Evaluating healthcare learning in virtual reality: a systematic review
Resumo
Virtual Reality (VR) is increasingly employed in healthcare training because it can create interactive three-dimensional learning environments that minimize risk to patients. As VR-based educational interventions become more widespread, evaluating their learning outcomes is becoming a critical focus for researchers and practitioners alike. Although there are a few other studies which verified VR learning in healthcare, they had as their subject the effectiveness of VR itself, not the methods which are used to evaluate learning. This systematic review examined 72 studies (selected from an initial pool of 22773 retrieved from IEEE Xplore, Scopus, Springer, ACM, and PubMed) that span a range of healthcare domains, with a primary focus on surgery and rehabilitation. The studies demonstrated a broad diversity of evaluation methods, including objective measures, subjective questionnaires, and AI-assisted assessments. While the overall methodological quality was generally high, the significant variability in evaluation approaches creates challenges for cross-study comparison and synthesis. The findings underline the necessity for validated, VR-specific assessment frameworks to facilitate the development and expansion of VR applications in lesser-explored areas of healthcare education.
Palavras-chave:
systematic review, virtual reality, learning, evaluation, healthcare
Referências
Bhone Myint Kyaw et al. Virtual reality for health professions education systematic review and meta-analysis by the digital health education collaboration. Journal of Medical Internet Research, 21(1):e12959, 2019.
Irene Alice Chicchi Giglioli et al. Augmented reality a brand new challenge for the assessment and treatment of psychological disorders. Computational and Mathematical Methods in Medicine, 2015(1):862942, 2015.
David A. Cook et al. Technology-enhanced simulation for health professions education a systematic review and meta-analysis. JAMA, 306(9):978–988, 2011.
Jingjie Zhao et al. The effectiveness of virtual reality-based technology on anatomy teaching a meta-analysis of randomized controlled studies. BMC Medical Education, 20:1–10, 2020.
Feng-Qin Chen et al. Effectiveness of virtual reality in nursing education meta-analysis. Journal of Medical Internet Research, 22(9):e18290, 2020.
Henna Makinen et al. User experiences of virtual reality technologies for healthcare in learning an integrative review. Behaviour & Information Technology, 41(1):1–17, 2022.
Hyunkyung Sung et al. Effectiveness of Virtual Reality in Healthcare Education Systematic Review and Meta-Analysis. Sustainability, 16(19):8520, 2024.
Fabiana Frata Furlan Peres et al. Methods for Evaluating Immersive 3D Virtual Environments A Systematic Literature Review. Proceedings of the 26th Symposium on Virtual and Augmented Reality (SVR 24), 140–151, 2024.
Sahra K. G. Silva et al. A framework for evaluating depth perception in stereoscopic virtual environments. Proceedings of the 24th Symposium on Virtual and Augmented Reality (SVR 22), 105–114, 2024.
Yuri Fernando Tiecher Sefrin, Claudio Roberto Marquetto Mauricio, and Fabiana Frata Furlan Peres. Usability Evaluation of a 3D Digital-Twin System Oriented to Monitoring of Engineering Assets. Proceedings of the 23rd Symposium on Virtual and Augmented Reality (SVR 21), 157–161, 2022.
Filipe A. Fernandes et al. Evaluating User Experience of a Software Engineering Education Virtual Environment. Proceedings of the 24th Symposium on Virtual and Augmented Reality (SVR 22), 137–141, 2024.
Esther Z. Barsom, Maurits Graafland, and Marlies P. Schijven. Systematic review on the effectiveness of augmented reality applications in medical training. Surgical Endoscopy, 30:4174–4183, 2016.
Jaziar Radianti et al. A systematic review of immersive virtual reality applications for higher education design elements, lessons learned, and research agenda. Computers & Education, 147:103778, 2020.
Jeremy N. Bailenson et al. Equilibrium theory revisited mutual gaze and personal space in virtual environments. Presence Teleoperators & Virtual Environments, 10(6):583–598, 2001.
Mel Slater and Sylvia Wilbur. A framework for immersive virtual environments (FIVE) speculations on the role of presence in virtual environments. Presence Teleoperators and Virtual Environments, 6(6):603–616, 1997.
Bob G. Witmer and Michael J. Singer. Measuring presence in virtual environments a presence questionnaire. Presence, 7(3):225–240, 1998.
Taina Ribeiro de Oliveira et al. Virtual reality solutions employing artificial intelligence methods a systematic literature review. ACM Computing Surveys, 55(10):1–29, 2023.
Christopher J. Dede, Jeffrey Jacobson, and John Richards. Virtual, augmented, and mixed realities in education. Springer, 2017.
Ronei M. Moraes and Liliane S. Machado. Fuzzy continuous evaluation in training systems based on virtual reality. Proceedings of IFSA World Congress, 102–107, 2009.
Andrew Gelman et al. Bayesian data analysis. Chapman and Hall/CRC, 1995.
Zahira Merchant et al. Effectiveness of virtual reality-based instruction on students’ learning outcomes in K–12 and higher education a meta-analysis. Computers & Education, 70:29–40, 2014.
Jessica Isbely Montana et al. Neurorehabilitation of spatial memory using virtual environments a systematic review. Journal of Clinical Medicine, 8(10):1516, 2019.
Doug A. Bowman and Ryan P. McMahan. Virtual reality how much immersion is enough. Computer, 40(7):36–43, 2007.
Sergio Teodoro-Vite et al. A high-fidelity hybrid virtual reality simulator of aneurysm clipping repair for vascular neurosurgery training. Simulation in Healthcare, 16(4):285–294, 2021.
Jose Ignacio Guzman, Mauricio Herrera, and Camilo Rodriguez Beltran. A new portable simulator based on virtual reality for teaching essential skills in minimally invasive surgeries. International Journal of Online and Biomedical Engineering, 19(13), 2023.
Jun Liu et al. Cloud computing-enabled IIOT system for neurosurgical simulation using augmented reality data access. Digital Communications and Networks, 9(2):347–357, 2023.
Anas Amin Preukschas et al. Comparing a virtual reality head-mounted display to on-screen three-dimensional visualization and two-dimensional data for training in hepatic surgery. Surgical Endoscopy, 38(5):2483–2496, 2024.
Reza Karimzadeh et al. Design and implementation of brain surgery bipolar electrocautery simulator using haptic technology. Iranian Journal of Science and Technology, 47(3):859–869, 2023.
H. Cakmak et al. Haptic ventriculostomy simulation in a grid environment. Computer Animation and Virtual Worlds, 20(1):25–38, 2009.
Sandrine De Ribaupierre et al. Healthcare training enhancement through virtual reality and serious games. Virtual, Augmented Reality and Serious Games for Healthcare, 1:9–27, 2014.
Seunghan Lee, Amar Sadanand Shetty, and Lora A. Cavuoto. Modeling of learning processes using continuous-time markov chain for virtual reality-based surgical training. IEEE Transactions on Learning Technologies, 17:462–473, 2023.
Dariusz Laski et al. New comprehensive surgical curriculum of pre-graduate surgical education. Videosurgery and Other Miniinvasive Techniques, 8(3):200–210, 2013.
Louise Moody et al. Objective metrics for evaluation of simple surgical skills in real and virtual domains. Presence Teleoperators & Virtual Environments, 12(2):207–221, 2003.
Fei Li et al. Personalized assessment and training of neurosurgical skills in virtual reality an interpretable machine learning approach. Virtual Reality & Intelligent Hardware, 6(1):17–29, 2024.
Costas S. Tzafestas et al. Pilot evaluation of a virtual paracentesis simulator for skill training. Presence Teleoperators and Virtual Environments, 17(2):212–229, 2008.
Paulo V. F. Paiva et al. SimCEC a collaborative VR-based simulator for surgical teamwork education. Computers in Entertainment, 16(2):1–26, 2018.
Junzhen Du et al. Toward immersive and interactive surgical training using extended reality simulator for IoMT. International Journal of Human–Computer Interaction, 41(8):4833–4850, 2025.
Vuthea Chheang et al. Toward interprofessional team training for surgeons and anesthesiologists using virtual reality. International Journal of Computer Assisted Radiology and Surgery, 15:2109–2118, 2020.
Jun J. Pan et al. Virtual reality training and assessment in laparoscopic rectum surgery. International Journal of Medical Robotics and Computer Assisted Surgery, 11(2):194–209, 2015.
Amir Amini et al. Virtual reality vs phantom model benefits and drawbacks of simulation training in neurosurgery. Operative Neurosurgery, 27(5):618–631, 2024.
Vasileios Lahanas et al. Virtual reality-based assessment of basic laparoscopic skills using the Leap Motion controller. Surgical Endoscopy, 31:5012–5023, 2017.
Aline Menin, Rafael Torchelsen, and Luciana Nedel. An analysis of VR technology used in immersive simulations with a serious game perspective. IEEE Computer Graphics and Applications, 38(2):57–73, 2018.
Simone Gazzellini et al. Clinical study and health technology assessment of a robot-assisted gait training on children with neurological disorders. Journal of Health and Social Sciences, 8(1):76–92, 2023.
Ashok Kumar Patil et al. Fusion of multiple lidars and inertial sensors for real-time pose tracking of human motion. Sensors, 20(18):5342, 2020.
Roy Francis Navea et al. Gamified shoulder rehabilitation for mild stroke patients using virtual reality. International Journal of Technology, 16(1), 2025.
Patricia Capsi-Morales et al. Impact of visual feedback configurations in task-oriented immersive virtual reality mirror therapy. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2024.
Maria Matsangidou et al. Participatory design and evaluation of virtual reality physical rehabilitation for people living with dementia. Virtual Reality, 27(1):421–438, 2023.
Murat Akinci et al. The effects of combined virtual reality exercises and robot-assisted gait training on cognitive functions and quality of life in stroke patients. Perceptual and Motor Skills, 131(3):756–769, 2024.
Van-Hanh Nguyen, Frederic Merienne, and Jean-Luc Martinez. Training based on real-time motion evaluation for functional rehabilitation in virtual environments. International Journal of Image and Graphics, 10(2):235–250, 2010.
Daria Tsoupikova et al. Virtual immersion for post-stroke hand rehabilitation therapy. Annals of Biomedical Engineering, 43:467–477, 2015.
Mindy F. Levin et al. Virtual reality versus conventional treatment of reaching ability in chronic stroke clinical feasibility study. Neurology and Therapy, 1:1–15, 2012.
Christoph Rockstroh, Johannes Blum, and Anja S. Goritz. A mobile VR-based respiratory biofeedback game to foster diaphragmatic breathing. Virtual Reality, 25(2):539–552, 2021.
Horace H. S. Ip et al. Enhance emotional and social adaptation skills for children with autism spectrum disorder a virtual reality enabled approach. Computers & Education, 117:1–15, 2018.
Rashmita Chatterjee and Zahra Moussavi. Evaluation of a cognition-sensitive spatial virtual reality game for Alzheimer’s disease. Medical & Biological Engineering & Computing, 2024.
Sun Kyung Kim et al. Expanding virtual reality simulation with reflective learning to improve mental health nursing skills. Education and Information Technologies, 2024.
Yingjie Li et al. Haptic-based virtual environment design and modeling of motor skill assessment for brain injury patients rehabilitation. Computer-Aided Design and Applications, 8(2):149–162, 2011.
Anna Junga et al. Teach the unteachable with a virtual reality brain death scenario. Perspectives on Medical Education, 14(1):44, 2025.
Nicholas Ho et al. Virtual reality training for assembly of hybrid medical devices. Multimedia Tools and Applications, 77:30651–30682, 2018.
Xiaodan Yan et al. Privacy preserving for AI-based 3D human pose recovery and retargeting. ISA Transactions, 141:132–142, 2023.
Jordi Mill et al. Domain expert evaluation of advanced visual computing solutions and 3D printing for planning of left atrial appendage occluder interventions. International Journal of Bioprinting, 9(1):640, 2022.
Lucas H. Sallaberry, Romero Tori, and Fatima L. S. Nunes. Automatic performance assessment in three-dimensional interactive haptic medical simulators a systematic review. ACM Computing Surveys, 55(7), 2022.
W. A. IJsselsteijn, Y. A. W. de Kort, and K. Poels. The Game Experience Questionnaire. Technische Universiteit Eindhoven, 2013.
Marvin Mergen et al. Feasibility study on virtual reality-based training for skin cancer screening bridging the gap in dermatological education. Education and Information Technologies, 30(4):5251–5282, 2025.
Bouthina K. Greiw. Objective Structured Clinical Examination (OSCE). Misurata Medical Sciences Journal, 2015.
Jessica Fish. Lawton-Brody instrumental activities of daily living scale. Encyclopedia of Clinical Neuropsychology, 1438–1439, 2011.
Irene Alice Chicchi Giglioli et al. Augmented reality a brand new challenge for the assessment and treatment of psychological disorders. Computational and Mathematical Methods in Medicine, 2015(1):862942, 2015.
David A. Cook et al. Technology-enhanced simulation for health professions education a systematic review and meta-analysis. JAMA, 306(9):978–988, 2011.
Jingjie Zhao et al. The effectiveness of virtual reality-based technology on anatomy teaching a meta-analysis of randomized controlled studies. BMC Medical Education, 20:1–10, 2020.
Feng-Qin Chen et al. Effectiveness of virtual reality in nursing education meta-analysis. Journal of Medical Internet Research, 22(9):e18290, 2020.
Henna Makinen et al. User experiences of virtual reality technologies for healthcare in learning an integrative review. Behaviour & Information Technology, 41(1):1–17, 2022.
Hyunkyung Sung et al. Effectiveness of Virtual Reality in Healthcare Education Systematic Review and Meta-Analysis. Sustainability, 16(19):8520, 2024.
Fabiana Frata Furlan Peres et al. Methods for Evaluating Immersive 3D Virtual Environments A Systematic Literature Review. Proceedings of the 26th Symposium on Virtual and Augmented Reality (SVR 24), 140–151, 2024.
Sahra K. G. Silva et al. A framework for evaluating depth perception in stereoscopic virtual environments. Proceedings of the 24th Symposium on Virtual and Augmented Reality (SVR 22), 105–114, 2024.
Yuri Fernando Tiecher Sefrin, Claudio Roberto Marquetto Mauricio, and Fabiana Frata Furlan Peres. Usability Evaluation of a 3D Digital-Twin System Oriented to Monitoring of Engineering Assets. Proceedings of the 23rd Symposium on Virtual and Augmented Reality (SVR 21), 157–161, 2022.
Filipe A. Fernandes et al. Evaluating User Experience of a Software Engineering Education Virtual Environment. Proceedings of the 24th Symposium on Virtual and Augmented Reality (SVR 22), 137–141, 2024.
Esther Z. Barsom, Maurits Graafland, and Marlies P. Schijven. Systematic review on the effectiveness of augmented reality applications in medical training. Surgical Endoscopy, 30:4174–4183, 2016.
Jaziar Radianti et al. A systematic review of immersive virtual reality applications for higher education design elements, lessons learned, and research agenda. Computers & Education, 147:103778, 2020.
Jeremy N. Bailenson et al. Equilibrium theory revisited mutual gaze and personal space in virtual environments. Presence Teleoperators & Virtual Environments, 10(6):583–598, 2001.
Mel Slater and Sylvia Wilbur. A framework for immersive virtual environments (FIVE) speculations on the role of presence in virtual environments. Presence Teleoperators and Virtual Environments, 6(6):603–616, 1997.
Bob G. Witmer and Michael J. Singer. Measuring presence in virtual environments a presence questionnaire. Presence, 7(3):225–240, 1998.
Taina Ribeiro de Oliveira et al. Virtual reality solutions employing artificial intelligence methods a systematic literature review. ACM Computing Surveys, 55(10):1–29, 2023.
Christopher J. Dede, Jeffrey Jacobson, and John Richards. Virtual, augmented, and mixed realities in education. Springer, 2017.
Ronei M. Moraes and Liliane S. Machado. Fuzzy continuous evaluation in training systems based on virtual reality. Proceedings of IFSA World Congress, 102–107, 2009.
Andrew Gelman et al. Bayesian data analysis. Chapman and Hall/CRC, 1995.
Zahira Merchant et al. Effectiveness of virtual reality-based instruction on students’ learning outcomes in K–12 and higher education a meta-analysis. Computers & Education, 70:29–40, 2014.
Jessica Isbely Montana et al. Neurorehabilitation of spatial memory using virtual environments a systematic review. Journal of Clinical Medicine, 8(10):1516, 2019.
Doug A. Bowman and Ryan P. McMahan. Virtual reality how much immersion is enough. Computer, 40(7):36–43, 2007.
Sergio Teodoro-Vite et al. A high-fidelity hybrid virtual reality simulator of aneurysm clipping repair for vascular neurosurgery training. Simulation in Healthcare, 16(4):285–294, 2021.
Jose Ignacio Guzman, Mauricio Herrera, and Camilo Rodriguez Beltran. A new portable simulator based on virtual reality for teaching essential skills in minimally invasive surgeries. International Journal of Online and Biomedical Engineering, 19(13), 2023.
Jun Liu et al. Cloud computing-enabled IIOT system for neurosurgical simulation using augmented reality data access. Digital Communications and Networks, 9(2):347–357, 2023.
Anas Amin Preukschas et al. Comparing a virtual reality head-mounted display to on-screen three-dimensional visualization and two-dimensional data for training in hepatic surgery. Surgical Endoscopy, 38(5):2483–2496, 2024.
Reza Karimzadeh et al. Design and implementation of brain surgery bipolar electrocautery simulator using haptic technology. Iranian Journal of Science and Technology, 47(3):859–869, 2023.
H. Cakmak et al. Haptic ventriculostomy simulation in a grid environment. Computer Animation and Virtual Worlds, 20(1):25–38, 2009.
Sandrine De Ribaupierre et al. Healthcare training enhancement through virtual reality and serious games. Virtual, Augmented Reality and Serious Games for Healthcare, 1:9–27, 2014.
Seunghan Lee, Amar Sadanand Shetty, and Lora A. Cavuoto. Modeling of learning processes using continuous-time markov chain for virtual reality-based surgical training. IEEE Transactions on Learning Technologies, 17:462–473, 2023.
Dariusz Laski et al. New comprehensive surgical curriculum of pre-graduate surgical education. Videosurgery and Other Miniinvasive Techniques, 8(3):200–210, 2013.
Louise Moody et al. Objective metrics for evaluation of simple surgical skills in real and virtual domains. Presence Teleoperators & Virtual Environments, 12(2):207–221, 2003.
Fei Li et al. Personalized assessment and training of neurosurgical skills in virtual reality an interpretable machine learning approach. Virtual Reality & Intelligent Hardware, 6(1):17–29, 2024.
Costas S. Tzafestas et al. Pilot evaluation of a virtual paracentesis simulator for skill training. Presence Teleoperators and Virtual Environments, 17(2):212–229, 2008.
Paulo V. F. Paiva et al. SimCEC a collaborative VR-based simulator for surgical teamwork education. Computers in Entertainment, 16(2):1–26, 2018.
Junzhen Du et al. Toward immersive and interactive surgical training using extended reality simulator for IoMT. International Journal of Human–Computer Interaction, 41(8):4833–4850, 2025.
Vuthea Chheang et al. Toward interprofessional team training for surgeons and anesthesiologists using virtual reality. International Journal of Computer Assisted Radiology and Surgery, 15:2109–2118, 2020.
Jun J. Pan et al. Virtual reality training and assessment in laparoscopic rectum surgery. International Journal of Medical Robotics and Computer Assisted Surgery, 11(2):194–209, 2015.
Amir Amini et al. Virtual reality vs phantom model benefits and drawbacks of simulation training in neurosurgery. Operative Neurosurgery, 27(5):618–631, 2024.
Vasileios Lahanas et al. Virtual reality-based assessment of basic laparoscopic skills using the Leap Motion controller. Surgical Endoscopy, 31:5012–5023, 2017.
Aline Menin, Rafael Torchelsen, and Luciana Nedel. An analysis of VR technology used in immersive simulations with a serious game perspective. IEEE Computer Graphics and Applications, 38(2):57–73, 2018.
Simone Gazzellini et al. Clinical study and health technology assessment of a robot-assisted gait training on children with neurological disorders. Journal of Health and Social Sciences, 8(1):76–92, 2023.
Ashok Kumar Patil et al. Fusion of multiple lidars and inertial sensors for real-time pose tracking of human motion. Sensors, 20(18):5342, 2020.
Roy Francis Navea et al. Gamified shoulder rehabilitation for mild stroke patients using virtual reality. International Journal of Technology, 16(1), 2025.
Patricia Capsi-Morales et al. Impact of visual feedback configurations in task-oriented immersive virtual reality mirror therapy. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2024.
Maria Matsangidou et al. Participatory design and evaluation of virtual reality physical rehabilitation for people living with dementia. Virtual Reality, 27(1):421–438, 2023.
Murat Akinci et al. The effects of combined virtual reality exercises and robot-assisted gait training on cognitive functions and quality of life in stroke patients. Perceptual and Motor Skills, 131(3):756–769, 2024.
Van-Hanh Nguyen, Frederic Merienne, and Jean-Luc Martinez. Training based on real-time motion evaluation for functional rehabilitation in virtual environments. International Journal of Image and Graphics, 10(2):235–250, 2010.
Daria Tsoupikova et al. Virtual immersion for post-stroke hand rehabilitation therapy. Annals of Biomedical Engineering, 43:467–477, 2015.
Mindy F. Levin et al. Virtual reality versus conventional treatment of reaching ability in chronic stroke clinical feasibility study. Neurology and Therapy, 1:1–15, 2012.
Christoph Rockstroh, Johannes Blum, and Anja S. Goritz. A mobile VR-based respiratory biofeedback game to foster diaphragmatic breathing. Virtual Reality, 25(2):539–552, 2021.
Horace H. S. Ip et al. Enhance emotional and social adaptation skills for children with autism spectrum disorder a virtual reality enabled approach. Computers & Education, 117:1–15, 2018.
Rashmita Chatterjee and Zahra Moussavi. Evaluation of a cognition-sensitive spatial virtual reality game for Alzheimer’s disease. Medical & Biological Engineering & Computing, 2024.
Sun Kyung Kim et al. Expanding virtual reality simulation with reflective learning to improve mental health nursing skills. Education and Information Technologies, 2024.
Yingjie Li et al. Haptic-based virtual environment design and modeling of motor skill assessment for brain injury patients rehabilitation. Computer-Aided Design and Applications, 8(2):149–162, 2011.
Anna Junga et al. Teach the unteachable with a virtual reality brain death scenario. Perspectives on Medical Education, 14(1):44, 2025.
Nicholas Ho et al. Virtual reality training for assembly of hybrid medical devices. Multimedia Tools and Applications, 77:30651–30682, 2018.
Xiaodan Yan et al. Privacy preserving for AI-based 3D human pose recovery and retargeting. ISA Transactions, 141:132–142, 2023.
Jordi Mill et al. Domain expert evaluation of advanced visual computing solutions and 3D printing for planning of left atrial appendage occluder interventions. International Journal of Bioprinting, 9(1):640, 2022.
Lucas H. Sallaberry, Romero Tori, and Fatima L. S. Nunes. Automatic performance assessment in three-dimensional interactive haptic medical simulators a systematic review. ACM Computing Surveys, 55(7), 2022.
W. A. IJsselsteijn, Y. A. W. de Kort, and K. Poels. The Game Experience Questionnaire. Technische Universiteit Eindhoven, 2013.
Marvin Mergen et al. Feasibility study on virtual reality-based training for skin cancer screening bridging the gap in dermatological education. Education and Information Technologies, 30(4):5251–5282, 2025.
Bouthina K. Greiw. Objective Structured Clinical Examination (OSCE). Misurata Medical Sciences Journal, 2015.
Jessica Fish. Lawton-Brody instrumental activities of daily living scale. Encyclopedia of Clinical Neuropsychology, 1438–1439, 2011.
Publicado
30/09/2025
Como Citar
SILVA, Vitor Dos Santos; NUNES, Fátima L. S..
Evaluating healthcare learning in virtual reality: a systematic review. In: SIMPÓSIO DE REALIDADE VIRTUAL E AUMENTADA (SVR), 27. , 2025, Salvador/BA.
Anais [...].
Porto Alegre: Sociedade Brasileira de Computação,
2025
.
p. 312-321.
