# Knowledge, attitudes, and practices of medical students at a Chinese university toward virtual simulation experimental training: a cross-sectional survey of self-perceived experience

## TL;DR

This study surveyed Chinese medical students about their knowledge, attitudes, and use of virtual simulation training, finding positive attitudes but limited actual engagement.

## Contribution

The study provides empirical insights into Chinese medical students' KAP toward virtual simulation training and identifies factors influencing their practice.

## Key findings

- Students showed adequate knowledge and positive attitudes toward virtual simulation training.
- Actual engagement in virtual simulation training was limited despite positive attitudes.
- Knowledge and attitude significantly influenced practice, with attitude mediating most of the effect.

## Abstract

Virtual simulation has emerged as an innovative teaching approach in medical education, offering immersive and repeatable practice opportunities that can address the limitations of traditional skills training. This study aimed to assess the knowledge, attitudes, and practices (KAP) of Chinese medical students toward virtual simulation experimental training.

A cross-sectional survey was conducted from August to September 2025 at Anhui Medical University, China. Data were collected using a structured questionnaire, which included demographic information and KAP-related assessments.

A total of 525 valid responses were obtained from 536 distributed questionnaires, yielding a valid response rate of 97.95%. Among the 525 valid respondents, 245 (46.7%) were male and 280 (53.3%) were female. By grade, 212 (40.4%) were in the junior year, 164 (31.2%) in the senior year, and 149 (28.4%) in the fifth year. Regarding majors, 245 (46.7%) studied Clinical Medicine, 59 (11.2%) Radiology, 139 (26.5%) Medical Imaging, and 82 (15.6%) Anesthesiology. The mean scores for knowledge, attitude, and practice were 12.11 ± 2.40 (possible range: 3–15), 15.78 ± 3.26 (possible range: 4–20), and 12.22 ± 2.60 (possible range: 4–16), respectively. Multivariate linear regression revealed that knowledge and attitude were significantly associated with practices (β = 0.186, 95% CI: [0.101, 0.271] and β = 0.593, 95% CI: [0.537, 0.649], both P < 0.001). Mediation analysis showed that the direct effect of knowledge on practice remained significant (β = 0.191, 95% CI: [0.114, 0.268], P < 0.001), while the indirect effect through attitude was also significant (β = 0.437, Bootstrap 95% CI: [0.348, 0.548]), accounting for 69.59% of the total effect.

Chinese medical students generally demonstrate adequate knowledge and positive attitudes, yet their actual engagement in virtual simulation training remained limited. Enhancing awareness and training could further promote its application and integration into medical education curricula.

Not applicable.

The online version contains supplementary material available at 10.1186/s12909-026-08803-w.