Supplementary Material for: Preparing for Reality: A Randomized Trial on Immersive Virtual Reality for Bronchoscopy Training

<b><i>Background:</i></b> Bronchoscopy is an essential procedure in the diagnosis and treatment of pulmonary diseases. However, the literature suggests that distractions affect the quality of bronchoscopy and affect inexperienced doctors more than experienced. <b><i>Objectives:</i></b> The objective of the study was as follows: does simulation-based bronchoscopy training with immersive virtual reality (iVR) improve the doctors’ ability to handle distractions and thereby increase the quality, measured in procedure time, structured progression score, diagnostic completeness (%), and hand motor movements of a diagnostic bronchoscopy in a simulated scenario. Exploratory outcomes were heart rate variability and a cognitive load questionnaire (Surg-TLX). <b><i>Methods:</i></b> Participants were randomized. The intervention group practiced in an iVR environment with a head-mounted display (HMD) while using the bronchoscopy simulator, while the control group trained without the HMD. Both groups were tested in the iVR environment using a scenario with distractions. <b><i>Results:</i></b> 34 participants completed the trial. The intervention group scored significantly higher in diagnostic completeness (100 i.q.r. 100–100 vs. 94 i.q.r. 89–100, <i>p</i> value = 0.03) and structured progress (16 i.q.r. 15–18 vs. 12 i.q.r. 11–15, <i>p</i> value 0.03) but not in procedure time (367 s standard deviation [SD] 149 vs. 445 s SD 219, <i>p</i> value = 0.06) or hand motor movements (−1.02 i.q.r. −1.03–[−1.02] versus −0.98 i.q.r. −1.02–[–0.98], <i>p</i> value = 0.27). The control group had a tendency toward a lower heart rate variability (5.76 i.q.r. 3.77–9.06 vs. 4.12 i.q.r. 2.68–6.27, <i>p</i> = 0.25). There was no significant difference in total Surg-TLX points between the two groups. <b><i>Conclusion:</i></b> iVR simulation training increases the quality of diagnostic bronchoscopy in a simulated scenario with distractions compared with conventional simulation-based training.