
==== Front
BMC Med Educ
BMC Med Educ
BMC Medical Education
1472-6920
BioMed Central London

5991
10.1186/s12909-024-05991-1
Research
Investigating the impact of virtual simulation experiment and massive open online course (MOOC) on medical students’ wound debridement training: a quasi-experimental study
Zhang Wang 1
Xie Zhe 1
Li Jingfeng 2
Liu Changhuan 1
Wang Zheng 1
Xie Yadian 3
Liu Yuping 4
Li Zonghuan 1
Yang Xiaqing 1
Fang Xue 1
Wang Xinghuan 5
Wei Renxiong renxiong.wei@whu.edu.cn

23
Wang Xin wangxinznyy@whu.edu.cn

156
1 https://ror.org/01v5mqw79 grid.413247.7 0000 0004 1808 0969 Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei China
2 https://ror.org/01v5mqw79 grid.413247.7 0000 0004 1808 0969 Department of Spine and Bone Oncology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei China
3 https://ror.org/01v5mqw79 grid.413247.7 0000 0004 1808 0969 Teaching Affair Office, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei China
4 grid.13291.38 0000 0001 0807 1581 Department of anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, 610066 Sichuan China
5 https://ror.org/033vjfk17 grid.49470.3e 0000 0001 2331 6153 Department of Surgery, Second Clinical College, Wuhan University, Wuhan, 430071 Hubei China
6 https://ror.org/01v5mqw79 grid.413247.7 0000 0004 1808 0969 Elderly Hip Fracture Diagnosis and Treatment Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei China
18 9 2024
18 9 2024
2024
24 102329 7 2024
4 9 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Objective

This study aims to evaluate the impact of virtual simulation experiment teaching model and Massive Open Online Course (MOOC) teaching model on the teaching effect in debridement teaching.

Methods

The study adopted a quasi-experimental design and used virtual simulation technology to construct a virtual simulation experimental teaching platform for debridement. This study was conducted at the Second Clinical College of Wuhan University. The experimental group was composed of 135 third-year clinical medicine students in the 2020 grade, who received the virtual simulation experimental teaching model; the control group was 122 third-year students in the same major in the 2019 grade, who used the MOOC teaching model. The performance of the two groups of students was evaluated through theoretical tests and animal experiment operation. In addition, the effectiveness of the experimental teaching model and student satisfaction were evaluated through questionnaire surveys.

Results

The theoretical test scores and animal experiment report scores of the experimental group were significantly higher than those of the control group, and the debridement animal experiment operation time of the experimental group was shorter than that of the control group, and the difference was statistically significant (P < 0.05). The post-class questionnaire survey of the experimental group showed that most students were satisfied with the virtual simulation experimental teaching model and believed that it represented the future teaching trend.

Conclusions

In the teaching of debridement, virtual simulation experiment is an effective t teaching model, which not only helps to improve student performance, but also significantly reduces skill operation time and is recognized by students.

Keywords

Virtual simulation experiment
Massive open online course
Medical education
Wound debridement training
Quasi-experimental study
First-class Undergraduate Curriculum Construction Project of Hubei Province2023044 2023044 2023044 2023044 2023044 2023044 2023044 2023044 2023044 2023044 2023044 2023044 2023044 Key Project of Teaching Construction of Wuhan University School of Medicine2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 2024ZD20 Virtual Simulation Experimental Teaching Innovation Alliance Research Project Establishment2024059 2024059 2024059 2024059 2024059 2024059 2024059 2024059 2024059 2024059 2024059 2024059 2024059 issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcBackground

Virtual simulation experimental teaching is a pedagogical approach that combines virtual reality technology with experimental teaching methods. In recent years, this approach has seen widespread application in disciplines such as surgery, anatomy, and nursing [1–3].Numerous studies have demonstrated that simulation-based learning experiences facilitate the integration of theoretical knowledge with practical skills, allowing learners to develop the competencies necessary for independent practice within environments perceived as authentic [4–6].

General Surgery Experiment is a course on basic surgical operating skills. It is a professional core course for undergraduates in clinical medicine. It is a basic ability that medical students must possess [7]. Among them, experimental teaching is the connection between theoretical teaching and clinical practice. As one of the basic operations in the general experiment of surgery, debridement is a key part of the compulsory basics of surgery. The main purpose of debridement is to remove foreign matter, necrotic tissue and bacteria in the wound and create good conditions for wound healing. In the medical education of general surgery experiments, how to effectively teach debridement skills is crucial to improving clinical practice capabilities. Massive Open Online Course (MOOC) is a digital course that utilizes digital technology and large databases to store teaching videos, learning content, and online test questions on an Internet platform [8].However, MOOC teaching method face many challenges in actual operation, such as lack of practical operation and low interaction [9]. Therefore, how to effectively improve students’ experimental operation skills has become one of the urgent problems to be solved in the current teaching reform of debridement experimental course.

The virtual simulation experiment platform is a computer-based system that replicates real experimental environments and processes using virtual reality, augmented reality, 3D modeling, and data interaction [10, 11].At present, surgical virtual simulation experiments mainly focus on virtual endoscopy and orthopedic learning procedures or concepts [12], virtual simulation experiments have not been fully utilized in clinical medicine [13], the use of virtual simulation experimental platforms in debridement teaching has not yet been reported. Virtual simulation experimental teaching holds considerable practical significance in debridement experimental courses. It enhances skills and knowledge retention, offers a safe learning environment, boosts learner interest, and conserves medical teaching resources [14–16]. In addition, by playing the role of virtual doctors, students can cultivate their professionalism early and improve their medical humanistic qualities.

This study compares the virtual simulation experimental teaching model with the MOOC teaching model to analyze the impact of the virtual simulation experimental platform on teaching debridement courses, aiming to explore its potential application in medical education.

Characteristics of debridement virtual simulation experiment

Experimental principle

The experimental teaching of debridement through virtual simulation adopts an immersive interaction-driven approach, integrating independent learning, human-computer interaction, practice, and assessment. It allows students to learn the treatment process and operational steps of debridement through three-dimensional virtual simulation animations and interactive operations. The platform focuses on clinical scenarios for debridement of moderately injured wounds, specifically those with tendon rupture, this is what our course requires of undergraduates. The scenarios are accurately configured to include the open wound status, ongoing treatment actions, and relevant medical equipment. The platform showcases changes in the wound during the debridement process, aiding in the comprehension of different knowledge points and the relationships between various operational steps. Debridement virtual simulation experiment website (https://www.ilab-x.com/details/page?id=10474&isView=true).

Virtual simulation core design

Virtual simulation core design focuses on the debridement scenario of moderately injured wounds with tendon rupture that medical undergraduates should master. The system allows users to enter the practice or assessment module, where they encounter the initial scene with the open wound configuration, treatment actions, and relevant medical equipment. Through three-dimensional interactive teaching, users can engage in dynamic simulation and interactive control, enabling them to view and learn operating steps from various angles, cross-sections, perspectives, rotations, and zooming features. The design also allows for three-dimensional free perspective, where users can rotate, zoom, and pan through the operating parts. Changes in the wound during the debridement process can be displayed in different viewing angle modes, helping users understand the relationship between each knowledge point and operation step. The system emphasizes learning the kessler suture method of tendon as part of basic skills training, providing interactive exercises for mastery. The interface is user-friendly, offering realistic experimental scenarios and operation interactions to enhance the sense of experience and interactivity. The debridement virtual simulation experiment platform is shown in Fig. 1.

Fig. 1 Debridement virtual simulation experiment platform. A: Home page of the debridement virtual simulation experiment platform website; B: Being asked to adjust the order of debridement experiment steps before the virtual simulation experiment; C: Experimental practice and assessment module; D: Debridement The “wound disinfection” operation in the virtual simulation experiment of debridement; E:“Tendon kessler suture method” in the virtual simulation experiment of debridement; F: Schematic diagram of the postoperative treatment steps in the virtual simulation experiment of debridement

Methods

Study design and participants

This study was designed as a quasi-experimental study. The experimental group included 135 third-year students majoring in clinical medicine who were enrolled in 2020 and received virtual simulation experimental teaching on debridement. The control group comprised 122 third-year students majoring in clinical medicine who were enrolled in 2019 and received the MOOC teaching method. Although both groups of students did not receive our teaching in the same year, they both received a different teaching model of debridement in the first semester of their junior year. The sample inclusion criteria were: (i) no prior learning experience in debridement experimental courses; (ii) no previous exposure to debridement virtual simulation and debridement MOOC; (iii) obtaining informed consent from all research participants. Exclusion criteria: (i) Students who have received debridement study; (ii) have not completed debridement virtual simulation experiment teaching or MOOC teaching; (iii) have received teaching but have not completed the questionnaire and test paper. This study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University (2022144 K), and informed consent was obtained from all study participants, confirming their understanding of the study’s purpose, process, potential risks and benefits, and their voluntary participation. Our study did not involve clinical trials, so there was no clinical trial number. We only sent questionnaires to the study population and collected objective data of the exam, which also obtained their informed consent.

Learning program

Experimental group (accepting the virtual simulation experimental teaching model, including virtual simulation experimental platform training, theoretical teaching, and animal experiment classes) and the control group (accepting the MOOC teaching model, including watching the debridement teaching video before the experimental class (no virtual simulation experiment Platform training), theoretical teaching, animal experiment classes). The design of this study is shown in Fig. 2.

Experimental group teaching process

The students in the experimental group utilized the debridement virtual simulation experimental platform for training. They were tasked with completing the debridement study and assessment module, which consisted of several components. Firstly, knowledge learning, where the system automatically presented information on the definition, purpose, indications, and contraindications of debridement. Subsequently, the students were assessed on the general operating procedures of debridement. Skill training involved working with 3D virtual open wounds of varying degrees, preparing for debridement and suturing, performing intra-operative procedures, and managing post-operative treatment. The system had two main sections: the learning module and the assessment module. Through the assessment module, students could directly evaluate their mastery of debridement and identify areas for improvement in knowledge and skills. Following independent learning, students in the experimental group took part in a debridement animal experiment class. Prior to the experiment, students spent 15 min in the classroom learning the theoretical aspects of debridement.

Control group teaching process

The control group implemented the MOOC learning model and studied on the Wuhan University Luojia online platform (http://www.mooc.whu.edu.cn/entry/). During this process, students were required to complete all course studies. After the students in the control group completed independent learning, they participated in the debridement animal experiment class. Before the animal experiment class, the students were arranged to the classroom and learned the theoretical knowledge of debridement for 15 min in the on-site class. The Wuhan University Luojia online platform is shown in Fig. 3.

Fig. 2 Design of the research study

Fig. 3 Luojia Online MOOC Platform of Wuhan University. A-B: Schematic diagram of the website providing a “General Surgery Experiment course” on the Luojia Online MOOC platform of Wuhan University; C-F: The specific operating steps of the debridement animal experiment, which include demonstrating the operation of removing the wound edge skin, rinsing the wound, and suturing the wound

Assessment of teaching effectiveness

Teaching effect evaluation encompasses various components, such as theoretical tests on debridement theory, evaluation of debridement animal experiment reports, and post-teaching questionnaires administered to two groups of students. The theoretical test aims to assess students’ grasp of theoretical knowledge pertaining to debridement. Both groups of students undergo a closed-book theoretical knowledge test before and after the teaching intervention. All students are required to complete this test. Evaluation indicators for the debridement animal experiment report include teacher ratings and operation time. In our study, 2 teachers were responsible for assessing students. Students in each grade were assessed by 2 teachers from the same teaching team and specifically trained to ensure consistency and standardization of grading. Following the teaching session, participant satisfaction is gauged through a questionnaire utilizing a Likert scale. Each item is scored on a scale of 1 to 5, where 5 represents ‘strongly agree’, 4 represents ‘agree’, 3 represents ‘not necessarily’, 2 represents ‘disagree’, and 1 represents ‘strongly disagree’. The questionnaire for the experimental group comprises a survey on learning effect satisfaction, evaluation of virtual simulation experiment projects, and assessment of virtual simulation experiment applications. Conversely, the questionnaire for the control group only focuses on learning effect satisfaction, as they did not utilize the virtual simulation experiment platform for learning purposes. The questionnaires were distributed via the Questionnaire Star online platform (https://www.wjx.cn/). The questionnaire was developed for this study and has been added to the supplementary material. The overall Cronbach’s alpha of the questionnaire is 0.981, indicating strong reliability, while the KMO value of 0.941 suggests good validity.

Statistical analysis

The data obtained were entered into IBM SPSS 23.0 software and data were presented as mean ± standard deviation (SD). Independent t-tests were used for continuous variables that fit a normal distribution, such as age, test scores, and Likert scale scores, nonnormally distributed data were analyzed using non-parametric Mann-Whitney U rank sum test, chi-square test was used for categorical variables such as gender. A significance level of P < 0.05 was used.

Results

Comparison of general information on the two groups of students

The two groups of students were comparable in terms of age and gender distribution (Table 1).

Table 1 The basic information of students

	Experimental
Group(n = 135)	Control
Group (n = 122)	t/χ2-value	P-value*	
Age	21.66 ± 0.80	21.52 ± 0.74	1.477	P = 0.141	
Sex					
Male [n (%)]	69(51.1%)	60(49.2%)			
Female [n (%)]	66(48.9%)	62(50.8%)	0.096	P = 0.757	
*Significant differences when p-value < 0.05

Comparison of theory test scores between the two groups of students

The results of the theory test scores showed that there was no statistically significant difference between the scores of the experimental group (70.59 ± 11.51) and the control group (71.64 ± 11.60) in the pre- theoretical test, whereas the scores of the experimental group (96.00 ± 8.03) in the post-t theoretical test at the end of the course were significantly higher than those of the control group (77.87 ± 11.52) as shown in Table 2.

Table 2 Results of theoretical test scores

	Experimental
Group(n = 135)	Control
Group(n = 122)	t-value	P-value*	
pre-theoretical test	70.59 ± 11.51	71.64 ± 11.60	-0.725	P = 0.469	
post-theoretical test	96.00 ± 8.03	90.49 ± 9.78	4.904	P = 0.000	
*Significant differences when p-value < 0.05

Two groups of student’s debridement animal experiment course experimental report results

The results showed that the teacher’s score in the lab report of the animal laboratory class on debridement was higher in the experimental group (93.67 ± 1.58) than in the control group (83.83 ± 5.87). In addition, the operation time of debridement was significantly lower in the experimental group (84.63 ± 9.62) than in the control group of students (96.71 ± 17.28) (P < 0.05, Table 3).

Table 3 Results of the debridement experiment report

	Experimental
Group(n = 24)*	Control
Group (n = 24)*	t-value	P-value*	
Teachers’ ratings	93.67 ± 1.58	83.83 ± 5.87	7.931	P = 0.000	
operating time	84.63 ± 9.62	96.71 ± 17.28	-2.992	P = 0.005	
*Number of groups in experiment class. Significant differences when p-value < 0.05

Two groups of students learning effectiveness satisfaction questionnaire results

The questionnaire participation rate was 89.63% (121/135) in the experimental group and 91.80% (112/122) in the control group. The scores of the student satisfaction questionnaire showed that students in the experimental group were more satisfied with the training compared with the control group, and the difference between the two groups was statistically significant (Table 4). The item with the lowest score for the experimental group was “Teacher-student and student-student interaction”, while the item with the lowest score for the control group was “Increase course interest”.

Table 4 The comparisons of the learning effectiveness satisfaction levels of experimental group and control group

Project Evaluation Score	Experimental
Group(n = 121)	Control
Group (n = 112)	t-value	P-value*	
Increase course interest	4.58 ± 0.70	4.01 ± 0.92	5.293	P < 0.05	
Improve learning efficiency	4.65 ± 0.65	4.17 ± 0.82	4.964	P < 0.05	
Deepen the understanding of theoretical content	4.69 ± 0.63	4.23 ± 0.81	4.851	P < 0.05	
Improve surgical skills	4.69 ± 0.63	4.12 ± 0.85	5.785	P < 0.05	
Improve clinical thinking ability	4.64 ± 0.70	4.15 ± 0.76	5.077	P < 0.05	
Improve the effect of experimental learning	4.72 ± 0.62	4.24 ± 0.76	5.219	P < 0.05	
Teacher-student and student-student interaction	4.55 ± 0.78	4.21 ± 0.76	3.435	P < 0.05	
Reduce the burden of learning surgical skills	4.60 ± 0.68	4.12 ± 0.84	4.868	P < 0.05	
Improve analytical and problem-solving skills	4.65 ± 0.70	4.18 ± 0.83	4.687	P < 0.05	
Enhance professionalism	4.68 ± 0.65	4.22 ± 0.76	4.908	P < 0.05	
*Significant differences when p-value < 0.05

Results of questionnaire survey on virtual simulation experiment of experimental group

Regarding the feedback from the questionnaire, in the evaluation of virtual simulation experiment project, the experimental group had high satisfaction ratings of greater than 4.5 for “Virtual simulation experiment scene realistic”“Comprehensive course knowledge”“Smooth operating system”“Accurate evaluation criteria and analysis”(Figure 4). In the evaluation of the application of virtual simulation experiments, more than 90 per cent of the experimental group answered “satisfied” and “very satisfied”. Students believe that the virtual simulation experiment platform is better for learning compared to traditional teaching methods and is the trend for future course teaching. (Fig. 5).

Fig. 4 Results of the questionnaire survey on the evaluation of virtual simulation experiment project of experimental group. In the figure, the horizontal coordinate is the questionnaire question, and the vertical coordinate is the score value of Likert scale

Fig. 5 Results of the questionnaire survey on the evaluation of application of virtual simulation experiment in experimental group. The numbers 1, 2, 3, 4, and 5 after the color squares in the figure represent Likert scale scores respectively; The horizontal coordinate in the figure is the corresponding score, the proportion of students

Discussion

MOOC construction is a successful model in the reform of theoretical teaching, MOOC advances medical education and practice [17, 18]. MOOC teaching method exhibit limitations in terms of authenticity, objectivity, timeliness, and the frequency of feedback from instructors [19]. Moreover, students frequently experience boredom and distraction during these sessions. To address these challenges, the surgical field has increasingly embraced virtual simulation technology [20]. Virtual simulation systems not only facilitate repeated practice opportunities without posing risks to patients, but they also offer real-time feedback for both educators and learners.

This study has developed a virtual simulation experimental teaching platform specifically for debridement, thereby addressing a gap in the virtual simulation training for this procedure. The objective of this study is to investigate the effectiveness of virtual simulation experimental technology in debridement education and to leverage advanced technology to enhance the teaching process.

Virtual simulation experimental teaching helps improve students’ debridement experimental learning results

This study compared the effects of virtual simulation experimental teaching and MOOC teaching in debridement education. Prior to the debridement experimental class, there were no statistically significant differences in test scores between the two groups. However, after the experimental class, the students in the experimental group scored significantly higher than those in the control group. These results indicate that virtual simulation experimental teaching can enhance students’ understanding of surgical theories and lead to improved exam performance, aligning with previous research findings [21, 22]. The assessment of students’ surgical practical skills is conducted through debridement animal experiment classes. Evaluation of students’ practical operation outcomes is based on teachers’ ratings and operation time documented in the experimental report. Findings indicated that students in the experimental group outperformed those in the control group during debridement experimental teaching, as evidenced by shorter operating times and higher scores in the experimental report. A blend of simulation and deliberate practice has been proven to be more effective in skill acquisition compared to the traditional Halsted method, this is consistent with previous studies [23–25]. The results of this study show that after virtual simulation experimental teaching, the theoretical performance and operational skills of the experimental group are better than those of the control group. Indicating that the teaching design is effective and should continue to be used in the future. Our findings contrast with previous studies [26–28] by comparing virtual simulation experimental teaching with MOOC teaching, rather than traditional classroom methods. More importantly, we integrated debridement with virtual simulation experiments, demonstrating that this teaching design is effective. Consequently, the use and promotion of virtual simulation experiments in the continuation of debridement teaching is warranted.

Virtual simulation experimental teaching helps improve students’ learning initiative and is recognized by students

The results of the questionnaire survey revealed that the experimental group exhibited higher satisfaction with the learning outcomes compared to the control group, indicating that virtual simulation experimental teaching effectively enhanced students’ learning motivation. Interestingly, the item receiving the lowest score in the experimental group was ‘Teacher-student and student-student interaction’, while the control group’s lowest scoring item was ‘Increase course interest’. This suggests that, although virtual simulation teaching can enhance interaction in offline experimental classes, there is room for improvement. Teachers can utilize the virtual simulation experiment system to monitor students’ learning progress, activities, and results, identify challenges faced by students, reinforce positive feedback [29]. In addition, students in the control group believed that MOOC teaching was not very effective in increasing their interest in learning, which was also a shortcoming of the traditional teaching model. However, a similar situation did not occur in the experimental group. The above results can be attributed to the virtual simulation provided by repeated training and student interest in designing experiments. The experimental group showed stronger learning motivation, stronger clinical thinking ability, and the ability to combine theory and practice. These findings are consistent with previous studies [30, 31]. By engaging in virtual simulation experimental teaching, students can practice simulated experimental procedures in a virtual laboratory, gaining a deeper understanding of the process and key aspects of experimental operations. This method effectively enhances experimental skills and operational proficiency [32, 33]. The questionnaire results from the experimental group’s virtual simulation experiment reveal high satisfaction scores above 4.5 points in areas such as ' Virtual simulation experiment scene realistic’, ‘Comprehensive course knowledge’, ' Smooth operating system’, and ' Accurate evaluation criteria and analysis’. Our research indicates that over 90% of the experimental group expressed satisfaction with the use of virtual simulation experiments. They believe that this approach is more conducive to learning compared to traditional teaching methods and view it as a trend in the future development of courses. This finding aligns with results from similar studies [34, 35]. Therefore, the promotion and application of virtual simulation experimental teaching in similar courses is highly recommended [36].

Limitations

However, this study also has some limitations. For instance, the teaching reform was implemented in only one teaching group, indicating the need for multiple repetitions to gather more data and ensure the reliability of the results. Additionally, the main disadvantage of quasi-experimental studies is the lack of random assignment, and the use of randomized controlled trials is considered in the future.

Conclusions

This study utilized virtual simulation technology for debridement experimental teaching, which resulted in enhanced student performance and notable reduction in skill operation time. The virtual simulation experiment was well-received by students, indicating the effectiveness of this teaching framework and its potential for application in similar courses.

Acknowledgements

Not applicable.

Author contributions

Wang Zhang 、Zhe Xie and Jingfeng Li wrote the main manuscript text. Changhuan Liu、Zheng Wang、Yuping Liu、Zonghuan Li、Xiaqing Yang and Xue Fang reviewed the manuscript. Yadian Xie and Xinghuan Wang provided thesis guidance. Xin Wang and Renxiong Wei were responsible for the design of the entire study, planning and implementation. Each author independently reviewed the content of the manuscript. Wang Zhang, Zhe Xie, Jingfeng Li, Renxiong Wei and Xin Wang were the first batch of review authors, and the remaining authors conducted the second batch review to ensure the logic, consistency and completeness of the research. This includes checking the comprehensiveness of the literature review, the accuracy of the data analysis, the reasonableness of the discussion of results, and the standardization of the references.

Funding

1. First-class Undergraduate Curriculum Construction Project of Hubei Province (2023044). 2. Key Project of Teaching Construction of Wuhan University School of Medicine(2024ZD20). 3. Virtual Simulation Experimental Teaching Innovation Alliance Research Project Establishment(2024059).

Data availability

The datasets used and analyzed during the current study available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University(2022144 K), and informed consent were obtained from all study participants.

Consent for publication

Not applicable.

Consent to publish

The person in charge of the virtual simulation experimental platform involved in this study agreed to release the relevant photos involving human faces.

Conflict of interest

All authors declare no conflict of interest.

Wang Zhang, Zhe Xie and Jingfeng Li are co-first authors.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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