The VICTORIA study: evaluating the effectiveness of synchronous online training and web-based virtual reality training designed for critical care physician residents using a multiple-method approach.

Introduction: The global shortage of intensive care doctors highlights the need for efficient and scalable training methods. Digital education, including virtual reality (VR), provides new opportunities for interactive and flexible learning. Aims: The VICTORIA study compared the effectiveness of synchronous online training and web-based, self-paced VR training for intensive care physicians. Materials and methods: This two-arm, multiple-method study was conducted between April and September 2024. A total of 141 European early-career intensive care residents were randomized to synchronous online training (n=67) or web-based VR training (n=74). Data were collected using different assessment tools: demographics, perceived clinical competence with Entrustable Professional Activities (EPAs), and a knowledge and skills evaluation test. In addition, 18 participants took part in semi-structured interviews exploring their experiences with the two training formats. Quantitative data were analyzed using non-parametric tests and mixed-effect regression models, while qualitative data were analyzed using thematic analysis. Results: 96 participants completed all assessments (47 online, 49 VR). Knowledge and skills scores increased significantly from baseline to immediately after the intervention (β = 11.66, p < 0.001) and remained significantly higher at the four-month follow-up (β = 7.42, p < 0.001). However, a significant decline was observed between the immediate post-intervention and the follow-up evaluation test (β = –4.24, p = 0.014). When comparing the two educational modalities, no statistically significant difference was observed (β = –0.07, p = 0.982). Perceived clinical competence improved in both study arms, although the differences between them were not statistically significant. Qualitative findings highlighted that VR training was perceived as more interactive, motivating, and flexible. Online training was valued for its real-time expert-led discussions and strong foundational content, though participants noted fatigue and information overload due to the delivery format. Conclusions: VR training was non-inferior to synchronous online training. Both modalities improved knowledge, skills, and perceived clinical competence among early-career intensive care physicians. While performance outcomes were comparable, VR provided greater learner satisfaction and flexibility, underscoring its potential as a scalable and sustainable tool for intensive care education.