Research Group "Virtual Reality Simulation in Medical Education"

Research topics

Acceptance and Learning Outcomes of VR Simulation

Since 2020, medical students in their 10th semester have been using the VR training program as part of a curricular seminar accompanying their internal medicine clerkship at a teaching hospital. Following the simulation of virtual patient cases, students participate in structured case discussions with instructors. Within an evaluation study, perceived realism (immersion), potential side effects (simulation sickness and stress), and subjective learning outcomes were assessed. The findings indicate a high level of acceptance of VR-based simulation within the seminar format, along with strong perceived learning gains, moderate stress levels, and negligible simulation sickness.

In a subsequent randomized controlled trial, objective competence gains, their long-term retention, and potential influencing factors (e.g., experienced stress during simulation) were examined. The results suggest that VR learning environments can lead to more sustainable knowledge acquisition compared to traditional teaching methods. This study was supported by the Teaching Research Award 2022 of the Vogel Foundation Dr. Eckernkamp.

Feasibility, Fairness, and Validity of VR-Based Assessments

The use of VR in standardized practical examinations such as Objective Structured Clinical Examinations (OSCEs) aims to overcome limitations of conventional assessment formats, including high personnel and material costs, organizational complexity, and limited scenario realism. Funded by the Foundation for Innovation in Higher Education, the existing VR training program was expanded within the VR-OSCE project (2022–2025) to include an examination interface. The results  demonstrate that VR-based assessments are technically feasible and can achieve at least comparable psychometric quality to traditional formats.

A further study conducted in 2024 used VR simulation to assess the practical skills of early-career resident physicians in managing emergency scenarios. Their objectively measured performance was compared with self-assessments, providing a differentiated picture of clinical competencies: while basic stabilizing measures were generally well performed, deficits were observed in specialty-specific diagnostics and treatment.

Ongoing follow-up studies investigate whether prior experience with VR environments and the ability to operate VR hardware and software (“immersive competence”) influence performance in VR-based assessments. This line of research aims to ensure fairness and prevent disadvantage in future examination settings. In collaboration with the Chair of Human-Computer Interaction at the University of Würzburg, an application for measuring general immersive competence has been developed and tested in a pilot study. Given that current VR systems employ diverse interaction mechanisms, we have also developed an approach to assess immersive competence directly within the application (“in situ”). A recent randomized controlled trial demonstrated a causal relationship between immersive competence and medical performance, highlighting the need for measures to ensure fairness and validity in VR-based assessments.

Development and Evaluation of Interprofessional Multi-User VR Scenarios

In emergency medicine in particular, patient outcomes depend heavily on effective interprofessional collaboration. This subproject aims to extend the VR program with a multi-user functionality, enabling medical students and nursing trainees to jointly manage emergency scenarios in a shared virtual environment. The project was supported and facilitated by WueDive. Since summer 2024, the multi-user functionality has been available, and current research focuses on whether VR environments can effectively support the training of interprofessional teamwork. The training and evaluation are based on the TeamSTEPPS framework, with advisory support from the DACH steering group. Following a pilot phase, the study protocol will be implemented at five additional German sites in early 2025. The Team Performance Observation Tool (TPOT), an established instrument for objective teamwork assessment, has been adapted and validated under our leadership for VR-based scenarios involving interprofessional dyads.

Use of Large Language Models as Virtual Tutors in VR Environments

The project Speaking VirtuAI (Freiraum funding line 2023), funded by the Foundation for Innovation in Higher Education, aims to extend the existing VR learning environment by integrating an AI-based virtual tutor capable of natural language interaction. The project is conducted in collaboration with the Chair for Natural Language Processing (Prof. Goran Glavaš) at the University of Würzburg. This approach is expected to enable a more immersive and individualized learning experience that better accommodates learners’ pace. In addition, it may allow VR-based emergency training to be conducted more frequently and with reduced dependence on teaching staff. Accompanying research investigates whether learning outcomes achieved through AI-based dialogic feedback differ from those obtained through static feedback.

 

Example images of the appearance and use of the VR environment

     

 

Team

• Dr. med. Tobias Mühling (Head of research group)
• Prof. Dr. Sarah König (Head of department)
• Franca Keicher (MD)
• Marco Lindner (MD student)
• Isabelle Späth (MD student)
• Verena Schreiner (MD student)
• Marie Lehmann (MD student)
• Jan Schaal (MD student)
• Alexander Zamzow (MD)
   

Cooperation partners

• OrangeWhip Interactive - Agency for interactive 3D-visualization (co-developer of STEP.VR)
• Chair for Human-Computer Interaction of Wuerzburg University (News | Human-Computer Interaction (uni-wuerzburg.de))
• Chair for Natural Language Processing of Wuerzburg University (Natural Language Processing)
• Institute of Education and Student Afairs, University of Münster (IfAS)
• Non-Profit Vogel-Foundation Dr. Eckernkamp Würzburg (Home - Vogel Stiftung Dr. Eckernkamp)

 

Publications

• J. Schaal, T. Leutritz, M. Lindner, J. Backhaus, S. König, T. Mühling (2025) Immersive competence as a source of bias in virtual reality clinical assessment. npj Digital Medicine (2026). https://doi.org/10.1038/s41746-026-02482-z 
• M. Lehmann, S. Hinz, A. Zamzow, J. Mikulasch, H. Poimann, J. Backhaus, M. Mergen, T. Mühling. Adapting the TeamSTEPPS team performance observation tool for dyadic interprofessional VR simulations (vTPOT): a multi-step validation study. Advances in Simulation (2026). https://doi.org/10.1186/s41077-026-00431-0
• V. Schreiner, J. Backhaus, M. Lindner, M. Heinisch, S. König, S. Oberdörfer, T. Mühling (2025). Specific Immersive Competence in VR-Based Assessments: Development, Psychometric Evaluation and Associations with Medical Performance. JMIR Medical Education (2026). doi: 10.2196/82136 
• S. Oberdörfer, M. Heinisch, T. Mühling, V. Schreiner, S. König, M. Latoschik (2025). Ready for VR? Assessing VR competence and exploring the role of human abilities and characteristics. Frontiers in Virtual Reality. https://doi.org/10.3389/frvir.2025.1608593
• F. Keicher, M. Müller, K. Ruf, C. Härtel, S. König, T. Mühling (2025). Enhancing Pediatric Emergency Training: The Impact of Virtual Reality- Simulations on Medical Student Knowledge and Learning Experience. Virtual Reality. https://doi.org/10.1007/s10055-025-01243-9 
• T. Mühling, L. Demmler, J. Backhaus, S. König (2025). How Personality and Affective Responses are Associated with Skepticism towards Virtual Reality in Medical Training – A Pre-Post Intervention Study. Cyberpsychology, Behavior, and Social Networking. https://www.liebertpub.com/doi/10.1089/cyber.2024.0567
• M. Lehmann, J. Mikulasch, H. Poimann, J. Backhaus, S. König, T. Mühling (2025). Training and Assessing Teamwork in Interprofessional Virtual Reality-based Simulation using the TeamSTEPPS framework – Protocol for a Randomized Pre-post Intervention Study. JMIR Research Protocols https://www.researchprotocols.org/2025/1/e68705
• M. Lindner, T. Leutritz, J. Backhaus, S. König, T. Mühling (2025). Knowledge Gain and the Impact of Stress in a Virtual Reality-based Medical Emergencies Training with Automated Feedback – A Randomized Controlled Trial. Journal of Medical Internet Research  https://www.jmir.org/2025/1/e67412
• T. Mühling, V. Schreiner, M. Appel, T. Leutritz, S. König (2025). Clinical Competency Assessments: A Comparative Study of Virtual-Reality-Based and Traditional Physical OSCE Stations. Journal of Medical Internet Research  https://www.jmir.org/2025/1/e55066
• F. Keicher, J. Backhaus, S. König, T. Mühling (2024). Virtual reality for assessing emergency medical competencies in junior doctors – a pilot study. International Journal of Emergency Medicine. https://doi.org/10.1186/s12245-024-00721-2
• M. Lindner, T. Leutritz, J. Backhaus, S. König, T. Mühling (2023). Kompetenzgewinn und der Einfluss von Stress in einer Virtual Reality-basierten Notaufnahme. Jahrestagung der Gesellschaft für Medizinische Ausbildung 2023. doi: 10.3205/23gma151
• F. Keicher, T. Mühling, M. Müller, K. Ruf, S. König (2023). Von der Theorie in die (simulierte) Praxis – pädiatrische Notfälle in Virtual Reality für PJ-Studierende und BlockpraktikantInnen. Jahrestagung der Gesellschaft für Medizinische Ausbildung 2023. doi: 10.3205/23gma177
• T. Mühling, I. Späth, J. Backhaus, N. Milke, S. Oberdörfer, A. Meining, M. Latoschik, S. König (2023). Virtual reality in medical emergencies training: benefits, perceived stress, and learning success. Multimedia Systems. DOI: https://doi.org/10.1007/s00530-023-01102-0
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