Transforming anaesthesia education with extended reality: from preclinical training to independent clinical practice

Introduction

Over the last century, anaesthesia education has radically evolved. Rather than heavily relying on the Socratic method, by the late 1900s, undergraduate medical training began incorporating adult learning principles and focused on self‐directed, problem‐based and experiential learning [1]. In the early 2000s, graduate medical education in anaesthesia also placed a greater emphasis on practice‐based learning [1]. Residents are now encouraged to critically evaluate their own performance, integrate evidence‐based medicine into their practice and continuously adapt to new information and technologies [1]. Simulation is also a key component, providing hands‐on experience in a safe learning environment [2, 3].

Modern anaesthesia training has integrated a variety of advanced technologies to supplement these adult learning strategies [3]. Online courses, e‐learning platforms and webinars offer wide accessibility, allowing anaesthesia trainees to study anytime and from any location. Simulation has also become more advanced, utilising sophisticated manikins in controlled environments [3]. Mobile in‐situ simulations add further flexibility, enabling the assessment of actual clinical workflows and discovery of latent safety threats [3, 4]. Extended realities (XR) have also been incorporated into anaesthetic curricula, enhancing the teaching of non‐technical skills, including communication, empathy and modelling complex procedures, such as nerve blocks and vascular access [5].

Extended realities encompass virtual reality (VR), augmented reality (AR) and mixed reality (MR), blending real and digital environments through head‐mounted devices and smart displays [5]. These technologies are increasingly utilised across healthcare, highlighting their transformative potential. Virtual reality encases users' visual fields in computer‐generated environments, providing distraction and procedural anxiolysis for patients through immersion into novel environments [6]. Augmented reality enhances the natural world by overlaying digital content onto the observed environment, with broad applications in medical education, including crisis management training with eye tracking [2, 7]. Mixed reality blends real and digital worlds to create interactive experiences within a physical environment. Unlike in AR, the digital objects in MR can interact with the physical environment, such as a digital object ‘falling’ off a real table and ‘landing’ on the real floor [5]. While traditional teaching modalities offer structured learning environments and mentorship with personal interactions, XR supplements traditional teaching to improve learner experience and recall [5].

Despite the vast potential of XR, its use in anaesthesia education remains limited [8]. While XR is effectively utilised in otorhinolaryngology, neurosurgery and urology for remote learning and skills training, such as point‐of‐view video coaching with 3D holograms, anaesthesia has not fully embraced these tools [5]. Anaesthetists can leverage XR for crucial skill training such as airway management, resuscitation and nerve blocks, as well as therapeutic applications in interventional pain management [5, 8, 9, 10]. Although these applications hold promise, several challenges must be considered, including cybersickness, limitations in haptic feedback and costs, which may inhibit widespread adoption [11]. Ultimately, as with the incorporation of any innovative technology, the adoption of XR into anaesthesia education will require consideration of the unique circumstances associated with the participant's level of training as well as the healthcare setting.

This editorial reviews the capabilities, barriers and future directions of XR in anaesthesia education. The focus will evaluate how XR will play a significant role in training future anaesthetists, address the educational needs of graduate medical trainees and support continuing medical education.

Extended reality in undergraduate medical education

Anaesthetists are ideally suited to incorporate XR into medical education (Table 1). Recognised as innovators, they have spearheaded safety initiatives, standardised practices and developed advancements in drug delivery [17]. As educators, anaesthetists can utilise XR to teach critical clinical skills which encompass an in‐depth understanding of physiology, pharmacology and anatomy [17]. Their leadership in crisis management further enhances the potential for effective XR integration into the training of future anaesthetists [17].

Table 1.

Anaesthesia education and extended reality integration.

Stages of career path	Opportunities for XR integration	Examples
Undergraduate medical education	Enhancing anatomy education by visualising physiology Reducing cost of cadavers Basic and advanced life support training	Didactic lectures supplemented by congenital heart disease holographic models [12] Students can engage outside the confines of the traditional cadaver laboratory [13] Automated, autonomous feedback reducing depending on CPR instructors [14]
Postgraduate education	Practice complex techniques, such as peripheral nerve blocks and neuraxial techniques Simulating procedures to provide education and practice for central venous cannulation Enhancing visualisation for procedures with limited margin of error	AR head‐mounted device can align a procedural needle with a virtual trajectory, such as thoracic epidurals or difficult neuraxial techniques in pregnant patients [9] First person point of view AR applications for simulation of central venous cannulation [15] AR assisted video laryngoscopy for neonates [16]
Continuing medical education	Innovating the OSCE examination Enhancing current model of MOCA Rethinking current modes for providing CME	Customised XR scenarios to assess specific competencies, complemented by quantitative data, such as eye tracking [7] Moving MOCA beyond knowledge to assessing technical and behavioural skills Provide CME remotely, filming conferences in 360° videos and more immersive format

AR, augmented reality; CME, continuous medical education; CPR, cardiopulmonary resuscitation; MOCA, maintenance of certification in anaesthesiology; OSCE, objective structured clinical examination; XR, extended reality.

Understanding the complex pathophysiological principles of organ systems is crucial for students interested in anaesthesia. However, traditional teaching methods which rely on textbooks fall short in conveying dynamic physiological interactions [18]. Virtual reality allows students to immerse themselves in cellular environments, making abstract concepts easier to conceptualise [18]. Moreover, students engaged with VR benefit from increased active learning, enhanced motivation, improved problem solving skills and positive feedback [18].

Understanding anatomy is equally important, particularly in relation to physiology. Extended reality allows the exploration of complex anatomical and physiological interactions, for example by supplementing lectures with holographic models of congenital heart disease [12]. Within XR, students can dynamically move, remove and spatially rearrange computer‐generated tissues and organs, which is crucial for grasping anatomical relationships [13]. Extended reality can also be used to combine anatomy and physiology to provide dynamic aspects of in vivo conditions and thus, improve upon static 3D printed models used in preparing for difficult airway management [19, 20, 21]. Furthermore, the XR anatomy laboratories of the future can address the issue of costly cadavers and limited availability of pathological specimens, which may be of particular concern to low resource institutions, and will benefit students with complete learning engagement outside the confines of a physical laboratory space [5, 13].

As medical students transition to patient care, mastering cardiopulmonary resuscitation (CPR) becomes essential for managing medically complex patients in acute and intensive care settings [14]. However, limited availability of qualified instructors and training facilities can hinder effective learning [2]. Proficiency in CPR declines within just 3–6 months after training, necessitating more frequent practice to maintain proficiency [14]. Virtual and augmented realities offer solutions by eliminating the reliance on physical facilities and enabling increased training frequency. These technologies provide automated, autonomous feedback and reduce the dependency on instructors [14]. Furthermore, VR and AR enhance the quality of CPR performance, particularly the rate of compressions [14]. As students graduate medical school, the number of opportunities for XR integration into anaesthesia education further expands.

Extended reality in postgraduate medical education

Postgraduate medical residents face demanding work schedules and time constraints, rendering it challenging to balance clinical responsibilities while mastering essential knowledge. The General Medical Council in the UK and the Accreditation Council for Graduate Medical Education in the USA have acknowledged issues related to well‐being and long working hours, highlighting the need for efficient educational methods to ensure comprehensive learning and adequate clinical experience [3, 22]. Extended reality training offers unique opportunities for repeated practice without jeopardising patient safety, enhancing efficiency (Table 1) [13]. Its portability allows for immersive learning experiences beyond the classroom and hospital, providing trainees the opportunity for affordable, high‐fidelity training outside of traditional teaching spaces [13].

Extended reality is increasingly being integrated into anaesthesia training, particularly for practical procedures. This immersive technology enables residents to repeatedly practice peripheral nerve blocks, neuraxial anaesthesia techniques and catheter placement in a controlled environment [9]. Extended reality also enhances pre‐procedural planning by overlaying navigational images on anatomical structures. For example, an AR head‐mounted device can align a procedural needle with a virtual trajectory, which is valuable in challenging procedures [9]. For central venous line insertions, XR offers a transformative approach to training. For instance, a first‐person point of view AR application that simulates central venous catheter insertion improved inexperienced proceduralists to become as reliable as experienced ones [15].

The traditional apprenticeship model has limitations when anatomical and physiological complexities increase risks to patients, particularly in situations with limited margin of error, such as neonatal laryngoscopy [16]. Augmented reality‐assisted videolaryngoscopy can transmit real‐time images to the proceduralist's line of sight, enhancing intubation proficiency among novice clinicians. This technology projects a magnified image of the patient's airway into the user's field of view, providing critical feedback without obstructing their sight—an invaluable asset when managing difficult airways [16]. As residents progress toward independent practice, familiarity with XR as a training tool will provide the basis for using XR as a learning adjunct throughout their careers.

Extended reality for continuing professional development

Anaesthetists must master knowledge, skills and clinical judgement to become independent practitioners. Following postgraduate training, anaesthetists internationally engage in continuing education based on various revalidation programmes. Organisations, such as the Royal College of Anaesthetists in the UK, the American Board of Anaesthesiology through its Maintenance of Certification in Anaesthesiology (MOCA) programme, the Singapore Medical Council and the Hong Kong College of Anaesthesiologists, maintain requirements for continuing professional development standards with mandated revalidation [23, 24].

One of the most challenging aspects of specialty certification is preparing for objective structured clinical examinations (OSCEs), during which candidates demonstrate communication, professionalism and clinical management in realistic simulation scenarios. These are used in the USA as part of the APPLIED Exam and in the UK as part of the primary Fellowship of the Royal College of Anaesthetists Exam and involve simulation, which can be costly due to hardware expenses and personnel [25], but XR may offer a more sustainable and cost‐effective alternative to high‐fidelity simulation centres, which require substantial resources and funding [25, 26]. Moreover, XR scenarios can be customised to assess specific competencies, complemented by quantitative data, such as eye tracking, for more thorough evaluations [7].

In recent years, MOCA introduced a web‐based platform accessible via a smartphone application which is used to refresh knowledge with feedback. Desktop‐based virtual environments have been utilised for teaching anaesthetic emergencies. However, these desktop virtual training modules created through a collaboration between the American Society of Anesthesiologists and Elevate Healthcare (Sarasota, FL, USA) offer limited participant immersion [8]. Extended reality has the potential to transform these learning experiences with immersive scenarios covering a broad range of topics, moving beyond knowledge to encompass both technical and behavioural skills [27].

Extended reality can also elevate continuing medical education (CME) programmes, including international conferences, which are essential to sharing the latest evidence and advancements in anaesthesia. In a large‐scale survey across low and high resource practice settings in Australia, New Zealand and Asia, 92% of anaesthetists reported valuing CME; however, 31% faced participation barriers and 14% struggled to apply new knowledge [23]. In addition, only 17% of French anaesthetists in a national survey about CME participation attended international conferences, with financial and time constraints as the most common reasons for lack of attendance [28]. In addition, international conferences can be overwhelming at times, with prolonged sessions making it difficult to maintain focus [28, 29].

These challenges highlight the costs and time associated with attending CME conferences. Anaesthetists frequently travel to expensive conferences for workshops and lectures to obtain CME, which can be prohibitive for those in low‐resource settings. Extended reality can be leveraged for remote training and assessment, which is particularly beneficial for clinicians unable to travel to conferences, as illustrated in the application of remote VR tracheostomy courses [30]. This technology can also be utilised by filming conferences in 360° videos, allowing participants to experience lectures in a more immersive format. These possibilities not only enhance the learning experience but also make CME more accessible and inclusive (Table 1).

Conclusion

Anaesthetists are ideally positioned to adopt XR technologies, which enhance education at every stage—from undergraduate medical education to continuing professional development. Despite some limitations and relative underutilisation to date, these tools offer engaging, flexible and personalised simulations which address key demands of modern training. To deliver the highest quality medical education, anaesthetists should consider the advantages of these technologies and support their widespread adoption. By integrating XR into current training modalities, educators can create synergy with modern curricula and better prepare current and future anaesthetists for a new era of technology‐enhanced learning.