Medical and nursing students experience high stress that can impair well-being and training. Immersive technologies may offer brief, scalable relaxation. MK360 combines short guided mindfulness with immersive 360° projection in a shared multisensory room environment without wearables.
To assess feasibility and explore short-term changes in perceived stress and immediate autonomic arousal following a brief, predominantly group-based immersive 360° mindfulness program in medical and nursing students.
Single-site pre–post pilot at the University of Lleida. Students attended four ~20-min MK360 sessions over 4 weeks. Heart rate (HR) and blood pressure (SBP/DBP) were recorded immediately before and after each session. The Perceived Stress Scale (PSS-14), the Goldberg Anxiety and Depression Scale-anxiety subscale (GADS/EADG), and the Maslach Burnout Inventory-Student Survey (MBI-SS) were administered at baseline and endline. Pre–post changes were tested using Wilcoxon signed-rank tests (
Twenty-six students initiated the study (mean age 21.0 years; 88.9% female; 83.3% medical students), and 18 completed all assessments (completion 69.2%). Perceived stress decreased from baseline to endline (PSS-14 median [IQR] 29.5 [26.0–33.5] to 26.5 [19.5–33.8];
MK360 was feasible and well tolerated, with signals consistent with reduced perceived stress over 4 weeks and transient reductions in cardiovascular arousal within sessions. Given the uncontrolled design and small sample, causal inference is not warranted; controlled studies should confirm effectiveness, examine dose–response, and compare delivery formats.
Burnout and stress are highly prevalent among health sciences students and are linked to poorer mental health, reduced empathy, and attrition from clinical careers (
Beyond documenting prevalence, recent evidence has examined whether brief, scalable, technology-enabled interventions can buffer stress during training (
Syntheses of IVR for stress and well-being in young adults and students report mixed but generally favorable short-term effects on perceived stress and relaxation, while noting heterogeneity of protocols and small samples (
Against this backdrop, we conducted a single-site pilot to explore whether a brief, four-session IVR program is feasible and associated with short-term reductions in perceived stress and immediate post-session decreases in physiological arousal among medical and nursing students during clinical rotations (
We conducted a single-site, uncontrolled pre–post pilot study at the Faculty of Medicine, University of Lleida (Lleida, Spain). The intervention was delivered using the MK360 immersive projection system in a dedicated room at the university facilities.
The study protocol was reviewed and approved by the Clinical Research Ethics Committee of IRBLleida (Institut de Recerca Biomèdica de Lleida), Lleida, Spain (approval code/reference: CEIC 2878; date of approval: June 24, 2023). All participants provided written informed consent prior to participation. The study was conducted in accordance with applicable ethical standards and data protection regulations.
Participants were medical and nursing students aged ≥18 years enrolled at the University of Lleida and able to provide informed consent. Exclusion criteria were: history of epilepsy or photosensitive seizures; severe motion sickness; current vestibular disorder; pregnancy-related restrictions according to institutional guidance; and any other condition deemed incompatible with exposure to immersive audiovisual stimulation.
Recruitment used a convenience sampling strategy. Invitations were distributed by email and reinforced through brief informational sessions. Specifically, emails were sent to all medical and nursing students in the 1st and 3rd year for nurses and the 5th for medical students. Eligibility screening was based on email reply and checklist.
A total of 82 students were contacted by email, 35 responded, and 28 met eligibility criteria.26 provided consent and initiated the program, and 18 completed endline assessments. Reasons for non-participation or attrition were recorded when available (e.g., scheduling conflicts, withdrawal, incomplete follow-up).
No formal sample size calculation was performed given the pilot nature of the study. An
Participants were offered four sessions over 4 weeks (target dose: one session per week), each lasting approximately 20 min. Sessions were self-scheduled to accommodate academic duties and clinical rotations.
Each session followed a standardized structure:
Guided mindfulness (≈5 min): audio-guided attention to breathing and present-moment awareness.
Immersive 360° projection (≈15 min): immersive audiovisual content accompanied by non-verbal ambient music.
To minimize habituation and explore acceptability of different restorative environments, the 360° visual content varied across weeks: (i) natural landscapes, (ii) beach/ocean scenes, (iii) abstract/psychedelic imagery, and (iv) an urban cityscape. Sessions could be completed individually or in small groups (maximum 4 students). In practice, most sessions were completed in small groups (approximately 90%).
Standardized instructions (room setup, safety precautions, and mindfulness guidance) were provided via a QR code accessible at the intervention site. Participants were advised to stop the session if they experienced discomfort.
The primary outcome was change in perceived stress measured by the Perceived Stress Scale (PSS-14) from baseline (pre-intervention) to endline (after the 4-week program). As the PSS assesses stress during the previous month, endline responses were interpreted as reflecting perceived stress across the intervention window rather than acute session effects.
Language/validation: The PSS-14 was administered using a validated Spanish-language version (
Immediate autonomic arousal markers: pre- to post-session change in heart rate (HR) and blood pressure (SBP/DBP) recorded immediately before and after each session.
Anxiety symptoms: baseline to endline change using the Goldberg Anxiety and Depression Scale – anxiety subscale (GADS/EADG) (9 dichotomous items; total 0–9; higher scores indicate more symptoms; ≥4 suggesting probable anxiety).
Burnout symptoms: baseline to endline change using the Maslach Burnout Inventory–Student Survey (MBI-SS) (15 items; subscales Exhaustion, Cynicism, Academic Efficacy).
Participant-reported emotional change: a single-item self-report at endline describing perceived emotional change (e.g., “much better/somewhat better/no change/somewhat worse/much worse”)
Language/validation: Validated Spanish-language versions were used for GADS/EADG and MBI-SS (
HR, SBP, and DBP were obtained using an automated upper-arm blood pressure monitor (OMRON). Measurements were taken in a seated position after a brief seated rest. Cuff size was adapted to arm circumference. Each timepoint consisted of a single reading. Measurements were collected immediately before and immediately after each session.
Potential acute confounders (e.g., caffeine intake, sleep, time-of-day, medication, physical activity) were not systematically recorded and are addressed as limitations.
Adverse effects were monitored after each session using a brief cybersickness checklist. This checklist was developed
Continuous variables are summarized as median (interquartile range, IQR) and categorical variables as counts and percentages. Pre–post changes were evaluated using the Wilcoxon signed-rank test (two-sided
A total of 26 students initiated the study and 18 completed the full 4-session program, yielding a completion rate of 69.2%.
Baseline characteristics of participants (initiators vs. completers).
| Sociodemographic variables | Participants | |
|---|---|---|
| Initiators | Completers | |
| Age mean (SD) | 20.6 (2.8) Min 18–Max 27 | 21.0 (2.8) Min 18–Max 27 |
| Gender (female) | 76.9% (20) | 88.9% (16) |
| Student category | ||
| Nurse students | 26.9% (7) | 16.7% (3) |
| Medical students | 73.1% (19) | 83.3% (15) |
| Academic year | ||
| 1st | 69.2% (18) | 66.7% (12) |
| 3rd | 7.7% (3) | 0.0% (0) |
| 5th | 23.1% (6) | 33.3% (6) |
| Anxiety/depression background | ||
| No | 76.9% (20) | 72.2% (13) |
| Anxiety | 23.1% (6) | 27.8% (5) |
| Depression | 0.0% (0) | 0.0% (0) |
| Both | 0.0% (0) | 0.0% (0) |
| Under treatment (Yes) | 3.9% (1) | 5.6% (1) |
| Emotional change at the end | ||
| No changes | n.a. | 38.9% (7) |
| Somewhat better | n.a. | 50.0% (9) |
| Much better | n.a. | 5.6% (1) |
| Somewhat worse | n.a. | 5.6% (1) |
| Much worse | n.a. | 0.0% (0) |
Values are expressed as mean (SD) for continuous variables and as percentage (frequency) for categorical variables. n.a., not applicable; n.s., not significant.
Pre–post changes among completers (
Burnout, stress and anxiety relation with IRV.
| MBI-SS (median IQR) | Baseline | Post | Δ (post–pre) |
|
|---|---|---|---|---|
| Exhaustion | 18.5 (15.2–22.0) | 16.0 (14.0–19.0) | −2 | 0.05 |
| Cynism | 10.0 (7.2–13.8) | 6.0 (5.2–10.0) | −1 | 0.108 |
| Academic efficacy | 25.5 (20.2–26.0) | 27.0 (22.2–30.0) | +3 | 0.16 |
| PSS median (IQR) | 29.5 (26.0–33.5) | 26.5 (19.5–33.8) | −3 | 0.07 |
| GADS median (IQR) | 5.0 (3.2–6.8) | 5.5 (1.5–7.0) | 0 | 0.972 |
PSS primary comparison tested one-tailed (pre-specified direction: decrease). All other comparisons two-tailed.
Perceived stress (PSS-14) decreased from baseline to endline (29.5 [26.0–33.5] to 26.5 [19.5–33.8];
Vital signs recorded in each session.
| Session | HR pre | HR post | SBP pre | SBP post | DBP pre | DBP post |
|---|---|---|---|---|---|---|
| 1 | 81.3 (13.5) | 77.8 (11.7)* | 113.3 (13.7) | 107.8 (10.6)* | 74.2 (7.1) | 74.6 (4.5) |
| 2 | 75.7 (11.5) | 73.8 (10.3)* | 112.6 (9.9) | 104.2 (9.7)* | 72.4 (7.3) | 66.6 (7.3)* |
| 3 | 78.1 (12.9) | 73.8 (11.0)* | 110.4 (11.9) | 104.2 (11.8)* | 69.2 (6.5) | 67.7 (8.8) n.s |
| 4 | 79.2 (9.3) | 73.7 (9.6)* | 108.8 (8.0) | 106.1 (8.4)* | 72.3 (7.8) | 66.8 (7.4)* |
Values are expressed as mean (SD). HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure. *
Descriptive analysis of post-pre differences in vital signs measured before and after each session.
| Session | Δ HR | Δ SBP | Δ DBP |
|---|---|---|---|
| 1 | −5.5 (5.4) | −5.4 (9.0) | 0.3 (4.1) |
| 2 | −1.8 (4.1) | −8.4 (10.4) | −5.9 (6.3) |
| 3 | −4.3 (6.8) | −6.2 (8.8) | −1.6 (6.1) |
| 4 | −5.5 (8.4) | −2.7 (5.8) | −5.6 (5.2) |
Values are expressed as mean (SD). HRΔ, post-pre difference in heart rate; SBPΔ, post-pre difference in systolic blood pressure; DBPΔ, post-pre difference in diastolic blood pressure.
Self-reported emotional change. At endline, 50.0% of completers reported feeling somewhat better emotionally and 38.9% reported no change; 5.6% reported feeling much better and 5.6% somewhat worse (
In this single-site, uncontrolled pre–post pilot, a brief four-session immersive 360° mindfulness program (guided mindfulness plus 360° projection) was feasible to implement within a health sciences curriculum. Allowing participants to self-schedule sessions accommodated heterogeneous academic and clinical timetables, and delivery in small groups may have supported adherence and completion.
Over the 4-week period, we observed a signal of reduced perceived stress (PSS-14), whereas anxiety and burnout subscales did not show statistically significant changes. In parallel, heart rate and blood pressure showed small immediate pre–post reductions within sessions, consistent with an acute relaxation response. This pattern aligns with a growing body of research indicating that VR-based relaxation, mindfulness, and virtual nature exposures can reduce stress and distress—often with small-to-moderate short-term effects and substantial heterogeneity across populations, content, and outcome measures (
Mechanistically, immersive environments may facilitate attentional absorption and perceived “presence,” supporting downregulation of arousal via parasympathetic activation. Experimental and comparative work has linked relaxing VR exposure to changes in autonomic markers and stress-related outcomes, sometimes with profiles comparable to established physiological relaxation approaches (
The partial dissociation observed here—signals on global perceived stress but not on burnout or anxiety—may be expected given the brief dose, the pilot sample size, and the constructs involved. The PSS captures a global appraisal of stress over the preceding month, which overlaps temporally with the intervention window and may be relatively responsive to low-burden interventions. In contrast, burnout reflects more cumulative processes (exhaustion and disengagement) that may require greater intensity, longer duration, or additional components targeting workload, recovery, and meaning at work/study. This is particularly relevant in health sciences education, where stressors are episodic and context-dependent, peaking during clinical exposures and performance evaluation. Evidence from university mindfulness research more broadly supports modest improvements in stress and wellbeing, with variable effects on anxiety and other outcomes depending on design, dose and follow-up (
The consistent within-session decreases in heart rate and systolic blood pressure observed across sessions support an interpretation of acute autonomic calming during/after exposure. However, vital signs are coarse markers and can be influenced by posture, measurement timing, and situational factors. These findings align with experimental work indicating that immersive VR exposures can modulate physiological responses and may influence autonomic arousal (
Interpretation benefits from a broader psychobiological framework of stress in which short-term autonomic responses (e.g., heart rate and blood pressure) and endocrine pathways (e.g., HPA-axis activity) may not change in tandem and can be partially dissociated, particularly in brief interventions (
This pilot has important limitations. First, the uncontrolled pre–post design restricts causal inference and remains vulnerable to regression to the mean, history effects, and expectancy. Second, potential acute confounders (sleep, caffeine, medication, physical activity, and time-of-day) were not systematically measured. Third, the PSS reflects the prior month; therefore, changes should be interpreted as a global perceived-stress signal across the intervention window rather than a direct acute effect of any single session. Fourth, physiological assessment was limited to vital signs without HRV or endocrine indicators, and we did not collect qualitative feedback that could have strengthened acceptability and mechanism interpretation.
A further consideration is that most sessions were delivered as a shared experience. Group delivery may influence outcomes through social context (e.g., perceived safety, peer effects, distraction), introducing heterogeneity relative to individual VR paradigms. Future studies should prospectively standardize delivery format (individual vs. group), measure expectancy and engagement, and use analytic approaches that characterize heterogeneity (e.g., baseline stratification and mixed-effects models).
Future research should prioritize controlled designs (preferably randomized), with pre-specified analytic plans and outcomes spanning: (i) state and trait psychometrics, (ii) autonomic measures with higher resolution (e.g., HRV), (iii) endocrine indicators (e.g., diurnal salivary cortisol), and (iv) qualitative evaluation of the participant experience. These additions would clarify mechanisms, identify subgroups most likely to benefit, and support decisions about optimal content, dosing, and delivery format. Trials in student populations may also benefit from aligning timing with known high-stress periods (e.g., examinations or clinical rotation transitions), where signal-to-noise may be greater.
In a small, single-site pre–post pilot, a brief four-session immersive 360° mindfulness program was feasible and showed signals consistent with reduced perceived stress over 4 weeks and transient decreases in autonomic arousal within sessions. Controlled trials incorporating state measures, qualitative evaluation, and autonomic/endocrine indicators are needed to confirm effectiveness, clarify mechanisms, and define optimal content, dosing, and delivery format.
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
The studies involving humans were approved by Comitè ètica investigació Medicament (CEIM) IRBLLEIDA. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
GR: Writing – original draft, Data curation, Investigation. OY: Writing – review & editing, Investigation, Writing – original draft, Data curation.
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that Generative AI was not used in the creation of this manuscript.
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