Neither virtual reality simulation nor video instructions can replace physical phantoms and human instructions in lumbar puncture training: a randomized controlled trial

Lumbar puncture (LP) skills can be acquired by simulation-based training (SBT) on physical phantoms but experienced instructors are needed which can limit availability and increase costs. Instructional videos are readily available and virtual reality (VR) simulators offer automatic real-time feedback supporting self-regulated learning. However, it is unknown whether these training modalities can fully or partially eliminate the need for human instructors during LP SBT. The study was conducted as a randomized controlled trial in a simulated setting. Medical students without prior theoretical learning or practical experience in lumbar puncture were randomly assigned to one of the two interventions as preparation for LP. The VR simulator group (VR group, n = 12) received feedback from the simulator, while the control group prepared by watching goal- and learner-centered videos (Video group, n = 12). After training, each participant took a validated test on a phantom and underwent additional supervised training if needed. There were no significant differences in outcome performance measures between the two groups (LumPAT, Global Rating, Supervisor Time Consumption, and Global Judgment). Half of the participants in both groups (n = 6) failed the validated test and needed additional supervised training on a phantom. Both the VR group and the Video group experienced less anxiety during the self-regulated training than during the following testing and training with a supervisor (− 2.00, P = 0.002, − 2.00, P = 0.005), but participants in both groups still believed that hands-on supervision was important for better performance (− 1.33, P = 0.018,− 1.25, P = 0.006). Self-regulated VR simulator training and learner-centered video-based learning showed comparable effects on lumbar puncture performance. However, additional instructor-led hands-on training was required by some participants in both groups to achieve the predefined performance standard, suggesting that direct instruction remains an important component of lumbar puncture simulation-based training, even with technological advancements.