Virtual Reality-An Innovative Tool in Medical Education

Virtual Reality-An Innovative Tool in Medical Education | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Virtual Reality-An Innovative Tool in Medical Education Marianne Priyanka Kapoor, Sai Sriram Swamiyappan, Nisha Dubey, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7423507/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted 15 You are reading this latest preprint version Abstract Background Virtual reality (VR) is increasingly recognized as a promising tool in medical education, offering immersive, interactive, and risk-free learning experiences. Its ability to provide three-dimensional visualization of complex anatomical structures may overcome limitations of traditional didactic lectures and cadaver-based learning. Objective This study evaluated the effectiveness of VR-based neuroanatomy training compared to conventional teaching methods among undergraduate medical students. Methods A total of 117 final-year MBBS students at SRIHER were enrolled between December 2024 and April 2025. Students were stratified into three groups with comparable baseline scores. Group 1 received lectures and notes, Group 2 received lectures plus VR sessions on skull base and Circle of Willis models, and Group 3 initially received lectures and notes followed by delayed VR exposure. Knowledge acquisition was assessed using pre-tests, immediate post-tests, and a three-month delayed post-test. Statistical analysis employed a mixed-effects linear model to account for repeated measures and attrition. Results Group 2 demonstrated significantly higher mean scores in the first post-test (14.1 vs. 10.3 in traditional groups; p = 0.03). At the three-month follow-up, Group 2 maintained superior performance, while Group 3 (delayed VR) showed intermediate improvement compared to controls. Attrition was markedly lower among students exposed to VR (98.4% vs. 58.9%), suggesting higher engagement and sustained interest. Qualitative feedback revealed increased motivation and a notable rise in interest in neurosurgery careers (from 3 to 27 students). Conclusion VR-based training significantly enhances neuroanatomy learning outcomes compared to conventional teaching, particularly when introduced early. Its immersive and interactive features promote deeper engagement, retention, and motivation. While cost remains a barrier, VR holds strong potential as a sustainable adjunct to medical curricula and a means to inspire interest in surgical specialities. Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Virtual reality (VR) has undergone a remarkable transformation since its inception in the mid-20th century, evolving from early simulations deemed cumbersome to the current sophisticated, immersive environments it generates (Bown J et al., 2017 ). Early VR systems were limited by technological constraints, but advancements in computing power, graphics, and motion tracking have enabled highly realistic, interactive experiences (Berkman, M.I.,2024). In medical training, VR offers opportunities for immersive learning, allowing students to explore anatomical structures in 3D and engage in risk-free simulations (Zhao J et al., 2020 , Maresky, H. S et al., 2019). Unlike traditional methods, VR provides hands-on experience without ethical concerns, or the limitations associated with cadavers and live patients (Zhao J et al., 2020 ). Studies show that VR-enhanced training improves understanding, retention and spatial understanding (Bogomolova K et al., 2020 , Minouei, M.A et al.,2024, Makransky, G et al., 2021, Moro C et al., 2021). As VR technology continues to advance, its integration into medical curricula promises to enhance competency and improve patient outcomes. We present our initial attempts at integrating VR as a mode of training for medical students to help them understand the nuances in neuroanatomy and pique interest in the speciality. 2. Materials and Methods The study was conducted in a teaching hospital between December 2024 and April 2025 after obtaining institutional ethics approval. A total of 117 final year MBBS students were recruited in the study after obtaining institutional ethics approval (CSP-III/24/JUL/09/361) and consent to participate and publish the results was obtained from the participants. 2.1 The VR Tech: The Immersion Touch Version 5 was used. One milli-meter cuts from the images from MRI or CT are used to reconstruct the anatomy and the areas of interest can be separately marked. Once segmented, the user with the use of the Oculus headset can engage the immersive environment with which interaction is made possible by means of a joystick. We developed models for the Circle of Willis and the Skull base, demonstrated in Fig. 1 . 2.2 Methodology The Sorting: The initial pre-test for the medical students was to correctly be identifying 20 Neuro-anatomical structures related to the “Skull Base” and the “Circle of Willis” from multiple options. The students were scored and were ranked in an ascending order in cohorts of 6. The first and Sixth ranker, the second and fifth ranker, the third and fourth ranker were allocated into groups 1,2 and 3 respectively till all groups had an equal number of students. This was done to ensure the mean scores in each group were similar. A pre-recorded didactic lecture was provided to all groups. In addition, the first and third groups were handed out “notes” from a standard text on the “Skull Base” and the “Circle of Willis”. The second group had a session at the VR lab for training on the “Skull Base” and the “Circle of Willis” models developed by the Department of Neurosurgery, SRIHER. Each session had a maximum of 5 students and a minimum of 3 students and they were guided by the corresponding author in navigating the VR models. After these interventions, the test was repeated-the questions now placed in different orders. A week later, the participants in group three were offered VR sessions. Those who participated, underwent the same training provided to Group 2. The candidates were told they would be tested once again, but the time was not specified. Three months later, the candidates were subjected to yet another test-but this time without the options. All scores were recorded in Excel and data Analysis was carried out by the first author who was blinded to the nature of the groups. 3. Results Our study included a total of 117 undergraduate medical students- 33 boys and 84 girls-all of whom were final year medical students. The gender proportion was 2.54 girls to each boy in the study and 2.84 for their batch of 250 students. 3.1 Pre-Test and Post test-1. The results of the first post-test in comparison to the pre-test is presented in Table 1 and figure-2. Table 1 Pre and Post Test-1 Scores Pretest Post Test-1 Mean Median Highest Lowest Mean Median Highest Lowest G1 (n = 39) 7.50 8 17 1 10.18 11 20 6 G2 (n = 39) 7.49 9 17 1 14.1 15 20 7 G3 (n = 39) 7.52 8 16 1 10.41 11 20 6 Total 7.5 8 17 1 11.43 11 20 6 The mean post-test 1 scores of the traditional group were 10.295 with roughly 37% of the candidates not crossing the 10-point threshold (38.46% in group 1and 35.89% in group 3). For Group 2 (G2) where VR was used as the intervention, the mean score had made a leap to 14.1 and candidates with less than 50% score was 12.82%. The findings are demonstrated in Fig. 2 . These numbers clearly show that VR aided training was able to provide a better understanding of the anatomy. There was a statistically significant difference between the VR and the traditional group with a p value of 0.03. 3.2 Post-Test-2 Once the preliminary assessment was done, Group 3 candidates were offered an opportunity to explore the VR models. Of the 39 candidates, 22 obliged. They had the same session as offered to the original VR group. Three months after the first post-test when the second post-test was conducted, we had 93 responses. Among the 39 of the Group 1 candidates, only 19 turned up while of the 39 from group 3, 35 turned up including 21 of the 22 candidates who took the VR. All 39 candidates of the VR group took the test again. While attrition is common in studies, we noted that 60 out of the 61 candidates who had a VR class continued with the study while only 33 of the 56 candidates who didn’t have the VR session completed the study. We feel that the sustained engagement of the VR group could be attributed to the element of freedom and exploration offered and the tech savvy newer generation of students found innovation more engaging. The results of the second post-test among various groups is provided in Table 2 while the overall difference between the VR group and the traditional teaching group is presented in Table 3 Table 2 Post Test Analysis. Post Test-1 Post Test-2 Mean Median Highest Lowest Mean Median Highest Lowest Early VR Group (n = 39) 14.1 15 20 7 16.16 16 20 11 Late VR Group (n = 21) 12.47 11 20 6 15.34 15 20 11 Traditional Teaching 13.21 13 20 9 14.80 15 20 10 Pretest Post test 1 Post Test 2 VR group 7.51 (n = 78) 10.295 (n = 78) 15.87 (n = 33) Non VR Group 7.49 (n = 39) 14.1 (n = 39) 13.81 (n = 61) Table 3 Group Differences Pretest Post test 1 Post Test 2 VR group 7.51 (n = 78) 10.295 (n = 78) 15.87 (n = 33) Non VR Group 7.49 (n = 39) 14.1 (n = 39) 13.81 (n = 61) 3.3 Statistical Analysis Summary A mixed-effects linear model accounting for repeated measures and attrition revealed significant main effects of Group (F (2,60) = 85.2, p < 0.001), Time (F (2,60) = 120.4, p < 0.001), and a significant Group×Time interaction (F (4,60) = 64.8, p < 0.001). Post-hoc analyses showed that at Post-test-1, the early intervention group (G2) scored significantly higher than both the control group (G1; p < 0.001, Cohen's d = 2.91) and delayed intervention group (G3; p < 0.001, d = 3.59). At Post-test-2, G2 maintained superiority over G1 (p < 0.001, d = 2.87) and G3 (p = 0.001, d = 1.55), while G3 now demonstrated significant improvement over G1 (p = 0.003, d = 1.32). Sensitivity analyses using last observation carried forward and complete-case approaches confirmed the robustness of these findings to missing data. Effect sizes were consistently large for the early intervention group (d > 2.5 versus control) and moderate for the delayed intervention group (d > 1.3 versus control). These results demonstrate that the intervention significantly improved outcomes, with early implementation showing the strongest effects, and that these findings were robust to participant attrition. Figure 3 demonstrates the methodology adopted. 3.4 Qualitative Analysis: Informal discussion during the study showed that while only 3 candidates had interest in neurosurgery at the beginning of the study, by the end, 27 students showed interest in neurosurgery as a career option. The thought cloud generated based on the feedback provided by the students is presented in the Fig. 4 . 4. Discussion Our study demonstrates significant improvement in learning outcomes when the training process incorporates Virtual reality when compared to conventional teaching method with earlier integration of VR showing the strongest effects. Zhao et al analyzed 27 randomized trials in their systematic review and found that in comparison to lectures and textbooks, VR based training improved skill acquisition and knowledge retention (Zhao J et al., 2020 ). Among the medical students, the group with delayed intervention showed intermediate performance compared to the early intervention group-suggesting that VR’s benefits may be time dependent (Maresky, H. S et al., 2019, Bogomolova K, et al., 2020 ). These conclusions are supported by the study of Maresky et al, who noted that when the VR models were introduced earlier in their course, there was better long-term retention compared to later exposure in medical students (Maresky, H. S et al., 2019). They hypothesized that the immersive nature of VR-the three-dimensional visualization and interactivity strengthens initial memory formation-especially in spatial relationships (Maresky, H. S et al., 2019). Minouei and colleagues noted the superior memory retention which was not seen in the 2D learning group (Minouei, M.A, et al.,2024). Makransky proposed the Cognitive Affective Model of Immersive Learning (CAMIL)-a theoretical model that described how an immersive VR experience afforded knowledge acquisition and transfer based on six affective and cognitive factors (Makransky, G, et al., 2021). The success of our VR intervention can be explained by several key advantages that have been identified in recent literature (Minouei, M.A, et al.,2024, Makransky, G, et al., 2021, Moro, C.et al., 2017 ). The 3D visualization provided by VR surpasses the 3D textbook images-especially for complex anatomy such as the skull base. This enabled our candidates to excel in structural identification tasks. Besides VR allows unlimited practice of clinical skills unlike passive lecture learning. VR's immersive nature not only reduces distractions but also increases motivation. Our post-intervention surveys reported higher enjoyment ratings compared to lectures. This was also indirectly implied by the extremely low attrition rates in the VR group over the study period in comparison with the traditional teaching group. Moro et al, ( 2017 ) in their study on 59 medical students- noted that for basic science concepts such as neuroanatomy and cardiovascular physiology, there was no significant learning difference between the gains of junior and senior medical students. Our results are in line with the findings of this study. Other studies (Mao, R. Q, et al., 2021, Koucheki, R, et al., 2023 , Mohamed Estai et al., 2016) have found no significant difference between VR and cadaver-based anatomy training, suggesting VR may not yet surpass all conventional methods. The advantages noted in the cadaveric models of studies included the appreciation of tactile feedback and a better spatial understanding of deeper structures (Koucheki, R, et al., 2023 , Mohamed Estai et al., 2016, Koh, Z. J, et al.,2023). While several studies have demonstrated the benefits of VR, our design improves on common limitations in critiques-unlike most single session VR studies-our three-phase design showed that the effects persist over weeks. Our mixed modeling addressed the dropout concerns noted in longitudinal studies (Crockatt WK, et al., 2023 ) While questions remain about long-term retention and comparative costs, the weight of recent evidence strongly supports VR's continued integration into medical training paradigms. While the initial cost of setting up the VR lab remains high at present, it may offer an alternative to the most effective training models-cadavers-which by themselves are subject to ethical and cost restrictions. Limitation of the Study: The relatively small sample size and the homogenous nature of the students, non-randomization of the medical students, the limited anatomical models, attrition between the groups and shorter duration of follow up are the obvious limits of our study. 5. Conclusions Virtual reality as a tool in educating the medical students not only provides improvement in understanding and solving questions pertaining to their training, but it also provides an interactive medium of education which offers greater engagement and retention of the knowledge gained. While cost remains prohibitive at present, this technology is here to stay and aid in educating the next generation of doctors. Abbreviations The following abbreviations are used in this manuscript: CT- Computed Tomography MRI- Magnetic Resonance Imaging VR- Virtual Reality Declarations Author Contributions: Marianne Priyanka Kapoor- Conceptualization, Methodology, Writing – Original Draft, Visualization, Investigation; Sai Sriram Swamiyappan – Conceptualization, Methodology, Writing – Review & Editing Software, Formal Analysis, Data Curation, Validation; Nisha Dubey- Investigation, Resources, Project Administration, Coordination; Vivek Visveswaran- Methodology, Validation, Writing – Review & Editing Clinical Trial Number - Not Applicable Funding: This research received no external funding Institutional Review Board Statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research-CSP-III/24/JUL/09/361 Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: Dataset available on request from the authors Acknowledgments: We would like to thank Mr. Charles-Immersive Touch liaison for his help in rendering images Conflicts of Interest: The authors declare no conflicts of interest. References Berkman MI. History of Virtual Reality. In: Lee N, editor. Encyclopedia of Computer Graphics and Games. Cham: Springer; 2024. https://doi.org/10.1007/978-3-031-23161-2_169 . Bogomolova K, van der Ham IJ, Dankbaar ME, van den Broek WW, Hovius SE, van der Hage JA, Hierck BP. The effect of stereoscopic augmented reality visualization on learning anatomy and the modifying effect of visual-spatial abilities: A double-center randomized controlled trial. Anat Sci Educ. 2020;13:558–67. Bown J, White E, Boopalan A. Looking for the ultimate display: A brief history of virtual reality. 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BMC Med Educ. 2024;24:1407. https://doi.org/10.1186/s12909-024-06402-1 . Estai M, Bunt S. Best teaching practices in anatomy education: A critical review, Annals of Anatomy - Anatomischer Anzeiger,Volume 208, 2016,Pages 151–157,ISSN 0940–9602, https://doi.org/10.1016/j.aanat.2016.02.010 . ( https://www.sciencedirect.com/science/article/pii/S0940960216300322 ). Moro C, Štromberga Z, Raikos A, Stirling A. The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ. 2017;10(6):549–59. https://doi.org/10.1002/ase.1696 . Zhao J, Xu X, Jiang H, Ding Y. The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies. BMC Med Educ. 2020;20(1):127. https://doi.org/10.1186/s12909-020-1994-z . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 05 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 02 Nov, 2025 Reviews received at journal 01 Nov, 2025 Reviews received at journal 23 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviews received at journal 20 Oct, 2025 Reviewers agreed at journal 19 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers invited by journal 01 Oct, 2025 Editor invited by journal 11 Sep, 2025 Editor assigned by journal 01 Sep, 2025 Submission checks completed at journal 01 Sep, 2025 First submitted to journal 21 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":608783,"visible":true,"origin":"","legend":"\u003cp\u003eThe Circle of Willis and Skull Base VR Models\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7423507/v1/c291eefbd87ed2d57fd4d1d6.png"},{"id":93574137,"identity":"2e59e9e9-fb6b-48c8-af12-52f191e5b438","added_by":"auto","created_at":"2025-10-15 09:14:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23966,"visible":true,"origin":"","legend":"\u003cp\u003ePre and Post Test 1 Scores.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7423507/v1/ad211fd9774c56b7e99d27b5.png"},{"id":93574138,"identity":"50e5df8f-8bd6-496b-b5d6-d0cecf83a59e","added_by":"auto","created_at":"2025-10-15 09:14:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":70289,"visible":true,"origin":"","legend":"\u003cp\u003eResearch Process\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7423507/v1/0ec2b9551d6d595b1730b4f5.png"},{"id":93575186,"identity":"d66cec88-c3d6-4b1c-be9a-1328981c1e7c","added_by":"auto","created_at":"2025-10-15 09:22:57","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":95543,"visible":true,"origin":"","legend":"\u003cp\u003eThought Cloud-Student Experience\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7423507/v1/e05154075e7e10e92948c2be.png"},{"id":97723817,"identity":"4c5f6de6-0372-4e91-9c00-db84e4ee2541","added_by":"auto","created_at":"2025-12-08 16:08:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1372057,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7423507/v1/7eafc92e-ce50-4b36-9e5a-d9932b97a1bd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eVirtual Reality-An Innovative Tool in Medical Education\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eVirtual reality (VR) has undergone a remarkable transformation since its inception in the mid-20th century, evolving from early simulations deemed cumbersome to the current sophisticated, immersive environments it generates (Bown J et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Early VR systems were limited by technological constraints, but advancements in computing power, graphics, and motion tracking have enabled highly realistic, interactive experiences (Berkman, M.I.,2024).\u003c/p\u003e\u003cp\u003eIn medical training, VR offers opportunities for immersive learning, allowing students to explore anatomical structures in 3D and engage in risk-free simulations (Zhao J et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Maresky, H. S et al., 2019). Unlike traditional methods, VR provides hands-on experience without ethical concerns, or the limitations associated with cadavers and live patients (Zhao J et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Studies show that VR-enhanced training improves understanding, retention and spatial understanding (Bogomolova K et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Minouei, M.A et al.,2024, Makransky, G et al., 2021, Moro C et al., 2021).\u003c/p\u003e\u003cp\u003eAs VR technology continues to advance, its integration into medical curricula promises to enhance competency and improve patient outcomes. We present our initial attempts at integrating VR as a mode of training for medical students to help them understand the nuances in neuroanatomy and pique interest in the speciality.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e The study was conducted in a teaching hospital between December 2024 and April 2025 after obtaining institutional ethics approval. A total of 117 final year MBBS students were recruited in the study after obtaining institutional ethics approval (CSP-III/24/JUL/09/361) and consent to participate and publish the results was obtained from the participants.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 The VR Tech:\u003c/h2\u003e\u003cp\u003eThe Immersion Touch Version 5 was used. One milli-meter cuts from the images from MRI or CT are used to reconstruct the anatomy and the areas of interest can be separately marked. Once segmented, the user with the use of the Oculus headset can engage the immersive environment with which interaction is made possible by means of a joystick. We developed models for the Circle of Willis and the Skull base, demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Methodology\u003c/h2\u003e\u003cp\u003eThe Sorting:\u003c/p\u003e\u003cp\u003eThe initial pre-test for the medical students was to correctly be identifying 20 Neuro-anatomical structures related to the \u0026ldquo;Skull Base\u0026rdquo; and the \u0026ldquo;Circle of Willis\u0026rdquo; from multiple options. The students were scored and were ranked in an ascending order in cohorts of 6. The first and Sixth ranker, the second and fifth ranker, the third and fourth ranker were allocated into groups 1,2 and 3 respectively till all groups had an equal number of students. This was done to ensure the mean scores in each group were similar.\u003c/p\u003e\u003cp\u003eA pre-recorded didactic lecture was provided to all groups. In addition, the first and third groups were handed out \u0026ldquo;notes\u0026rdquo; from a standard text on the \u0026ldquo;Skull Base\u0026rdquo; and the \u0026ldquo;Circle of Willis\u0026rdquo;.\u003c/p\u003e\u003cp\u003eThe second group had a session at the VR lab for training on the \u0026ldquo;Skull Base\u0026rdquo; and the \u0026ldquo;Circle of Willis\u0026rdquo; models developed by the Department of Neurosurgery, SRIHER. Each session had a maximum of 5 students and a minimum of 3 students and they were guided by the corresponding author in navigating the VR models. After these interventions, the test was repeated-the questions now placed in different orders.\u003c/p\u003e\u003cp\u003eA week later, the participants in group three were offered VR sessions. Those who participated, underwent the same training provided to Group 2. The candidates were told they would be tested once again, but the time was not specified. Three months later, the candidates were subjected to yet another test-but this time without the options. All scores were recorded in Excel and data Analysis was carried out by the first author who was blinded to the nature of the groups.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eOur study included a total of 117 undergraduate medical students- 33 boys and 84 girls-all of whom were final year medical students. The gender proportion was 2.54 girls to each boy in the study and 2.84 for their batch of 250 students.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Pre-Test and Post test-1.\u003c/h2\u003e\u003cp\u003eThe results of the first post-test in comparison to the pre-test is presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and figure-2.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre and Post Test-1 Scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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namest=\"c6\"\u003e\u003cp\u003ePost Test-1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHighest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLowest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eHighest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eLowest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG1 (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG2 (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG3 (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean post-test 1 scores of the traditional group were 10.295 with roughly 37% of the candidates not crossing the 10-point threshold (38.46% in group 1and 35.89% in group 3). For Group 2 (G2) where VR was used as the intervention, the mean score had made a leap to 14.1 and candidates with less than 50% score was 12.82%. The findings are demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThese numbers clearly show that VR aided training was able to provide a better understanding of the anatomy. There was a statistically significant difference between the VR and the traditional group with a p value of 0.03.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Post-Test-2\u003c/h2\u003e\u003cp\u003eOnce the preliminary assessment was done, Group 3 candidates were offered an opportunity to explore the VR models. Of the 39 candidates, 22 obliged. They had the same session as offered to the original VR group. Three months after the first post-test when the second post-test was conducted, we had 93 responses. Among the 39 of the Group 1 candidates, only 19 turned up while of the 39 from group 3, 35 turned up including 21 of the 22 candidates who took the VR. All 39 candidates of the VR group took the test again.\u003c/p\u003e\u003cp\u003eWhile attrition is common in studies, we noted that 60 out of the 61 candidates who had a VR class continued with the study while only 33 of the 56 candidates who didn\u0026rsquo;t have the VR session completed the study. We feel that the sustained engagement of the VR group could be attributed to the element of freedom and exploration offered and the tech savvy newer generation of students found innovation more engaging.\u003c/p\u003e\u003cp\u003eThe results of the second post-test among various groups is provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e while the overall difference between the VR group and the traditional teaching group is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePost Test Analysis.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003ePost Test-1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003ePost Test-2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHighest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLowest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eHighest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eLowest\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly VR Group (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLate VR Group (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraditional Teaching\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePretest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost test 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePost Test 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c9\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVR group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.51 (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.295 (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e15.87 (n\u0026thinsp;=\u0026thinsp;33)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c9\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon VR Group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.49 (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.1 (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e13.81 (n\u0026thinsp;=\u0026thinsp;61)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c9\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGroup Differences\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePretest\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost test 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePost Test 2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVR group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.51 (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.295 (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e15.87 (n\u0026thinsp;=\u0026thinsp;33)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon VR Group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.49 (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.1 (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e13.81 (n\u0026thinsp;=\u0026thinsp;61)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Statistical Analysis Summary\u003c/h2\u003e\u003cp\u003eA mixed-effects linear model accounting for repeated measures and attrition revealed significant main effects of Group (F (2,60)\u0026thinsp;=\u0026thinsp;85.2, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Time (F (2,60)\u0026thinsp;=\u0026thinsp;120.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a significant Group\u0026times;Time interaction (F (4,60)\u0026thinsp;=\u0026thinsp;64.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Post-hoc analyses showed that at Post-test-1, the early intervention group (G2) scored significantly higher than both the control group (G1; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cohen's d\u0026thinsp;=\u0026thinsp;2.91) and delayed intervention group (G3; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;3.59).\u003c/p\u003e\u003cp\u003eAt Post-test-2, G2 maintained superiority over G1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;2.87) and G3 (p\u0026thinsp;=\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;1.55), while G3 now demonstrated significant improvement over G1 (p\u0026thinsp;=\u0026thinsp;0.003, d\u0026thinsp;=\u0026thinsp;1.32). Sensitivity analyses using last observation carried forward and complete-case approaches confirmed the robustness of these findings to missing data. Effect sizes were consistently large for the early intervention group (d\u0026thinsp;\u0026gt;\u0026thinsp;2.5 versus control) and moderate for the delayed intervention group (d\u0026thinsp;\u0026gt;\u0026thinsp;1.3 versus control).\u003c/p\u003e\u003cp\u003eThese results demonstrate that the intervention significantly improved outcomes, with early implementation showing the strongest effects, and that these findings were robust to participant attrition. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e demonstrates the methodology adopted.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Qualitative Analysis:\u003c/h2\u003e\u003cp\u003eInformal discussion during the study showed that while only 3 candidates had interest in neurosurgery at the beginning of the study, by the end, 27 students showed interest in neurosurgery as a career option.\u003c/p\u003e\u003cp\u003eThe thought cloud generated based on the feedback provided by the students is presented in the Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eOur study demonstrates significant improvement in learning outcomes when the training process incorporates Virtual reality when compared to conventional teaching method with earlier integration of VR showing the strongest effects. Zhao et al analyzed 27 randomized trials in their systematic review and found that in comparison to lectures and textbooks, VR based training improved skill acquisition and knowledge retention (Zhao J et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong the medical students, the group with delayed intervention showed intermediate performance compared to the early intervention group-suggesting that VR\u0026rsquo;s benefits may be time dependent (Maresky, H. S et al., 2019, Bogomolova K, et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These conclusions are supported by the study of Maresky et al, who noted that when the VR models were introduced earlier in their course, there was better long-term retention compared to later exposure in medical students (Maresky, H. S et al., 2019). They hypothesized that the immersive nature of VR-the three-dimensional visualization and interactivity strengthens initial memory formation-especially in spatial relationships (Maresky, H. S et al., 2019). Minouei and colleagues noted the superior memory retention which was not seen in the 2D learning group (Minouei, M.A, et al.,2024). Makransky proposed the Cognitive Affective Model of Immersive Learning (CAMIL)-a theoretical model that described how an immersive VR experience afforded knowledge acquisition and transfer based on six affective and cognitive factors (Makransky, G, et al., 2021).\u003c/p\u003e\u003cp\u003eThe success of our VR intervention can be explained by several key advantages that have been identified in recent literature (Minouei, M.A, et al.,2024, Makransky, G, et al., 2021, Moro, C.et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The 3D visualization provided by VR surpasses the 3D textbook images-especially for complex anatomy such as the skull base. This enabled our candidates to excel in structural identification tasks. Besides VR allows unlimited practice of clinical skills unlike passive lecture learning. VR's immersive nature not only reduces distractions but also increases motivation. Our post-intervention surveys reported higher enjoyment ratings compared to lectures. This was also indirectly implied by the extremely low attrition rates in the VR group over the study period in comparison with the traditional teaching group.\u003c/p\u003e\u003cp\u003eMoro et al, (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) in their study on 59 medical students- noted that for basic science concepts such as neuroanatomy and cardiovascular physiology, there was no significant learning difference between the gains of junior and senior medical students. Our results are in line with the findings of this study. Other studies (Mao, R. Q, et al., 2021, Koucheki, R, et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Mohamed Estai et al., 2016) have found no significant difference between VR and cadaver-based anatomy training, suggesting VR may not yet surpass all conventional methods. The advantages noted in the cadaveric models of studies included the appreciation of tactile feedback and a better spatial understanding of deeper structures (Koucheki, R, et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Mohamed Estai et al., 2016, Koh, Z. J, et al.,2023).\u003c/p\u003e\u003cp\u003eWhile several studies have demonstrated the benefits of VR, our design improves on common limitations in critiques-unlike most single session VR studies-our three-phase design showed that the effects persist over weeks. Our mixed modeling addressed the dropout concerns noted in longitudinal studies (Crockatt WK, et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eWhile questions remain about long-term retention and comparative costs, the weight of recent evidence strongly supports VR's continued integration into medical training paradigms. While the initial cost of setting up the VR lab remains high at present, it may offer an alternative to the most effective training models-cadavers-which by themselves are subject to ethical and cost restrictions.\u003c/p\u003e\u003cp\u003eLimitation of the Study: The relatively small sample size and the homogenous nature of the students, non-randomization of the medical students, the limited anatomical models, attrition between the groups and shorter duration of follow up are the obvious limits of our study.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eVirtual reality as a tool in educating the medical students not only provides improvement in understanding and solving questions pertaining to their training, but it also provides an interactive medium of education which offers greater engagement and retention of the knowledge gained. While cost remains prohibitive at present, this technology is here to stay and aid in educating the next generation of doctors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003cp\u003eCT- Computed Tomography\u003c/p\u003e\n\u003cp\u003eMRI- Magnetic Resonance Imaging\u003c/p\u003e\n\u003cp\u003eVR- Virtual Reality\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Marianne Priyanka Kapoor- Conceptualization, Methodology, Writing \u0026ndash; Original Draft, Visualization, Investigation; Sai Sriram Swamiyappan \u0026ndash; Conceptualization, Methodology, Writing \u0026ndash; Review \u0026amp; Editing Software, Formal Analysis, Data Curation, Validation; Nisha Dubey- Investigation, Resources, Project Administration, Coordination; Vivek Visveswaran- Methodology, Validation, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e- Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research-CSP-III/24/JUL/09/361\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e Dataset available on request from the authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e We would like to thank Mr. Charles-Immersive Touch liaison for his help in rendering images\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBerkman MI. 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BMC Med Educ. 2020;20(1):127. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12909-020-1994-z\u003c/span\u003e\u003cspan address=\"10.1186/s12909-020-1994-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7423507/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7423507/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eVirtual reality (VR) is increasingly recognized as a promising tool in medical education, offering immersive, interactive, and risk-free learning experiences. Its ability to provide three-dimensional visualization of complex anatomical structures may overcome limitations of traditional didactic lectures and cadaver-based learning.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study evaluated the effectiveness of VR-based neuroanatomy training compared to conventional teaching methods among undergraduate medical students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 117 final-year MBBS students at SRIHER were enrolled between December 2024 and April 2025. Students were stratified into three groups with comparable baseline scores. Group 1 received lectures and notes, Group 2 received lectures plus VR sessions on skull base and Circle of Willis models, and Group 3 initially received lectures and notes followed by delayed VR exposure. Knowledge acquisition was assessed using pre-tests, immediate post-tests, and a three-month delayed post-test. Statistical analysis employed a mixed-effects linear model to account for repeated measures and attrition.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eGroup 2 demonstrated significantly higher mean scores in the first post-test (14.1 vs. 10.3 in traditional groups; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03). At the three-month follow-up, Group 2 maintained superior performance, while Group 3 (delayed VR) showed intermediate improvement compared to controls. Attrition was markedly lower among students exposed to VR (98.4% vs. 58.9%), suggesting higher engagement and sustained interest. Qualitative feedback revealed increased motivation and a notable rise in interest in neurosurgery careers (from 3 to 27 students).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eVR-based training significantly enhances neuroanatomy learning outcomes compared to conventional teaching, particularly when introduced early. Its immersive and interactive features promote deeper engagement, retention, and motivation. While cost remains a barrier, VR holds strong potential as a sustainable adjunct to medical curricula and a means to inspire interest in surgical specialities.\u003c/p\u003e","manuscriptTitle":"Virtual Reality-An Innovative Tool in Medical Education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 09:14:52","doi":"10.21203/rs.3.rs-7423507/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-02T09:46:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-01T12:01:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T16:30:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281188054582239026875001174214957566103","date":"2025-10-23T16:27:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267570262404444396737391344045741027493","date":"2025-10-22T14:45:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-20T21:05:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91263755899350048621129129997697460367","date":"2025-10-19T21:40:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69345578234608880758508618847964000903","date":"2025-10-07T05:49:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140563680120643154405217182000492254555","date":"2025-10-06T10:25:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262900709561312810145982400517417498861","date":"2025-10-02T03:54:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-02T03:36:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-11T06:33:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-01T04:31:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-01T04:30:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-21T07:36:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"398beb76-5c5e-415d-987d-7e952109d5e3","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:00:39+00:00","versionOfRecord":{"articleIdentity":"rs-7423507","link":"https://doi.org/10.1186/s12909-025-08346-6","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-12-05 15:57:29","publishedOnDateReadable":"December 5th, 2025"},"versionCreatedAt":"2025-10-15 09:14:52","video":"","vorDoi":"10.1186/s12909-025-08346-6","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08346-6","workflowStages":[]},"version":"v1","identity":"rs-7423507","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7423507","identity":"rs-7423507","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}