Immersive versus Partially Immersive Virtual Reality for Training Clinical Reasoning and Patient Management in Undergraduate Medical Education

Background: Virtual reality (VR) is increasingly used in medical education, yet it remains unclear whether higher levels of immersion improve learning outcomes, particularly for learning clinical reasoning and patient management. This study compared fully immersive and partially immersive VR conditions using identical curriculum-aligned emergency medicine scenarios for undergraduate medical students.Methods: We conducted a counterbalanced crossover study with third-year, undergraduate medical students at UNSW Sydney. Participants (n = 91) completed two emergency department scenarios developed by Oxford Medical Simulation in a fully immersive (head-mounted display) and partially immersive (laptop) modality. Each scenario was attempted twice with immediate feedback and faculty debriefing. Primary outcomes were objective performance scores generated by the platform’s standardised scoring rubric. Secondary outcomes included change in self-reported confidence in technical and non-technical skills and learner experience, assessed through quantitative and qualitative survey responses. Results: Seventy-five students completed both sessions. Performance significantly improved from first to second attempt in both modalities. Performance scores did not significantly differ between head-mounted display and laptop modalities (p = .069, d = .21). Confidence in technical and non-technical skills increased in both modalities with no between-modality differences. Student preference was divided: 55% favoured laptop-based simulation and 45% favoured head-mounted display. Qualitative analysis identified three themes: immersion versus usability, technical and physical constraints, and educational value. Students in both groups reported that VR was valuable for developing clinical reasoning skills in a safe environment.Conclusions: Immersion level did not affect objective performance or confidence in clinical reasoning and patient management training. Head-mounted display simulation increased perceived realism, but laptop-based simulation offered comparable educational value with fewer practical barriers. Both modalities appear effective for teaching clinical reasoning and patient management. Educators may prioritise laptop-based virtual reality for scalability while reserving head-mounted displays for scenarios where enhanced presence is deemed essential.