Nursing students who watched faculty demonstrations filmed in immersive 360-degree video went on to perform markedly better in simulated catheterization procedures than students trained through conventional simulation, according to a cluster randomized trial published in Advances in Simulation. The study, led by María del Carmen Agüera-Bolea and colleagues, randomly assigned 32 teaching subgroups of second-year nursing students to one of two training pathways, each followed by an identical hands-on seminar one week later.

The trial enrolled 443 consenting second-year nursing students, of whom 442 were included in the analysis: 222 in the virtual reality arm and 220 in the control arm. The first session lasted four hours in both arms and covered urinary, nasogastric and rectal catheterization. In the virtual reality arm, students watched faculty demonstrations recorded in 360-degree video, followed by questions, feedback and Plus/Delta debriefing, with no physical practice in virtual reality. In the control arm, students received live demonstrations and practiced on part-task trainers.

One week after that first session, both groups attended the same four-hour seminar consisting of theory and practice. Procedural skill was assessed with a three-station objective structured clinical examination, scored independently by two blinded assessors, alongside a 30-item knowledge test. Knowledge was reassessed four weeks after the first session. Statistical models accounted for clustering by teaching subgroup, and item-level analyses were treated as exploratory.

The difference in procedural performance was substantial. Mean composite OSCE scores were 87.33 ± 5.05 in the virtual reality arm versus 70.70 ± 8.51 in the control arm, on a 0–100 scale. After adjustment for age and sex, the between-arm difference was 16.65 points, with a 95% confidence interval of 14.37 to 18.94 and a wild cluster bootstrap p value below 0.001. Performance scores favored the virtual reality approach across all three procedures tested.

Knowledge scores also differed between the arms. On a 0–30 scale, the virtual reality group scored 19.02 ± 2.84 versus 14.12 ± 3.78 in the control group immediately after the common seminar. Four weeks after the first session, the corresponding scores were 19.45 ± 2.75 and 15.21 ± 3.83, an unadjusted between-arm difference of 4.24 points with a cluster-robust 95% confidence interval of 3.24 to 5.24. The authors cautioned that knowledge outcomes require care in interpretation because of measurement limitations.

Exploratory item-level analyses of the checklist added nuance to the overall picture. Ten individual checklist items favored the virtual reality arm, whereas material preparation favored the control arm. This pattern suggests that the immersive-video pathway strengthened most scored elements of procedural performance while leaving some practical preparation steps better served by conventional hands-on training.

Within the virtual reality arm, an exploratory paired analysis compared student satisfaction with the study seminar against satisfaction with previous virtual reality experiences. Satisfaction with the study seminar was higher, indicating that the specific educational design used in the trial, rather than immersion alone, may have driven the positive response.

The authors were explicit about what the findings do and do not show. Immersive 360-degree video combined with questions and debriefing, followed by hands-on practice, improved simulated procedural performance compared with conventional training. However, they emphasized that the results support this blended sequence, not the replacement of physical practice or an isolated effect of immersion. The trial was retrospectively registered on the Open Science Framework on 6 July 2026.

For educators designing clinical skills curricula, the trial offers a practical model: a consistent, repeatable immersive demonstration can precede, rather than replace, supervised physical practice. Because the study was conducted among second-year nursing students within a single training program and assessed performance in a simulated OSCE setting rather than real patient care, the authors’ conclusions remain scoped to simulated procedural performance, with knowledge findings requiring caution because of measurement limitations.

Subject of Research: A cluster randomized trial comparing immersive 360-degree video training with conventional simulation for teaching catheterization procedures to nursing students.

Article Title: From immersive observation to procedural performance: a cluster randomized trial of training in catheterization procedures among nursing students

Article References: Agüera-Bolea, M. D. C., Fernández-Molina, P., Portillo-Castaño, F. J., Valero-Merlos, E., García-Ibáñez, P., & Navarro-Sánchez, S. (2026). From immersive observation to procedural performance: a cluster randomized trial of training in catheterization procedures among nursing students. Advances in Simulation. https://doi.org/10.1186/s41077-026-00492-1

Image Credits: AI Generated

DOI: 10.1186/s41077-026-00492-1

Keywords: nursing education, virtual reality, 360-degree video, simulation, catheterization, OSCE, cluster randomized trial, clinical skills, debriefing, knowledge retention, healthcare training, immersive learning