Virtual Reality Improves Confidence and Short-Term Retention During Tibial Intramedullary Nail Insertion: A Randomized Trial

Surgeon self-confidence is a valued trait that may be built over time and can improve surgeon-patient relationships. The authors seek to study how the use of Virtual Reality (VR) impacts the confidence of a naive trainee. Twenty-five first- and second-year medical students were recruited to compare methods of preparation for intramedullary tibial nail insertion. Participants were randomized into groups that used a technique guide, VR simulation, or both. Each completed an assessment of confidence and retention before and after preparation. Procedural confidence was significantly higher in the VR and combined groups in three of the four parameters evaluated: confidence with steps, confidence with a compact bone model, and confidence performing the surgery with an a!ending present. Retention of procedural steps was significantly higher in VR and combined groups. A trainee’s confidence and short-term retention of a procedure can be improved through virtual reality simulations. Improved confidence may foster improved autonomy and improve trainee education. (Journal of Surgical Orthopaedic Advances 35(1):041 – 044, 2026)

Key words: virtual reality, tibial nail insertion, residency education, confidence, retention