The cortical and subcortical brain regions influence multitasking skills using immersive virtual reality simulation in experienced nurses

Clinical simulations using immersive virtual reality (IVR) are increasingly used in nursing education to enhance multitasking skills. However, the differences in the neural correlates between experienced nurses (EN) and nursing students (NS) during the use of multitasking simulation remain unknown. We combined an IVR multitasking simulation with functional magnetic resonance imaging (fMRI) to compare EN and NS. Thirty-three participants completed a virtual hospital scenario requiring prioritization across two multitasking scenes, followed by an auditory fMRI task that reproduced the same IVR contents. EN showed engagement of cortical and subcortical regions, including the left precuneus/posterior cingulate cortex, right insula, bilateral precentral/postcentral gyrus, and thalamus. In contrast, NS primarily recruited subcortical regions, including the basal ganglia and bilateral thalamus. These findings suggest that clinical experience is associated with broader cortical–subcortical recruitment during multitasking situations that require clinical reasoning and decision-making.