Evidence map›Paper›PMID 40336062›Full record

Trial reportBMC medical education2025

Image-based and textbook-based virtual reality training on operational skills among junior residents: a proof of concept study.

Wan-Ni Lin, Hai-Hua Chuang, Yi-Ping Chao, Li-Jen Hsin, Chung-Jan Kang, Tuan-Jen Fang, Hsueh-Yu Li, Li-Ang Lee

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC medical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03501641 (A Study of Heart Rate Variability and Cognitive Load on Image-Based Virtual Reality Instructional Design in Otolaryngology), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03501641 nacompletednot on this map

A Study of Heart Rate Variability and Cognitive Load on Image-Based Virtual Reality Instructional Design in Otolaryngology

TypeinterventionalSponsorChang Gung Memorial HospitalRan2018 to 2020Enrolled64ConditionsCognitive Function 1, Social, Competence, Heart Rate Fast, Learning, SpatialArmsimage-based virtual reality learning, video-based learning
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Perceptions of Artificial Intelligence in Gynecologic Oncology Education: Insights from a Qualitative Study Using Semi-Structured Interviews.Journal of cancer education : the official journal of the American Association for Cancer Education · 2026
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Wan-Ni Lin *Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan.
Hai-Hua Chuang *Department of Community Medicine, Cathay General Hospital, Taipei, Taiwan.
Yi-Ping ChaoDepartment of Otorhinolaryngology-Head and Neck Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan.
Li-Jen HsinDepartment of Otorhinolaryngology-Head and Neck Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan.
Chung-Jan KangDepartment of Otorhinolaryngology-Head and Neck Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan.
Tuan-Jen FangDepartment of Otorhinolaryngology-Head and Neck Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan.
Hsueh-Yu LiDepartment of Otorhinolaryngology-Head and Neck Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan.
Li-Ang LeeDepartment of Otorhinolaryngology-Head and Neck Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan. 5738@cgmh.org.tw.

Funding

Chang Gung Medical Foundation, Taiwan CMRPG3L0811-2National Science and Technology Council 108-2511-H-182A-001
6 · The paper itself

Abstract

backgroundOperational training is a key component of resident education. Recently, innovative virtual reality (VR) training methods have been introduced to enhance training efficiency. Image-based VR (IBVR), which incorporates cognitive load, is theorized to improve task performance. However, the impact of IBVR on learning outcomes requires further investigation. This study aims to assess the efficacy of IBVR compared to textbook-based VR (TBVR) in teaching operational skills to junior residents.

methodsIn a prospective cross-over pilot study, ten volunteers were randomly assigned to either the IBVR-TBVR or TBVR-IBVR group. Participants engaged in four learning sessions using either IBVR or TBVR modules during the first phase. Performance was assessed using quizzes, and Milestone/Direct Observation of Procedural Skills (DOPS) ratings on real patients. After one month, participants switched to the alternate VR module for further training. Cognitive load and stress were assessed during each session through questionnaires and heart rate variability (HRV). At the end of the study, learning satisfaction, experience, and overall effectiveness were evaluated using a global satisfaction scale, the AttrakDiff2 questionnaire, and group interviews. Qualitative data were analyzed using a thematic analysis framework.

resultsThe IBVR module yielded significantly better Milestone (p = 0.04), and DOPS (p < 0.01) scores compared to TBVR. There were no significant differences in knowledge gain, cognitive load, or HRV between the two modules. TBVR was favored in terms of global satisfaction (p = 0.03), hedonic stimulation (p = 0.01), and hedonic identification (p = 0.03), whereas IBVR was perceived as a more immersive and enriching experience. The majority (70%) of participants reported a positive experience with IBVR, while 50% expressed positive feedback regarding TBVR. Thematic analysis identified two key themes: usability of instructional content and ease of engagement.

conclusionAlthough TBVR yielded higher learner satisfaction and hedonic appeal, IBVR resulted in greater improvements in operational performance and was positively received by most participants. This proof-of-concept study highlights the complementary strengths of both VR approaches and calls for further research to validate these preliminary findings and inform the design of effective VR-based surgical education strategies.

trial registrationClinicaltrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 ; date of registration: April 18, 2018.

Indexed as

Clinical CompetenceInternship and ResidencySimulation TrainingTextbooks as TopicVirtual RealityAdultCross-Over StudiesEducational MeasurementFemaleHumansMalePilot ProjectsProof of Concept StudyProspective StudiesCognitive loadDirect observation of procedural skillsHeart rate variabilityMilestoneQualitative feedbackTechnology acceptanceVirtual reality

Identifiers

PMID40336062
PMCPMC12060568

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.