This research investigates the effectiveness of virtual reality (VR) in enhancing neuroanatomy learning among medical students, focusing on optimizing cognitive load, intrinsic motivation, and user experience. A total of 77 s-year medical students participated in the study, which compared traditional video-based instruction with three VR conditions: active, guided, and passive. The results demonstrate that VR significantly improved anatomical learning performance compared to traditional methods, particularly in the passive and active conditions. VR also enhanced intrinsic motivation, reduced extraneous cognitive load, and increased germane cognitive load. Interestingly, the guided VR condition yielded the poorest learning performance, although differences between the VR conditions were not statistically significant. These findings suggest that higher interactivity is not inherently linked to better learning outcomes in VR-based education. The study highlights the importance of balancing interactivity and cognitive load in the design of effective VR learning environments. Overall, VR holds strong potential as an educational tool, but its instructional design must be carefully tailored to support both motivation and cognitive efficiency. Future research should further examine the role of interaction modes and learner expertise in shaping the instructional effectiveness of VR. © 2025 Elsevier LtdRead less <