Currently submitted to: JMIR Medical Education
Date Submitted: Feb 23, 2026
Open Peer Review Period: Feb 24, 2026 - Apr 21, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Smells Like Real-World Spirit: Olfactory Cues Trigger Patient Safety Behavior in VR Medical Simulation
ABSTRACT
Background:
Simulation-based medical education is essential for improving patient safety. In virtual reality (VR)–based simulation, immersion is primarily generated through visual and auditory cues, while other sensory modalities are typically absent. This sensory limitation may reduce the emergence of authentic safety-relevant behaviors. Olfaction plays an important role in clinical reasoning, risk perception, and self-protective behavior and is closely linked to memory and emotion. Although olfactory cues have been shown to influence hand hygiene behavior in real or simulated-real environments, their targeted integration into fully immersive VR-based medical simulation has not been systematically examined.
Objective:
This study aimed to investigate whether adding a real olfactory cue (disinfectant scent) to a fully virtual clinical simulation increases patient safety–relevant behavior, specifically hand hygiene compliance (hand disinfection and glove usage).
Methods:
In a randomized controlled study at the University of Münster (winter term 2025/26), 89 medical students participated in a VR-based clinical simulation. Study rooms were pre-assigned to either an olfactory intervention or a control condition, and participants selected their room without knowledge of the assigned condition. Hand hygiene and glove use were automatically tracked as outcomes. Odds ratios were calculated to assess the effect of the intervention on these behaviors.
Results:
The olfactory intervention nearly tripled the odds of hand disinfection (OR = 2.81, 95% CI 1.09–7.75, P = 0.037), while no significant difference was observed for glove use (OR = 1.62, P = 0.278).
Conclusions:
The integration of a real olfactory cue into a fully immersive VR medical simulation significantly increased hand disinfection behavior, particularly after patient contact, but did not affect glove use. These findings suggest that olfactory augmentation can selectively reinforce safety-relevant behaviors in digital training environments. Incorporating real-world sensory cues into VR may represent a simple yet effective design strategy to enhance behavioral authenticity and patient safety outcomes in simulation-based medical education. Clinical Trial: not applicable
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