Immersive versus partially immersive virtual reality for training clinical reasoning and patient management in undergraduate medical education

Abstract Background Virtual reality (VR) is increasingly used in medical education, yet it remains unclear whether higher levels of immersion improve learning outcomes, particularly for learning clinical reasoning and patient management. This study compared fully immersive and partially immersive VR conditions using identical curriculum-aligned emergency medicine scenarios for undergraduate medical students. Methods We conducted a counterbalanced crossover study with third-year, undergraduate medical students at UNSW Sydney. Ninety-one participants completed one or both of two emergency department scenarios developed by Oxford Medical Simulation, in a fully immersive (head-mounted display) and a partially immersive (laptop) modality. Eighty completed both sessions. Each scenario was attempted twice with immediate feedback and faculty debriefing. Primary outcomes were objective performance scores generated by the platform’s standardised scoring rubric. Secondary outcomes included change in self-reported confidence in technical and non-technical skills and learner experience, assessed through quantitative and qualitative survey responses. Results Eighty students completed both sessions. Performance significantly improved from first to second attempt in both modalities. Performance scores did not significantly differ between head-mounted display and laptop modalities ( p = .069, d = 0.21). Confidence in technical and non-technical skills increased in both modalities with no between-modality differences. Student preference was divided: 55% favoured laptop-based simulation and 45% favoured head-mounted display. Qualitative analysis identified three themes: immersion versus usability, technical and physical constraints, and educational value. Students in both groups reported that VR was valuable for developing clinical reasoning skills in a safe environment. Conclusions For the scenarios and outcomes examined, head-mounted display simulation was associated with higher perceived realism but no detectable additional benefit in measured performance or self-reported confidence compared with laptop-based simulation. The study was not designed to test equivalence. Laptop-based simulation may offer a more scalable option, and the conditions under which greater presence adds educational benefit require further research. Trial registration Not applicable.