Virtual reality simulation for chemotherapy drug spill management training in pharmacy education: A cohort-allocated crossover quasi-experimental study in Taiwan.

Authors

Yen-Lin Chang, Yi-Chen Lin, Liang-Ching Hung, Hsiu-Mei Chen, Tsu-Yi Hsieh, Chih-Ho Yen

Published in

BMC medical education. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

Hazardous drugs such as antineoplastic agents pose occupational risks to healthcare workers, making appropriate chemotherapy spill management essential for workplace safety. Hands-on training opportunities in pharmacy education are often limited by safety concerns and resource constraints. Virtual reality (VR) simulation may provide immersive, guided rehearsal without hazardous-drug exposure, but comparative evidence remains limited.
This study examined changes in pharmacy interns' self-perceived knowledge, understanding, and ability following VR simulation-based training and traditional instructor-led instruction and explored whether short-term changes differed between the two cohort-defined instructional orders.
This cohort-allocated crossover quasi-experimental study included 37 pharmacy interns at a tertiary medical center in Taiwan. Instructional order was assigned by training cohort rather than by individual randomization and was completely confounded with cohort and calendar period. Cohort 1 (n = 17) received instructor-led instruction followed by VR training; Cohort 2 (n = 20) received the reverse order. Four single-item domains-knowledge of spill-kit contents, understanding of spill-management procedures, ability to independently don personal protective equipment (PPE), and ability to independently manage a spill-were assessed using a 5-point response scale at baseline, after the first intervention, and after crossover. Non-parametric tests were used.
After the first session, self-perceived scores increased significantly across all four items in both cohorts (all p < 0.001). The instructor-led-first cohort showed greater first-phase changes than the VR-first cohort in self-perceived knowledge of spill-kit contents (p = 0.006) and ability to independently don PPE (p = 0.047); differences in the other two items were not statistically significant. These findings could not be attributed to instructional modality alone. Following crossover, second-phase change scores did not differ significantly between the cohort-defined orders (p = 0.221-0.956). All participants met the prespecified satisfaction criterion for the VR training (37/37, 100.0%; rating ≥ 4/5); 27 (73.0%) identified instructor-led explanation combined with VR as the most helpful option, and 28 (75.7%) indicated that VR could not replace instructor-led explanation.
Both first-session instructional approaches were followed by short-term increases in pharmacy interns' self-perceived knowledge, understanding, and ability. Because instructional order was completely confounded with cohort and calendar period, the absence of significant second-phase differences neither establishes equivalence between the orders nor rules out an instructional-order effect. VR may serve a complementary rather than competing instructional role and provide a safe approach for rehearsing hazardous-drug spill-management procedures. These conclusions are limited to short-term self-perceived outcomes and post-training learner perceptions.

PMID:
42410407
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

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