# Immersive Virtual Reality Training to Improve Novice Physicians’ Emergency Response Skills: Randomized Controlled Trial

## TL;DR

This study compared VR and high-fidelity simulation for training doctors to handle emergencies, finding both effective but with different strengths.

## Contribution

The study provides direct evidence comparing VR and HFS for medical training, highlighting their unique benefits and similar confidence improvements.

## Key findings

- VR and HFS both significantly improved interns' confidence in managing oxygen desaturation.
- HFS participants reported higher satisfaction, tutor guidance, and authenticity compared to VR.
- VR was valued for immersion and focused repetition, while HFS emphasized realism and hands-on practice.

## Abstract

Simulation-based training is essential for preparing medical interns to manage high-stakes emergencies. Although virtual reality (VR)-based simulation has been rapidly integrated into medical education, there remains limited evidence directly assessing its effectiveness relative to established high-fidelity simulation (HFS) methodologies.

This study aimed to assess the perceived educational effectiveness of VR and HFS in enhancing novice physicians’ confidence, satisfaction, and perceived preparedness for managing acute oxygen desaturation.

A randomized controlled trial was conducted with 168 medical interns from Seoul National University Hospital. Participants were randomly assigned to VR group (n=81) or HFS group (n=87). Overall, 4 participants were excluded due to incomplete surveys, leaving 164 for analysis (VR: 79 and HFS: 85). Both groups were trained to manage simulated patients with low oxygen saturation. Confidence (10-point Likert scale) and satisfaction (7-point Likert scale) were measured using pre and posttraining surveys. Usability was assessed with the User Experience Questionnaire-Short. Between-group comparisons were conducted using t tests and chi-square tests, while within-group confidence changes were analyzed using paired t tests and repeated-measures analysis of variance. To account for correlated data and estimate effect sizes, generalized estimating equations were applied, with statistical significance set at P<.05. Focus group interviews at 1 and 5 months posttraining explored real-world application and behavior transfer. Transcripts were independently reviewed by 2 researchers (YJH and SJM) and thematically analyzed to identify recurring patterns and insights related to clinical behavior.

Confidence in managing oxygen desaturation significantly improved from a mean 3.78 (SD 2.12) to mean 6.20 (SD 2.02) across VR and HFS groups (t163=−14.04; P<.001), with no significant difference between groups (F1,162=3.28; P=.07). Satisfaction was high overall mean 6.07 (SD 1.02), but significantly greater in the HFS group than in the VR group (mean 6.23, SD 0.92 vs mean 5.89, SD 1.10; t162 =2.29; P=.02). HFS participants rated tutor guidance (mean 6.49, SD 0.86 vs mean 6.10, SD 1.02; P=.008) and authenticity (mean 6.24, SD 1.05 vs mean 5.77, SD 1.15; P=.006) higher, whereas both groups scored usability above 5 on all items. Qualitative analyses revealed complementary strengths. Interns valued VR for its immersive environment, focused repetition, and reduced distractions that facilitated stepwise problem-solving. HFS was praised for palpable realism, hands-on practice with equipment, and immediate feedback that reinforced team communication and role clarity. Across follow-up interviews, interns reported improved recognition of desaturation, more structured initial responses (airway assessment, oxygen delivery adjustments, and escalation), and greater willingness to act promptly under pressure—suggesting perceived transfer of learning to clinical practice beyond the simulation lab.

VR may complement HFS in emergency response training. Both modalities were associated with improvements in interns’ self-reported confidence and perceived preparedness. The scalability and accessibility of VR suggest its potential value in diverse training contexts.