VR-Live Hybrid Neurosurgery Clerkship:Boosting Neurosurgical Presence & Decisions

Enhancing Clinical Presence and Decision-Making in Neurosurgical Clerkships: A Hybrid Model Integrating Virtual Reality and Live-Streamed Encounters

The goal of this randomized controlled trial was to learn whether a hybrid telemedicine curriculum that combines virtual-reality (VR) simulation with interactive live-streamed neurosurgical cases improves neurosurgical intentionality and clinical decision-making in fourth-year medical students whose clerkships were disrupted by COVID-19. It also assessed technical skills, theoretical knowledge, and student experience. The main questions it aimed to answer were:

Does the 4-week hybrid model (VR + live cases) produce greater gains in neurosurgical intentionality and decision-making than traditional online videos and readings? Does the hybrid model improve VR technical skill performance and student satisfaction without harming theoretical knowledge? Researchers randomized 112 students 1:1 to the hybrid intervention (15 h VR neuroanatomy/procedures + 20 h live-streamed surgeries/ICU rounds + real-time Q&A) or a time-matched control group (pre-recorded videos, textbook readings, asynchronous forums).

Participants in both groups:

Completed 40 hours of remote content over 4 weeks Were tested at baseline and post-course on intentionality (modified Zwisch scale), decision-making (neurosurgery-specific SCT), 50-item MCQ knowledge, and VR proficiency metrics Joined focus groups and rated satisfaction on a 5-point Likert scale

Study Overview

• Status: Completed
• Conditions: Telemedicine; Virtual Reality
• Intervention / Treatment: Other: VR Simulation (15 hours)+Live-Streamed Neurosurgical Procedures (20 hours)+Live-Streamed Neurocritical Care Rounds (5 hours)

• Study Type: Interventional
• Enrollment (Actual): 112
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Sichuan
    • Chengdu, Sichuan, China
      • West China Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Fourth-year medical students assigned to the neurosurgical clerkship rotation
2. Able to participate fully in remote learning (stable internet and VR-headset compatible computer)
3. Provided written informed consent

Exclusion Criteria:

1. Had already completed a prior neurosurgical elective
2. Lacked reliable internet access or hardware required for VR/live-streaming
3. Declined to consent or unable to complete the 4-week curriculum

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Group	Other: VR Simulation (15 hours)+Live-Streamed Neurosurgical Procedures (20 hours)+Live-Streamed Neurocritical Care Rounds (5 hours); VR Simulation (15 hours): Customized modules on the NeuroVR Platform (validated for neurosurgical education):Neuroanatomy (5 hours): 3D interactive models of cerebral cortex, brainstem, cranial nerves, and spinal cord (with vascular/meningeal overlays).Procedural skills (10 hours): Craniotomy basics, ventriculostomy, lumbar puncture, and spine decompression-with real-time feedback on instrument handling and anatomical precision.; Live-Streamed Neurosurgical Procedures (20 hours): 18 diverse cases (brain tumor resection [n=6], spine fusion [n=5], aneurysm clipping [n=3], epilepsy surgery [n=4]) via HIPAA-compliant Zoom for Healthcare. Each session included:Pre-procedure briefing (anatomical landmarks, surgical goals).Intraoperative expert commentary (neurosurgeon + neuroanesthesiologist).Real-time Q&A (focused on neurocritical decision-making: e.g., "How do you adjust resection for eloquent cortex mapping?").; Live-Streamed Neurocritical Care Rounds (5 hours): Week
No Intervention: Control group; Pre-recorded neurosurgical videos (20 hours): Matched case types from the Neurosurgical Education and Training Resource (NETR) library, with voiceover but no interactivity.; Textbook/journal readings (15 hours): Chapters from Neurosurgery: The Essential Guide and articles from Journal of Neurosurgical Education (aligned with case content).; Asynchronous case discussions (5 hours): Text-based forums on the institution's LMS, moderated by faculty (48-hour response window).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neurosurgical Intentionality	Neurosurgical Intentionality: Intervention group post-intervention scores were compared with controls, the higer the score, the better the outcome	4 weeks
Clinical decision-making score	Clinical Decision-Making Score Range: 24-120 points (5-point Likert, 24 items) Levels: 24-48 = low 49-84 = moderate 85-120 = high The higher the score, the better the outcome	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Theoretical Knowledge	These comprised of theoretical knowledge with 50-item multiple-choice-questions (MCQ) exam on neuroanatomy, pathology, and surgical indications ,the higer the score, the better the outcome	4 weeks
Technical Skill Performance score	Technical Skill Performance with VR proficiency metrics such as time to completion, anatomical accuracy, and instrument error rate from NeuroVR's built-in assessment tool. The higer the score,the better the outcome	4 weeks
Student experience score	Student experience using semi-structured focus groups such as 6 groups of 8-10 students/group and reflective journals, analyzed via Braun & Clarke's thematic analysis ; and satisfaction using 12-item Likert scale (1=strongly dissatisfied to 5=strongly satisfied) measuring curriculum relevance, engagement, and skill development. The higher the score, the better the outcome	4 weeks

Collaborators and Investigators

• Sponsor: West China Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2023
• Primary Completion (Actual): April 30, 2024
• Study Completion (Actual): December 1, 2024

Study Registration Dates

• First Submitted: December 2, 2025
• First Submitted That Met QC Criteria: December 11, 2025
• First Posted (Actual): December 26, 2025

Study Record Updates

• Last Update Posted (Actual): December 26, 2025
• Last Update Submitted That Met QC Criteria: December 11, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Neurosurgical education; live-streaming; clerkship training
• Other Study ID Numbers: WestChinaH-HX-2025-03

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Protocol
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No