Understanding medical students' continuance intention to use VR-based learning systems: an integrated model approach

As Virtual Reality (VR) technology advances, VR-based learning systems offer medical students immersive, repeatable, and risk-free simulation environments, which are crucial for clinical skill development. Continued Intention (CI) to use these systems is a key determinant of their long-term educational impact. This study investigates the factors influencing medical students' CI by proposing an integrated research model grounded in the Unified Theory of Acceptance and Use of Technology and continuance theory. The model posits that System Characteristics (SC), Social Influence (SI), and Facilitating Conditions (FC) influence CI indirectly through the mediating roles of Perceived Ease of Use (PE) and Perceived Usefulness (PU). Survey data were collected from 258 medical students at Chinese universities with prior experience with VR learning systems and analyzed using Structural Equation Modeling. The results confirm that SC, SI, and FC exert no direct effects on CI but are fully mediated by PE and PU. Specifically, PE mediated the effects of FC and SI on CI, while PU mediated the impact of SC and SI on CI. Based on these identified pathways (e.g., SC→PU→CI; SI→PE→CI), we provide targeted recommendations: a) Enhancing system design and content relevance to improve perceived usefulness directly; b) Leveraging social proof and learning communities to strengthen perceptions of ease of use and usefulness; and c) Optimizing technical and instructional support to reduce usage barriers and foster positive user experience. This study offers theoretical insights into the post-adoption behavior of VR systems and practical guidance for promoting their sustained integration into medical curricula.