Immersive learning in health professions education

INTRODUCTION

Immersive learning is learning through deliberately designed artificial experiences that the learners perceive as direct and authentic, without an obvious intervening medium.^[1] The experiences engage the learners holistically, integrating cognitive, affective, and psychomotor domains and enabling learning through participation. As an educational approach, the experience itself becomes the primary vehicle for learning.^[1]

IMMERSIVE LEARNING IN HEALTH PROFESSIONS EDUCATION AND TRAINING

Health professions education is challenged by increasing healthcare complexity, patient safety imperatives, and competency-based mandates that demand approaches that lead to learning that is transformative. Immersive learning is a pedagogical strategy that has emerged as one that offers learners realistic and interactive experiences that are reflective of real-world clinical practice.

Immersive learning shifts the focus from what educators teach to what learners experience. This shift aligns directly with competency-based education, where competencies are understood as integrated sets of characteristics that enable effective and superior professional performance.^[2,3] Immersive learning cultivated these competencies through experience-rich environments that promote active engagement, reflection, and meaning-making.

Immersive learning is based on the Experiential Learning Theory. The actual experience is central to learning. As described by Kolb, and the knowledge building is created through transformation of experience.^[4,5] Immersive education intentionally designs artificial experiences that are close to clinical realism while remaining educationally safe.^[1] Several scholarly systematic reviews and meta-analyses in health professions education discuss the effectiveness of the immersive approach.^[6,7] Emerging technologies such as the metaverse have further expanded discussions around immersive environments in healthcare education, highlighting challenges related to implementation, equity, and governance.^[8]

CORE PRINCIPLES UNDERPINNING IMMERSIVE LEARNING

The experiential learning principle is the core of immersive learning.^[4,5] Artificial experiences may be created using either the transformation of physical spaces into narrative-driven, role-based learning environments or virtual environments such as virtual reality (VR), augmented reality, and extended reality.^[1] While technology can enhance immersion, it does not define it.

The PRAS model offers a useful framework for understanding immersive learning experiences and includes four key elements:

• Presence: Learners experience a sense of physical and psychological engagement within the learning environment, supported by realistic interfaces and sensory feedback^[1]

• Role: Learners assume defined identities within the experience, fostering ownership, accountability, and deeper engagement^[1]

• Activity: Learning is driven by interactive tasks requiring decision-making, collaboration, and problem-solving rather than passive observation^[2,3]

• Scaffolding: Cognitive load is deliberately managed through structured guidance and feedback that support progressive learning and competence development.^[4,5]

METHODS OF IMMERSIVE LEARNING

Immersion methods can be technological or non-technological. The non-technological methods are as follows:

• Narrative-based learning

• Theatre and dramatization

• Role play

• Standardized or simulated patient encounters

• Simulated clinical scenarios

These approaches reinforce that immersion is defined by experiential authenticity rather than technological sophistication.^[1] Health profession’s education is toward preparing competent, reflective, and system-ready practitioners, and immersive learning is a core pedagogical strategy,^[4,5] which is aligned with competency-based education^[2,3] and responsive to emerging immersive technologies and system realities.^[6-8]

TECHNOLOGY-ENHANCED LEARNING

Immersive learning using technology includes AR and VR as tools to improve the student’s experience. It eliminates visible boundaries and frames, allowing the learners to be fully enveloped in the virtual environment.

Augmented reality focuses on augmenting the physical world with digital images, videos, or experiences overlaid with computer-generated images and 3D models. An example is to superimpose live images of human veins for blood-drawing procedures or to show how the joints function during movement.

Non-immersive VR users view virtual content on a conventional display, where the users are aware of a visible boundary and frame between the virtual and the real world. Interactions occur through classical devices such as a mouse, keyboard, or joystick.

Semi-immersive VR involves a virtual environment but uses large-scale projection surfaces, making visible boundaries and frames less obvious to users. Interactions occur through freehand gestures or tangible interfaces.

Other tools used are Meta artificial intelligence (AI) and AI Avatars.

Meta AI uses an AI assistant to answer questions, generate images, provide creative ideas, and interact with users in a conversational manner.^[8]

Meta Avatars allows users to create 2D stickers used in messages and stories and advanced 3D models for a personalized virtual experience.

HOW TO SUCCESSFULLY IMPLEMENT CHALLENGES AND OPPORTUNITIES?