Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 358 363 Saeideh Sadat Mousavi Department of Curriculum Studies and Instruction, Ferdowsi University of Mashhad, Mashhad, Iran. Morteza Karami Department of Curriculum Studies and Instruction, Ferdowsi University of Mashhad, Mashhad, Iran. Seyed Mohammad Mireskandari Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Shahram Samadi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2022 02 22 2022 04 04 Background: This study aimed to assess the effect of virtual reality technology on knowledge, attitude, and skills of first-year anesthesia residents in spinal anesthesia procedure training. Methods: 25 anesthesia residents were enrolled in this experimental study. They were randomly divided into two groups of virtual reality (n =11) and conventional training (n = 14). The virtual reality (VR) group received a combined virtual and clinical training environment while the conventional group received only a clinical training environment for one month. A Similar content (herein, spinal anesthesia procedure) was trained to the both groups. The participants were the anesthesia residents in the academic year 2020-2021. Similar exams assessed knowledge, attitudes, and skills in both groups and data were analyzed using t-test and ANCOVA. Results: The mean knowledge score acquired by residents in the VR group was higher than the conventional learning group (16.45 ± 2.5 vs 13.57 ± 2.1). The method of training had also a significant effect on the post-test score; F (1) = 6.16, P = 0.02. In addition, the mean attitude score acquired by residents in the VR group was higher than the conventional learning group (110.63 ± 14.7 vs 107.64 ± 12.3), although the method of training had not a significant effect on residents’ attitude score; T (23) = 0.55, P = 0.58). The mean skills score acquired by residents in the VR group was higher than the conventional learning group (100.4 ± 3.17 vs 88.14± 11.8); While the method of training had a significant effect on residents’ skill score. T (23) = 3.34, P < 0.05), too. Conclusion: The combined virtual and clinical training environment was superior to a conventional method for enhancement of knowledge and skill in spinal anesthesia procedure training in anesthesiologist residents. This study can help the educational designers of the University of Medical Sciences to improve the competence of residents by using a combined learning environment. https://aacc.tums.ac.ir/index.php/aacc/article/view/490