The Science Behind BLSXR: How Immersion Changes the Brain

By Farzad Najam, MD, FACS, Founder & CEO, VRKure | Clinical Professor of Surgery, GWU School of Medicine

The Training We Trust With Our Lives Is Failing Us

BLS training is the most fundamental certification in healthcare. It is the floor—the absolute minimum competency we ask of every provider who may one day stand between a patient and death. Over 70 million healthcare workers are certified in Basic Life Support every year worldwide. Seventy million people are entrusted with the skills to perform chest compressions and manage airways when seconds count.

But here is the question no one in healthcare wants to confront: What is the actual retention rate of that training?

The answer, supported by over a century of cognitive science, is devastating. With certification methods that overwhelmingly rely on a four-hour class and a paper certificate, up to 90% of what is taught is forgotten within a single week.

Pause on that. We have built an entire global system—one that grants the license to perform the most basic life-saving procedures in medicine—on a training model where nearly everything a provider learns evaporates within days. Chest compressions. Airway management. The sequence of interventions that determine whether a human heart restarts or does not. Gone within a week.

So Where Does the Problem Lie?

Healthcare is one of the most regulated industries in the world. Every credential is scrutinized. Every protocol is reviewed. Every facility is audited. So if the system is this tightly controlled, where exactly does the failure originate?

Are healthcare workers not certified? They are. Are they not motivated to learn, to earn the licensure for the skills they are training in? They are. Are they not motivated to save lives? Of course they are.

In over twenty-five years as a cardiac surgeon and thousands of procedures, I have never—not once—met a doctor, a resident, or a nurse who was not devoted to what they do. I have watched colleagues sacrifice their sleep, their health, their time with their families, their own physiological needs, to take care of ailing patients entrusted to them. I have done it myself. We all have. That is not where the problem lives.

No one in healthcare—and I mean no one—wakes up in the morning thinking, today I will make a mistake.

But the system that empowers them is wrong.

The problem is not the people. The problem is the method. The training methods themselves fight against how our brains work. We have been feeding information to the human brain in ways that the brain was never designed to process—and then acting surprised when that information does not stick. Lectures. Slides. Videos. Written exams. These are modalities of passive transmission, and the neuroscience is now unambiguous: passive transmission produces fragile, rapidly decaying memory traces.

The human brain does not learn life-saving skills by watching. It does not consolidate critical motor sequences by reading. It learns through a mechanism it uses for actual experience—a mechanism that actively encodes real-life experiences into long-term memory. The brain needs to do in order to know.

The Aviation Test

Consider this thought experiment. Imagine if commercial aviation trained its pilots the way healthcare trains its BLS providers. A four-hour class. A written exam. A certificate valid for two years. And 90% of their skill competency gone within a week.

What would happen?

We know exactly what would happen. Planes would fall from the sky. The FAA would ground every aircraft in the country before the week was out. The public outcry would be deafening, and the entire industry would be dismantled and rebuilt from the ground up.

Now imagine our fighter pilots—the men and women we trust with national security and the most advanced aircraft ever built—losing most of their skills within days of training. No military in the world would accept that. No commander would send those pilots into combat. The proposition is so absurd it does not require debate.

And yet, in healthcare, we accept it. Every single day.

The status quo in healthcare training is not merely inadequate. It is glaringly, measurably costing us lives—the very lives the system is entrusted to save.

What the Brain Actually Needs to Learn

In 1885, the German psychologist Hermann Ebbinghaus made a discovery that should have changed education forever. Through rigorous self-experimentation, he mapped what he called the forgetting curve—a mathematical model showing that memory retention declines rapidly and predictably without reinforcement. His findings were stark: 50% of newly learned information is lost within the first hour. 70% is gone within 24 hours. And within a single week, up to 90% has vanished.

These numbers were replicated and confirmed in 2015. This is not outdated psychology. It is settled science, 140 years in the making.

Ebbinghaus also proposed the solution: spaced repetition—distributing practice over intervals—combined with active recall, the act of retrieving information from memory rather than passively reviewing it. These two principles form the foundation of how durable learning works. They also form the basis of BLSXR’s high-frequency, low-dose learning methodology.

A person who completes BLS training in a four-hour class today experiences significant skill decay almost immediately. BLS recertification is mandated every two years—but the decay happens in days, not years. The gap between certification and competency is not a crack in the system. It is a chasm.

What Happens in the Brain During Immersion

The Hippocampus: Your Brain’s Learning Engine

The hippocampus is the region of the brain that drives learning and memory. Neurons in the hippocampus synchronize their electrical activity in rhythmic patterns called theta rhythms, which have been known to be essential for encoding new information and forming memories. When theta rhythms are disrupted, learning is impaired. When they are strengthened, learning accelerates.

In 2021, a landmark study published in Nature Neuroscience by Safaryan and Mehta at UCLA’s W. M. Keck Center for Neurophysics demonstrated something remarkable: immersion in virtual reality amplified theta rhythmicity in the hippocampus by more than 50%. The study also revealed a never-before-seen brain rhythm, which the researchers named “eta,” emerging in the cell bodies of hippocampal neurons while theta dominated the dendrites. Two different parts of the same neuron, keeping different rhythmic beats.

This was more than any drug, any stimulation technique, or any other intervention had achieved in over sixty years of research.

The implication is profound: virtual reality does not simply present information differently. It fundamentally changes the electrical behavior of neurons in the brain’s learning center.

[Reference: Safaryan, K., & Mehta, M. R. (2021). Enhanced hippocampal theta rhythmicity and emergence of eta oscillation in virtual reality. Nature Neuroscience, 24(8), 1065–1070.]

The Brain Rewires Itself

What the UCLA study revealed at the level of brain rhythms, broader neuroscience research has confirmed at the level of brain structure. In virtual reality, the brain undergoes neuroplasticity—it reorganizes, forms new connections, and adapts. VR exposure has been shown to increase cortical gray matter volume and enhance neural connectivity. Multiple studies have demonstrated that VR induces profound neurobiological transformations in neuronal connectivity, motor learning, and cognitive function.

VR does not merely simulate an experience. It changes the physical architecture of the brain in response to that experience.

Why Emotion Locks In Memory

Research from the University of Regensburg found that emotional arousal was the single biggest predictor of learning effectiveness in VR. When an experience is emotionally compelling, the brain’s limbic system releases dopamine and norepinephrine—neurotransmitters that amplify cognitive focus, drive motivation, and strengthen memory formation.

VR naturally stimulates these emotional pathways. The stress of a simulated cardiac arrest. The urgency of performing compressions correctly. The consequence of getting it wrong. When a learner is performing BLS in BLSXR and there is a code, they feel the stress of the event. The heart races. It is the brain’s memory system activating.

Why the Body Remembers What the Mind Forgets

The Embodied Simulation Loop

VR and the brain: they work on the same principle. The brain constantly creates a simulation of the body in space, predicting the sensory consequences of every action we take. This process—called embodied simulation—is how we navigate, learn, and form expectations about the world.

VR works by mimicking this exact prediction loop. The more closely the virtual environment matches the brain’s internal model, the deeper the sense of presence—and the more powerfully the brain encodes the experience.

This is why performing chest compressions in BLSXR using medical simulation training is not “pretend” to your neurons. It activates the same motor planning and sensory integration circuits as a real cardiac arrest. The brain does not distinguish between a well-designed immersive simulation and an actual event—it processes both through the same embodied mechanism.

Two Memory Systems, One Immersive Solution

Traditional BLS training primarily targets declarative memory—facts and rules. The facts decay fastest under the Ebbinghaus curve, and it is the most vulnerable to stress during a real emergency.

VR engages something fundamentally different. It simultaneously activates episodic memory—the vivid, contextual memory of an experience (what happened, where, and when)—and procedural memory—the motor skills, sequences, and physical patterns that the body learns through repetition. Procedural memory is the most durable memory type we possess. It is why you never forget how to ride a bicycle, even decades after you last rode one. It persists even when declarative memory fades.

The Enactment Effect: Doing Is Knowing

Research published in Neuropsychologia by Plancher and colleagues demonstrated that active encoding—physically performing an action—creates fundamentally stronger memory traces than passive observation. This is known as the enactment effect: the physical act of performing a skill adds a motor component to the memory trace that pure cognitive encoding cannot replicate. This encoding is automatic—it happens without the learner needing to consciously try to memorize.

[Reference: Plancher, G., et al. (2012). Using virtual reality to characterize episodic memory profiles. Neuropsychologia, 50, 592–602.]

In BLSXR, by administering BLS training with VR, every repetition lays down motor patterns that become increasingly automatic. The depth of compressions. The rhythm of the rate. The positioning of the hands. The coordination of airway management. These are not facts being memorized—they are motor programs being written into the nervous system. And that is exactly what you need when a real cardiac arrest happens and conscious thinking gives way to trained response.

The Data: Immersion vs. Traditional Training

Studies have shown that tasks are completed up to four times faster in VR than in a traditional classroom. BLSXR allows learners to achieve BLS competency in approximately 30 minutes versus the standard four-hour class—not by cutting corners, but by aligning the training with how the brain naturally acquires and retains motor skills.

Retention tells the most important story. While traditional training loses 90% of its content within a week, VR-based training has demonstrated retention rates of up to 80% at one year post-training. That is not an incremental improvement. It is a fundamentally different trajectory of skill retention.

Osso VR demonstrated that surgeons trained in virtual reality learned 230% faster and showed significantly better skill retention compared to traditional methods. VR-trained surgeons made 40% fewer errors than their conventionally trained peers. In an industry where a single error can be the difference between life and death, these are not academic distinctions—they are clinical imperatives.

BLS recertification every two years creates a massive gap where skills decay unchecked. The cost of that gap is not measured in test scores. It is measured in human error—and human error, in healthcare, is measured in lives.

BLSXR Is Built on How the Brain Works

Every element of BLSXR maps to a specific mechanism of brain-based learning. Immersive environment activates hippocampal theta rhythms for stronger encoding. First-person embodied experience engages both episodic and procedural memory systems. Simulated emergencies trigger emotional arousal, releasing dopamine and norepinephrine for prioritized memory formation. Active motor performance produces the enactment effect, building durable motor memory traces that persist under stress.

And then there is what makes BLSXR fundamentally different from any other VR training: AI-powered competency verification. BLSXR’s artificial intelligence tracks compression depth, compression rate, chest recoil, hand placement, and timing—creating the real-time feedback loop that the brain needs to correct errors and consolidate skill. This is the brain receiving precisely the signal Ebbinghaus identified 140 years ago as essential for lasting retention: immediate, active feedback during the act of learning itself.

BLSXR enables what the brain requires: repeated, immersive, feedback-rich practice at intervals that reset the forgetting curve before skills decay. This is the paradigm shift—from a snapshot certification that decays within days to dynamic, continuous verification of competency.

This is what we call Immersive Medicine: a new discipline where training technology is aligned with how the brain actually forms and retains clinical skills. Not training for compliance. Training for competency. Not certification as a moment. Certification as a continuous state.

This Isn’t About Technology. It’s About Neuroscience.

BLSXR is not about virtual reality technology. It is about how our brains work.

The brain learns through experience that is immersive, embodied, emotional, repetitive, and accompanied by feedback. Not through PowerPoint slides. Not through four-hour lectures. Not through paper certificates that expire long after the skills they represent have vanished.

This is what I learned during my many years as a cardiac surgeon: learning is experiential. It is built on repetition at constant intervals. It is forged under the pressure of real consequences. And it is retained only when the method of training respects the biology of the brain that must perform when it matters most.

We have known this intuitively for as long as medicine has existed. Now we have the neuroscience to prove it—and the technology to act on it.

The question is no longer whether we can train healthcare providers in a way that their brains will actually retain. The question is how much longer we will choose not to.