Effectiveness of fully immersive virtual reality-based simulation training on objective knowledge acquisition in acute coronary syndrome/ST-elevation myocardial infarction emergency management: a pre-post-intervention study

Effective management of emergencies, particularly acute coronary syndrome (ACS), demands rapid, guideline-based interventions to optimize outcomes. However, many medical students and young professionals report feeling unprepared due to limited hands-on experience. Virtual reality (VR) presents a promising training tool, though its efficacy remains unproven.

In this single-center study, 247 medical students were assigned to three different guidance modes to manage a virtual ST-elevation myocardial infarction patient using the Simulation-based Training of Emergencies for Physicians using Virtual Reality (STEP-VR) application. A pre-post-test design, based on European Society of Cardiology (ESC) guidelines, was used to evaluate learning outcomes. Our results showed a significant increase in knowledge after the training. Students in the tutor-moderated ‘human guidance’ group demonstrated the greatest knowledge improvement ($M=+24\text{\%},\mathrm{SD}=13\text{\%}$), being significantly better than the ‘no guidance’ group ($M=14\text{\%}$, $\mathrm{SD}=9\text{\%}$). However, there was no significant difference between the ‘human guidance’ group and the ‘integrated guidance’ group ($M=+19\text{\%},\mathrm{SD}=14\text{\%}$), which used an embedded learning mode within STEP-VR. To evaluate the potential impact on clinical performance, we calculated composite quality indicators based on ESC-defined metrics. Consistently, we found a significant improvement in these indicators [clinical quality indicators (CQI) 0.47 (pre) vs. 0.76 (post) and 0.8 (post), respectively], with no significant difference between the ‘human guidance’ and ‘integrated guidance’ groups.

In conclusion, our findings demonstrate that VR-based acute coronary syndrome/ST-elevation myocardial infarction training is both operationally feasible and educationally effective. Notably, integrated guidance yielded outcomes comparable to tutor-led instruction, underscoring the potential of this approach as a platform for independent, extracurricular learning. While our data suggest VR training may support clinical performance, future studies with objective assessments are needed to confirm its real-world value.