Beyond Immersion: A Stage-Based Framework for Cross-Modal Immersive Technologies in Medical Education

Background Immersive technologies such as virtual reality (VR), augmented reality (AR), and point-of-care ultrasound are increasingly used in medical education, yet most studies evaluate these tools in isolation. As a result, the relationships among immersive experience, cognitive workload, technical performance, and downstream diagnostic assessment remain poorly understood. This exploratory secondary analysis applied the Immersive Learning Engagement-Performance (ILEP) conceptual framework to a staged multimodal dataset to examine whether selected immersive psychological variables were associated with downstream Extension Proficiency Composite and exploratory distal diagnostic performance. Methods This theory-informed secondary analysis used participant-level data from a prospective staged protocol involving VR, AR, and ultrasound. All participants completed a VR module before assignment to an AR or ultrasound extension arm, and a subset also completed a dermoscopic image interpretation task as an exploratory downstream diagnostic assessment. Because of the staged design and modest sample size, analyses were conducted using a reduced observed-variable regression approach rather than latent structural equation modeling. Results Among participants completing the full final analytic pathway (N = 41), baseline dermoscopy knowledge was the strongest adjusted correlate of dermoscopic diagnostic accuracy (β = 0.86, p < 0.001). Extension Proficiency Composite showed a positive adjusted coefficient that did not reach statistical significance (β = 0.17, p = 0.060), while osteopathic manipulative medicine (OMM) Composite was not independently associated (p = 0.213). In the upstream model, VR-derived psychological presence and cognitive workload were not significantly associated with pooled extension-module performance, and the model demonstrated limited explanatory power (adjusted R^2 = 0.030). Conclusion Within this exploratory theory-informed analysis, distal dermoscopic diagnostic performance was primarily associated with baseline knowledge, whereas immersive psychological variables and Extension Proficiency Composite demonstrated limited or non-significant associations.