Effect of virtual reality-based simulation using an ischemic stroke scenario: A randomized study

To evaluate a six-week program integrating virtual reality (VR) and high-fidelity simulation (HFS) for ischemic stroke nursing compared with HFS alone.

The additional educational benefits of integrating VR with HFS require evaluation across learning outcomes and over time.

An individually randomized, single-blind, two-group trial.

Fifty-two nursing students were randomized equally to VR-integrated HFS or HFS alone. Outcomes were assessed at baseline, immediately post-intervention and four weeks later. The main complete-case analysis included 47 students. Linear mixed-effects models included participant and course-section random intercepts, with Holm adjustment. An intention-to-treat analysis included all 52 students using available observations under a missing-at-random assumption.

Group-by-time interactions were significant for all four outcomes. Learning engagement and self-reported clinical competence were higher in the intervention group immediately post-intervention, but not at follow-up. The immediate between-group mean difference in clinical competence was 19.99 points (95% confidence interval, 7.89-32.09). Metacognition was higher immediately post-intervention and at follow-up. Academic self-efficacy did not differ significantly between groups at either post-intervention assessment. The intention-to-treat analysis showed the same pattern of statistical significance.

VR-integrated HFS was associated with immediate advantages in learning engagement and clinical competence and a sustained metacognition advantage at four weeks. Larger studies with objective performance assessments and longer follow-up are needed.