Virtual and Augmented Reality: The Perceived Impact on Surgical Training, a Systematic Review

The integration of Extended Reality Simulation (XR), which incorporates Virtual and Augmented Reality, is increasingly growing within surgical education. The advantages of faster skill acquisition, immersive operative environments and feedback opportunities have been noted in the research thus far. The primary educational theory supporting XR simulation is Kolb's Experiential Learning Theory. However, a comprehensive qualitative systematic review of the literature that explores surgical trainees' experiences is currently lacking and was therefore conducted.

Three major databases-Medline, Embase and Mendeley-were searched primarily for qualitative and mixed-methods studies published in the past 5 years, which explored surgical trainees' experiences with XR. The search strategy followed PRISMA reporting guidelines and was conducted between January and May 2025. Initial search results yielded 330 articles, and following the inclusion criteria and full-text review, 11 papers were selected for final critical appraisal. This was conducted using the Modified Mixed Methods Appraisal Tool. Nvivo 14 was utilized to code and tabulate the data. An Interpretivist paradigm was used to approach the qualitative findings and subsequently draw the contextual subtext of the educational experiences of XR. Braun and Clarke's six-stage model was used to subsequently identify sub-themes, themes and thematic relationships. Theme development was further refined and reflected on a thematic map to highlight key relationships and cross-over amongst shared sub-themes.

Three major themes and six sub-themes emerged from the thematic analysis: "Integration of XR into Surgical Education," "Mentorship, Collaboration and Reflective Practice," and "Challenges in Accessibility, Equity and Usability." The three major themes highlighted the potential for XR in the surgical curriculum, the benefits of mentorship and collaboration, and the challenges to accessibility that XR both addresses and faces.

This qualitative systematic review highlights XR's potential to support surgical trainees in enhancing their operative confidence, procedural understanding and self-reflection. The barriers faced by XR, including socioeconomic differences and technological issues, currently limit widespread usage; however, strategic investments and careful integration with the surgical curriculum would encourage a greater user base and should be considered by educators.