Augmedicine: Ultrasound: Training in ultrasound using XR – a randomized controlled trial

Point-of-care ultrasound (POCUS) is a diagnostic tool increasingly used. For novices, challenges such as probe orientation and hand-eye coordination make POCUS difficult to master. Extended reality (XR) can enhance POCUS training by projecting 3D anatomical models and offering real-time feedback on probe positioning. We developed the ‘Augmedicine: Ultrasound’ XR application, which enables heart POCUS training without the need for an instructor or test subject. The goal of this study was to determine whether XR-based training is non-inferior to standard POCUS training. Medical students in their internal medicine clerkship were randomized to XR-integrated POCUS training or standard training under direct instructor supervision. Competence was assessed through a practical test, where students obtained two ultrasound images and measured e-point septal separation (EPSS) and tricuspid annular plane systolic excursion (TAPSE). Expert-determined values served as references and were used to determine non-inferiority. Secondary endpoints included test completion time and image quality. Fifty-six students participated: 28 in the XR group and 28 in the standard training group. The mean difference in EPSS between groups was 0.3 mm (95% CI − 0.8 to 1.3 mm), and for TAPSE 0.5 mm (95% CI − 1.4 to 2.6 mm). In both cases, the confidence intervals remained within the predefined non-inferiority margins, indicating comparable performance between XR-based and standard training. There was no significant difference in the time taken to complete the test, and image quality was slightly higher in the XR group compared to the standard group. XR-based POCUS training proved to be non-inferior to standard training in acquiring and measuring basic cardiac ultrasound images. Beyond comparable performance, the XR approach offers clear benefits in flexibility, scalability, and reduced reliance on instructors and test subjects—making it particularly valuable for training large cohorts and allowing learners to practice at any time and for any duration. These findings support the integration of XR as a practical and effective addition to ultrasound education. ISRCTN Registry, ISRCTN13887304. https://doi.org/10.1186/ISRCTN13887304