Enhancing long-term knowledge retention in undergraduate stroke education through virtual simulation: a randomized study

Background Virtual simulation is increasingly used in undergraduate medical education, but its value for long-term retention in stroke teaching remains unclear. This trial compared virtual simulation-based teaching with conventional bedside teaching in undergraduate stroke education. Methods This was a single-center, prospective, parallel-group, randomized educational trial with a 1:1 allocation ratio. Fourth-year undergraduate medical students were assigned to a simulation group or a conventional group. Both groups received the same didactic teaching followed by practical training in different formats with equal teaching hours. Outcomes were assessed 1 day before the module, 1 day after the module, and 10 months later. The primary outcome was the 10-months follow-up assessment score. Secondary outcomes included the post-course assessment score, decay score, and score trajectories over time. Results A total of 110 students were randomized, with 55 assigned to each group; 107 were included in the final longitudinal analysis. At the 10-months follow-up, assessment scores were higher in the simulation group than in the conventional group (median [IQR], 81.0 [77.0–85.5] vs. 74.5 [71.0–78.0]). After adjustment for pre-course assessment score and prior academic performance, the simulation group remained associated with higher follow-up scores (adjusted mean, 81.18 vs. 74.81; adjusted mean difference, 6.37 points; 95% CI, 4.83–7.91; P < 0.001). The primary result remained stable after additional adjustment for self-reported re-exposure during follow-up (adjusted mean difference, 5.92 points; 95% CI, 4.35–7.49; P < 0.001). Post-course scores were also higher and decay scores were lower in the simulation group. No adverse or unintended events were identified. Conclusion Virtual simulation-based teaching was associated with higher immediate post-course scores and better long-term retention in undergraduate stroke education, supporting its use as a valuable adjunct to conventional bedside teaching.