Abstract
<title>Abstract</title> <p>Background: This study aimed to investigate whether AI-supported virtual reality (VR) feedback intervention can support the developmental enactment of feedback literacy behaviors in clinical education and to compare it with regular clinical clerkship activities. Methods: A randomized controlled study was conducted among 68 fourth-year medical students to examine the effects of AI-supported VR feedback intervention (with and without peer support) compared to a control condition, during the transition to clinical clerkships. Students’ feedback literacy was assessed by supervisors as an observable and developmental capability before and after the intervention. Quantitative data were analyzed to compare the differences in pre- and post-test scores between the groups, and qualitative data from 36 student reflections were analyzed thematically. Results: A significant improvement from pre- to post-test was observed in the experimental groups of AI–VR (24.3 ± 3.7) and AI–VR+peer (27.0 ± 5.0) compared to the control group (3.8 ± 7.8; both p < 0.001). Reflective activities indicated that integrating peer interaction with AI provided greater psychological safety and collaborative sense-making, ultimately creating a more transferable feedback literacy capability. Conclusions: The results highlight the effectiveness of AI-supported VR environments in enhancing feedback literacy in medical education. Furthermore, incorporating peer discussion may further strengthen students’ ability to engage with and use feedback in clinical learning.</p>