In this study, we used VR using HMD and mobile containing a set of systematic VR anatomy lessons. To evaluate the effectiveness of the proposed method, we conducted an experiment in four anatomy learning units in a medical school. The results showed that students who practiced VR had significant academic achievement compared to those who learned through traditional teaching methods in a regular classroom. In addition, the VR group had a high degree of technology acceptance for using VR in the classroom. Regarding the academic achievement test, the findings are consistent with the results of similar studies, which show that VR has a positive effect on learning achievements [23–30]. In the present study, three specific reasons can illustrate the benefits of VR. First, the higher success of the VR group may be the result of positive VR features (immersion, interaction and immediate feedback). This is similar to previous studies in that effective VR interactions and communications allow users to focus more on learning, thus leading to better acquisition [31–35]. Second, face-to-face interactions are better for creative problem-solving and idea generation, while computer conferencing environments support better linking of ideas, interpretations, and integration of problems [36–37]. Therefore, face-to-face group learning activities combined with VR-supported interactive environments may provide a rich learning experience. In addition, visual descriptions of scientific content and instant feedback from the intelligent robot in the virtual scene may enhance the conceptual development of scientific knowledge . The results also showed that students who worked in the e-learning group had a much higher academic achievement compared to students who learned through traditional teaching methods in a regular classroom. This means that e-learning enables students to engage with extracurricular science concepts by engaging in an e-learning environment. Inside the classroom, teachers used class time to discuss emerging ideas. This finding was supported by the study by Elfeky et al. , they concluded that there is a significant difference in the learning outcomes of learners during teaching with e-learning method. It could be that the e-learning classroom has created a deep learning environment that contributes to higher student performance. This is also buttressed by Mitra et al.  Which showed that the use of technological tools improves learning outcomes and encourages students to learn more actively. This function was better possible because e-learning is commensurate with the individual's learning speed and constantly provides tasks that accelerate learning outcomes. This brings both fast and slow learners to the same level of learning, and students are encouraged to frequently practice scientific concepts and experiments at home and at school. Convenience is also central to e-learning, allowing students to study at their own pace and thus improve performance. This strategy reduces the pressure on students and this gives them a better opportunity to practice and recall what they have learned. A study of Zipay et al.  showed that those who learn through e-learning performed better and retained more than their peers who use the conventional method of teaching. This is because today's students enjoy digital media because it allows them to read comfortably.
This study also showed that VR group students have a positive attitude towards accepting technology to use VR in the classroom. They found that VR is easy to use and improves their understanding of scientific knowledge. In addition, the high level of usefulness and ease of use shows that VR does not distract students during learning activities.
Implications, limitations and future research
Because there is so little information on this subject, one of the contributions of this research is due to its efforts to do more research on the use of VR in classrooms. The novelty of this study was that - in a classroom environment - a real virtual reality classroom consisting of 30 students and a teacher, who were in charge of the student learning process and class management through VR tools, was examined. This means that virtual reality tools have the ability to enhance classroom learning by providing visual knowledge and motivating young students with authentic learning experiences. For example, the mobile phone (VR education system) used in this study, which is used as a teaching tool, allows the teacher to interact directly with students by monitoring and managing their learning content in HMD. Slowly Therefore, the teacher can manage the classroom and learning content to perform learning activities more effectively. This study provides a reference for educators who wish to use this method in the classroom to perform similar learning activities on different topics.
This study also helps to identify and validate the empirical benefits (academic achievement) of using VR with HMD in the classroom. In addition, VR lessons can be integrated into existing anatomy curriculum as complementary resources. In this way, students have more opportunity to engage with scientific content and processes.
However, issues such as investing and teacher training are all important things to consider before successfully using VR with HMD in school classrooms. Schools and educators who want to use VR without investing may consider low-cost options. In addition, teachers may be challenged with the technical skills needed to design VR lessons or use VR technology for classroom practices. Because they need to spend more time and effort understanding the potential features of VR, participating in the design of virtual environments and classroom activities, and preparing for VR lessons.
This study also has several limitations. First, it was only proven that current VR is effective for fourth-year medical students, meaning that the results may not be generalizable to all age levels. Designing or implementing future VR for anatomy learning activities in the classroom should consider more of the learner's characteristics (age, gender, and perceived immersion). For example, as suggested by Cheng and Tsai , future studies could consider the immersion factors of basic attention and enjoyment. We also agree with Makransky and Lilleholt  that VR features, such as direct control, should be considered when designing VR environments. In addition, although the present study showed that VR can provide instant feedback for student learning, is this type of VR design, which includes elements of feedback, not as effective as many other online systems or traditional classroom conditions? Therefore, in the future, VR feedback elements should be educationally and technologically designed to improve anatomy learning. Moreover, since VR student groups had to use HMD during learning activities the student groups had to take turns using the HMDs during the learning activities, Future research should seek to prepare students for the effective use of HMD shared time and to explore how this group of students works in a VR environment. Finally, research into the long-term effects of using VR in classrooms is also needed to learn anatomy.