A randomized controlled trial comparing 2D video and virtual reality for distance learning of FAST in initial trauma care

Background Virtual reality (VR) is increasingly applied in medical education, but its effectiveness compared with conventional two-dimensional (2D) video remains unclear. This study compared VR and 2D video for distance learning of Focused Assessment with Sonography for Trauma (FAST) and examined psychological learning effects including self-efficacy, intrinsic value, emotional engagement, and comprehension. Methods We conducted a randomized controlled trial across five medical schools and university hospitals in Japan. Eligible participants were fourth- to sixth-year medical students and first- or second-year residents. Participants were stratified by institution and randomly assigned to 2D or VR groups. Both groups attended a 30-minute remote lecture on initial trauma care and viewed a 10-minute live-action FAST procedure in either 2D or VR. Primary outcomes were psychological indicators (self-efficacy, intrinsic value, emotional engagement); secondary outcomes were subjective comprehension and post-test scores. Outcomes were measured pre- and post-lecture using validated scales. Multiple regression analysis evaluated associations between VR use and outcomes, and subgroup analysis was conducted based on prior FAST experience. Results A total of 64 participants were included (2D, n = 33; VR, n = 31). No significant differences were observed between groups for psychological outcomes (self-efficacy: B = -0.62, 95% confidence interval [CI] -5.62 to 4.38, p = 0.80; intrinsic value: B = 0.44, 95% CI -2.72 to 3.59, p = 0.78; emotional engagement: B = 0.98, 95% CI -2.12 to 4.08, p = 0.53). Post-test scores were significantly higher in the VR group compared with 2D (B = 0.27, 95% CI 0.02 to 0.52, p = 0.03). Subgroup analysis showed that among participants with prior FAST experience, VR tended to increase intrinsic value (B = 2.22, 95% CI -1.33 to 5.77, p = 0.21) and emotional engagement (B = 2.16, 95% CI -1.46 to 5.78, p = 0.24). In contrast, among those without prior FAST experience, intrinsic value (B = -3.61, 95% CI -11.77 to 4.56, p = 0.34) and emotional engagement (B = -2.11, 95% CI -10.92 to 6.69, p = 0.59) tended to be lower in the VR group. However, none of these differences were statistically significant. Conclusions VR was not superior to 2D video for psychological learning outcomes but might improve knowledge acquisition and showed differential motivational effects depending on prior FAST experience. VR may be particularly effective for reinforcing procedures with which learners already have familiarity, supporting its targeted use in trauma education.