Comparing Human- and Machine-Guided Virtual Reality Training: The Role of Physiological Stress in Learning Outcomes

Abstract

Virtual reality (VR) is increasingly used in medical education due to its capacity to provide immersive, standardized, and scalable training environments, yet direct comparisons between human-guided and machine-guided VR instruction remain limited, particularly regarding the role of learners’ physiological responses. The present study compared human-guided (IG) and machine-guided (MG) VR-based Basic Life Support (BLS) training and examined whether physiological stress responses during training and examination phases moderated learning outcomes. Fifty-five undergraduate students completed a VR BLS session under either IG (N = 25) or MG (N = 30), followed by a VR-based exam assessing learning outcomes. Electrodermal activity (EDA) was recorded continuously as an index of physiological stress, with mean EDA values computed separately for the training and exam phases, and participants also reported their sense of presence in the virtual environment. Independent samples t-tests indicated no significant group differences in physiological stress during either the training or exam phases, suggesting comparable levels of physiological activation across instructional modalities. In contrast, participants in IG reported a significantly higher sense of presence than those in MG. An ANCOVA controlling for presence and stress levels during both phases revealed a significant main effect of instructional group on exam performance, with participants in IG achieving higher scores than those in MG, while none of the covariates significantly predicted performance. These findings indicate that the benefits of human-guided VR instruction extend beyond differences in average physiological arousal or subjective presence.

Keywords: Basic Life Support, Virtual Reality, Stress, Learning

DOI: 10.54941/ahfe1007476