Stakeholder Engagement in XR Healthcare Education

Healthcare education has increasingly embraced immersive technologies, yet effective stakeholder engagement remains a critical challenge in developing implementations that address both technical and emotional dimensions of clinical practice. This review synthesizes current literature on stakeholder engagement in XR healthcare education, highlighting opportunities for more systematic approaches through Educational Design Research methodologies. Healthcare education has evolved through distinct phases of XR implementation, from early virtual patients to sophisticated mixed reality environments (Kononowicz et al., 2019; Akhtar et al., 2024a ). Research demonstrates XR efficacy in enhancing procedural competence, with systematic reviews indicating improvements in knowledge retention (effect size d=0.72) and technical skill acquisition (d=0.65) compared to traditional methods (Stretton et al., 2024). However, current implementations predominantly focus on environmental and procedural authenticity while neglecting affective dimensions of clinical practice. Recent findings highlight emotional regulation as a critical determinant of clinical performance, with studies showing healthcare professionals experiencing elevated stress demonstrate 28-34% decrease in diagnostic accuracy and 41% reduction in effective communication during critical incidents (Armstrong et al., 2024). Despite this evidence, existing XR implementations typically present static, pre-programmed scenarios that fail to respond to learners' emotional states (Birt et al., 2024). The development of XR technologies in healthcare education requires effective stakeholder engagement to ensure relevance and adoption. However, Li et al. (2024) found that only 23% of XR implementation projects involve systematic stakeholder consultation throughout development. The majority (62%) engage stakeholders only during initial needs assessment or final evaluation phases, creating disconnect between technological capabilities and educational requirements. Key stakeholders typically include clinical educators, healthcare students, practicing clinicians, technical developers, and patients, each bringing unique perspectives on simulation authenticity and usability. Studies show that projects involving multiple stakeholder groups throughout development achieve 49% higher adoption rates and 57% better alignment with educational objectives compared to developer-driven implementations (Yeung et al., 2021). Educational Design Research (EDR) offers a methodological framework well-suited to addressing this complex challenge. Its iterative, participatory nature enables close collaboration between educators, technologists, and clinical practitioners, essential for developing emotionally responsive learning environments (McKenney & Reeves, 2021; Akhtar et al., 2024b). Previous applications of EDR in healthcare simulation, such as the MESH360 framework, demonstrate its effectiveness in bridging technological innovation with authentic educational needs (Cochrane et al., 2020). The importance of cultural competence adds another dimension to stakeholder requirements. Research by Taylor et al. (2019) highlighted significant variations in healthcare delivery approaches across different cultural contexts in Australasia, yet Zhang et al. (2024) found that only 12% of XR healthcare simulations incorporate culturally specific elements or consider variations in stress responses and decision-making patterns. Stakeholder engagement faces several documented challenges, including disciplinary language differences between technical developers and healthcare educators (reported in 78% of projects), competing priorities among stakeholder groups (67%), and difficulties translating clinical authenticity into technical specifications (82%) (Lam et al., 2021). User experience design principles represent a promising approach, with studies documenting improvements in stakeholder satisfaction (43% increase) and technology adoption rates (37% increase) when employing co-design methodologies that position healthcare educators and students as design partners rather than consultants (Hamstra et al., 2014). The literature reveals a clear need for more systematic approaches to stakeholder engagement in XR healthcare education, particularly when addressing complex challenges such as emotional resilience development (Aiello et al., 2023). The proposed Emotionally Responsive XR Clinical Environments (ERXCE) framework represents a novel approach that addresses these gaps by integrating stakeholder perspectives throughout the development process, from initial needs assessment through iterative refinement and evaluation. The presentation will outline how the project will engage with key stakeholders as a model for other similar projects.