virtual reality thesis title

109 Virtual Reality Topics & Essay Examples

When writing a virtual reality essay, it is hard to find just one area to focus on. Our experts have outlined 104 titles for you to choose from.

🏆 Best Virtual Reality Topics & Essay Examples

🕶️ good virtual reality research topics, 🤖 interesting virtual reality research paper topics, ❓ research questions about virtual reality.

Humanity has made amazing leaps in technology over the past several years. We have reached frontiers previously thought impossible, like the recreation of virtual environments using computers. These three-dimensional worlds can be accessed and explored by people. This is made possible with VR headsets, such as Oculus Rift or HTC Vive. If you’re eager to find out more, peek at our collection of VR research topics below!

• Virtual Reality Versus Augmented Reality In fact, this amounts to one of the merits of a virtual reality environment. A case example of this type of virtual reality is the Virtual Reality games.
• Virtual Reality Technology The third negative impact of virtual reality is that it causes human beings to start living in the world of fantasy.
• Virtual Reality Tourism Technology In the world of virtual tourism, we can be transported to any country and have the ability to interact and manipulate the elements within the world we are touring in a way that would not […]
• Virtual Reality Technology for Wide Target Audience Due to the numerous applications in both leisure and industry, as well as massive popularity with audiences of different ages, there is a chance that, in several years, evaluating the target audiences of Virtual Reality […]
• Virtual Reality: A Powerful New Technology for Filming The creation of VR highlights a new perception of space because, through technology, people can be transmitted to a different environment.
• Rusnak’s “The Thirteenth Floor” and The Concept of Virtual Reality In such consideration, this paper conducts a comparative analysis of The Thirteenth Floor and how the concept of virtual reality was developed and is applied in today’s films.
• A Growth Trajectory of the Virtual Reality Drilling Rig Training During the final three months of development, the VR training program will be refined and tested for usability and effectiveness. Collecting feedback from users is essential for the success of the VR drilling rig training […]
• “The Role of Virtual Reality in Criminal Justice Pedagogy” by Smith The journal is titled “The role of virtual reality in criminal justice pedagogy: An examination of mental illness occurring in corrections”.
• Virtual Reality and Cybersecurity As a result, it is the mandate of the framework entities to establish solutions to the inherent barriers to the implementation of the business plan.
• A Stand-Up Comedy Virtual Reality Platform for Qatar Tourism Choosing the right number of avatars, customization of the product, and pricing the product were the three major challenges that were faced in this project. The second challenge that emerged in the development stage was […]
• Entrepreneurial Opportunities in Virtual Reality In terms of the practical context, the research will focus on the organizations and sectors which are the primary beneficiaries of virtual reality and remote work during the pandemic.
• Virtual Reality Space Product Project Challenges During the project, several challenges came up, which included providing leadership to the team, identifying the customer segment for the product, and understanding the “pains” of the customer segment.
• Reflection on Aspects of Virtual Reality Videos For instance, the video Wolves in the Walls has good graphics and gives the independence to look at every section of the set-up separately.
• Augmented and Virtual Reality for Modern Firms The business environment is not an exception, as firms seek to maximize their value through the implementation of high-tech solutions. AR is another major component of contemporary professional training, as it contributes to the better […]
• The Rules of the Virtual Reality Online environment has been providing the platform for casual interactions as well as economic activities for quite a while.
• How Virtual Reality Is Changing the World of Interior Design In order to become competitive in the sphere of luxury interior design, “More” must make its projects look modern and trendy.
• Top Companies in the Virtual Reality Industry Currently, Google is the leading search engine company, and there are signs that the company might emerge as one of the heavyweights in the virtual reality industry.
• Internet, Virtual Reality, and World Wide Web Defining the concept of the Internet is a challenging task, mostly because of the changes that it has undergone over the course of its development.
• Virtual Reality Technology and Soccer Training Moreover, the level of interactivity needs to be significant, and the most attention should be devoted to the modeling of situations that are viewed as the most problematic.
• Char Davies’ Osmose as Virtual Reality Environment On the following position, the installment suggests the invitees a chance to trail the discrete interactor’s voyage of imageries from end to end of this counterpart of natural surroundings.
• Virtual Reality in Healthcare Training The objective data will be gathered to inform the exploration of the first question, and it will focus on such performance measures as time, volume, and efficiency of task completion; the number of errors pre- […]
• Scholar VR: Virtual Reality Planning Service Studio To ensure that the small and mid-sized companies in the United Kingdom understand the leverage they can get by using VR technology.
• IOS and Browser Applications and Virtual Reality From the consumer’s point of view, any mobile application is good if it is of interest to the public and covers a large target audience.
• Virtual Reality’s Main Benefits The rapid development and the growing popularity of virtual reality raise a logical interest concerning the advantages and disadvantages that are related to the application of this new technology in various spheres of knowledge and […]
• Virtual Reality’ Sports Training System Working Steps The efficiency of the given technology is evidenced by the fact that it is used by various coaches and teams to provide training for their players. For this reason, it is possible to predict the […]
• Virtual Reality Technology in Referee Training Referees need to experience the practical nature of the profession during the training process, and the VR technology will eliminate the underlying challenges to the development of experience in the profession.
• Surgeon Students’ Virtual Reality Learning Programs In order for the students to feel like they are operating on living patients instead of waving instruments in the air, it is necessary to provide the environment that would compensate for the shortcomings of […]
• Virtual Reality and Solitary Confinement Nowadays, the majority of the representatives of the general public all over the world are familiar with the concept of virtual reality, and many of them have already experienced it.
• Samsung Gear Virtual Reality Product Launch The paper at hand is devoted to the analysis of the launch of Samsung Gear VR from different perspectives: the product development model, the business analysis, its technical implementation, etc.
• Virtual Reality in Military Health Care The purpose of the research is to identify the capabilities of VR and its applications in military health care. This study will explore the current uses of VR, its different functionalities, applications in the field […]
• Virtual Reality Ride Experience at Disneyland Florida The basic concept of the proposed ride is to utilize the current advances in VR technology to create a simulated experience for park-goers that is safe, widely usable, and sufficiently immersive that there is a […]
• Imagineering Myths About Virtual Reality Walt Disney Imagineering team, which encompassed a wide range of professionals responsible for various entertainments offered by theme parks, resorts, and other venues, is currently devoting a lot of time and effort to unlock the […]
• Virtual Reality Industry Analysis While it is true that the production and sale of virtual reality headsets could be in the millions in the future as the technology develops and becomes more acceptable, it cannot be stated at the […]
• Virtual Reality in Construction Originally, the use of virtual reality in construction within the past decade has been limited to 3D object design wherein separate 3D representations of the exterior and interior of the buildings are designed utilizing 3D […]
• Virtual Reality’s Benefits and Usages in Concurrent Engineering Figure 1: Phases of concurrent engineering Source As shown in the figure above, the initial stage of concurrent engineering is the identification of the components of the design system.
• Virtual Reality in Soccer Training The following work will focus on the analysis of the use of Virtual Reality in the training of soccer players with the evaluation of the practices adopted by particular soccer teams.
• Abstract on Architecture and the Role of Virtual Reality
• Advantages and Disadvantages of Escapism and Virtual Reality
• Strategic Analysis of the Creation of a New Rating System in Virtual Reality Gaming
• Study on Real/Virtual Relationships Through a Mobile Augmented Reality Application
• Benefits and Dangers of Virtual Reality
• Can Virtual Reality Kill?
• Cognitive Psychology & Virtual Reality Systems
• Computer Science and Virtual Reality
• Development of Virtual Reality Technology in the Aspect of Educational Applications
• Difference Between Augmented Reality and Virtual Reality
• Role of Virtual Reality in Education
• Humanity Versus Virtual Reality
• Simulation and Virtual Reality in a Sport Management Curriculum Setting
• Smart VR: A Virtual Reality Environment for Mathematics
• Sports Management Curriculum, Virtual Reality, and Traditional Simulation
• SWOT Analysis: The Lego Product and the ‘Virtual Reality’
• The Augmented Reality and Virtual Reality Market Forecast and Opportunities in U.S.
• Tracking Strategy in Increased Reality and Virtual Reality
• Using the Virtual Reality to Develop Educational Games for Middle School Science Classrooms
• What Is Virtual Reality?
• What Are the Advantages and Disadvantages of Virtual Reality?
• What Do Consumers Prefer for the Attributes of Virtual Reality Head-Mount Displays?
• Virtual Reality and Its Potential to Become the Greatest Technological Advancement
• Lucid Dreams as the First Virtual Reality
• Development of Virtual Reality
• Introduction to Virtual Reality Technology and Society
• Issue “Virtual Reality in Marketing”: Definition, Theory and Practice
• Applying Virtual Reality in Tourism
• Application of Virtual Reality in Military
• Augmented Reality & Virtual Reality Industry Forecast and Analysis to 2013 – 2018
• Breakthrough Virtual Reality Sex Machine
• Components Driving Virtual Reality Today and Beyond
• Data Correlation-Aware Resource Management in Wireless Virtual Reality (VR): An Echo State Transfer Learning Approach
• Gaming to Health Care: Using Virtual Reality in Physical Rehabilitation
• Smart Phones and Virtual Reality in 10 Years
• Evolution of Art in Virtual Reality
• Use of Virtual Reality in Molecular Docking Science Experiments
• Use of Virtual Reality for Concussion Diagnosis
• Virtual Reality as Analgesia: An Alternative Approach for Managing Chronic Pain
• Virtual Reality: The Real Life Implications of Raising a Virtual Child
• When Virtual Reality Meets Realpolitik: Social Media Shaping the Arab Government-Citizen Relationship
• Can Virtual Reality Ever Be Implemented in Routine Clinical Settings?
• What Is More Attractive, Virtual Reality or Augmented Reality?
• What Is Virtual Reality and How It Works?
• What Are the Benefits of Virtual Reality?
• Is Virtual Reality Dangerous?
• How Is Virtual Reality Used in Everyday Life?
• What Are the Risks of Virtual Reality?
• What Is the Future of Virtual Reality in Education?
• How Do You Think Virtual Reality Devices Will Change Our World?
• What Are Three Disadvantages of Virtual Reality?
• What’s the Point of Virtual Reality?
• How Can Virtual Reality Optimize Education?
• How Did Virtual Reality Affect Our Lives?
• Will Virtual Reality Eventually Replace Our Real Reality?
• What Are Some Cool Virtual Reality Ideas?
• When Will We Have Full-Sensory Virtual Reality?
• What Do I Need to Develop Virtual Reality Games?
• Why Did Virtual Reality Never Take Off so Far?
• What Are Medical Applications of Virtual Reality?
• How Virtual Reality Can Help in Treatment of Posttraumatic Stress Disorder?
• What Are the Biggest Problems Virtual Reality Can Solve?
• What Unsolved Problems Could Virtual Reality Be a Solution For?
• How Would a Fully Immersive Virtual Reality Work?
• When Will Virtual Reality Become Popular?
• What’s the Best Way to Experience Virtual Reality Technology?
• How Will Virtual Reality Change Advertising?
• Which Are the Best Virtual Reality Companies in India?
• What Are the Pros and Cons of Virtual Reality?
• What Are the Coding Languages Required for Virtual Reality?
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PhD Dissertation Designing Virtual Reality for Learning

• February 2021
• Thesis for: PhD
• Advisor: Guido Makransky

• University of Copenhagen

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Scientific data is the basis for the analysis of complex physical phenomena such as meteorological or biological processes. However, while often ignored, models and measurements typically incorporate uncertainties. Visualizing such uncertainties is crucial for domain experts to truly understand these phenomena, as well as gain a sense of trust for the reliability of the data. While approaches exist, that help communicate such uncertainties in ensembles, such as Surface Boxplots (Genton et al. 2014), these are typically made for classic desktop environments. In this thesis, we want to explore, how the additional dimensions provided by immersive displays could be used to provide an alternative, more interactive and intuitive encoding of uncertainties in 2D scalar field ensembles. This includes designing and implementing an immersive application and evaluating the solution in an appropriate user or expert study. Further details will be discussed in a meeting. Contact: Dr. Tim Gerrits

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The impact of virtual reality on student engagement in the classroom–a critical review of the literature

Xiao ping lin.

1 Faculty of Education, Silpakorn University, Nakhon Pathom, Thailand

2 Melbourne Graduate School of Education, The University of Melbourne, Melbourne, VIC, Australia

Zhen Ning Yao

3 Graduate Department, Xi’an Physical Education University, Xi’an, China

Mingshu Zhang

4 College of Commerce and Tourism, Hunan Vocational College for Nationalities, Yueyang, China

5 Graduate Department, Sehan University, Yeongam County, Republic of Korea

José Manuel de Amo Sánchez-Fortún, University of Almeria, Spain

The purpose of this review is to identify the impact of virtual reality (VR) technology on student engagement, specifically cognitive engagement, behavioral engagement, and affective engagement.

A comprehensive search of databases such as Google, Scopus, and Elsevier was conducted to identify English-language articles related to VR and classroom engagement for the period from 2014 to 2023. After systematic screening, 33 articles were finally reviewed.

The use of VR in the classroom is expected to improve student engagement and learning outcomes, and is particularly effective for students with learning disabilities. However, introducing VR into middle school education poses several challenges, including difficulties in the education system to keep up with VR developments, increased demands on students’ digital literacy, and insufficient proficiency of teachers in using VR.

To effectively utilize VR to increase student engagement, we advocate for educational policymakers to provide training and technical support to teachers to ensure that they can fully master and integrate VR to increase student engagement and instructional effectiveness.

Introduction

In recent years, virtual reality (VR) has emerged as a transformative technology in education, providing new avenues for immersive and interactive learning experiences ( Pottle, 2019 ). At its core, VR offers a departure from the tangible, allowing users to delve into an environment transcending conventional reality ( Brooks, 1999 ; Jeong et al., 2019 ). VR’s essence is captured in three pillars: presence, interactivity, and immersion ( Lee et al., 2017 ). Presence grants users access to previously unreachable 3D landscapes, facilitating a unique, experiential insight ( Poux et al., 2020 ). Interactivity kindles user curiosity, enabling dynamic engagements within the virtual milieu ( Steuer et al. 1995 ; Huvila, 2013 ; Song et al., 2023 ). Immersion pushes the boundaries of conventional experiences, reviving or manifesting phenomena outside the realm of everyday life ( Sanchez-Vives and Slater, 2005 ; Poux et al., 2020 ).

The introduction of VR in education might increase student engagement, which is closely related to the cognitive, behavioral, and affective dimensions of the engagement model ( Wang and Degol, 2014 ). Cognitive engagement underscores the depth of students’ attention, comprehension, and retention ( Wang and Degol, 2014 ). Behavioral engagement is observable, characterized by consistent attendance and active classroom participation ( Wang and Degol, 2014 ). Affective engagement delves into the emotional realm, encompassing motivation, passion, and learning efficacy ( Wang and Degol, 2014 ).

Existing literature emphasizes the importance of virtual reality technology in promoting full student engagement in cognitive, behavioral, and affective dimensions, and states that the application of virtual reality technology in education has become a trend ( Mystakidis et al., 2021 ). Some literature shows that higher education institutions are increasingly adopting VR, with adoption rates as high as 46% at US universities and 96% at United Kingdom universities ( United Kingdom Authority, 2019 ; Agbo et al., 2021 ). In addition, the establishment of dedicated VR laboratories at leading universities such as Harvard University and Colorado State University underscores the commitment to using VR for educational innovation and advancement ( Reid, 1987 ; Leidner and Jarvenpaa, 1995 ). This literature shows that the widespread use of VR in education has attracted the attention of a growing number of researchers and educators, with a particular interest in the impact of VR in the classroom in terms of students’ cognitive, behavioral, and affective engagement.

It is worth noting that although existing literature begins to discuss the impact of VR on student engagement, there are still shortcomings in determining the impact of VR on various dimensions of student engagement, which may limit our overall understanding of the topic. Therefore, further discussion is needed to more specifically identify the impact of VR on the various dimensions of student engagement to gain a more comprehensive and concrete understanding. To accomplish this, this review is guided by the following three questions: (1) What are the positive impacts of VR in education? (2) What are the challenges of VR in education? (3) What interventions can address these challenges? With this in mind, the article will first discuss the positive impact of VR on students’ cognitive, behavioral, and affective engagement to help readers understand its potential in education. It will then discuss the challenges facing VR to make constructive recommendations to address the problems in education.

Searching strategy

In our methods, we used critical review. According to Grant and Booth (2009) “an effective critical review presents, analyses and synthesizes material from diverse sources”(p.93). Critical perspectives were used to assess the potential of VR in reforming educational practices and improving teaching and learning outcomes. The purpose of this article was to collect literature on the impact of VR on student engagement. Therefore, this article summarizes the previous studies as follows. First, information was obtained from Google, Scopus, and Elsevier databases: “virtual reality,” “cognitive engagement,” “affective engagement,” “behavioral engagement” and “learning outcomes.” The search was limited to articles published between January 2014 and December 2023 in English. The first search used all combinations of the above keywords and, after an initial review, produced 97 potentially relevant articles (Google: 92, Scopus: 3, Elsevier: 2).

In the second phase, secondary terms such as “affect,” “challenge,” and “education” were added, reducing the number of studies to 63 (Google:60, Scopus:1, Elsevier:2). Of these, 34 did not meet the criteria and were excluded. They were excluded because their target audience was teachers and did not discuss the impact of VR on student engagement from the student’s perspective. In the final stage, another 53 articles were excluded because they were repetitive and their purpose was to discuss either technology or engagement, or both. Finally, their full texts were reviewed to determine if their work fits the focus of this article 20 articles (Google: 17, Scopus: 1, Elsevier: 2) qualified for final review, covered a sample on the impact of VR on student engagement, and were included in the analysis.

Inclusion and exclusion criteria

To ensure the quality of the literature, we selected only peer-reviewed journal articles published in English in the last decade. The main purpose of this article was to review the impact of VR on student engagement. Therefore, we selected only review articles on the impact of VR on student engagement in educational settings. Articles that were not written in English did not discuss the impact on engagement from a student perspective, and were published beyond the previously established time and language were excluded. In addition, a selection of articles was identified and assessed by manually searching the references of articles related to the topic, of which 13 met the eligibility criteria. Therefore, 13 additional articles were added to the 20 identified. In total, 33 articles that met these eligibility criteria were included and reviewed here. Full-text versions of the articles were obtained, with each article being reviewed and confirmed as appropriate by the authors. Finally, to maximize transparency and traceability, we list the rationale and relevant evidence for all articles included (see Table 1 ). The process of article selection followed the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement ( Moher et al., 2009 ; see Figure 1 ). Figure 1 illustrates the process of article selection.

Publications reviewed in full text with reasons for inclusion or exclusion.

PRISMA flow diagram for article selection.

The review found that the number of publications increased each year from 2014 to 2023, indicating the continued interest of researchers in exploring the impact of VR on student engagement. When reviewing the impact of VR on student engagement, Wang and Degol’s (2014) article had the most citations at 450, suggesting that the article had a strong impact in the area of student use of VR in the classroom. The majority of articles had only 10 or fewer citations, which may have indicated that these articles were relatively new or had less impact in the field. It was worth noting that more recently published articles, such as Rzanova et al. (2023) , did not have enough time to accumulate citations, so their impact on the field may not have been fully reflected in current citations.

To summarize, the differences in the number of citations for these articles highlighted their different levels of influence in the area of VR’s impact on student engagement. However, there were some limitations to the review methods. For example, some articles might not have fully reflected their impact on the field in the current citations due to their short time frames, which might have resulted in less comprehensive findings. Furthermore, the literature included was small, and in the future consideration would be given to expanding the search of literature and databases, such as PubMed and Web of Science databases, as well as expanding the search with keywords, such as “students’ attitudes toward VR.” In addition, the inclusion and exclusion criteria might have limited the generalizability of the results of the review, and therefore more caution was needed when generalizing the results of the review.

The positive impact of VR on education

This section will discuss the impact of VR on students’ cognitive, behavioral, and affective engagement participation. It is important in the field of education. Radianti et al. (2020) noted that student engagement in educational settings was critical to learning outcomes and classroom climate. Yuan and Wang (2021) further noted that the combined effects of cognitive, behavioral, and affective engagement could directly impact student learning outcomes and classroom contextual experiences. Therefore, a deeper understanding of the impact of VR on these three dimensions of engagement can provide valuable insights into educational practices and help educators better optimize classroom environments and teaching methods.

First, Papanastasiou et al. (2019) noted that VR immersive learning experiences promoted students’ cognitive engagement and aided in understanding complex and abstract knowledge. That is, through immersive learning, students can understand and remember what they have learned in greater depth and increase cognitive engagement. Pellas (2016) also found that VR encouraged students to learn through self-directed inquiry and move away from traditional teacher-centered instruction. Pellas (2016) further explained that, through VR scenario reenactments and simulations, students could engage in real-world unavailable learning experiences such as exploring historical sites and visiting distant planets. This means that such learning experiences enable students to explore knowledge in deeper and more varied ways, thus increasing cognitive engagement. Similarly, Maples-Keller et al. (2017) showed that VR was beneficial in engaging different types of students in learning, particularly for at-risk students, including those with learning difficulties, anxiety disorders, and other mental illnesses. VR provided personalized and adaptive learning environments that helped students improve cognitive engagement and achievement ( Maples-Keller et al., 2017 ). In summary, VR facilitates understanding of complex knowledge and promotes cognitive engagement for different types of students through immersive learning experiences and self-directed inquiry learning.

Secondly, Pirker and Dengel (2021) demonstrated that VR could promote student behavioral engagement. They discussed the potential of immersive VR in education through an in-depth analysis of 64 articles. They showed that “learning tasks in 3-D VLEs can foster intrinsic motivation for and engagement with the learning content” (p.77). Sun and Peng (2020) also suggested that by combining classical educational concepts with VR, such as Confucianism’s promotion of teaching for fun, students were better able to engage in learning activities. For example, Rzanova et al. (2023) found that the use of VR in the teaching of poetry to create the scenarios depicted in the verses enabled students to actively participate in classroom activities. Similarly, Freina and Ott (2015) also found that by simulating real school escape scenarios in VR, students could take on different roles to perform escape drills, and this sense of behavioral engagement can help students better master escape techniques and enhance safety awareness. These articles seem to echo that VR helps to enhance student behavioral engagement.

It is worth noting that there is debate about whether VR has a positive impact on student behavioral engagement. Proponents noted that students’ hands-on experience and exploration in virtual environments stimulated interest and behavioral engagement ( Wong et al., 2010 ; Allcoat and Von Mühlenen, 2018 ). This view suggests that VR provides an immersive learning experience that enhances students’ motivation and promotes deeper engagement in classroom activities. However, contrary findings exist, suggesting that the use of VR may have some negative effects. For example, students might have become addicted to the virtual world and neglected their real-life tasks and responsibilities, thus affecting their behavior in the classroom ( Cheng et al., 2015 ; Greenwald et al., 2018 ; Makransky et al., 2019 ). In addition, some other scholars noted that there might have been a gap between learning experiences in virtual environments and real-world learning experiences, which might have affected students’ ability to acquire and apply knowledge ( Makransky and Petersen, 2021 ). These conflicting results remind us that these complexities and diversities need to be taken into account when evaluating the role of VR technology in improving student engagement in the classroom.

Finally, scholars such as Wu et al. (2013) , Schutte and Stilinović (2017) , and Yuen et al. (2011) found that VR helped to promote student affective engagement. For example, Schutte and Stilinović (2017) found that contexts provided by VR for children with emotional impairments or disabilities taught them skills in communicating with people and managing their emotions, thus fostering empathy. This implies that VR may stimulate affective engagement. Wu et al. (2013) and Yuen et al. (2011) also found that VR provided opportunities for affective interaction, enabling students to interact with characters in the virtual environment. In language learning, for example, practicing through conversations with virtual characters could help students improve their oral expression ( Dhimolea et al., 2022 ). This means that affective interactions may increase students’ affective engagement with the learning content. Similarly, Misak (2018) noted that VR allowed students to role-play in virtual literature and experience the affective portrayed in the story. In other words, affective experiences may deepen students’ understanding of literary works and increase affective engagement. This literature seems to reflect that VR can promote student affective engagement.

In general, VR positively impacts students’ cognitive, behavioral, and affective engagement. In terms of cognitive engagement, VR can facilitate students’ cognitive engagement with learning materials and better understanding of abstract and complex knowledge by creating immersive situations. In terms of behavioral engagement, VR stimulates active student engagement and action through interactive learning. Although there is debate about whether VR has a positive impact on student behavioral engagement, literature has demonstrated the positive impact of VR on student behavioral engagement. In terms of affective engagement, VR promotes students’ emotional engagement by triggering affective resonance through affective experience and affective interaction. This full engagement helps students improve their learning and develop empathy.

The following section discusses the challenges faced when introducing VR in education. Through understanding these challenges, we can better understand the problems in the education system and make some constructive suggestions to help address them.

The challenge of VR in education

Despite the positive impact of VR on students’ cognitive, behavioral, and affective engagement, there are still two challenges to introducing VR into middle education, namely the difficulty of the educational system in keeping up with VR developments and the lack of teacher proficiency in VR use ( Islam et al., 2015 ; Zhong, 2017 ; Abich et al., 2021 ). For example, Islam et al. (2015) observed that the pace of technological advancement, including VR, outpaced the ability of the education system to adapt. This phenomenon is due to the slow reform of the education system, which takes time for the acceptance and adoption of emerging technologies ( Islam et al., 2015 ). To this end, the education sector may take longer to standardize the syllabus, resulting in students not having immediate access to VR ( Zhong, 2017 ). In other words, students may not have the opportunity to experience VR in the classroom until the education department completes the standardization process. Sahlberg (2016) further stated that while reform and standardization in the education sector took time, once VR and the education system evolved in tandem, students benefited from an education that matched the VR of the day.

Other scholars observed that VR education faced several challenges in developing digital literacy in students ( Aviram and Eshet-Alkalai, 2006 ; Sahlberg, 2016 ). According to Reddy et al. (2020) , “digital literacy is a set of skills required by 21st Century individuals to use digital tools to support the achievement of goals in their life situations” (p. 66). Digital literacy encompasses the assessment of digital technologies, critical thinking, and the ability to create and express oneself digitally ( Reddy et al., 2020 ). For example, Tsivitanidou et al. (2021) and Necci et al. (2015) emphasized the need for students to identify the differences between the results of simulation experiments and real experiments and to assess the reliability and accuracy of simulation experiments. In other words, students need to judge the plausibility of the results of simulation experiments and interpret and evaluate those results in real-world situations.

Similarly, Farmer and Farmer (2023) found that digital literacy required students to master VR painting and sculpting tools to create art. This involved learning to select appropriate colors and textures and creating three-dimensional effects with VR tools ( Skulmowski et al., 2021 ). Meanwhile, Andone et al. (2018) further noted that students also needed to learn to share and present their work to others in virtual reality. This observation seems to reflect the high demand for students’ creativity, technical skills, and expressive abilities when introducing VR into education. In sum, while the development of VR education benefits students’ learning in conjunction with VR, there are challenges to students’ digital literacy and the technological adaptability of the education system.

In addition, teachers’ lack of proficiency in the use of VR is another major challenge in introducing VR into middle education. For example, Abich et al. (2021) found that teachers might lack proficiency in the operation and application of VR, which might result in teachers not being able to fully utilize VR to supplement instruction. Jensen and Konradsen (2018) claimed that “for HMDs to become a relevant tool for instructors they must have the ability to produce and edit their content” (p.1525). This means that teachers need to spend time familiarizing themselves with HMDs and related software to create, edit, and customize content to meet their specific instructional needs. Similarly, Fransson et al. (2020) discussed the challenges of teachers operating VR equipment and software. They interviewed 28 teachers to understand teachers’ challenges with implementing helmet display VR in educational settings. Fransson et al. (2020) indicated that there might be a technological threshold and learning curve for teachers in controlling and operating VR devices, which might affect the effective use of VR for teaching and learning.

While teachers may lack familiarity with VR, there are solutions to this challenge. For example, Alfalah (2018) noted that proper training and support could help teachers make the most of VR to supplement instruction. That is, teacher training can provide teachers with the technical knowledge and operational skills they need to familiarize themselves with how VR equipment and software work. To this end, Alfalah (2018) found the impact of providing teachers with VR training in schools. They used a quantitative approach by distributing a questionnaire online to 30 IT teachers. Alfalah (2018) indicated that “technology training may be maximized for the integration of VR technology” (P.2634). This finding seems to reflect that proper teacher training and support can be effective in helping teachers overcome the operational and application of VR technology’s difficulties.

In sum, prior literature has shown that introducing VR into middle school education faces several challenges. First, the rapid development of technology makes the educational system keep up with VR, resulting in a disconnect between the educational curriculum and VR. Second, there may be a lack of proficiency in students’ digital literacy and teachers’ handling and application of VR. However, these challenges are not insurmountable. With proper training and support, teachers can make full use of VR to supplement their teaching and learning to realize the potential of VR in education. It is worth noting that through the literature we have found that in practice, due to the rapid development of technology and the limitations of the educational system, achieving a complete balance may take some time and effort. Therefore, considering how to address the gap between the speed of VR development and the education system to better integrate and apply VR in education makes sense.

This article describes the impact of VR on student cognitive, behavioral, and affective engagement and the challenges posed by VR education. The literature review finds that using VR in the classroom can positively impact student engagement and learning outcomes. An interesting finding is that VR can be a promising tool for providing education to students with learning disabilities. For example, the previous literature review section describes how for students with learning difficulties, anxiety disorders, and other mental illnesses, VR can provide personalized and adaptive learning environments that can help students improve cognitive engagement and academic performance. And, for children with emotional disorders or disabilities, VR provides contexts that can teach them skills for communicating with others and managing their emotions, thereby developing empathy and stimulating affective engagement.

However, the potential problems with incorporating VR in middle education are the difficulty of the education system in keeping up with VR developments, the higher demands of student digital literacy, and the lack of teacher proficiency in the use of VR. These challenges require educational policymakers to provide training and technical support to teachers to ensure that they can fully master and integrate VR to improve student engagement and teaching effectiveness.

Author contributions

XL: Writing – original draft, Writing – review & editing. BL: Conceptualization, Writing – original draft, Writing – review & editing. ZNY: Writing – original draft, Writing – review & editing. ZY: Funding acquisition, Supervision, Writing – original draft, Writing – review & editing. MZ: Funding acquisition, Writing – original draft, Writing – review & editing, Supervision.

Acknowledgments

We are deeply appreciative of the editors and reviewers of this journal for their unwavering dedication and contributions that have shaped the publication of this article. Their constructive feedback and invaluable insights were instrumental in bringing this piece to fruition. We extend our heartfelt thanks to the readers with a keen interest in virtual reality technology. It is our sincere hope that this article will inspire enriched discussions within the academic community about the potential and nuances of using virtual reality in educational contexts.

Funding Statement

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the General Topics of China’s Hunan Province Social Science Achievement Evaluation Committee Fund [Grant no. XSP2023JYC123].

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Use of Augmented Reality (AR) and Virtual Reality (VR) to address four of the “National Academy of Engineering Grand Challenges for Engineering in the 21st Century”.

Type of degree.

Computer Science and Software Engineering

Engineering is the shrewd application of science to the exploitation and transformation of natural resources for the benefit of humanity. Humankind has always resorted to engineering in order to overcome limitations, overpower challenges and improve life on the planet. In recent years, immersive technologies such as Augmented Reality (AR) and Virtual Reality (VR) have gained a lot of popularity. The rapid development of AR/VR technology has the potential to help a broad range of sectors, with education, healthcare, manufacturing and retail among the most obvious beneficiaries. In this thesis, the authors discuss developing of applications using immersive technologies such as Virtual Reality (VR) and Augmented Reality (AR) and their significance in addressing some of the engineering challenges identified by the National Academy of Engineering. The aim of this study is to develop two augmented reality (AR) and one virtual reality (VR) applications, as well as to assess their effectiveness in terms of interaction, functionality, usability, and user experience. These apps can be used to construct an immersive learning environment, locate and compare drinking water supplies in Auburn University (AU) buildings, visualize the Sun's position and direction at a given time and place, and take a virtual tour of our solar system.

https://etd.auburn.edu//handle/10415/7620

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Theoretical foundations and implications of augmented reality, virtual reality, and mixed reality for immersive learning in health professions education

• Maryam Asoodar   ORCID: orcid.org/0000-0001-6044-6790 1 ,
• Fatemeh Janesarvatan   ORCID: orcid.org/0000-0001-7152-386X 1 , 3 ,
• Hao Yu   ORCID: orcid.org/0000-0003-0473-2914 1 &
• Nynke de Jong   ORCID: orcid.org/0000-0002-0821-8018 1 , 2  

Advances in Simulation volume  9 , Article number:  36 ( 2024 ) Cite this article

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Augmented Reality (AR), Virtual Reality (VR) and Mixed Reality (MR) are emerging technologies that can create immersive learning environments for health professions education. However, there is a lack of systematic reviews on how these technologies are used, what benefits they offer, and what instructional design models or theories guide their use.

This scoping review aims to provide a global overview of the usage and potential benefits of AR/VR/MR tools for education and training of students and professionals in the healthcare domain, and to investigate whether any instructional design models or theories have been applied when using these tools.

Methodology

A systematic search was conducted in several electronic databases to identify peer-reviewed studies published between and including 2015 and 2020 that reported on the use of AR/VR/MR in health professions education. The selected studies were coded and analyzed according to various criteria, such as domains of healthcare, types of participants, types of study design and methodologies, rationales behind the use of AR/VR/MR, types of learning and behavioral outcomes, and findings of the studies. The (Morrison et al. John Wiley & Sons, 2010) model was used as a reference to map the instructional design aspects of the studies.

A total of 184 studies were included in the review. The majority of studies focused on the use of VR, followed by AR and MR. The predominant domains of healthcare using these technologies were surgery and anatomy, and the most common types of participants were medical and nursing students. The most frequent types of study design and methodologies were usability studies and randomized controlled trials. The most typical rationales behind the use of AR/VR/MR were to overcome limitations of traditional methods, to provide immersive and realistic training, and to improve students’ motivations and engagements. The most standard types of learning and behavioral outcomes were cognitive and psychomotor skills. The majority of studies reported positive or partially positive effects of AR/VR/MR on learning outcomes. Only a few studies explicitly mentioned the use of instructional design models or theories to guide the design and implementation of AR/VR/MR interventions.

Discussion and conclusion

The review revealed that AR/VR/MR are promising tools for enhancing health professions education, especially for training surgical and anatomical skills. However, there is a need for more rigorous and theory-based research to investigate the optimal design and integration of these technologies in the curriculum, and to explore their impact on other domains of healthcare and other types of learning outcomes, such as affective and collaborative skills. The review also suggested that the (Morrison et al. John Wiley & Sons, 2010) model can be a useful framework to inform the instructional design of AR/VR/MR interventions, as it covers various elements and factors that need to be considered in the design process.

Introduction

Health professions education is a dynamic and complex field that requires constant adaptation to the changing needs of society and the health care system [ 20 , 71 ]. One of the emerging trends in this field is the use of virtual technologies, such as augmented reality (AR), virtual reality (VR), and mixed reality (MR), to enhance the teaching and learning of various skills and competencies. These technologies offer the potential to create immersive, interactive, and realistic environments that can facilitate learning through feedback, reflection, and practice, while reducing the risks and costs associated with real-life scenarios. However, the effective integration of these technologies into health professions education depends on the sound application of instructional design principles and theories, as well as the evaluation of learning outcomes and impacts. This scoping review aims to provide a comprehensive overview of the current state of the art of using AR/VR/MR in health professions education, with a focus on the instructional design aspects and the learning and behavioral outcomes reported in the literature.

Current educational methods in health professions training encompass various approaches. These include problem-based learning [ 70 ], team-based learning [ 1 ], eLearning (Van Nuland et al. [ 19 ]), and simulation-based medical education (SBME) [ 19 ]. Recently, virtual technologies have emerged in alignment with educational trends. Augmented Reality (AR, Virtual Reality (VR, and Mixed Reality (MR are increasingly utilized not only in general education but also specifically in health professions education (Van Nuland et al. [ 19 ],). These technologies offer a range of potential strategies for comprehensive and practical training, contributing to safer patient care [ 19 ].

In the field of healthcare, diverse AR/VR/MR applications are already in use to train healthcare professionals, primarily assisting in surgical procedures for enhanced navigation and visualization [ 9 , 62 ]. These applications aim to facilitate learning through immersion, reflection, feedback, and practice, all while mitigating the inherent risks of real-life experiences. Simulators play a pivotal role in introducing novel teaching methods for complex medical content [ 16 , 21 , 27 , 29 , 35 ]. They allow repeated practice across a wide spectrum of medical disciplines [ 39 , 59 ], Peterson et al. [ 61 ] and may address challenges encountered in traditional health training programs.

VR creates an artificial environment where users interact with computer-generated sights and sounds. It immerses them in a simulated world using devices like headsets and motion sensors [ 69 ]. AR is an interactive overlay onto a real environment, where it offers an extra layer on top of the environment and the user experiences an immersive, interactive setting [ 13 , 27 ]. In MR, elements of VR and AR are combined, and computer graphics interact with elements of the real world, allowing users to interact with both virtual and physical elements simultaneous [ 29 ]. Extended Reality (XR) serves as an umbrella term that unifies Augmented Reality (AR), Virtual Reality (VR), and Mixed Reality (MR) into a single category, reducing public confusion [ 6 ].

In short, AR/VR/MR technologies create digital environments that closely resemble real-world features. These environments enable trainees to learn tasks safely, whether within the bounds of realism or in entirely new experiences beyond traditional constraints [ 41 ]. Notably, in healthcare, the use of computer-enhanced learning has led to positive outcomes such as improved patient safety, enhanced training experiences, and cost reduction [ 34 ].

Investigating prior research in the field of AR/VR/MR in healthcare is important, as this reveals the current state of the field and offers guidance to researchers who are seeking suitable topics to explore and educationists who want to improve the teaching and learning at their institutes [ 34 ]. Currently, there is a lack of insight on the effective application of AR/VR/MR particularly in health professions education and their added value based on instructional design models or theories as most reviews have focused on the technological aspects on AR/VR/MR for medical education, or on comparison with other methods.

This review takes a global perspective to identify the usage and potential benefits of including AR/VR/MR tools for education and training of students and professionals in the health domain. Technologies are constantly evolving and there is a need for obtaining an overview of current trends in an educational context. No review, however, was found that had considered to study whether and how instructional design theories or models guided the use of AR/VR/MR for teaching in health professions education to optimize complex learning within a recent time frame. An important aspect in this regard is the theoretical grounding on which the use of methods, technological or otherwise, is based. Already four decades ago, Reigeluth [ 65 ] argued for the grounding of instructional design in sound theoretical models, stating that instruction is often ineffective and knowledge about instructional design needs to be taken into account in order to remedy this problem. In other words, in addition to focusing on what is taught, how it is taught is also of critical importance [ 65 ]. Unfortunately, interventions are often insufficiently or inconsistently grounded in such theoretical models [ 38 ], Reigeluth & Carr-Chellman [ 66 ].

By now, numerous instructional design models exist that can serve as the basis for determining how content should be taught [ 32 ]. The model that is of particular interest to the topic of this review is the model proposed by Morrison et al. [ 55 ]. This model provides instructional designers with flexibility in determining the design steps to be taken and places significant emphasis on selecting the delivery mode, including considering technology’s potential role Obizoba et al. [ 58 ].

Starting from essential elements to be taken into account when planning instructional design (learners, objectives, methods and evaluation), the Morrison et al. [ 55 ] stipulates a circular design process consisting of nine elements: instructional problems, learner characteristics, task analysis, instructional objectives, content sequencing, instructional strategies, designing the message, instructional delivery, and evaluation instruments (Fig.  1 ).

Instructional Design by Morrison et al. [ 55 ]

In Table  1 , the elements of this models have been set alongside the ADDIE model showing analyze, design, develop, implement and evaluate. The design of the Morrison et al. [ 55 ] model is purposefully circular, signaling flexibility in terms of the order of elements on which to work on rather than prescribing a rigid linear process. Furthermore, the nine elements are considered to be interdependent Obizoba et al. [ 58 ] [ 3 ]F. Placed around these nine elements are formative evaluation and revision, as well as planning, project management, summative evaluation and support services [ 55 ].

The purpose of the study

There are a number of review studies that explore the application of AR/VR/MR in healthcare education and training. These studies primarily concentrate on evaluating the effectiveness of these technologies in learning [ 10 ], comparing their effectiveness with conventional or other teaching methods (as studied by [ 45 ]), and examining the prevailing trends in this field (as reviewed by [ 31 ]). Currently, there is lack of insight on the application of an instructional design model or instructional theories for the design of education with the integration of AR/VR/MR into education, particularly in health professions education. The first objective of this scoping review is to identify the usage and the potential benefits of including AR/VR/MR tools for education and training of students and professionals in the health domain. Therefore, we will provide a global overview of how AR/VR/MR tools are applied in health professions education and training with regard to the distribution over time, domains, methodologies, rational, outcomes, and findings. The second objective is to investigate whether any instructional design models or instructional theories have been applied when using these tools in designing education. We mapped the results based on the Morrison et al. [ 55 ] model. No other review was found that had considered instructional design theories or models guiding the use of AR/VR/MR for teaching in health professions education considering the recent time frame. To fill that gap in the literature, in this study we located and then analyzed all of the peer-reviewed studies in the mentioned databases in the methods section. The purpose is to present a review of the literature on how AR/VR/MR are used in healthcare educational settings from 2015 until 2020. Therefore, with regard to the use of AR/VR/MR in healthcare education and training, the following research questions (RQ) are addressed:

RQ1: What is the distribution over time of the selected studies?

RQ2: Which domains of healthcare and what types of participants are addressed?

RQ3: What type of (instructional) design/methodologies are used? ( Instructional design aspects + educational theories), how do they map on the Morrison et al. [ 55 ] model?

RQ4: What is the rationale behind the exposure to AR/VR/MR?

RQ5: What types of learning and behavioral outcomes (based on Blooms taxonomy) are encouraged?

RQ6: What are the findings of the selected studies?

In this study, we have conducted a scoping review following the framework proposed by Arksey and O’Malley [ 7 ] . The purpose of this scoping review is to map the existing literature on the topic, identify key concepts, sources of evidence, and gaps in the research. The process began with identifying the research question, followed by identifying relevant studies through a comprehensive search of databases such as PubMed, Web of Science, and other publishers. An iterative selection process was used to determine the inclusion and exclusion criteria, and the selected studies were charted based on their key characteristics and findings. The results were then gathered, summarized, and reported.

This scoping review specifically aims to explore the benefits of using AR/VR/MR tools in health education and training. It will also investigates the application of instructional design models or theories in designing education with these tools.

Databases searched

The electronic databases searched in this review were a set of databases accessible through Libsearch, which is the search engine available through our University library. The databases available through this search engine are: WorldCat.org, Web of science, MEDLINE, SpringerLink, ScienceDirect, Wiley Online Library, Taylor and Francis Journals, ERIC, BMJ Journals, and Sage journals.

Our research focused on papers published from 2015 through the end of 2020. We selected only peer-reviewed papers written in English.

Our data collection was completed before the COVID-19 outbreak, and due to the significant impact of the pandemic on the nature of studies conducted, we deliberately excluded papers published in 2021 and beyond. A preliminary review revealed that the methodologies of studies during this period underwent significant changes. This would have necessitated substantial modifications to our research questions. Consequently, we made the decision to confine our research to the year 2020.

Search terms

The databases were searched using key terms related to virtual, augmented and mixed-reality as well as terms for possible usage of these devices in medicine, health and bio-medical education. The following search string was used:

[("virtual reality" OR "augment* reality" OR "mixed reality") AND (health OR health science* OR medicine OR "medical science*" OR biomed* OR "biomed* science" OR “life science*”)].

Search for education and training in medical, biomedical and health sciences

The search returned a large number of papers n  = 5629 (Fig.  2 ). This set was further screened by manually going through all titles and abstracts for relevant terminology like “AR, VR or MR,” “training,” “education,” “medical,” “biomedical,” and “health sciences”. Papers selected on this basis were collated and duplicates removed ( n  = 414).

Flow chart showing the screening process

Selection of papers for inclusion in the review

To select the appropriate studies for inclusion in the review, the full papers ( n  = 414) and the additional papers ( n  = 20) retrieved via cross referencing were screened and a number of further criteria were applied. Selected papers had to (a) include empirical evidence related to the use of AR/VR/MR in education and training, (b) the training had to be in the field of medicine, biomedical sciences or health sciences. The PICOS (population, intervention, comparison, outcome, study design) framework [ 54 ] guided the inclusion and exclusion criteria of this study (Table  2 ).

Coding of selected papers

The papers selected on the basis of the inclusion criteria were coded. To summarize, papers were coded with respect to:

the publication year;

the type of participants addressed in the study;

which one of the AR/VR/MR was used for teaching/learning;

the country and continent where the first author of the paper was based;

behavioral outcomes based on Bloom’s taxonomy: cognitive, affective or psychomotor skills;

the domain of healthcare that AR/VR/MR has been used: neurosurgery, endoscopic surgery, etc.;

what type of (instructional) design/methodologies are used? (Instructional design aspects + educational theories);

the rationale behind using AR/VR/MR for training: whether the AR/VR/MR could offer an environment that could overcome the current limitation. For examples, overcoming limitations on teaching surgical steps, or teaching and practicing psychomotor and cognitive skills, etc.;

variables related to the study: the research design used in the study, categorized as a randomized control trial (RCT); quasi-experimental; survey; correlational or qualitative design; and

the findings of the selected studies.

Quality of the studies

Papers were assessed according to the following criteria: (1) quality of research design: RCT; quasi-experimental controlled study, pre-test/post-test design (an explicit research design had to be present, not just reports on a tool); (2) relevance of the aim of the study for using AR/VR/MR and (3) findings of the study (did the findings of the paper really relate to education/some sort of learning? Were the participants really doing something to learn, rather than for example only testing the tool? Was it used to teach someone to do something?

Consistency and reliability of coding

All authors took part in the identification, coding and quality coding of papers but, for consistency, one of the researchers (MA) oversaw all the coding. A first sample of articles was taken to discuss and align the coding. Subsequently, regular meetings were scheduled between the authors to discuss the papers and their coding.

The systematic search identified a total of 5629 articles (Fig.  3 ). After removing duplicates, 4999 articles were screened for relevance based on title and abstract. As a result, 4585 articles were excluded, leaving 414 articles for full-text review. Cross-reference search identified 20 more articles to be eligible. After full-text review, a total of 184 articles remained relevant for inclusion.

Distribution of the studies from 2015 till end of 2020

Distribution of studies over time

Overall, the number of studies including AR/VR/MR in health education, seems to be increasing. A total of 17 (9%) of the 184 articles included in our review were published in 2015; 24 (13%) of the articles were published in 2016, and 23 (12%) in 2017. In 2018, 35 (19%) articles were published, in 2019, 34 (18%) and in 2020 there were 51 (27%) articles. Figure  3 , depicts a rise in the number of studies per year from 2015 till end of 2020.

Domains of healthcare and types of participants

Most research studies primarily explored the application of AR/VR/MR technology in the medical field, specifically for training medical and nursing students in surgical procedures and anatomy courses. However, a limited number of studies investigated other healthcare domains. For instance, twelve studies specifically examined dentistry, while seven studies included biomedical and health sciences students alongside medical students. For the studies focusing on medicine, the majority of uses for AR/VR/MR in teaching was for training surgical skills (Fig.  4 ). Most the surgeries were mainly related to minimally invasive surgeries, like endoscopy, laparoscopy, etc. When counting all the research related to AR/VR/MR in surgery, which also included the research in fields like endoscopy, laparoscopy, etc. we ended up with 69 papers (Fig.  4 ). A second common use for AR/VR/MR in medical education was to teach anatomy, n  = 31 papers (Fig.  4 ). The focus of these studies were on neuroanatomy, 3D learning structures, and improving visual ability on anatomical understandings.

Domains of healthcare—categories mentioned here are not mutually exclusive, they can overlap and intersect with one another

In the comprehensive analysis of the studies included, a diverse spectrum of student levels is addressed. This encompasses bachelor students, master’s students, residents, and specialized continuous education. Notably, certain studies also delve into student training programs and multi-level training sessions, which involve a combination of students, residents, and expert specialists (Table  3 ).

The bubble chart in Fig.  5 links study domains and population. As evident, most studies are related to training residents’ surgery skills ( n  = 32) and to teaching anatomy to bachelor students ( n  = 24). The coded number of papers based on the domain and population can be found in Appendix 1, Table A. The reference to the codes can be found in Appendix 2.

A visual representation of the study domains and population

Types of Study design/methodologies

For consistency, we took the terms AR, VR or MR used by the authors of the original papers to make our classification. As shown in Fig.  6 , the large majority of studies ( n  = 149; 81%) focused in VR, followed by AR ( N3  = 25; 14%) and MR ( n  = 10; 5%).

Distribution of research focus across VR, AR, and MR

We divided the articles and distinguished between studies with qualitative, quantitative or mixed designs. Large majority of studies used a quantitative methodology ( n  = 152; 83%), followed by mixed-methods designs ( n  = 22; 12%), and there were only a very small number of qualitative studies ( n  = 10; 5%) (Fig.  7 ).

Distribution of research methodologies: quantitative, mixed-methods, and qualitative

In Fig.  8 , you see that most studies focused on usability aspects of AR/VR/MR ( n  = 53, 29%). Their purpose was typically to see if these tools could be used for a particular purpose, and mostly to check all the functions of the tool. The second most common study methodology is Randomized Controlled Trial (RCT) ( n  = 41, 22%).

Types of study methodologies in percentages

To plot the study design against the mode of technology used, Table B in Appendix1, was prepared. The reference to the coded papers can be found in Appendix 2. Figure  9 , clearly shows that 123 papers used VR in quantitative study designs. Eighteen papers used AR in quantitative study designs and 17 studies used VR in mixed method research designs.

Distribution of study designs by technology mode

To plot the study methodology against the mode of technology used, Table C in Appendix 1 was prepared. Coded papers in Table C can be found in appendix 2. Figure  10 clearly shows that 40 studies used VR in usability studies, 34 studies used VR in RCT research methodologies and there were 30 experimental studies with VR.

Plotting distribution of study methodologies by technology mode

Instructional design aspects and educational theories used in these studies

Looking at instructional design and educational theories in combination with AR/VR/MR, we see that only 44 studies out of the total of 184 had something mentioned about theories or instructional designs that they used for designing their teaching and learning. Interestingly, some studies specifically investigated usability aspects of AR, VR, or MR in medical education but did not incorporate any explicit educational design theory. This underscores the need for intentional integration of instructional design principles and educational theories when implementing these immersive technologies in educational settings. Table 4 displays the different theories that some studies applied for their educational design. These theories have literally been mentioned in the studies by the authors (Table 4 ). Among them, self-directed, competency-based and PBL, and evidence-based learning were most commonly used.

In Table  5 , we tried to link the already existing theories to the underlying elements in an instructional design theory. Here the Morrison et al. [ 55 ] was a good match. The purpose was to show how an instructional design model and, in this case, the different elements of the Morrison et al. [ 55 ] model, could be used as guidelines in designing courses with AR/VR/MR in medical education. We especially looked at the design element in the Morrison et al. [ 55 ] model. We hope to reveal some guidelines for including instructional design aspects when planning to use AR/VR/MR in medical education. While Table  5 clearly indicates that only a limited number of studies have taken instructional design elements into account, it’s worth noting that a small subset of studies did indeed consider these aspects. For example, code 141 is a study by Chheang, et al. [ 15 ], they are relying on instructional strategies like problem-based learning, hoping that these strategies would open new directions for operating room training during surgery. We also see, in the study by Liaw, et al. [ 47 ], (code 113), that VR has been used as an instructional strategy for collaborative learning across different healthcare courses and institutions in preparing for future collaborative-ready workforces. Another example can be the way VR is used in course design and in relation to cognitive load. Vera, et al. [ 75 ], (code 127), show that a certain VR operating tool can be integrated in the residency program which is sensitive to residents' task load, and it could be used as a new index to easily and rapidly assess task (over)load in healthcare scenarios. In another research, (code 24), Küçük, et al. [ 44 ] designed a study to determine the effects of learning anatomy via mobile AR on medical students' academic achievement and cognitive load.

Rationale behind using AR/VR/MR in healthcare education

The predominant motivation behind incorporating AR/VR/MR (Augmented Reality, Virtual Reality, and Mixed Reality) in healthcare education was to address specific limitations. These common limitations included factors such as the absence of realism, the financial burden associated with maintaining real-life props, time constraints, the need to simulate complex scenarios, ensuring a safe and controlled practice environment, managing cognitive load, and facilitating repetitive training opportunities (Table  6 ). For example, VR was used as an alternative to plastic or cadaver models, which were mentioned as being subject to a lack of realism and pertaining high maintenance costs, respectively [ 1 , 8 ]. Furthermore, learners in the wider healthcare field, often needed many hours of practice to master a skill, AR/VR/MR were good examples to provide an efficient field for practice. In some specialties, VR was specifically used because it provided the possibility to set up highly complex scenarios at a low cost. Through the use of VR, these limitations could be overcome and practice could be provided in a safe, controlled setting [ 29 ]. In a similar vein, some studies mentioned that they would use VR to reduce students’ cognitive load [ 16 , 44 ], by manipulating some aspects of the task over others. The ability to manipulate aspects of the task can be useful for both training and assessment.

Another rationale was to improve students’ motivation [ 39 , 50 ] and/or self-directed learning [ 27 , 46 ]. As students are used to using digital technologies in almost all aspects of their lives, using these technologies in education was thought to have a positive impact on their perceptions. This rationale was often mentioned for teaching anatomy, which is a course that students often tend to find uninteresting [ 27 , 44 ].

Moreover, in the context of Augmented Reality (AR), technologies have been employed to enhance student engagement and observation beyond what is achievable under typical circumstances.. For example, AR technologies would be used to overlay information from other modalities (e.g., MRI) on to-be-diagnosed images, making it easier to combine the information in order to locate abnormalities [ 12 ].

We plotted instructional design aspects against the rationale for using AR/VR/MR tools that each research considered for their study design or simulation design (Table  7 ). Since rationale behind using a specific method or tool comes at the analysis part of instructional design, we took the analysis section of the Morrison et al. [ 55 ]. The purpose is to see how relying on the analysis section of an instructional design model can help with logically designing the rationale behind using a tool operated by AR/VR/MR in health education.

The available data shows that some studies considered the learner characteristics by having two groups with different knowledge levels (novice/expert) and compared their performance [ 22 ],code 19). Some provided immersive training as an instructional objective to improve face and content validity [ 24 ],code 20). Some others utilized simulation in order to improve student’s motivation [ 27 ],code 21). Some considered task analysis by providing tasks at different simulations [ 28 , 39 ],codes 22, 23). In other studies, simulation was used for personalized and self-directed learning [ 50 ],codes 26) and some attempted to resolve the issues, difficulties and disadvantages of current methods [ 53 ],code 28).

Types of learning and behavioral outcomes

The AR/VR/MR articles were divided into the different learning and behavioral domains. According to Bloom’s revised taxonomy [ 5 ], three domains can be distinguished: the cognitive, affective and the psychomotor domain. The cognitive domain refers to the mental processes needed to engage in (higher-order) thinking. The affective domain refers to development of students’ values and attitudes, while the psychomotor domain has to do with developing the physical skills required to execute a (professional) task [ 5 ]. Of the included studies, seventy-five used AR/VR/MR for teaching cognitive skills (41%, Fig.  11 . Psychomotor skills were targeted in 53 studies (29%, and 5 studies (3% focused on affective outcomes aiming at improving learners’ confidence in surgery; especially, training in neurosurgery, laparoscopy, orthopaedic, endoscopy, sinus surgery, bone surgery, electro-surgery, and eobotic surgery. It is also interesting to know that fifty-one studies (27%) utilized a mixed skills training.

Outcomes of the studies that used AR/VR/MR in healthcare education

The included studies in this review generally categorized an intervention as effective if the majority of the participants achieved significantly higher scores in tests (experiment/control, pre-posttest, exercises) compared to traditional instructional approaches, such as analogue surgery or ultrasound procedures (Table  8 ). Up to 56% of the studies were experimental studies (Fig.  12 ).

Effectiveness of included studies

Some studies were considered as partly effective (Table  8 ), when there were no significant differences in all participants scores (19%, Fig.  12 ) (e.g. [ 17 , 35 ],Van Nuland et al., 2016; [ 76 ]). Here, differences among the participating groups in the studies could be attributed to the level of the training or expertise of the learners (e.g., [ 33 ]). Although in some of these studies, students using the more traditional approaches were performing at the same level as the students in the AR/VR/MR group, there were partial differences reported that learning with AR/VR/MR improved aspects like time efficiency, or precision sensitivity (e.g., [ 52 , 64 , 73 , 74 ]).

Some studies did not report any effectiveness (3%, Fig.  12 ). Study by Llena et al. [ 49 ] showed that although students experienced the AR technology as favorable, no significant differences in learning were found between group learning with AR compared to the group learning with traditional teaching methods. In the study by Huang et al. [ 40 ], no differences were found between students learning with a VR model versus a traditional physical model.

There were also studies showing mixed results, with some but not all outcomes improving in the AR/VR/MR conditions (e.g., [ 68 ]). Other studies reported the positive effects of applying AR/VR/MR as usable (e.g., [ 41 , 51 ],Van Nuland et al., 2016), feasible (e.g. [ 67 ]) tool for healthcare training (e.g. [ 47 , 72 , 75 , 76 ]). Few studies considered contextual factors like face/content validity (e.g. [ 30 , 63 ]), construct validity (e.g. [ 1 , 21 , 22 , 56 ]), study protocols [ 4 ], and accuracy (e.g. [ 12 , 43 , 60 ]).

Several studies reported on variables that impact the effectiveness of AR/VR/MR technologies. One commonly mentioned variable was level of expertise: learners/practitioners with more experiences and/or years of training outperformed novices (e.g., [ 37 ]), and experience had a positive effect on skills acquisition when using these technologies (e.g., [ 44 ]). An exception to this was the study of Hudson et al. [ 42 ], in which nurses with more years of practice found it more difficult to use the technology. Furthermore, Lin et al. [ 48 ] reports an effect of gender, in which men tended to reach proficiency sooner than women when using a laparoscopic surgery simulator. Nickel et al. [ 57 ] further indicated that experiencing fun was also relevant for the student’s learning. In the study by Huber et al., [ 41 ] were they investigated the use of VR to improve residents’ surgery confidence, a correlation was found between confidence improvement and students’ perceived utility of rehearsal. In the same study, the authors showed that the effect of the rehearsal on learner’s confidence was further dependent on trainees’ level of experience and on task difficulty. Finally, Chalhoub et al. [ 14 ] found that gamers had an advantage over non-gamers when using a ‘smartphone game’ to learn laparoscopic skills in the first learning session, although all participants improved in a similar manner.

In this comprehensive review of literature, we explored the application of AR/VR/MR technologies in the instruction of various stages of medical and health professions education. We identified six key research questions to guide our investigation: 1) the trend of studies over time, 2) the healthcare domains and participant types included in these studies, 3) the design methodologies and instructional design aspects/educational theories employed in these studies, 4) the benefits and underlying reasons for using AR/VR/MR in medical and health professions education, 5) the kinds of learning and behavioral outcomes promoted by the use of AR/VR/MR in this field, and 6) the results regarding these learning outcomes in studies that examine the use of these technologies in medical and health professions education.

In general, we observed a rising trend in the number of studies focusing on the application of AR/VR/MR in medical and health professions education. This suggests a consistent and growing interest in leveraging these technologies to enhance student learning across various healthcare disciplines. The primary use of these tools was found to be in teaching surgical skills to residents and anatomy skills to undergraduate students.

When examining the research methodologies employed to study the integration of AR/VR/MR, a notable finding was the predominant focus on quantitative methodology. However, given the limited number of participants in programs such as residency or professional training, qualitative methods could offer researchers the opportunity for a more comprehensive analysis of these tools’ usage and provide detailed insights into these complex learning situations [ 2 , 18 ].

It is interesting to note that the study of affective outcomes is often overlooked when integrating AR/VR/MR into health professions education. While studies are typically categorized based on cognitive, psychomotor, and affective outcomes, the majority focus on cognitive aspects, followed by psychomotor outcomes. Only a small number of studies explore the use of AR/VR/MR for teaching affective outcomes.

Usually, when AR/VR/MR is used in contexts related to emotions and affections, it serves more psychological purposes for patients rather than instructional ones [ 26 ]. However, there is potential value in using these technologies for specific situations, such as targeting affective outcomes like empathy (e.g., [ 25 ]).

In the context of 21st-century multidisciplinary healthcare, prioritizing patient needs and addressing their concerns is crucial. Compassionate and appropriate communication within healthcare teams can build patient trust [ 23 ]. To foster interpersonal skills among healthcare providers, it’s important for health professions education programs to emphasize student competencies in the affective domain of learning [ 20 ]. Interestingly, despite its importance, this aspect is less explored compared to other applications of AR/VR/MR in health professions education.

In this review, we not only examined outcomes but also scrutinized the findings from the included studies. These findings were grouped into three categories: experimental design, usability studies, and contextual factors (Table  8 ). Interestingly, not all experimental studies demonstrated effective outcomes for the application of AR/VR/MR in medical and health profession education. Some studies argued that display technologies did not significantly enhance learning across all or most outcome measures (e.g., [ 14 , 17 , 21 , 35 , 40 , 49 , 69 , 76 ]).

This review also uncovered that only a handful of studies built their AR/VR/MR applications based on specific instructional design models or theories, and there is little description on how these applications can be incorporated into the teaching curriculum. As mentioned in the introduction, instructional design should be rooted in robust theoretical models. Instruction is often ineffective, and knowledge about instructional design needs to be considered to address this issue and optimize complex learning. In other words, the focus should not only be on what is taught but also on how it is taught, which is of paramount importance [ 38 ], Reigeluth & Carr-Chellman [ 66 ].

We suggest that several factors should be considered when creating educational materials based on AR/VR/MR. In this review, we recommend using the instructional design model by Morrison et al. [ 55 ]. When focusing on this model, it is crucial to consider the unique value that a virtual environment can add to enhance students’ learning process when addressing instructional problems and strategies. For instance, AR/VR/MR can offer distinct advantages to learning by providing scenarios where patient privacy is crucial Pan, et al. [ 59 ] or where standardization is key [ 43 , 67 , 74 ].

Regarding learner characteristics, it is important for learners to be at ease with the general use of technology and specifically for learning. VR can provide a safe environment for both patients and students to practice essential skills (e.g., [ 8 , 29 , 33 , 57 , 60 , 63 ]).

When considering task analysis , it’s crucial to understand that all students will be performing the same task, leading to the point of standardization. All participants can practice the same task, allowing teachers to manage what everyone is learning. The tasks can be whole-task problems (e.g., students demonstrating they can conduct a full consultation) [ 56 ], or part-tasks (e.g., surgical procedures) [ 43 , 51 , 67 , 76 ]. Similar to the instructional problem mentioned earlier, it’s important to consider the objectives of the task before designing the teaching/learning methodologies and applications.

In terms of instructional objectives , it is a widely accepted practice in education to clearly define intended learning outcomes (ILOs) prior to designing learning and assessment tasks [ 11 ]. This principle holds true for the use of AR/VR/MR in health professions education. As previously mentioned, the application of these technologies should have a specific purpose, rather than being used merely for their “cool” factor or “motivating” qualities (e.g., [ 17 , 27 , 39 , 49 , 50 , 69 ]). The most common justifications found in the studies included in this review were to overcome certain limitations (such as lack of realism, high maintenance costs for real-life props, time constraints, practicing complex scenarios, providing a safe/controlled setting for practice, cognitive load, and the opportunity for repetitive training), to boost students’ motivation, or to enhance students’ observation skills and attentiveness beyond their usual capabilities.

Beyond integration, it’s also crucial to consider where in the curriculum the technology will be most effective, which relates to the aspect of content sequencing . This will depend on the course and curriculum content, as well as the intended learning outcomes (ILOs). In terms of assessment tools, these technologies can also be utilized for evaluation purposes . Particularly in formative assessment, they can offer learning opportunities coupled with feedback for the users [ 36 ].

When discussing all the elements of the Morrison et al. [ 55 ] model, it is equally important to consider instructional delivery , particularly in terms of the necessary resources and support. For instance, teacher training is crucial, as it can not be assumed that teachers are inherently capable of utilizing the technology. This pertains not only to the technological aspects of the application (how does it operate?), but also to the pedagogical aspects (how should it be implemented in class, and how should students be guided?). With the insights from this research and the recommendations based on the Morrison et al. [ 55 ] model, the understanding of new training and practice methods will enable practitioners to choose from a wider range of training options.

Limitations

This review has several limitations. Firstly, we exclusively examined studies that incorporated an intervention and utilized AR/VR/MR to teach knowledge or skills to the healthcare professions population. We ignored all theoretical papers. There might be more discussions in theoretical papers on the use of different educational models and theories. Future work might need to include all sorts of studies to cover a broader picture.

Secondly, we limited ourselves to publications between 2015 and 2020, assuming that this would be the timeline when AR/VR/MR gained more popularity in the health education domain.

Thirdly, our study did not thoroughly investigate the limitations and barriers associated with utilizing AR/VR/MR technologies for educational purposes.. When using these technologies in the classroom, it is necessary to acquire the required equipment and to be able to store it safely, both in terms of physical storage of devices as well as cloud storage of data. Batteries may need to be charged and the equipment must be kept clean. Updates may sometimes be required, and it is possible that these will happen at an inconvenient time (e.g., mid-session). Special requirements may be present for the software to run. For example, it might be necessary to make an account in order to be able to use the software, which must then be arranged while also taking into account data protection rules. The space in which instruction takes place should also be considered. For example, is it necessary that students can walk around? If so, this should also be facilitated. Finally, it is worthy of mentioning that none of the named limitations impairs the value of this work, in fact it provides opportunities to more research and further strengthening this topic.

Conclusion and recommendations for future research

The most important points that stand out when looking at the results of this review are general lack of instructional design theories or models guiding the use of these technologies for teaching and learning, and the abundant use of these tools for teaching courses like anatomy or for designing part-task practice routines in surgery, especially things like offering the possibility of scalability and repeated practice. For the lack of models and theories in course design with AR/VR/MR, we have tried looking at the instructional design model by Morrison et al. [ 55 ] and plotting our findings against this model to help guide further studies on how they can use an instructional design model in designing courses that include AR/VR/MR tools.

In general, when looking at the quality of the existing studies and applications including the educational benefits of these technologies, further studies need to be conducted to gain better insight into the added value of including these expensive and sophisticated tools into our education [ 31 ]. The most common rationales that were found in the included studies referred to overcoming some sort of limitation (lack of realism, high maintenance costs for real life props, time limitations, practicing high complex scenarios, providing safe/controlled setting for practice, cognitive load and, providing the possibility of repetitive training), enhancing students’ motivation or improving students’ observation and attentiveness beyond their normal capabilities.

Availability of data and materials

All relevant data are available in the form of appendices.

Abbreviations

Augmented Reality

Virtual Reality

Mixed Reality

Maastricht University

Public Medical Literature

Educational Research Information Center

Institute Electrical Engineers

Scientific Content on Public Access

Electronic Book Service Company

Research Question

Analysis Design Development Implementation Evaluation

Population, intervention, comparison, outcome, study design

Medical Literature Analysis and Retrieval System Online

Medical Journal

Randomized control trial

Magnetic Resonance Imaging

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Asoodar, M., Janesarvatan, F., Yu, H. et al. Theoretical foundations and implications of augmented reality, virtual reality, and mixed reality for immersive learning in health professions education. Adv Simul 9 , 36 (2024). https://doi.org/10.1186/s41077-024-00311-5

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