Application of Immersive and Semi-Immersive Extended Reality Training Systems in Acupuncture Education: Scoping...

Acupuncture training requires precise acupoint localization and needle control, yet peer-to-peer practice raises safety concerns and physical phantoms offer limited anatomical fidelity. Extended reality (XR) is increasingly used in health professions education, but immersive and semi-immersive XR training systems for acupuncture have not been mapped.

This scoping review aimed to map the applications, hardware modalities, and reported technical and educational outcomes of immersive and semi-immersive XR training systems in acupuncture education.

This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and the five-stage scoping review framework of Arksey and O'Malley, as refined by Levac and colleagues. On September 19, 2026, we searched PubMed, Embase, Scopus, IEEE Xplore, CNKI, RISS, ScienceOn, and OASIS. No language or date restrictions were applied. Backward and forward citation searching supplemented the database search. Eligible sources were peer-reviewed original studies or full conference papers describing virtual reality (VR; either fully immersive [IVR] or semi-immersive [SIVR]), augmented reality (AR), or mixed reality (MR) systems for acupuncture training. Two reviewers independently screened records and charted the study design, hardware, training task, and outcomes. Each study was assigned an evidence tier.

Of 6176 records, 3378 were screened after removal of duplicates and ineligible document types, 80 reports were assessed in full text, and 26 studies were included (25 from databases and 1 from citation searching). Most studies came from East Asia (25/26, 96.2%), mainly China (n=18), and 20 (76.9%) were published between 2020 and 2026. Systems used VR (n=15), AR (n=5), or MR (n=6); 19 were IVR and 7 were SIVR. Training tasks addressed acupoint localization (n=13), needling skills (n=11), and clinical reasoning (n=2). Localization errors were reported with different metrics and were not directly comparable across systems. In a randomized comparison, a VR group scored higher on practical skills than a conventional instruction group (32.52, SD 2.28 vs 28.62, SD 2.77 points; P<.001). In an MR simulator with depth-responsive vibrotactile feedback active in both sessions, mean depth error decreased from 6.41 mm in the first practice session to 3.58 mm in the second. Of the 26 studies, 7 used a comparative design; the rest were technical validation (n=6), system development (n=10), or case and survey reports (n=3). Reported barriers included headset weight, narrow field of view, tracking instability, and limited tactile fidelity.

Immersive and semi-immersive XR systems for acupuncture training have been developed mainly for acupoint localization and needling. Randomized comparisons reported higher test scores than conventional instruction, but most evidence came from system development reports and small feasibility studies. Randomized trials comparing XR-based and conventional training on objective localization and needling outcomes are needed before these systems are adopted for competency assessment.