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expected to improve the process. 29,30 With computer-based Author Contributions
education, the learner no longer depends on a cumbersome HL and BV are coauthors and contributed equally to this
organization. 31–34 Moreover, we hypothesized that MCI man- work. HL and BV are responsible for designing the study,
agement depends on three independent factors: theoretical gathering and analyzing the data, and writing the final paper.
knowledge, military background, and emotional competen- HL also performed the statistics. JC and AV gathered data. MF
35
cies. Advanced realism and first-person gaming have been performed data analysis-statistics. RP, DS, and JPA reviewed
traditionally suggested to increase immersion, which should the manuscript.
36
have positive effects on nontechnical skills. In this popula-
tion of postgraduate students, no difference should have been HL, MF, and BV made substantial contributions to the concep-
expected concerning theoretical knowledge and military back- tion or design of the study. HL, JPA, and BV drafted the work
ground. Whereas SG offered a more immersive experience or critically revised it for important intellectual content. HL,
than text-based simulation does, there was no difference in RP, JC, AV, DS, JPA, and BV approved the final version of the
the analysis of emotional competencies using a standard scale work to be published. All the authors agree to be accountable
of anxiety to explain the behavioral changes; this might be for all aspects of the work in ensuring that questions related to
because of a lack of exposure time to TRAUMASIMS. the accuracy or integrity of any part of the work are appropri-
ately investigated and resolved.
This study has several limitations. Regarding sample size,
this study sample size is too small to find significant relation- References
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Acknowledgments (6 Suppl 5):S431–S437.
FHMS Academy obtained a trial-version of TRAUMASIMS 10. Issenberg SB, McGaghie WC, Petrusa ER, Gordon DL, Scalese
for the TRIAGE study in return for the participation of mil- RJ. Features and uses of high-fidelity medical simulations that
itary physicians (HL, JC, JPA, and BV) as experts in trauma lead to effective learning: a BEME systematic review. Med Teach.
care working pro bono for the design of the serious game. No 2005;27(1):10–28.
funds were received for the TRIAGE study. 11. McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical re-
view of simulation-based medical education research: 2003-2009.
Med Educ. 2010;44(1):50–63.
Conflicts of Interest 12. Cook DA, Hatala R, Brydges R, Zendejas B, Szostek J, Wang
None declared. AT, et al. Technology-enhanced simulation for health professions
education: a systematic review and meta-analysis. JAMA. 2011;
Approval and Funding 306(9):978–988. https://www.academia.edu/24907086/Technology
This study was approved by the French Society of Thoracic _Enhanced_Simulation_for_Health_Professions_Education_A_
Systematic_Review_and_Meta_analysis. Accessed 4 March 2021.
and Cardiovascular Surgery Institutional Review Board under 13. Travers S, Carfantan C, Luft A, Aigle L, Pasquier P, Martinaud
the number CERC-CTCV n°2018-4-26-10-59-49-deHe. This C, et al. Five years of prolonged field care: prehospital challenges
research did not receive any specific grant from funding agen- during recent French military operations. Transfusion. 2019;59
cies in the public, commercial, or not-for-profit sectors. (S2):1459–1466.
14. Michelson JD, Manning L. Competency assessment in simula-
Declaration of Interest tion-based procedural education. Am J Surg. 2008;196(4):609–615.
HL, JC, JPA, and BV have freely contributed to the software 15. Nullmeyer RT, Spiker VA, Golas KC, Logan RC, Clemons L. The
Effectiveness of a PC-Based C-130 Crew Resource Management
TRAUMASIMS from Medusims as institutional experts. No Aircrew Training Device. Air Force Research Laboratory, Human
grants have been received for their work. Effectiveness Directorate, Warfighter Training Research Division.

92 | JSOM Volume 23, Edition 2 / Summer 2023