Abstract
We investigated the effectiveness of Virtual Reality (VR) and three-dimensional (3D)-printed mannequins in replicating stress levels during pericardiocentesis training and compared their impact on learners' emotional and physiological responses. A secondary analysis explored how demographic, lifestyle, and academic factors influence stress responses, providing deeper insights into the variability of physiological markers among medical trainees. We conducted a randomized study involving 108 final-year medical students (mean age: 23.6 years, 87% female) to compare stress responses during pericardiocentesis training using a 3D-printed mannequin and VR model as simulation modalities, both custom-designed by the research team. We investigated the influence of demographic, lifestyle, and academic factors, including medication use and perceived stress, on heart rate variability (HRV) markers. The two simulations showed similar HRV parameters, validating their effectiveness in replicating physiological stress levels associated with clinical scenarios. Secondary analysis revealed significant associations between the low frequency/high frequency ratio and family income and a trend-level effect for anxiolytic use, suggesting an interplay of socioeconomic and pharmacological factors on stress responses. Age and sex interacted significantly with HRV metrics, with younger students demonstrating heightened sympathetic activation. Our results suggest that the incorporation of VR into medical training programs may enhance learning outcomes and accessibility.