Feasibility and perceived educational value of extended reality trauma simulation for emergency medical teams in a multinational training context

Abstract Background Large-scale civil military medical live simulation exercises such as NATO Centre of Excellence for Military Medicine’s (NATO MILMED COE) Vigorous Warrior (VW) series provide authentic environments to test interoperability and clinical performance of Emergency Medical Teams (EMTs). However, such exercises are resource intensive, logistically demanding, and infrequent, raising challenges for sustained workforce readiness. Extended Reality (XR) has emerged as a complementary modality with potential to extend access to trauma training, reduce costs, and support distributed learning. This study aimed to examine the educational feasibility of XR trauma simulation when embedded in multinational large scale live simulation. Methods We conducted an educational feasibility study during Vigorous Warrior 2024 in Hungary, embedded within NATO MILMED COE’s multinational large scale medical live simulation. Twenty-five EMT members from three countries (physicians, anaesthesiologists, nurses, and radiographers) participated in an XR-based penetrating chest trauma scenario using the MilExTS XR platform (Meta Quest 3 headset). Feasibility outcomes were evaluated across recruitment, implementation, usability, acceptability and perceived educational value using session logs, post-simulation surveys (Likert scales 1–5), and open-ended qualitative feedback. Data were analysed descriptively and thematically, in line with published feasibility frameworks for medical education. Results Recruitment and completion thresholds were fully achieved (100% participation, 100% survey completion). Acceptability was high, with 88% of participants rating XR as good or excellent for trauma training and indicating willingness to use it in future education. Two-thirds (66%) endorsed XR for enhancing teamwork, while 68% valued opportunities for individual decision-making practice in a safe environment. Usability findings were mixed: 56% of participants rated scenario realism as average or below, cited limited physiological fidelity, lack of tactile feedback, headset navigation challenges, and insufficient role differentiation. Qualitative data supported XR’s perceived educational value while identifying areas requiring further technological and pedagogical development. Conclusion XR trauma simulation demonstrated educational feasibility, high acceptability, and perceived learning value when embedded within a complex multinational large scale live simulation exercise. While limitations in realism and interface design remain, XR shows promise as a complementary modality for interprofessional trauma training. Further research should progress to efficacy testing, cost-effective analysis and curricular integration before wider adoption.