Toward the Systematic Design and Study of Mixed Reality Serious Games in Higher Education: Design Recommendations and a Multi-Dimensional Methodological Framework

Mixed Reality (MR) serious games combine immersive technologies with game-based learning to support training, skill development, and decision-making across diverse disciplines in university education. Although previous research has demonstrated improvements in engagement, usability, and learning outcomes, less attention has been devoted to developing design recommendations and methodological approaches for studying MR serious games. A theory-derived Meta Quest 3-based MR serious game for diagnostic classification was developed by integrating learning theories, gameplay mechanics, and gamification features while functioning as both an educational intervention and a research instrument. The system was evaluated through two complementary studies involving undergraduate students: the first compared learning outcomes across instructional approaches, whereas the second examined learner performance and transfer using a mixed-method approach incorporating objective metrics, questionnaires, and interviews. The proposed system achieved learning outcomes comparable to expert-guided field training while significantly outperforming classroom instruction and self-directed study. Significant transfer to real-world diagnostic tasks was demonstrated, and complementary evidence was triangulated to derive preliminary design recommendations and a multi-dimensional methodological framework. These contributions provide an initial foundation for the systematic design and study of MR serious games in higher education.