Limitations
SECONDARY, RECRUITMENT, BLIND
There are some limitations to this work. First, recruitment was limited due to COVID-19, and a pragmatic decision was taken to halt the trial early, restricting recruitment and participation. Second, this is a simulated trial, and it is possible that some observed benefits may be less significant when deployed in clinical environments. Furthermore, given that this was a pilot study, a number of exploratory secondary analyses were undertaken that may have introduced the risk of type I error. Third, the inability to fully blind observers to the intervention group due to the nature of the simulation and technology being trialed may have also introduced bias. Fourth, it is possible that this study was vulnerable to selection bias given that participants who offered to take part may have been more willing to adopt this novel technology. Fifth, a further key limitation to this study is the technology itself; it is relatively immature, with much scope for iterative development and improvement. It is expensive, with a requirement for expert technical knowledge to effectively create and deliver impactful and relevant content, which may prevent its adoption in resource- or knowledge-poor settings. Sixth, as with any technology-based trial, there is the potential for technology bias to influence results and for cost, resource, and technological barriers to limit adoption, scalability, and wider impact.