Implementation of an International Virtual-World Competition for Radiology Residents: A Multicenter Feasibility Study Across Spanish-Speaking Countries.

RATIONALE AND

OBJECTIVES

Resident Debil is an immersive, team-based virtual-world learning game for radiology residents. We conducted an international multicenter implementation to evaluate its feasibility, acceptability, and scalability across Spanish-speaking countries.

MATERIALS AND

METHODS

In this prospective multicenter implementation study, radiology residents from Spanish-speaking countries participated in a six-week competition covering thoracic, musculoskeletal, neuroradiology, abdominal, breast, and emergency imaging. Activities were predominantly asynchronous, accommodating different clinical schedules and time zones. Weekly educational panels supported self-directed learning before competitive challenges including individual multiple-choice tests and role-based activities. Feasibility was evaluated through recruitment, participation, retention, and completion. Acceptability was assessed through participant perceptions and qualitative feedback, while cognitive load was measured at weeks 3 and 6 using the Paas 9-point scale.

RESULTS

A total of 36 teams (144 residents) from 37 hospitals across seven countries started the competition, and 21 teams (84 residents; 58.3%) from 20 hospitals completed the six-week game. Mean in-game scores were 6.00 ± 2.64 for individual tests and 8.06 ± 1.59 for team tasks. Survey respondents (n=54) reported moderate-to-high extraneous cognitive load related to virtual navigation, while educational content and organizational aspects received high ratings (median 9-10), in contrast to lower ratings for inter-team interaction and alliance dynamics (median 5-6).

CONCLUSION

This international implementation supports the feasibility, acceptability, and scalability of an immersive virtual-world educational model for radiology residents. Although onboarding barriers, alliance dynamics, and participant attrition remained important implementation challenges, future controlled studies are needed to evaluate educational effectiveness and support broader international implementation.