Development and Evaluation of Virtual Simulation Games to Increase the Confidence and Self-efficacy of Healthcare Learners in Vaccine Communication, Advocacy, and Promotion

"The VSGs [virtual simulation games] as an educational tool, in combination with existing clinical immunization training, can be used to increase HCP [healthcare provider] confidence and engagement in vaccine discussions with patients, which may ultimately lead to increased vaccine confidence among patients."



Although healthcare providers (HCPs) are the most trusted source of vaccine information, there is a paucity of easily accessible, multidisciplinary educational tools on vaccine communication for them. Virtual simulation games (VSGs), a form of digital learning, are healthcare education tools that can provide additional decision-making opportunities for participants to complement in-person simulation. The objectives of this study were to develop VSGs to increase HCP confidence and self-efficacy in vaccine communication, advocacy, and promotion and to evaluate the VSGs' effectiveness using a pre-post self-assessment pilot study.



In 2022, the Canadian Alliance of Nurse Educators Using Simulation (CAN-Sim) brought together a diverse team of experts in the areas of medicine, nursing, and pharmacy to develop three VSGs based on evidence-based vaccine hesitancy topics commonly encountered in clinical practice. The VSGs incorporated presumptive statements (e.g., "Today you will receive two vaccinations, correct?") and used the PrOTCT framework, which provides HCPs with a structure to discuss vaccinations with patients and build trust by Presuming the patient will vaccinate, Offering to share knowledge and personal experiences with vaccines, Tailoring recommendations to address patients' specific health Concerns, and Talking through a specific plan for when and where to get vaccinated.



The following topics related to vaccine hesitancy were covered in each game: Jow to have a conversation with a patient expressing hesitancy around receiving a booster/completing a vaccine series (VSG1); how to support a patient who minimises the risk of disease while maximising the risk of the vaccine (VSG2); and how to foster personal resilience, maintain a professional sense of self-efficacy, and prevent burnout and moral distress during challenging patient interactions (VSG3).



The filming scripts were written in teams consisting of nurses, pharmacists, and physicians, as well as learners from these disciplines, to determine the dialogue between characters based on the learning outcomes and decision points. The scripts were reviewed by key stakeholders in the community, such as two vaccine-hesitant individuals. After completion of the peer review and incorporation of feedback, the VSGs were filmed in person with actors. The games were assembled by the CAN-Sim team and made available through an open-access website.



The researchers evaluated the VSGs with 24 nursing students, 30 pharmacy students, and 18 medical residents who completed surveys and 6-point Likert scale pre-post self-assessments to measure changes in their confidence and self-efficacy.



Following the completion of the VSGs, learners in medicine, nursing, and pharmacy showed significant improvement in their self-assessed confidence and self-efficacy in holding vaccine conversations. Specifically, post-VSG confidence and self-efficacy (median: 5) were significantly higher than pre-VSG (median: 4-5) for all three HCP disciplines (P ≤ 0.0005. Medical residents reported significantly lower post-VSG confidence and self-efficacy than nursing and pharmacy learners despite completing the most significant amount of education.



"Ultimately, HCPs are most likely to improve their confidence in communication skills through repeated practice with patients, and simulations are an effective way to emulate real patient scenarios. They offer a low-stakes environment where learners can try new skills, receive immediate feedback, and learn from mistakes." The researchers point to several strengths of the VSGs: their multidisciplinary development process, which engaged multiple stakeholders, collaboration with CAN-Sim, and the discipline and knowledge-agnostic content (in comparison to most other online learning modules that often target a specific vaccine or a single discipline).



In conclusion, the researchers: "recommend the development and use of VSGs for both HCP education programs and accredited continuing education programs as they are easily accessible and can be used by any HCP learner or practitioner. Further, these learning modules can easily be expanded to add additional content, further assessments, and practice material on many different vaccine hesitancy situations....Such interventions will continue to strengthen the patient-provider relationship, build trust, and provide support to both HCPs and the public in vaccination decisions."