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