote AR as an alternative.

• Simulation-based education is described as 'crucial for training health care professionals in advanced cardiac life support.'
• AR 'offers the potential to deliver remote, immersive training experiences that may overcome these barriers.'
• The effectiveness of AR compared with traditional simulation was described as 'uncertain' prior to this study.
• The cross-continental design (Brazil to USA) was intended to model real-world geographic separation.