User Experience Comparison of a Traditional Mannequin-Based and an Augmented Reality Lumbar Puncture Simulator in...

Lumbar puncture (LP) is a diagnostic procedure in geriatric medicine but may be technically challenging in older adults with spinal deformities, osteoarthritis, frailty, or cognitive impairment. Simulation-based training can provide repeated practice without patient risk. Augmented reality (AR) systems may improve anatomical visualization and sensory feedback, but their added value compared with mannequin-based simulators and whether perceptions differ according to clinical experience remain uncertain.

This study aimed to compare the user experience (UX) of a traditional mannequin-based LP simulator (M43E; T-S) and an augmented reality simulator with haptic feedback (Sim&Care 2; AR-S) across levels of expertise.

We conducted a single-center, randomized-order, within-participant comparative UX study at Angers University Hospital, France, in June 2025. A total of 30 participants (n=7, 23.3% sixth-year medical students; n=16, 53.3% postgraduate medical students; and n=7, 23.3% graduated physicians) used both simulators for 15 minutes each, with the exposure order randomized. After each session, participants completed an exploratory 5-point Likert questionnaire assessing face validity (FV), usability, perceived educational value (PEV), and overall satisfaction. After both sessions, they reported simulator preference, reasons for preference, and intention to reuse each simulator; open-ended comments were collected. Dimension-level paired comparisons were performed using the Wilcoxon signed-rank test, expertise-group comparisons used the Kruskal-Wallis test, and categorical outcomes were analyzed using the chi-square test. Item-level analyses were considered exploratory.

The AR-S achieved higher composite scores than the T-S for FV (median 3.8 [IQR 3.6-4.2] vs 3.4 [IQR 3.2-3.8]; P=.02) and PEV (median 4 [IQR 3.8-4.6] vs 3.6 [IQR 3.4-4.2]; P=.02). No significant differences were observed for usability (median 4.3 [IQR 4-4.95] vs 4.6 [IQR 4.4-4.8]; P=.11) or overall satisfaction (median 4 [IQR 4-5] vs 4 [IQR 3-4]; P=.16). Exploratory item-level analyses indicated higher ratings for the AR-S for anatomical realism (P=.03), tactile sensations (P=.003), and perceived acquisition of new knowledge (P=.005), whereas the T-S was rated higher for ease of use (P=.01), clarity of instructions (P=.01), and ease of operation during the procedure (P=.003). Overall preference was balanced: 53.3% (16/30) of participants preferred the AR-S, and 46.7% (14/30) of participants preferred the T-S. Preference was not significantly associated with expertise group (P=.09), although graduated physicians descriptively favored the AR-S and sixth-year students favored the T-S. In total, 76.7% (23/30) of participants reported willingness to reuse both simulators.

AR and traditional mannequin-based LP simulation appear to offer distinct and complementary educational advantages rather than one modality being uniformly superior. The AR-S was valued for anatomical and sensory realism and PEV, whereas the T-S retained advantages related to procedural familiarity and ease of use with conventional equipment. These findings support tailoring simulator selection to learner expertise and educational objectives. Larger studies incorporating objective procedural performance are needed to determine how the modalities should be integrated into LP curricula.