Virtual Reality, Actual Learning: How VR can (and already has) added to medical training


“Today, I think we look at the internet. But I think in the future you’re going to be in the experiences”

Mark Zuckerberg delivered this quote in October 2021 as he prepared his company’s launch into the virtual reality (VR) world of Meta. While Zuckerberg and his corporate entity may evoke varied responses, the potential of virtual reality to immerse users in new experiences cannot be denied. The evolution of VR since the 1990’s can now allow users to “be in” artificial worlds of their own choosing, and therein lies its promise as an educational tool for our field.

While difficult to measure, immersion is vital to medical simulation.1 The ability of participants to perceive simulated environments as real, to suspend the belief that what occurs around them is facsimile, allows them to interact with that environ and is a key factor in the conversion of experience to long term memory.2,3 It is why, to no small extent, we have witnessed a massive expansion of medical simulation-based training initiatives over the past two decades. By immersing learners in environments designed specifically to emphasize educational concepts, we facilitate the expansion of their long-term knowledge base. To accomplish this, medical simulationists have evolved from the Resuci-Annie mannequin of the early 1960’s to the Comprehensive Anesthesia Simulation Environments of the 1980’s and 1990’s4, to mannequins such as the Gaumard “Hal” with its ability to cry, bleed, and even urinate.5 Each iteration has increased the realistic feedback received by learners, allowing them to immerse themselves more easily.

That immersive experience can be taken to new heights by harnessing the potential of virtual (not just simulated) learning environs. In VR, every aspect of the user’s visuospatial and auditory input can be designed with intention, and learners may interact directly with those simulated stimuli. Take, for example, the task of delivering news of a devastating injury to a child’s parent. By creating a virtual environment, a parent-avatar, and guides to convey standard communication skills techniques, providers can “sit down” to prepare for such challenges. Moreover, learners can review their own body language and hear their own voice from the perspective of a parent receiving such information, simply by changing the perspective presented through the VR interface. This has been accomplished through a partnership between Stanford and VR firm STRIVR, and pilot data demonstrate strong self-reported benefits from even a single training session. Moreover, users of all experience levels agreed that the virtual experience “felt real” and expressed a strong desire to train further using this technology.6 This echoes the experience of users of the Stanford Virtual Heart Library, in which learners gained better anatomic understanding of congenital heart malformations by entering and exploring virtual reconstructions of the hearts themselves.7 It is repeated in curriculums preparing nurses for complex care regimens8 and in ER resuscitation training and debriefing.9 In each instance, VR technology allows instructors to create environs tailor-made to suit educational goals and allows learners to immerse themselves more completely in those environs.

The benefit of virtual and augmented reality systems to procedural challenges has already been demonstrated: VR has been used to successfully “fit test” donor hearts and ventricular assist devices before implantation, allowing surgeons the opportunity to manipulate implants in 3-dimensional space.10,11 Augmented reality, in which a virtual 3-dimensional image is overlaid onto the physical world, has been used successfully to guide breast cancer resections12 and electrophysiology lab ablations.13 Teams at Stanford and Duke have used virtual reality systems and computational modeling to demonstrate blood flow and allow surgeons to select optimal targets for repair.14,15 Each of these efforts, and ongoing work worldwide16, has shown the benefits of using VR technology to prepare for the physical work of complex, three-dimensional intervention. Future work will focus on the use of VR to convey conceptual learning and will allow individuals the chance to apply knowledge to real-world interactions.

VR instruction has been shown to be effective in teaching such complex concepts as empathy17 and pro-social behaviors.18 Those same experiences can help cultivate the complex concepts necessary to recognize and manage cardiac physiology, the team dynamics of a cardiac ICU, and the sensitivity necessary to support the families of critically ill children. As advances in artificial intelligence allow for ever-more-realistic worlds and interactions, we can create opportunities for providers of all disciplines to experience complications in the operating theater, acute changes in the ICU, and difficult conversations of all varieties. While this will surely never replace didactic or traditional simulation-based learning modalities, the immersion of a trainee in custom-designed learning environments is an incredibly powerful tool. Opportunities to “be in” experiences they will encounter, before ever facing them in actual reality, cannot fail to expand the abilities of our present and future colleagues.

  1. Hagiwara MA “Measuring participants’ immersion in healthcare simulation: the development of an instrument”, Advances in Simulation, 2016 1(1), p.4-9
  2. Kemple T, Adult learning theory.Br J Gen Pract, 2000. 50(452): p. 238.
  3. Laidley, TL and Braddock, IC. Role of Adult Learning Theory in Evaluating and Designing Strategies for Teaching Residents in Ambulatory Settings.Adv Health Sci Educ Theory Pract, 2000. 5(1): p. 43-54.
  4. Cooper JB and Taqueti VR. “A brief history of the development of mannequin simulators for clinical education and training”, Quality and Safety in Health Care 13(Suppl 1), p. i11 – i18
  5. Simon M.“This Hyper-Real Robot Will Cry and Bleed on Med Students”, Com, September 6th 2018,
  6. Mills M Workshops, I.P.S.S.a. Virtual Reality Training for Critical Conversations in Pediatrics. May, 2019; [cited Aug 2022]Available from:
  7. Health SCs. Lucile Packard Children’s Hospital Stanford pioneers use of VR for patient care, education, and experience.2017 March 2017 [cited Aug 2022]; Available from:
  8. Plotzky C “Virtual reality simulations in nurse education: A systematic mapping review”
  9. Chang TP et. al. “Comparisons of Stress Physiology of Providers in Real-Life Resuscitations and Virtual Reality-Simulated Resuscitations”. Simulation in Healthcare, 2019. 14(2): p.104-112.
  10. Moore RA “Virtual Implantation of the 50-cc SynCardia total artificial heart”. Journal of Heart Lung Transplantation, 2016. 35: p.824-827
  11. Davies RR “Using virtual reality simulated implantation for fit-testing pediatric patients for adult ventricular assist devices” Journal of Thoracic and Cardiovascular Surgical Techniques 6: p. 134-137
  12. Sato, Y., et al., “Image guidance of breast cancer surgery using 3-D ultrasound images and augmented reality visualization”. IEEE Trans Med Imaging, 1998. 17(5): p. 681-93.
  13. Prakosa, A., et al. “Personalized virtual-heart technology for guiding the ablation of infarct-related ventricular tachycardia”. Nat Biomed Eng, 2018. 2(10): p. 732-740.
  14. Shi, H “Harvis: An Interactive Virtual Reality Tool For Hemodynamic Modification And Simulation”. Journal of Comp. Sci., 2020. 43: 101091
  15. Biglino, G “A Hemi-Fontan Operation Performed by and Engineer: Considerations on Virtual Surgery”, Proceedings of the ASME 2013 Summer Bioengineering ConferenceVolume 1B. 2013
  16. Chessa, M “Three-dimensional printing, holograms, computational modelling, and artificial intelligence for adult congenital heart disease care: an exciting future”. European Heart Journal, 2022. 43(28): p. 2672-2684
  17. Herrera, F “Building long-term empathy: A large-scale composite of traditional and virtual reality perspective-taking”. PLoS ONE, 13(10): e0204494
  18. Rosenberg, RS, “Virtual Superheroes: Using Superpowers in Virtual Reality to Encourage Pro-Social Behavior”. PLoS ONE, 8(1), P.1-9

Loren D Sacks, MD

Clinical Associate Professor
Director, Advanced Fellowship Program
Pediatric Cardiovascular Critical Care
Stanford University