As the U.S. population ages, future physicians must be prepared to care for older adults with multiple health conditions and complex needs. This study will test whether cinematic virtual reality (VR)-an immersive, interactive learning tool-is more effective than traditional lectures in helping medical students learn about geriatric care. Students who complete the VR training will experience realistic patient scenarios that show what can go wrong in medical care and learn how to apply osteopathic principles to improve outcomes. Researchers will compare students' performance on a clinical skills assessment and explore their experiences with the VR training. The goal is to determine whether cinematic virtual reality can better prepare students for residency and improve their ability to provide compassionate, high-quality care for older adults.

Background: The United States population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of osteopathic physicians for this aging population, we need to provide training that captures the complexity of geriatric care. Cinematic virtual reality may be an innovative approach to teaching osteopathic medical students about the complexity of care in older adults. Prior research shows cinematic virtual reality's effectiveness in increasing empathy, improving attitudes toward chronic disease, reducing stigma towards disability, and increasing cultural self-efficacy. However, little to no research has compared the effectiveness of cinematic virtual reality to traditional learning methods.

Osteopathic Relevance: The proposed grant aligns with the American Osteopathic Association's mission by emphasizing the role of innovative educational technologies, like cinematic virtual reality, in advancing osteopathic medical education. Cinematic virtual reality is state-of-the-art training that offers an immersive and interactive approach to learn and practice clinical skills in safe, controlled environments, thus enhancing the quality and scope of osteopathic education.

Objective: We propose a two-arm, parallel designed, randomized controlled trial of a Graduate Medical Education (GME) Readiness Assessment with standardized patients to compare the effectiveness of a cinematic virtual reality training group to an attention control group (i.e., traditional didactic lecture). In addition, we will explore osteopathic medical students' experiences with the cinematic virtual reality training.

Methods: We will compare the effectiveness of the cinematic virtual reality training to a standard didactic lecture as preparation for a GME Readiness Assessment. The participants randomly assigned to the cinematic virtual reality training will follow an older adult with multiple geriatric syndromes, chronic health conditions, disabilities, and significant social needs, who is also vulnerable to elder abuse and neglect. The cinematic virtual reality training will show three interactions with physicians who can intervene, but do not, to prevent a bad outcome. The cinematic virtual reality simulations are designed intentionally to demonstrate what not to do in a medical encounter, based on learning theories which suggest that we are more likely to remember our mistakes than our successes. The visual content will be reinforced with a written curriculum addressing key mistakes while highlighting the integration of osteopathic principles, practices, and tenets. Participants in the attention control arm will receive the same written curriculum without the cinematic virtual reality simulations. After both groups complete their trainings, they will participate in a GME Readiness Assessment of an older adult brought to the emergency department for treatment of fever and altered mental status. All GME Readiness Assessments will be videotaped and recorded for blinded grading by osteopathic physicians not affiliated with the project. We will perform statistical analyses to compare GME Readiness Assessment scores by each osteopathic core competency between the cinematic virtual reality group and the standard didactic lecture group. Additionally, we will interview a subset of participants in the cinematic virtual reality group to explore their experiences with this new technology. We hypothesize that the osteopathic medical students in the cinematic virtual reality training group will record higher assessment scores on professionalism, patient care and procedural skills, medical knowledge and clinical reasoning, and interpersonal and communication skills compared to students in the standard didactic lecture group. If our hypothesis is supported, the cinematic virtual reality training may be an effective approach to preparing osteopathic medical students for graduate medical education.

Inclusion Criteria: able to read and speak English, are age 18 years and older, and are a medical student enrolled at the Ohio University Heritage College of Osteopathic Medicine enrolled in the 2025-2026 academic year.

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Exclusion Criteria: unable to read and speak English, 17 years or younger, and are not a medical student enrolled at the Ohio University Heritage College of Osteopathic Medicine enrolled in the 2025-2026 academic year.

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De-identified individual participant data (IPD), including GME Readiness Assessment scores and demographic variables, will be shared with qualified researchers upon request. Data will be available within 12 months of publication and remain accessible for five years. Interested researchers must submit a methodologically sound proposal and sign a data use agreement to ensure confidentiality. Requests will be reviewed by the study team for scientific merit and ethical compliance.

Data will be available within 12 months of publication and remain accessible for five years.

Access to the IPD will be granted to qualified researchers who submit a scientifically sound proposal, agree to a data use agreement protecting confidentiality, and receive approval from the study team.