Beyond knowledge gains - learner experience and technology acceptance of virtual reality for anatomy education in Zambia: a randomized exploratory study

Standalone virtual reality (VR) enables interactive exploration of three-dimensional anatomy, but comparative evidence from resource-constrained medical-education settings remains limited. This study explored immediate knowledge outcomes, learner acceptance, and experiences with VR and three other learning resources in Zambia.

In this four-arm randomized exploratory study, 67 first- and second-year Bachelor of Science in Clinical Sciences students were assigned using Excel-generated random group numbers (1-4; no allocation concealment) to standalone VR using 3D Organon, AMBOSS^®, curated textbook materials, or self-directed internet search for a self-paced learning session of up to 30 min. Knowledge was assessed using an unvalidated 10-item pre-post test, and immediate acceptance was measured with an adapted Technology Acceptance Model questionnaire. The primary between-group knowledge analysis used baseline-adjusted analysis of covariance with HC3-robust standard errors. Acceptance comparisons were adjusted for multiple testing. Brief open-text responses underwent qualitative content analysis. A pre-study review indicated that tested concepts could be located in the three fixed-content resources but did not establish equivalence in depth, organisation, or accessibility, and could not be applied to the self-directed internet group.

The knowledge analysis included 59 participants (VR n = 12; AMBOSS^® n = 17; textbook n = 16; Internet n = 14). Within-group increases reached the adjusted significance threshold in the AMBOSS^®, textbook, and web-resource groups but not in the VR group (adjusted p = .053). The primary analysis did not detect an overall difference in baseline-adjusted post-test scores between modalities, F(3,54) = 1.945, p = .133; none of the six pairwise comparisons was significant after Holm adjustment. This finding does not establish equivalence. Acceptance analyses included 55-60 participants per construct. After adjustment across six domains, only Attitude differed significantly between modalities, H(3) = 11.801, ε² = 0.17, adjusted p = .049; AMBOSS^® was rated more favourably than the self-directed internet search (adjusted p = .019, Cliff's δ = -0.60). Perceived ease of use and perceived enjoyment showed low internal consistency, limiting their interpretation. The qualitative corpus comprised 211 comments from 64 participants. Some VR participants valued visualisation, novelty, and enjoyment but reported navigation and content-access difficulties. AMBOSS^® participants frequently valued organisation and accessibility, while experiences with textbook and web resources were mixed.

This small exploratory study did not provide conclusive evidence of differences in immediate knowledge outcomes between the four modalities. Quantitative acceptance differences were also limited after adjustment for multiple comparisons. The findings identify content accessibility, curricular alignment, interface familiarization, and exposure time as priorities for larger, prospectively designed studies using validated instruments and longer-term outcomes.