Purpose <p>Virtual reality (VR) has been used to teach a variety of procedural skills in medical education. Ultrasound-guided lumbar puncture (USG LP) shows promise to increase procedural success in adults and pediatric patients without impactfully increasing procedure duration. We explore engagement, enjoyment, and procedure performance of medical students learning this skill from a pre-recorded slideshow or VR lecture.</p> Method <p>We recorded a slideshow lecture and a virtual reality lecture teaching background knowledge and technique necessary for performing USG LPs. Medical Students were randomized to participate in one of these modalities and filled out a survey on their experience. They were then timed and graded on their performance of the procedure on an LP task trainer.</p> Results <p>Fifty-five medical students (27 slideshow, 28 VR) at two universities were involved in the study. Level of fun was rated higher in the VR group (4.5 [4.0, 5.0] vs. 4.0 [3.0, 4.0], <i>p</i> = 0.0002) along with perceived effectiveness of the lectures (4.0 [4.0, 5.0] vs. 4.0 [4.0, 4.0], <i>p</i> = 0.0265) and level of enjoyment (5.0 [4.0, 5.0] vs. 4.0 [4.0, 5.0], <i>p</i> = 0.0232), while level of boredom (2.0 [1.0, 3.0] vs. 3.0 [2.0, 4.0], <i>p</i> = 0.0308) was rated lower in VR. There was no statistically significant difference in simulated cerebrospinal (CSF) acquisition, LP checklist score, or procedure duration. VR participants reported more side effects and technology issues.</p> Conclusions <p>Virtual reality is perceived as more fun, more effective, and a more enjoyable training modality with increased learner engagement compared to slideshow lectures when learning ultrasound guided-lumbar puncture. Procedural results were similar between the learning modalities, though there is a learning curve to understand and troubleshoot technological issues that may arise when utilizing VR.</p>