Virtual reality enhances ophthalmic anatomy learning: experimental evidence on comparable outcomes with peer and expert facilitators

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BACKGROUND: The aim of this study is to evaluate the effectiveness of virtual reality (VR) for learning ophthalmic anatomy and to determine whether peer-assisted facilitation produces learning outcomes comparable to expert-assisted facilitation among preclinical medical students. A secondary objective was to contextualize learning outcomes by comparing performance of preclinical students with that of senior medical students receiving expert-assisted VR instruction. METHODS: This is a prospective controlled experimental study with repeated-measures assessments. Second-year (preclinical) medical students without prior formal ophthalmic anatomy instruction were recruited voluntarily (peer-assisted n = 31, expert-assisted n = 32). Exclusion criteria included previous VR-based ophthalmic anatomy training, history of severe motion sickness or vertigo, or refusal to provide consent. In addition, fifth-year medical students undertaking their ophthalmology clerkship participated in a parallel prospective pre-post cohort (n = 61 baseline; n = 55 completed the intervention). All participants first attended a conventional didactic lecture on ophthalmic anatomy. Second-year students then completed an immersive VR learning session exploring a stereoscopic 3D model of the globe and adnexa using a head-mounted display. Sessions were facilitated either by an anatomy faculty expert or by trained peer facilitators. Fifth-year students completed the same instructional sequence with expert-assisted VR only. The primary outcome was change in anatomy knowledge measured by a 20-item assessment administered at baseline (T0), after didactic instruction (T1), and after VR (T2). RESULTS: Among second-year students, knowledge scores improved significantly across timepoints (repeated-measures ANOVA: F(2,124) = 251.0, p<.001, η²ₚ=0.802). Post-VR scores were comparable between peer-assisted and expert-assisted groups (15.1 ± 3.1 vs. 15.2 ± 3.4; t(61 =-0.12, p=.905, d=-0.03). Simulator sickness scores were low and did not differ between groups (4.2 ± 4.0 vs. 3.7 ± 3.7; p=.649), and satisfaction ratings were high in both conditions. Among fifth-year students, knowledge scores also increased significantly across instructional stages (F(2,106) = 33.4, p<.001, η²ₚ=0.387). Despite higher baseline scores among senior students (t(121)=-3.17, p=.002), post-VR performance was comparable between cohorts (t(115) = 1.11, p=.269). CONCLUSIONS: Peer-assisted facilitation produced learning outcomes comparable to expert-assisted instruction while maintaining high learner satisfaction and minimal simulator sickness. These findings suggest that peer facilitation may represent a scalable approach for implementing VR-based anatomy education.