Synergistic Enhancement: A Randomized Controlled Trial of AI-Virtual Simulation Combined with Traditional Model Training to Improve Thoracentesis Skill Transfer Efficacy in Resident Physicians

Synergistic Enhancement: A Randomized Controlled Trial of AI-Virtual Simulation Combined with Traditional Model Training to Improve Thoracentesis Skill Transfer Efficacy in Resident Physicians | 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 Synergistic Enhancement: A Randomized Controlled Trial of AI-Virtual Simulation Combined with Traditional Model Training to Improve Thoracentesis Skill Transfer Efficacy in Resident Physicians Haonan Zhang, Heng Yang, Zhengwen Lei, Jia Liu, Juan Luo, Jieyu Cao, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9224471/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: While artificial intelligence virtual simulation (AI-VS) offers standardization advantages in clinical skills training, its inherent "digital divide" impedes the transfer of skills to real-world procedures. Conversely, traditional model training (TMT) provides essential tactile feedback but often lacks efficiency and standardization in delivering that feedback. Methods: This study employed a double-blind, randomized controlled trial design. Thirty-six resident physicians were randomly allocated into either the experimental group (AI-VS + TMT, n=18) or the control group (AI-VS only, n=18). A time-matched control protocol ensured equal total training duration. Upon achieving proficiency in AI-VS, the experimental group progressed to the TMT phase, while the control group engaged in additional, duration-matched AI-VS modules. Procedural skills (primary outcome), theoretical knowledge, and teaching satisfaction were assessed before and after the training. Results: All measured outcomes demonstrated significant improvement from baseline in both groups (all *P* < 0.001). However, the experimental group achieved significantly higher post-training scores in core technical skills (H) compared to the control group (91.72 ± 2.78 vs. 83.28 ± 4.74, *P* < 0.001; Cohen's d = 2.16). Furthermore, the experimental group exhibited comprehensive superiority across multiple other dimensions, including guideline mastery (G), theoretical knowledge (A), and teaching satisfaction (F). Conclusion: The "AI-VS + TMT" hybrid model, through a synergistic "digital cognitive construction—physical tactile calibration" mechanism, effectively bridges the skill transfer gap. It reorients the instructor's role toward cultivating higher-order clinical thinking, providing an empirically supported novel paradigm for clinical skills education in the post-AI era. Blended Learning Thoracentesis Standardized Residency Training Artificial Intelligence Clinical Skills Training Multidimensional Evaluation System Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 22 Apr, 2026 Editor invited by journal 30 Mar, 2026 Editor assigned by journal 27 Mar, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 25 Mar, 2026 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9224471","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631900086,"identity":"f9dcde15-fbc4-422d-8c7f-b757ff297fa7","order_by":0,"name":"Haonan Zhang","email":"","orcid":"","institution":"Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China","correspondingAuthor":false,"prefix":"","firstName":"Haonan","middleName":"","lastName":"Zhang","suffix":""},{"id":631900087,"identity":"c11213d6-bc0b-4c89-8007-673134d1f903","order_by":1,"name":"Heng Yang","email":"","orcid":"","institution":"Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China","correspondingAuthor":false,"prefix":"","firstName":"Heng","middleName":"","lastName":"Yang","suffix":""},{"id":631900093,"identity":"eb95aed3-7cbd-4e4a-b68e-f1d47aaf4097","order_by":2,"name":"Zhengwen Lei","email":"","orcid":"","institution":"Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China","correspondingAuthor":false,"prefix":"","firstName":"Zhengwen","middleName":"","lastName":"Lei","suffix":""},{"id":631900100,"identity":"f759743d-08aa-415e-8ec7-c1327010f2f6","order_by":3,"name":"Jia Liu","email":"","orcid":"","institution":"Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Liu","suffix":""},{"id":631900109,"identity":"45e0270b-cc11-4686-9125-eec299e5bea7","order_by":4,"name":"Juan Luo","email":"","orcid":"","institution":"Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Luo","suffix":""},{"id":631900112,"identity":"ea7f4ca9-5351-4d8d-824c-c5150828372d","order_by":5,"name":"Jieyu Cao","email":"","orcid":"","institution":"Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China","correspondingAuthor":false,"prefix":"","firstName":"Jieyu","middleName":"","lastName":"Cao","suffix":""},{"id":631900114,"identity":"c9ca1357-67e8-43ba-902a-d1eb9ddf2b9d","order_by":6,"name":"Kejiang Long","email":"","orcid":"","institution":"Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China","correspondingAuthor":false,"prefix":"","firstName":"Kejiang","middleName":"","lastName":"Long","suffix":""},{"id":631900122,"identity":"9e6c1ac4-ff85-4f7f-b1da-16f0dc92ede3","order_by":7,"name":"Juan Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYBACNvnDBx984JGQ45d/fPBBQkUNYS18EmzJhjNkbIwlG9KSDR6cOUZYi5wEj5k0h01aosGBHDPJhy3MRDhMui3ZmCHncIJkw7G0isQGNgb+9u4E/FpkDh98XHDmcB4/Y/OxG4k7ZBgkzpzdgF8LQ1qy8cyew8WSzWxpNxLPsDEYSOQS0pJjJs3773DihmM8ZgWJbcxEaJEAauHhSUvccIbHjIE4LTzHgIHMAwzkGWzJEglnjvEQ9It8ezM0KiWYD378UVEjx9/ei18LBuAhTfkoGAWjYBSMAqwAAMqYS17A1rwkAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China","correspondingAuthor":true,"prefix":"","firstName":"Juan","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2026-03-25 14:38:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9224471/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9224471/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108196555,"identity":"8333644e-e4e1-421c-8907-fdea5c947404","added_by":"auto","created_at":"2026-04-30 10:56:03","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":774081,"visible":true,"origin":"","legend":"","description":"","filename":"ARandomizedControlledTrialofAIVirtualSimulationCombinedwithTraditionalModelTrainingtoImproveThoracentesisSkillTransferEfficacyinResidentPhysicians.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9224471/v1_covered_3ce93f30-10eb-4350-8b3e-4fb5dd725d5f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Synergistic Enhancement: A Randomized Controlled Trial of AI-Virtual Simulation Combined with Traditional Model Training to Improve Thoracentesis Skill Transfer Efficacy in Resident Physicians","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"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":"Blended Learning, Thoracentesis, Standardized Residency Training, Artificial Intelligence, Clinical Skills Training, Multidimensional Evaluation System","lastPublishedDoi":"10.21203/rs.3.rs-9224471/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9224471/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: \u0026nbsp;While artificial intelligence virtual simulation (AI-VS) offers standardization advantages in clinical skills training, its inherent \"digital divide\" impedes the transfer of skills to real-world procedures. Conversely, traditional model training (TMT) provides essential tactile feedback but often lacks efficiency and standardization in delivering that feedback.\u003c/p\u003e\n\u003cp\u003eMethods: This study employed a double-blind, randomized controlled trial design. Thirty-six resident physicians were randomly allocated into either the experimental group (AI-VS + TMT, n=18) or the control group (AI-VS only, n=18). A time-matched control protocol ensured equal total training duration. Upon achieving proficiency in AI-VS, the experimental group progressed to the TMT phase, while the control group engaged in additional, duration-matched AI-VS modules. Procedural skills (primary outcome), theoretical knowledge, and teaching satisfaction were assessed before and after the training.\u003c/p\u003e\n\u003cp\u003eResults: All measured outcomes demonstrated significant improvement from baseline in both groups (all *P* \u0026lt; 0.001). However, the experimental group achieved significantly higher post-training scores in core technical skills (H) compared to the control group (91.72 ± 2.78 vs. 83.28 ± 4.74, *P* \u0026lt; 0.001; Cohen's d = 2.16). Furthermore, the experimental group exhibited comprehensive superiority across multiple other dimensions, including guideline mastery (G), theoretical knowledge (A), and teaching satisfaction (F).\u003c/p\u003e\n\u003cp\u003eConclusion: The \"AI-VS + TMT\" hybrid model, through a synergistic \"digital cognitive construction—physical tactile calibration\" mechanism, effectively bridges the skill transfer gap. It reorients the instructor's role toward cultivating higher-order clinical thinking, providing an empirically supported novel paradigm for clinical skills education in the post-AI era.\u003c/p\u003e","manuscriptTitle":"Synergistic Enhancement: A Randomized Controlled Trial of AI-Virtual Simulation Combined with Traditional Model Training to Improve Thoracentesis Skill Transfer Efficacy in Resident Physicians","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 10:54:49","doi":"10.21203/rs.3.rs-9224471/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-22T10:01:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T10:29:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-27T08:18:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T08:18:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-25T14:28:00+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":"56767180-954e-4837-b183-6f03a5bb27d3","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T10:54:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 10:54:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9224471","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9224471","identity":"rs-9224471","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}