Currently submitted to: JMIR Medical Education
Date Submitted: Sep 23, 2026
Open Peer Review Period: Sep 24, 2026 - Nov 19, 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Warning: This is an author submission that is not peer-reviewed or edited.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.
Virtual Immersive Training is Non-inferior to Real-world Simulation in Drug Dispensing: A Three-arm Randomized Controlled Trial
ABSTRACT
Background:
Drug dispensing is a core pharmacy skill and a primary medication safety barrier, yet real-world error rates remain around 2%. Traditional simulation improve competency but are costly. Existing 2D platforms lack realism, while immersive virtual reality (VR) offers greater fidelity. However, evidence regarding VR dispensing training is limited, necessitating theory-informed evaluation of its non-inferiority to real-world simulation.
Objective:
NN
Methods:
A three-arm, non-inferiority trial was conducted with 60 first-year pharmacy students, randomly assigned to Control (no simulation), conventional Physical Analogue Real Table (PART), or the Virtual Immersive Teaching and Learning (VITaL) groups. Design of the VITaL aligned with the meaningful virtual reality learning framework, incorporating cognitive load management, dual coding, and generative learning principles. Participants completed pre-tests to assess baseline knowledge and engaged in VR or real-world dispensing simulations followed by a 10-minute debriefing. Drug dispensing performance was measured using a 12-item OSCE, and time spent on tasks was recorded. Non-inferiority analyses were conducted using generalized pivotal quantity-based methods with 1,000 Monte Carlo simulations, accounting for variance heterogeneity and non-normal distributions.
Results:
Baseline knowledge was similar for the Control and the PART groups, but lower in the VITaL group (statistic H 9.657, p = 0.008). With reference of the Control group, the VITaL (median = 12; IQR 10.5–12) was significantly non-inferiority to the PART group (median = 12; IQR 11–12) in overall drug dispensing performance (p = 0.008). The VITaL was non-inferior to the PART in time for students who passed the pre-test (p = 0.006) but not for those who failed (p = 0.419).
Conclusions:
Virtual reality of drug dispensing simulation offers a viable alternative to traditional training, supporting dispensing competencies and performance. It is recommended that that VR-based educational interventions be grounded in theoretical frameworks to ensure that cognitive, psychomotor and behavioral elements are intentionally aligned Clinical Trial: NN
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.