Exploring the Potential of Virtual Reality-Based Procedural Skill Training in Reducing Medical Errors: A Pilot Study

Procedural errors during 12-lead electrocardiography (ECG)particularly from incorrect electrode placement—can distort waveforms and contribute to diagnostic error. We evaluated a virtual-reality (VR) ECG training module that delivers standardized, feedback-rich practice and objective scoring. In a single-arm pre-post pilot at a medical college skills lab, second-year MBBS students <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$(\mathrm{N} = 30)$</tex> completed one guided VR session followed by an evaluation run. The primary outcome was total procedural error score in Evaluation Mode; secondary outcomes covered five domains (patient communication, preparation, lead placement, verification/patient safety, documentation). The platform scored swap errors (e.g., RA↔LA, V1↔V2) and positional misplacements exceeding a predefined geometric tolerance around anatomical targets (e.g., V1/V2 at the fourth intercostal space, V4 at fifth intercostal space mid-clavicular, V6 at mid-axillary). Analyses used Wilcoxon signed-rank tests with rank-based effect sizes <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$r=Z / \sqrt{N}$</tex>; domain inferences-controlled multiplicity (Bonferroni, <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$\boldsymbol{\alpha}_{\text{adj }}=\mathbf{0. 0 1}$</tex>). Total errors fell from <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$51.33 \pm 23.04$</tex> pre-VR to <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$18.08 \pm 18.68$</tex> post-VR <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$(Z=-4.36, \mathrm{p}&lt; 0.001, \mathrm{r}=0.80$</tex>), a 64.8% reduction. Domain improvements remained significant after adjustment for lead placement, preparation, and communication <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$(r=0.68-0.71)$</tex>; verification/patient safety and documentation did not. No sessions were terminated; no adverse events were recorded. A baseline comparison showed no difference in pre-training errors by prior VR exposure (Mann-Whitney <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$Z=-1.48$</tex>, <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$p= 0.139$</tex>). Findings suggest that a brief VR session can substantially reduce ECG procedural errors, particularly for tolerance-based lead placement. Future randomized, blended-learning studies with bedside transfer (OSCE), retention, usability, simulator-sickness metrics, and cost-per-learner analyses are warranted.