Pro-Con Debate: Virtual Reality Compared to Augmented Reality for Medical Simulation

Medical simulations bridge theory and practice in immersive settings. During this unique form of education, learners experience challenging medical scenarios without risking patient harm. The effectiveness of simulations stem from their ability to induce autonomic stress responses, which potentiate memory formation. Educators have adopted virtual reality (VR) and augmented reality (AR) to supplement traditional, mannequin-based simulations. In this Pro-Con commentary article, we discuss the competitive advantages and limitations of VR and AR simulation for medical training. VR uses computer-generated images (CGI) within head-mounted displays (HMDs) to enhance learning. Gamification of medical procedures in VR improves acquisition of complex skills, positioning VR simulation as a pivotal training tool. Participant embodiment while in VR develops non-technical skills such as improved communication and enhanced empathy. The placement of participants within CGI worlds that would otherwise be difficult or impossible to recreate situate VR as the ideal next step in simulation evolution. VR is superior to AR given its lower hardware costs, expansive software libraries, and complete immersion in CGI compared to limited holographic fields of view within AR. By displaying holograms within the participant's natural world, AR is primed to replace screen and VR technologies as the premier learning adjunct. The integration of real-world instruments with AR holograms provides innumerable methods for teaching procedural skills. In addition, AR enhances pre- and intra-operative planning by overlaying holographic, radiographic patient images over their own bodies. Because AR has the unique feature of maintaining direct eye contact between participants, scenarios that improve communication skills are easily created with holograms in the real world, eliminating the need for an entirely CGI VR environment. Immersive simulation efforts should skip the costs of creating VR scenarios and redirect efforts to developing AR simulation software. Although both VR and AR have limitations related to cost and ergonomics, immersive technologies are relatively more affordable and versatile than traditional mannequins and physical simulation centers. As adjuncts to enhance traditional simulation curricula, we advocate for continued research to demonstrate the validity and utility of these immersive technologies.