Virtual Reality versus Screen-Based 3D Anatomy Applications for Teaching Lower Gastrointestinal Anatomy: A Pilot Randomized Controlled Trial (Preprint)

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BACKGROUND Undergraduate anatomy teaching has faced sustained pressure from reduced curricular time, diminished access to cadaveric dissection, and variable teaching quality. The lower gastrointestinal tract (GI), with its complex three-dimensional (3D) relationships between the small and large bowel, mesentery, and vasculature, is particularly difficult to teach using conventional two-dimensional (2D) resources. Immersive virtual reality (VR) offers stereoscopic visualization that may better support spatial understanding, but high-quality comparative trials evaluating VR against other digital (non-VR) platforms for lower GI anatomy remain scarce. OBJECTIVE To compare the effects of an immersive VR platform (3D Organon) with a non-immersive, screen-based 3D anatomy platform (Human BioDigital) on medical students' knowledge, confidence, and spatial understanding of lower GI anatomy. METHODS This prospective, multicenter pilot randomized controlled trial was conducted across four workshops at the Universities of Bristol and Exeter, following CONSORT e-Health guidelines. Medical students were randomized to VR (via PICO 4 Ultra headsets) or non-VR (via laptop), with both groups completing an identical structured task list of lower GI anatomical structures over a 20-minute session; participants subsequently crossed over to the alternate modality. Knowledge was assessed via a 10-item multiple-choice question test; confidence, spatial understanding, presence, and usability were assessed via pre- and post-session Likert-scale questionnaires. Within-group changes were analyzed using Wilcoxon signed-rank tests, and between-group differences using Mann–Whitney U tests. RESULTS Forty-three participants were analyzed (VR = 26, non-VR = 17). The VR group showed significant within-group improvements in MCQ score (change = 1.48 ± 1.887; P=0.003) and confidence in lower GI anatomy (change = 1.00 ± 1.020; P=0.001), while the non-VR group did not (MCQ P=0.091; confidence P=0.444); however, between-group differences in these changes were not statistically significant (MCQ P=0.607; confidence P=0.139). In contrast, VR was rated significantly higher than non-VR across all measures of spatial understanding and immersion, including depth perception (3.88 ± 0.993 vs 2.71 ± 1.047; P=0.001) and sense of presence (4.08 ± 1.017 vs 2.47 ± 1.281; P=0.001). When asked to choose directly, participants overwhelmingly preferred VR for spatial relationships (91%), enjoyment (91%), and future preference (79%), with non-VR favored only for ease of use by a minority (28%). CONCLUSIONS VR produced significant short-term gains in knowledge and confidence not observed with a non-VR digital platform, though between-group differences did not reach significance. VR demonstrated a clear, consistent advantage in spatial understanding and immersion. These findings support VR as a promising adjunct to conventional lower GI anatomy teaching, warranting larger, longer-term trials incorporating objective measures of presence and cognitive load.

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