The findings of this study showed the first article on the use of IoT in medical education was published in 2013. The number of articles was initially low in the first four years (2013–2016) but experienced a significant increase in 2017 and 2018. However, in recent years, the number of articles has decreased (2019–2022), contrary to the expected trend of increasing publications over time. According to findings of Abdullah’s (2021) study, due to the COVID-19 pandemic, there has been an increase in the use of IoT technology by numerous firms and individuals in various industries such as healthcare, smart homes, smart workplaces, retail, airports, manufacturing, and hospitality (33). Although our study found that as a result of the pandemic, a drop in the number of studies on developing of IoT applications in medical education, other study found a rise in research and development activities in the IoT business (33).
Research on the use of IoT in medical education has been undertaken in twelve countries (developed and developing countries), with the United States accounting for more than half of these studies. The majority of the countries reviewed in this study, such as the United States, United Kingdom, Canada, Germany, Australia, and Korea, have high-ranking medical schools. On the one hand, medical schools in the United States are ranked among the best in the world (34, 35), while on the other hand, according to a research, the United States was the global leader in IoT spending in 2019, with 194 billion dollars invested. China and Japan came next, with Germany finishing fourth overall and first in Europe that year. South Korea is also predicted to rank fifth with 25.7 billion USD, surpassing European countries like as France and the United Kingdom. (36) The International Data Corporation (IDC), a global market research firm, predicts Worldwide Spending on the Internet of Things is Forecast to Surpass $1 Trillion in 2026. According this report, Western Europe, the United States, and China will account for more than half of all IoT spending, according to the forecast. (37) While China has made significant expenditures in IoT in numerous areas, including medicine (1), no research on the application of IoT in medical education have been identified.
Improving surgical technical skills is so important for surgeons. IoT and wearable technology have been employed in surgical training to enhance and assess surgeon abilities. According to our findings, integrating IoT technology, such as wearable devices and mobile applications, into medical education has shown promising outcomes in a variety of fields. Several studies have explored the application of IoT devices such as Google Glass (12, 13, 16, 18), sensors (15, 23, 38, 39), and virtual and augmented reality simulators (19, 40, 41), highlighting their potential in facilitating surgical / non-surgical medical education through realistic simulations, interactive platforms, and real-time feedback.
Based on our results, there are three significant categories of sensors that are essential in medical education: 1) Video cameras capture visual information, enabling the recording of medical scenario and content (16, 20), medical procedures (10–12, 17), simulations (12, 13, 16, 18, 19, 22), and consultations (13). Devices like Google Glass fall into this category as they feature a built-in camera for capturing real-time videos and images; 2) Health monitoring sensors focus on monitoring a person's health status, including vital signs such as blood pressure, heart rate, and oxygen level. By using biometric sensors, medical educators can generation of a realistic CBL scenario (20) and learners can track and measure their physiological characteristics, obtaining insights into their stress levels, sleep, and performance.(27, 28, 30); and 3) Activity monitoring sensors such as accelerometers, gyroscopes, and other forms of motion sensors are used to analyze a person's physical activity or movement (14, 15, 23, 25–27, 42), as well as sleep (25–27, 29, 32).
According to our findings, video glasses and wearable surgical visualisation systems such as Google Glass are among the most extensively utilised IoT devices in a variety of medical education fields. Google Glass incorporates a camera, accelerometer, gyroscope, magnetometer, ambient light sensor, proximity sensor, microphone, and bone conduction transducer, allowing users to access information, communicate, and immerse themselves in augmented reality experiences hands-free. This has led to the adoption of Google Glass in exploring different scenarios and facilitating augmented reality experiences in medical education (43). Google Glass has demonstrated its effectiveness in enhancing surgical skills and offering lifelike simulations. For example, during living donor liver transplantation, head-mounted action cameras were utilized to produce high-quality educational videos, surpassing the effectiveness of conventional text- and video-based materials (10).
Educational videos provide a unique first-person perspective, immersing trainees in the learning process and enhancing their ability to visualize surgical procedures effectively. (40, 41) Google Glass, as another surgical visualization method, has demonstrated its capability to aid overall learning and offer realistic simulations, particularly for open procedures with limited visibility, allowing instructors to see "blind" regions in the operating field (11, 13). Additionally, its integration into ultrasound-guided processes, like central venous catheter placement, showed that wearers took longer to gain access, required more needle redirections, but exhibited reduced head movements (18). Google Glass has also been beneficial for neurosurgery residents, facilitating surgical education through video review in various clinical scenarios.
By wearing Google Glass, trainees can visualize medical procedures from the perspective of the healthcare professional, enhancing their understanding of the procedure and allowing for experiential learning (17). This technology enhances spatial awareness and facilitates better understanding of the surgical steps and techniques (44). A wearable surgical visualization system enhance trainee performance in a simulated operating situation, particularly in suture placement accuracy (15). By providing an easily accessible and portable video recording and review system, Google Glass enhances the educational process and promotes self-assessment and continuous improvement (45). Google Glass was utilized to simulate different scenarios in cardiovascular practice, providing trainees with real-time video streams for educational purposes.
Telesimulation was utilized in conjunction with wearable and mobile technologies such as Google Glass to give an emergency medical services (EMS) course on mass casualty incidents (MCIs). An intercontinental MCI triage course was successfully completed via telesimulation, illustrating the potential of wearable and mobile technologies in remote medical education (16). This approach allowed participants to engage in realistic training scenarios while utilizing wearable devices for enhanced learning. The heart rate murmur simulator, a mobile augmented reality (AR) used provided an immersive learning experience by combining audio simulation of heart murmurs with visualizations of the heart on a mobile device (19). This technology enhances the learning experience and facilitates better understanding of complex cardiac sounds.
Additionally, the development of high-fidelity simulators controlled through mobile applications allowed medical students to learn cardiopulmonary auscultation and heart murmurs in an immersive manner (21). These simulators enable medical students to learn cardiopulmonary auscultation and heart murmurs in an immersive manner.(46) By using IoT technology, students can practice their auscultation skills in a realistic simulation environment, receiving immediate feedback on their performance. This allows for repetitive practice, skill refinement, and confidence building, ultimately improving clinical competence. These findings indicate that IoT technology can facilitate non-surgical medical education by providing realistic simulations, interactive platforms, and real-time feedback.
In the past decade, significant advancements have been made in the development of wearable sensor technologies across various fields (47). Particularly in education, wearable sensors offer students the invaluable advantage of continuous monitoring, providing real-time data on physical activity levels and health status throughout the learning process. These sensors can be conveniently applied to different parts of the student's body, enabling swift and efficient data collection. Some of these sensors are specifically designed to detect and track specific motions of interest (48).
Motion tracking sensors and wearable inertial sensors helped assess residents' performance during surgical procedures, identify learning gaps, and provide targeted coaching (14). These sensors enable objective evaluation of surgical skills, capturing data on movement patterns, precision, and efficiency. By analyzing this data, trainers can identify areas where trainees require improvement and provide personalized coaching, leading to enhanced surgical performance (38, 39). Surgical residents wore motion tracking sensors to stratify top and lower tier performers and streamline video review while performing a simulated LVH surgery (14). This wearable technology provides real-time visual feedback to trainees, facilitating better understanding and improved skill acquisition.
An IoT-based flipped learning platform was designed to create interactive and engaging medical education experiences, using sensors and wearables to collect data and provide feedback (20). By collecting real-time data on learners' performance, engagement, and physiological parameters, such as heart rate and movement, the platform can offer personalized feedback and tailor the learning experience to individual needs. This interactive and engaging approach to medical education promotes active learning and enhances knowledge retention (20). A wearable armband is used to measure the correctness of hand washing for mobile learning. The sensors are designed to recognize the activity of the forearm, palm and fingers. Using signal processing and machine learning, the quality of the hand washing process can be estimated and used as evaluation in medical teaching (23).
IoT devices have proven valuable in monitoring residents' activities, physical states, and sleep patterns to assess their impact on training and well-being. Studies in this category utilized wearable devices such as Fitbit and wrist-worn biometric devices to monitor sleep, heart rate, physical activity, and emotional well-being. The findings revealed associations between sleep deprivation, emotional state, and residents' well-being. Continuous monitoring of heart rate revealed significant increases suggestive of episodic tachycardia during critical care shifts (28). Moreover, the use of wearable devices allowed for the assessment of burnout levels among residents, providing insights into the prevalence of burnout and its potential impact on their health (30). These results emphasize the importance of monitoring residents' physical and emotional states using IoT technology to identify potential risk factors and promote well-being.
Moreover, one of the key applications of wearable devices in the education of resident students is sleep monitoring, which has been utilized to track the sleep patterns of healthcare professionals. Studies using wearable devices such as Fitbit Charge 2™ have investigated the association between sleep characteristics and depression risk among physicians in training (25–27, 32). These studies found that day-to-day variability in sleep patterns, including insufficient sleep and shift work, was associated with an increased risk of depression among physicians in training. This highlights the importance of monitoring and addressing sleep-related factors in physician well-being and mental health. In addition to sleep monitoring, wearable devices with accelerometry-based sensors were employed to monitor mood, sleep, and physical activity among medical interns. The impact of factors such as shift work, insufficient sleep, and physical inactivity on the stressful environment experienced by physicians during their training years (29). Several studies have explored the application of wearable devices and neuroimaging techniques to investigate the impact of sleep deprivation and fatigue on brain function. Neuroimaging techniques used to assess the possibility of brain function deterioration in sleep-deprived individuals. By monitoring changes in cerebral hemodynamics using a wearable optical topography device during a blood extraction procedure, researchers can understand the effects of sleep deprivation on brain activity (32). By utilizing wearable devices, researchers could gather objective data on these parameters and identify potential areas for intervention.
These findings collectively suggest that IoT technology has the potential to revolutionize surgical training and improve the technical skills of surgeons. These systems provide real-time visual feedback to trainees, enabling them to make adjustments and improve their technique. By enhancing visualization, these systems contribute to the development of finer motor skills and more precise surgical maneuvers. Combining the use of these sensors or devices together can be effective in learning and evaluating the condition of learners. By leveraging the data collected from these sensors, educators can gain a comprehensive understanding of learners' health, activity levels, and performance. This information can be used to tailor educational interventions, provide personalized feedback, and assess the effectiveness of instructional approaches in medical education.
Limitations of the study
The study faced two limitations. Initially, we opted not to conduct a quality assessment for the selected papers due to two reasons: a) this step is discretionary in a systematic mapping study, not mandatory; b) we aimed to avoid overlooking any attempts made to investigate the technological aspects of IoT development in medical education. Additionally, the study commenced in 2023, and the substantial time invested in its preparation and publication, extending over a year, resulted in the exclusion of articles related to 2023.