The study compared virtual reality integrated with multilevel team pedagogy (VR-TBP) to standard training in 120 anesthesiology residents in a randomized controlled trial with long-term follow-up. The intervention included immersive VR simulations and team teaching, while the control group received lectures and bedside instruction. After 12 months, the VR-TBP group achieved a higher success rate of tracheal intubation at the first attempt (86.7% vs. 68.3%, p=0.026), shorter intubation time (60.1 ± 11.0 s vs. 66.8 ± 12.6 s, p=0.006), fewer procedural errors (0.20 ± 0.07 vs. 0.9, p=0.007) and a higher success rate of ultrasound-guided nerve block (81.7% vs. 65.0%, p=0.041). Non-technical skills were better in Mini-CEX (6.7 ± 1.0 vs. 5.9 ± 1.1, p<0.001) and ANTS scores (11.5 ± 1.6 vs. 9.9 ± 1.7, p<0.001). Skill retention was higher (88.4% vs. 76.5%, p<0.001) and independent completion of procedures more frequent (76.7% vs. 58.3%, p=0.032), with a comparable incidence of adverse events. VR-TBP represents an effective model for enhancing residential training.