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

Abstract Background Immersive 360° video provides consistent demonstrations of clinical procedures. We compared an immersive-video program with conventional simulation, each followed by a common hands-on seminar. Methods Thirty-two teaching subgroups were randomized 1:1. Of 443 consenting second-year nursing students, 442 were analyzed (222 virtual reality [VR]; 220 control). The four-hour first session addressed urinary, nasogastric and rectal catheterization through faculty demonstrations in 360°, questions, feedback and Plus/Delta debriefing without physical practice in VR, or live demonstration and practice on part-task trainers in control. One week later, both arms attended the same four-hour seminar with theory, practice, a three-station objective structured clinical examination (OSCE) scored independently by two blinded assessors, and a 30-item knowledge test. Knowledge was reassessed four weeks after Session 1. Within the VR arm, an exploratory paired analysis compared satisfaction with previous VR experiences and with the study seminar. Linear models accounted for clustering by teaching subgroup; item-level analyses were exploratory. Results Mean composite OSCE scores were 87.33 ± 5.05 in the VR arm and 70.70 ± 8.51 in the control arm, on a 0–100 scale. The age- and sex-adjusted difference was 16.65 points (95% CI 14.37–18.94; wild cluster bootstrap, p < 0.001). Performance scores favored VR across all three procedures. Knowledge scores, on a 0–30 scale, were 19.02 ± 2.84 versus 14.12 ± 3.78 immediately after the common seminar and 19.45 ± 2.75 versus 15.21 ± 3.83 four weeks after Session 1. The unadjusted between-arm difference at four weeks was 4.24 points (cluster-robust 95% CI 3.24–5.24). Exploratory item-level analyses favored VR on ten checklist items, whereas material preparation favored control. Within the VR arm, satisfaction with the study seminar was higher than with previous VR experiences. Conclusions Immersive 360° video with questions and debriefing, followed by hands-on practice, improved simulated procedural performance compared with conventional training. The findings support this blended sequence, not replacement of physical practice or an isolated effect of immersion. Knowledge outcomes require caution because of measurement limitations. Trial Registration Retrospectively registered on the Open Science Framework on 6 July 2026: 10.17605/OSF.IO/T5JSW.