Immersive Virtual Reality Training to Improve Novice Physicians' Emergency Response Skills: Randomized Controlled Trial.

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.