Immersive virtual reality for practical clinical skills training in undergraduate medical education: a systematic review

Abstract

Fully immersive virtual reality (VR) delivered through head-mounted displays is increasingly used for practical clinical skills training in undergraduate medical education, but the certainty of its educational effectiveness remains unclear. This systematic review evaluated its effectiveness, acceptability, and feasibility. Quantitative studies published between January 2014 and March 2024 were identified through database and grey literature searches. Eligible studies included undergraduate medical students receiving fully immersive VR with active psychomotor practice. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was evaluated using GRADE. Thirty-one studies (19 randomized controlled trials and 12 observational studies; 4,926 participants) were included. Immersive VR improved or produced non-inferior immediate clinical skill performance compared with conventional training in 19 of 23 studies, although the certainty of evidence was low. Evidence for long-term skill retention was very uncertain because of limited follow-up data. Learner satisfaction was consistently high but supported by very low-certainty evidence. The most consistent findings were observed for imaging and procedural guidance skills. Immersive VR is a feasible and well-accepted educational approach with potential to support practical clinical skills training. However, the certainty of evidence remains low to very low, highlighting the need for adequately powered randomized trials with standardized interventions and long-term follow-up.