American Medical Extended Reality Association Expert Consensus: Best Practices for Patient and Public Involvement in Medical Extended Reality Research.

Extended reality (XR) technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), have revolutionized health care education by enhancing simulation-based learning environments. While classical simulation has long supported the bridging of theoretical knowledge and practical application, XR technologies further enhance this process through immersive, interactive, and realistic training experiences, using three-dimensional understanding facilitated through asynchronous learning platforms. However, the effective integration of XR into health care simulation remains a challenge, with differing approaches to components found in traditional simulation standards and best practices, including pre-briefing, observation, and debriefing. This narrative literature review explores the current state of XR in health care simulation and aims to provide a comprehensive understanding of how best to utilize XR technologies to improve educational outcomes in health care settings. The review focuses on the following areas: the professional development needs of facilitators specifically related to the adherence to the Healthcare Standards of Best Practice (HSSOBP), position statement for designing XR simulations, technical standards for hardware and software, and cognitive load management strategies. For the purposes of this paper, the terms “health care education” and “health care simulation” should be construed to include all disciplines across medicine, nursing, and allied health. AR and MR have been described as disruptive technologies with potential uses in medical education. One review of the literature indicates as of early 2024, there were over 26,000 articles in medical and academic journals that include the terms AR, VR, and MR. Increases in computing power and interactive realism, combined with reduced costs of entry, have led to rapid advances in the implementation of applications, making these technologies less expensive than other available simulators. In addition, serious games and gamification of procedural skills teaching are becoming more commonplace, further driving AR and MR growth and demand. The Covid-19 pandemic also accelerated adoption of this technology.