After searching the databases, 2172 articles were obtained (PubMed = 483, Embase = 637, Scopus = 531, and Web of Science = 521). After initial review, 712 duplicate references were removed and 1460 articles were screened after removing duplicate articles, and after two stages of screen including title and abstract screen and full text screen, finally 13 articles met the inclusion criteria (Fig. 1). Based on the findings of the present research, in most of the reviewed studies (46.1%) the application of virtual reality in general medicine was mentioned. Percentage of included studies that addressed field of education using VR is demonstrated in Fig. 2.
We investigated the main findings of the included resources along with the purpose of the study, target population, type of technology, type of device, and field of education. A description of the findings reported in the eligible studies is shown in Table 2.
A total of 13 studies during the COVID-19 outbreak included 1407 participants, of which 1167 (82.9%) were medical students, 120 (8.5%) were healthcare workers (HCW), 44 (3.1%) were emergency staff, 20 were residents (1.4%), 5 (0.3%) were surgical scrub nurses and 4 (0.2%) were consultant knee surgeons.
During the COVID-19 outbreak, 6 (46.1%) studies have been used VR as head-mounted displays (HMD), followed by MR with 4 (30.7%) studies, 2 (15.3%) studies used AR, and one study did not mention the type of technology. HoloLense2™ was the most common HMD utilized by 6 (46.1%) studies for all types of technology (VR, MR, and AR), and Oculus Quest 2™ was another device used in 3 (23.1%) studies for VR technology. Also, one study used Vuzix™ smart glasses for AR technology, and 4 (30.7%) studies did not mention the name of a specific device (Fig. 3).
MR and VR were mostly used for training in the fields of a general physician with a total of 3 (23.1%) studies, AR/MR in anatomy with 3 (23.1%) studies, followed by AR/VR in emergency medicine with a total of 2 (15.3%) studies, MR/VR in practical procedures with 2 (15.3%) studies, and VR in the orthopedics, pediatric, and health at work each with one study.
Education with VR were perceived as enjoyable, with high satisfaction and improved knowledge, and filled the gap in the current medical education. Also, in Ukrainian situation helped academic continuity in medical education. Education with MR was found to be effective, enjoyable, faster, efficient, and with high engagement. AR-based studies reported this technology-enhanced spatial relations and helped students better understand key concepts.
Most of the papers were published in high-income countries (HICs) (39), 7 articles (61.5%) were from Europe, which the UK with 4 articles had the most papers, 2 (15.3%) studies were from the United States (US), and one article from UAE. Low- and middle-income countries (LMICs) (40) published 3 papers which were from Indonesia, Iran, and Ukraine.
Table 2
Description of the findings reported in the eligible studies
ID | First Author | Country | Study design | The aim of study | Target population (N) | Type of technology | Type of device | Field of education | Main results |
1 | Laksha Bala (41) | UK | Qualitative | Teaching ward rounds via remote access | 11 (medical students) | MR | HoloLense2 | General physician | A unanimous consensus was reached among students that the use of this technology was enjoyable and provided access to teaching that would otherwise be unavailable. |
2 | Rachel Herbst (42) | USA | mixed-method (qualitative and quantitative) | Using VR-based behavioral health anticipatory guidance to educate pediatric residents | 14 (pediatric residency) | VR | - | Pediatric | According to preliminary data, VR may serve as an important tool for teaching pediatric residents behavioral health anticipatory guidance, which fills a gap in current medical education. |
3 | Martin Boros (28) | Czech Republic | Qualitative | Develop an OHS training system for multiple segments of the workforce. | 120 (Safety and healthcare workers) | VR | Oculus Quest 2 | Safety and health at work (OHS) | A total of 117 participants expressed satisfaction with the use of VR technology. |
4 | Radek Kolecki(29) | Poland | quantitative | Assess the attitude toward these new technologies and whether the use of MR technology can contribute to the improvement of medical education | 258 = 211 medical students + 47 academic faculty | MR | HoloLense2 | Anatomy | According to 70% of students and 60% of academic faculty, MR-supplemented education is more beneficial than classical instruction. |
5 | Christian Zammit (30) | UK | quantitative | Assessment of the impact of AR in the dissection theater through a validated survey | 130 (medical students) | AR | HoloLense2 | Anatomy | This study suggests that the use of AR technology enhances spatial relations, accelerates detailed material assimilation, and contributes to a better understanding of key concepts when utilized. Additionally, the majority of participants consider AR to be a valuable learning tool. |
6 | Maryam Alawadhi (31) | UAE | | An investigation of how United Arab Emirates students perceive metaverse systems in medical training. | 435 (medical students) | - | - | General physician | Learning and teaching will be transformed as a result of the technology, which is likely to replace the internet. |
7 | Muhammad Ivan Muntahir (32) | Indonesia | Qualitative | developing the simulation of infusion installation based on web XR and VR applications | 30 (medical students) | VR + WebXR | Oculus Quest 2 + Magic Leap 1 + HoloLense2 | Practical procedure | The overall satisfaction of VR application was higher than the WebXR. Additionally, these technologies decreased the risk of medical learning practicums. |
8 | Rukhnoor Malik(43) | UK | quantitative | Study looked at how HoloLens2 can enhance traditional remote case-based teaching. | 73 (medical students) | MR | HoloLens2 | Anatomy | As a result of teaching with HoloLens2, students reported that the experience was enjoyable, the concept demonstrations were effective, and the engagement was high. |
9 | Andrew J. Hall (34) | UK | mixed-method (qualitative and quantitative) | Assessing the effectiveness of virtual reality-mediated simulation and a multi-modality 'Bootcamp' in teaching total knee arthroplasty (TKA) to orthopedic surgical trainees. | 15 = (6 surgical trainees + 5 surgical scrub nurses + 4 consultant knee surgeons.) | VR | Oculus | Orthopedics | A VR-mediated simulation could enhance the training of surgical trainees and scrub team members by improving their understanding of the surgical process map. |
10 | Saman Behmadi (35) | Iran | quantitative | A comparison of virtual-based and lecture-based medical education in teaching emergency medical students. | 44 (Emergency medicine staff) | VR | - | Emergency medicine | VR is a promising method for improving undergraduate emergency students' knowledge, according to the results of this study. |
11 | Tsekhmister Yaroslav Volodymyrovych (44) | Ukraine | Qualitative | A study of the virtual reality technology and online learning system at Bogomolets National Medical University, Ukraine during the COVID-19 pandemic | 226 medical students | VR | - | General physician | Online teaching and virtual reality technology are crucial for academic continuity in Ukrainian medical education. 65.79% of students agreed with the user-friendly interface for VR and online teaching system. 64.03% of students agreed that VR and online teaching system compensated the suspension of in-person medical education. |
12 | Jeffery Baker (37) | USA | Qualitative | An investigation of the feasibility and usability of smart glasses in medical education. | 22 medical students | AR | Vuzix smart glasses | Emergency medicine | In the emergency department, smart glass technology can expose preclinical medical students to clinical medicine. |
13 | Paul Zikas (38) | Greece | quantitative | Developing a medical virtual reality simulation model for COVID-19 Swab Testing and Proper handling of personal protective equipment | 29 students | MR | HoloLense2 | Practical procedure | Compared to traditional training, the designed VR model offers a faster and more efficient method of cooperative, gamified, remote training for healthcare professionals. |
VR: Virtual Reality, AR: Augmented Reality, MR: Mixed Reality, UK: United Kingdom, USA: United States of America, UAE: United Arab Emirates |