1. Introduction
The integration of emerging technologies in education has transformed teaching and learning processes, enabling innovative tools that facilitate the understanding of complex concepts (Jumman et al. 2024). In this context, Virtual Reality (VR) stands out for its capacity to represent abstract content virtually and three-dimensionally, which is particularly valuable in disciplines requiring detailed visualization, such as physiology (Mohd et al. 2023; Yao 2024; Serrano-Ausejo & Mårell-Olsson 2024; Steen et al. 2024; Antón-Sancho, Vergara & Fernández-Arias 2024).
The present study focuses on applying VR as an open educational resource for teaching physiology within the Health Sciences. In addition to enhancing content assimilation, it examines VR’s contribution to developing transversal competencies such as critical thinking, problem-solving, and collaboration skills essential for professional performance in dynamic and evolving environments. In alignment with the commitments set forth by the UNESCO Dubai Declaration on Open Educational Resources (UNESCO 2024), which promotes equitable access to knowledge as a digital public good, this research supports integrating open emerging technologies like VR to enrich the educational experience in higher education settings. The use of this immersive educational technology responds to international calls for transforming education through accessible, collaborative, and inclusive means while also reinforcing the principles of Open Science by fostering the democratization of knowledge, the reuse of content, and the creation of high-value digital public goods for pedagogical innovation.
1.1 Generic Competencies
In higher education, generic competencies are essential skills that all students must develop regardless of their academic discipline. These competencies include critical thinking, problem-solving, collaboration, empathy, effective communication, and digital literacy skills that are fundamental for a successful transition from university to the professional world (Concepción et al. 2023; Hyytinen, Tuononen & Braun 2023). In the Health Sciences, these competencies are especially critical, as professionals are required to demonstrate strong leadership, interdisciplinary collaboration, and advanced digital skills to effectively operate in complex and dynamic healthcare environments (Pramila-Savukoski et al. 2024).
VR has emerged as an innovative and effective tool for developing these competencies. It offers immersive learning environments in which students engage with simulated complex scenarios that actively promote critical thinking and problem-solving within safe and controlled settings (Cabrera-Duffaut, Pinto Llorente & Iglesias Rodríguez 2020; Phillips, Jarden & Bowles 2024). Moreover, recent studies indicate that VR can significantly enhance socio-emotional competencies such as empathy and interpersonal communication by enabling students to interact from diverse social and cultural perspectives (Trevena, Paay & McDonald 2024). Additionally, the three-dimensional visualization and direct interaction with anatomical models in VR reinforce spatial competencies that are essential in medical and scientific disciplines (Antón-Sancho, Vergara & Fernández-Arias 2024).
This technological approach is grounded in connectivism, a learning theory emphasizing the importance of preparing students and educators to interact effectively with advanced technological tools and continuously adapt to ongoing educational innovations (Hegade et al. 2024).
1.2 Application in Physiology Teaching
Physiology requires a detailed understanding of anatomical and physiological processes, many of which are difficult to visualize through traditional teaching methods. In this regard, VR is a highly effective pedagogical tool capable of simulating interactive three-dimensional environments that allow students to explore the human body visually and immersively (Koolivand et al. 2024). These immersive environments replicate complex internal systems in real time, providing an experiential context that enhances comprehension and promotes spatial awareness—key skills in medical education.
The adoption of this technology in physiology teaching is grounded in its ability to promote more profound and enduring learning, significantly improving students’ information retention. VR enables the safe repetition of complex procedures, supporting virtual clinical practice that strengthens the practical competencies required in Health Sciences (Pears et al. 2024). Furthermore, the ability to manipulate virtual anatomical models enables students to engage actively in inquiry-based and constructivist learning processes.
Recent studies emphasize that VR significantly enhances the understanding of physiological content and increases student interest and motivation, fostering active and meaningful learning that transcends traditional methods (Ma et al. 2023; Antón-Sancho, Vergara & Fernández-Arias 2024).
1.3 Acceptance and Comparison with Traditional Methods
The acceptance of VR in university educational contexts has grown significantly in recent years, mainly due to its transformative potential compared to traditional teaching methods. Recent studies show that instructors and students view VR positively, recognizing its ability to provide more dynamic, immersive, and effective learning experiences (Ghazali et al. 2024). This perception is further reinforced by the increasing availability of affordable VR hardware and the growing repository of discipline-specific immersive content tailored for higher education.
VR enhances student engagement and participation by combining practical visualization with theoretical knowledge, better-preparing learners to face current and future challenges in educational and professional settings (Neha, Khan & Kurubacak 2024). Compared to conventional methods, VR significantly promotes active learning, autonomy, and critical thinking—competencies that are essential for comprehensive student development (Wang, Wang & Shen 2024).
Moreover, comparative studies have demonstrated that academic performance and student motivation tend to be higher in educational environments that incorporate VR than in those relying solely on traditional methods. Predescu, Caramihai and Moisescu (2023) reported increased cognitive engagement in students using the EduAssistant platform, which leverages immersive technologies such as interactive virtual classrooms.
Similarly, platforms like vRed have shown notable advantages over traditional approaches, particularly in online learning contexts, by offering more interactive and engaging experiences that considerably improve educational effectiveness (Rahman & Islam 2023). Another study by Albarracín-Acero et al. (2024) reinforces these findings, highlighting significant improvements in students’ understanding and participation when VR is used compared to conventional teaching methods.
Finally, current educational research emphasizes that integrating VR into the classroom helps overcome the inherent limitations of traditional methodologies, providing enriched educational experiences that effectively meet the contemporary demands of university-level learning (Ramos & Júnior 2024; Forsler 2024).
2. Research Objectives
The general objective of this study is to analyze the impact of VR, implemented as an open educational resource, on the learning of physiology among Health Sciences students and to assess how this technology contributes to developing transversal competencies essential for professional performance. It also seeks to understand how immersive learning environments influence motivation, engagement, and the personalization of learning experiences in real educational settings.
The specific objectives are as follows:
To evaluate the effect of VR use on students’ academic performance in physiology, comparing outcomes with those achieved through traditional teaching methods.
To analyze short- and medium-term knowledge retention resulting from the use of VR.
To determine the extent to which VR influences the development of key generic competencies, such as critical thinking, problem-solving, decision-making, adaptability, and interdisciplinary collaboration.
To explore students’ and instructors’ acceptance and perceptions of VR as a teaching method, identifying its advantages, challenges, and opportunities over conventional approaches.
To identify potential practical and pedagogical implications of VR for its sustainable integration into open educational ecosystems, in alignment with the principles of open education and open science outlined in the Dubai Declaration on Open Educational Resources (UNESCO 2024).
These objectives aim to establish VR’s contribution as an innovative and open pedagogical tool and provide evidence-based recommendations for its effective use in higher education contexts, particularly in Health Sciences curricula where spatial, procedural, and interactive learning is vital.
3. Methodology
The study employed a quasi-experimental design with non-equivalent control groups (Reichardt, Storage & Abraham 2023; Miller, Smith & Pugatch 2020). A total of 163 first-year Dentistry students from the Universidad Catolica de Cuenca participated in the research. These students were distributed across seven class sections at two campuses (Cuenca and Azogues), ensuring a representative and diverse sample.
The institution’s enrollment process determined student allocation to groups without researcher interference, preserving the authenticity of the academic context. This resulted in the formation of an experimental group (VRG, n = 100), which engaged with immersive VR environments (Figure 1), and a control group (CG, n = 63), which conducted traditional laboratory practices using cadaveric dissection methods (Figure 2). Both groups followed the same academic content and schedule, ensuring consistency across instructional variables.
Figure 1
Educational Technology Innovation Classroom – ITEVR – VRG.
Figure 2
Dissection Laboratory – CG.
The sample size was calculated using G*Power software based on a moderate effect size (0.5), a significance level of 5%, and a statistical power of 91.61% (Verma & Verma 2020; Kang 2021; Haile 2023). The participant groups were formed homogeneously, following predefined inclusion and exclusion criteria. This methodological rigor ensured the comparability between units of analysis. Such variability highlights the need to establish standardized guidelines that support both the comparability and reproducibility of findings in future research (Li et al. 2024).
3.1 Study Variables
The variables considered in this study were:
Level of learning: Assessed through quantitative tests administered before, immediately after, and 15 days following each of the four practical sessions.
Generic competencies: Measured using pre- and post-test questionnaires administered at the beginning and end of the academic term.
3.2 VR Systems and Applied Software
The sessions were conducted in classrooms with high-performance computers (RTX 2060) and Meta Quest 2 headsets connected via Meta Link. The implemented software was Sharecare YOU VR, which provides interactive 3D anatomical models, physiological simulations, and visualizations of pathological processes, facilitating an immersive and detailed learning experience.
3.3 Practical Sessions in the ITE VR Classroom
Four specific practical sessions were conducted as part of the physiology course: (a) Gas transport (pulmonary structures and respiratory function); (b) Cardiovascular physiology (cardiac structure and function); (c) Skeletal muscle physiology (muscle contraction); and (d) Renal function and micturition (renal structures and function).
3.4 Analysis of Learning Level Comparison Between Groups
Each practical session was conducted in groups of approximately 15 students, who either used individual VR stations (VRG) or followed traditional methods (CG). Evaluation tests were administered at three points: before, immediately after, and 15 days following each session. The assessments consisted of five dichotomous and multiple-choice questions, including image-based items, delivered via a MOOC educational platform and graded on a 10-point scale.
During the VR sessions, students explored the internal physiological systems of the human body within an immersive environment.
3.5 Verification of the Increase in Students’ Generic Competencies
An online questionnaire was administered to evaluate generic competencies. The instrument was validated through a three-stage process: a literature review to define theoretical constructs, expert validation by 10 specialists using Aiken’s V, and a pilot test involving 322 students to refine the final version. An exploratory factor analysis (EFA) confirmed the high reliability of the instrument (Cronbach’s alpha = 0.993). The questionnaire assessed seven key dimensions: Professional knowledge, Decision-making, Digital skills (ICT), Interpersonal skills, Practical application of knowledge, Lifelong learning capacity, and adaptability to change.
A 5-point Likert scale was used to quantitatively measure changes in these competencies before and after the implementation of VR (Table 1).
Table 1
Competency Dimensions.
| CODE | DIMENSIONS | DESCRIPTION |
|---|---|---|
| D1 | Knowledge | VR and its impact on understanding the field of study and professional area |
| D2 | Decision-Making | VR and the ability to make informed decisions |
| D3 | ICT Skills | VR and the acquisition of information and communication technology skills |
| D4 | Interpersonal Skills | VR and the development of interpersonal communication and teamwork abilities |
| D5 | Practical Application | VR and the application of knowledge in real or simulated professional practice |
| D6 | Lifelong Learning | VR and the capacity for continuous learning and self-updating |
| D7 | Adaptability | VR and the ability to adapt to new or changing situations |
4. Results
The following section presents the results obtained from the educational intervention using VR, highlighting the comparison of learning outcomes between the experimental group (VRG) and the control group (CG) and the analysis of the generic competencies developed by the students.
4.1 Comparison of Learning Levels Between VRG and CG
Initially, both groups showed similar levels of academic performance, with no statistically significant differences in the diagnostic assessment (VRG = 5.86, CG = 5.61, Table 2). However, following the implementation of VR, significant improvements were observed in the VRG, with mean scores surpassing those of the CG both in the immediate post-practice assessment (VRG = 7.92, CG = 7.04) and in the 15-day retention test (VRG = 7.99, CG = 6.34).
Table 2
Descriptive Statistics of the Study.
| GROUP | DIAGNOSTIC | DIAGNOSTIC | POST-PRACTICE | POST-PRACTICE | PRACTICE 15 DAYS | PRACTICE 15 DAYS |
|---|---|---|---|---|---|---|
| Statistics | SD | SD | SD | |||
| GC | 5.61 | 1.50 | 7.04 | 1.29 | 6.34 | 0.980 |
| GRV | 5.86 | 1.51 | 7.92 | 1.28 | 7.99 | 1.06 |
Statistical analysis revealed highly significant differences (p < 0.001) in favor of the VRG during the post-intervention phases, using the Mann–Whitney U test due to partial violations of normality assumptions (Table 3). The effect size increased over time, ranging from small (0.3671) in the post-practice phase to large (0.7386) in the 15-day retention assessment (Table 4).
Table 3
Statistical Tests.
| TESTS | P_VALUE NORMALITY | P_VALUE HOMOSCEDASTICITY LEVENE’S | P_VALUE MANN-WHITNEY | |
|---|---|---|---|---|
| CG | VRG | |||
| Diagnosis | 0.23 | 0.4 | 0.93 | 0.2961 |
| Post-Practice | 0.58 | 0.02 | 0.88 | 0.0001 |
| 15 Days | 0.04 | 0.1 | 0.92 | 0.0000 |
Table 4
Effect Size Magnitudes for Learning Outcomes.
| TEST | P_VALUE ROSENTHAL |
|---|---|
| Diagnostic | –0.1687 |
| Post-Practice | 0.3671 |
| 15-Day | 0.7386 |
Graphical representations using boxplots and trend charts illustrate these results, showing a favorable progression for the VRG compared to the CG (Figure 3 and Figure 4). The improvement percentage in the VRG was notable (25.93%), in contrast with a reduction observed in the CG (–9.87%), highlighting the effectiveness of the VR-based educational intervention in supporting knowledge retention and consolidation (Figures 5, 6, and 7).
Figure 3
Score Comparison Between Groups.
Figure 4
Performance Progression in Both Groups.
Figure 5
Comparison of Mean Scores in Diagnostic, Post-Practice, and 15-Day Retention Assessments.
Figure 6
Comparison of Improvement Percentages in Post-Practice and 15-Day Retention Assessments.
Figure 7
Trend Analysis of Percentage Improvement Between Post-Practice and 15-Day Assessments.
4.2 Pre-Test and Post-Test Analysis to Assess the Improvement of Generic Competencies Through the Use of VR
The analysis of generic competencies using pre-test and post-test questionnaires revealed statistically significant improvements in six out of the seven assessed dimensions: professional knowledge (D1), decision-making (D2), interpersonal skills (D4), practical application (D5), autonomous learning (D6), and adaptability to change (D7). Based on the Wilcoxon signed-rank test, which was applied due to the non-normal distribution of the data (see Table 5), p-values ranged from 0.00111 to 0.0296.
Table 5
Normality Analysis and Statistical Tests for Generic Competencies.
| DIMENSIONS | PRE-TEST | POST-TEST | P_VALUE WILCOXON | EFFECT COHEN’S | P_VALUE NORMALITY |
|---|---|---|---|---|---|
| D1 | 3.99 | 4.12 | 0.0155 | 460. | 0.0000000196 |
| D2 | 3.79 | 3.95 | 0.0296 | 476. | 0.000125 |
| D3 | 4.10 | 4.15 | 0.0885 | 326. | 0.00000000120 |
| D4 | 3.94 | 4.10 | 0.0135 | 455. | 0.000000317 |
| D5 | 3.96 | 4.15 | 0.00274 | 461. | 0.0000000183 |
| D6 | 3.97 | 4.15 | 0.00599 | 452. | 0.0000000258 |
| D7 | 3.97 | 4.19 | 0.00111 | 383. | 0.00000000148 |
Effect sizes, calculated using the r coefficient, confirmed moderate to significant impacts (0.35–0.45), with the most substantial gains observed in the adaptability to change dimension, followed by the practical application of knowledge. In contrast, the digital skills (ICT, D3) dimension showed only a marginal improvement (p = 0.0885), suggesting that this specific competency may require additional or complementary interventions.
The comparative pre- and post-test graph (Figure 8) clearly illustrates these improvements, highlighting the potential of VR to enhance key competencies for professional practice, such as adaptability and the practical application of knowledge.
Figure 8
Pre and Post-Test Comparison of Generic Competency Scores.
5. Discussion
The results of this study highlight VR as an effective educational tool capable of significantly improving academic performance and enhancing key competencies in university students. The findings show that immersive experiences facilitate deeper and longer-lasting learning by fostering greater cognitive and emotional engagement than traditional methods (Radianti et al. 2020; Johnson-Glenberg 2018). These results also suggest that VR promotes intrinsic motivation and student-centered learning, offering learners the opportunity to construct knowledge through active exploration and experiential engagement.
The performance gap observed between the experimental group (VRG) and the control group (CG), particularly evident in the 15-day retention assessment, underscores a standard limitation of conventional teaching: its reduced ability to sustain learning without additional reinforcement strategies. In contrast, VR provides safe and realistic environments where students can explore and consolidate knowledge, promoting autonomy, risk-free experimentation, and effective visualization of complex content (Makransky & Mayer 2022). Additionally, the multisensory stimulation inherent to VR environments may activate different cognitive pathways, reinforcing conceptual acquisition and memory retention.
From a broader perspective, these results align with the guidelines in the Dubai Declaration on Open Educational Resources, advocating for equitable access to knowledge through open digital technologies (UNESCO 2024; González-Pérez, Ramírez-Montoya & García-Peñalvo 2022). This approach facilitates the sharing and reuse of content under open licenses, fostering collaboration and educational innovation in line with the principles of Open Science (OECD 2020).
Moreover, using VR influences academic achievement and supports the development of transversal competencies such as practical knowledge application and interpersonal skills. These competencies, critical in today’s professional environments, are enhanced through immersive pedagogical practices that promote active interaction, critical thinking, and creative problem-solving (Cabrera-Duffaut, Pinto-Llorente & Iglesias-Rodríguez 2024). Notably, these gains are not limited to cognitive domains but extend to socio-emotional dimensions of learning, encouraging empathy, communication, and collaborative engagement in authentic contexts.
Nevertheless, it is essential to note that the success of VR implementation depends on its proper integration into the pedagogical process, the training of instructors in its practical use, and its adaptation to the specific needs of the student population (Jensen & Konradsen 2018; Castañeda & Selwyn 2018).
Ultimately, this research reaffirms the importance of viewing emerging technologies such as VR not merely as instrumental tools but as transformative agents that contribute to more democratic, inclusive, and open education, strengthening collaborative and sustainable learning ecosystems.
6. Future Research Directions and Implications
The findings of this study provide a foundation for numerous future research avenues. The demonstrated effectiveness of VR in enhancing both academic performance and generic competencies highlights the need to explore its application across broader educational contexts and disciplines. Future studies should focus on evaluating the long-term retention and transferability of knowledge acquired through immersive learning, particularly in professional practice environments where real-time decision-making and adaptability are crucial.
Another promising direction involves examining how individual learner differences—such as prior technological familiarity, cognitive styles, or motivation—interact with immersive environments to influence learning outcomes. Personalized VR experiences, driven by learning analytics and adaptive systems, could potentially maximize the educational impact on diverse student populations.
Additionally, research is needed to analyze how extended and repeated exposure to VR environments shapes the development of socio-emotional and collaborative skills over time. Integrating mixed-method and longitudinal designs could offer richer insights into these evolving competencies.
Beyond the educational outcomes, VR’s influence on student well-being, engagement, and academic identity warrants further investigation. Studies should also assess the scalability and sustainability of integrating VR into institutional curricula, considering the infrastructural, pedagogical, and financial challenges.
These emerging lines of inquiry are essential to solidify VR’s role not only as a learning enhancer but as a transformative educational paradigm aligned with the principles of open, inclusive, and future-ready education.
7. Conclusions
This study confirms that Virtual Reality is an effective pedagogical strategy for significantly improving academic performance and fostering the development of essential generic competencies in university students. The experimental group demonstrated a 25.93% improvement, in contrast with a 9.87% decrease in the control group, indicating a significant and lasting impact.
The VR intervention was particularly effective in strengthening competencies related to practical knowledge application, autonomous learning, and adaptability to change fundamental skills for facing real and evolving challenges in professional environments. Additionally, improvements in conceptual knowledge, decision-making, and interpersonal skills underscore VR’s capacity to promote holistic, critical, and collaborative learning.
From the perspective of open education and open science, the results reinforce the notion that VR, when used as an open educational resource, can democratize access to advanced educational experiences, enabling equitable and sustainable competency development. This approach not only enhances academic learning but also contributes to the growth of open, collaborative, and innovative educational ecosystems aligned with the Dubai Declaration.
Finally, the study carefully emphasizes the need to integrate VR into broader pedagogical strategies, considering specific contextual and methodological factors to maximize its transformative potential in higher education.
Data Accessibility Statement
Please email the corresponding author to obtain raw data.
Ethics and Consent
The study was conducted at the Universidad Catolica de Cuenca and reviewed and approved by the University of Cuenca external Bioethics Committee (CEISH) (reference: 2022-024ECEX-IE). All participants provided informed and voluntary consent, ensuring confidentiality and the exclusive use of the data for academic and scientific purposes.
Acknowledgements
The authors would like to express their deep gratitude to the Universidad Catolica de Cuenca and, in particular, to its Chancellor, Dr. Enrique Pozo Cabrera, for the support provided in carrying out this research, which was developed within the framework of the project PICCOVID-19-3, and in creating the ITEVR classrooms with their methodology. We also extend our gratitude to the doctoral program ‘Training in the Knowledge Society’ at the University of Salamanca for its academic and scientific guidance, which has significantly contributed to the development of this work.
Competing Interests
The authors have no competing interests to declare.
Author Contributions
Augusto Cabrera-Duffaut: Conceptualization; Investigation; Formal analysis; Writing – original draft; Data curation; Visualization.
Ana María Pinto-Llorente: Conceptualization; Methodology; Project administration; Supervision; Writing – review & editing.
Ana Iglesias-Rodríguez: Conceptualization; Methodology; Project administration; Supervision; Writing – review & editing.