Background <p>Thoracentesis is an essential clinical procedure, but its teaching is often limited by patient safety concerns and insufficient opportunities for repeated practice. Virtual reality (VR) offers immersive, repeatable simulation-based training; however, its effectiveness for thoracentesis has not been rigorously evaluated.</p> Methods <p>In this randomized controlled trial, 20 medical interns were randomly assigned to either a VR-based training group (<i>n</i> = 10) or a traditional training control group (<i>n</i> = 10). The VR group received theoretical instruction plus VR simulation practice (1&#xa0;h/day, 4 days/week for 3 weeks), while the control group received the same theoretical instruction plus traditional mannequin-based practice. All participants completed a 4-week training program. Outcomes were assessed at baseline, week 2, week 3, and week 4 using a standardized 300-point scoring rubric (preoperative, intraoperative, and postoperative components). Statistical comparisons were made using t-tests and chi-square tests. The primary outcome was the final thoracentesis procedural score at week 4.</p> Results <p>No adverse events occurred. Baseline characteristics and initial assessment scores did not differ significantly between groups. At week 2, the VR group scored significantly lower than the control group (<i>p</i> &lt; 0.05), reflecting an initial learning curve. However, at week 3 and week 4, the VR group significantly outperformed the control group (<i>p</i> &lt; 0.01). At the final assessment, 80% (8/10) of the VR group achieved scores ≥ 270 points (excellent), compared to only 10% (1/10) of the control group.</p> Conclusion <p>VR-based training may improve thoracentesis procedural skills after an initial adaptation period. VR appears to be a useful adjunct to traditional medical education, though these findings are preliminary due to the small sample size.</p>