Using head-mounted augmented and virtual reality devices for anaesthesia education: a scoping review

Summary

Head-mounted devices (HMDs) have been explored in anaesthesia education for their unique ability to have head-tracked immersive simulations adaptable to diverse clinical scenarios. This scoping review examines how HMD-based augmented or virtual reality enhances anaesthetic skill learning in clinicians, trainees, and students. Excluding patient-user focused studies, 22 articles addressed airway management, neuraxial and regional anaesthetic procedures, vascular access, and practice scenarios. Overall, HMDs improved engagement, knowledge retention, and user confidence, with some evidence of improved procedural performance, but technical limitations and difficulty adopting new technology persist. Airway studies reported improved recall and confidence. Neuraxial training suggested improved skill acquisition and needle placement. Regional anaesthesia training was as effective or superior to conventional methods while requiring fewer instructors. HMD-assisted vascular and central venous training reduced head movement but had mixed efficiency outcomes. Virtual scenario simulations using HMDs were engaging, but sometimes difficult to interact with. Despite promising findings, heterogenous methodologies, lack of control groups, and limited long-term results limit definitive conclusions on HMD superiority over conventional teaching, indicating a need for larger multicentre trials. Future research should standardise study design in comparison with conventional teaching, evaluate learning curves, technical limitations, cost-effectiveness, and investigate HMD-based team training. HMDs in their current form as devices with an immature technology and software base serve best as complementary, not replacement, simulation tools.

Editor’s key points.

• •Twenty-two studies were found where head-mounted devices (HMDs) were used for anaesthesia education, revealing overall improvements in engagement and improvements in skill acquisition speed and quality.
• •HMD use for airway management teaching helped with knowledge acquisition on intubation, airway conditions, laryngoscopy, and tracheostomy skills, but all used varying methodologies.
• •Learning regional and neuraxial anaesthetic blocks with HMD use was consistently rated as highly immersive, improved skill acquisition and performance but relied heavily on small simulation-based studies.
• •Learning vascular access procedures benefited from HMD use by reducing head movements, but their ability to improve procedural skills was mixed.
• •HMDs can be a novel method of simulating engaging clinical environments or enabling remote learning but can be complicated to understand and technically implement.

Trainee anaesthetists require diverse teaching and experience to achieve competency.¹ Simulation-based training is increasingly used to teach skills without patient risk.² Head-mounted devices (HMDs) offer a novel infrastructure-light method of simulating clinical scenarios by displaying content within the user's field of view in either augmented reality (AR) or virtual reality (VR).

In AR, the digital world is overlayed atop the real world, thus allowing for images, 3D models, and information to interact with and augment the surroundings. AR is typically less computationally intensive and is best used in educational applications where phantoms and simple manikins are available. In VR, the whole field of view is created virtually, and the entirety of the real world is obscured (Fig. 1). This allows for more flexibility and complexity in the digital information displayed as it can, but does not need to, interact with real-world objects. It is best used for complicated simulations, but is more computationally demanding and disorienting from reality.³

Fig 1.

Comparison of augmented reality (AR) and virtual reality (VR) views. (a) In AR, the user views the real world directly with additional content superimposed upon their view. (b) In VR, the whole of the user’s view is generated, and they cannot see the real world. (c) There are variations in VR where information or images from the real world can be incorporated into VR.

Simulation has proved effective and engaging, even for high-pressure clinical settings.4, 5, 6, 7 Accordingly, HMDs’ ability to simulate or augment clinical settings may benefit anaesthesia education.⁸ Their form factor enables a unique head-tracked visuospatial augmentation that other forms of technology-enabled manikin simulations or haptic feedback devices cannot provide.⁹ Furthermore, they are easily acquirable multifunctional devices, used in anything from pain management to learning, presenting a unique mix of accessibility and widespread application that other equipment cannot replicate.^10,11

This review explores the use of HMDs for anaesthesia education to guide clinical educators and future research. Although previous reviews examined AR for healthcare education more generally, none have individually focused on HMDs and their unique value.^3,10,12, 13, 14, 15 Existing literature reviews did not focus only on anaesthesia education,^3,10,12 or limit implementation of AR and VR to the HMD form factor.^14,15 This review integrates these criteria to elucidate the distinct education impact of HMDs in anaesthesia training.

Methods

Given the diverse methodologies and applications, we are presenting this scoping review in narrative form.¹⁶ A literature search was performed in January 2025 using Google Scholar and MEDLINE (PubMed), with no start date specified. The search strategy outlined in the Supplementary material focuses on the HMD form factor, integration of virtual and real environments, and applications in anaesthesia education.

We included full-text English, peer-reviewed studies involving HMD use for educational purposes among anaesthetists, trainees, students, or related clinicians. References lists were also screened for relevant articles.

Articles addressing clinical applications, rather than educational applications, or that focused on patient experiences of HMDs were outside of the scope of this review.

Results

We identified 22 articles, grouped into four themes: airway management, anaesthetic procedures, vascular access procedures, and practice scenarios with assessments (Supplementary Tables 1–4), summarising each use case and key findings.

Airway management

Five articles discussed airway management education, using HMDs for learning, visualisation, or simulation.17, 18, 19, 20, 21 One study used AR, displaying a video feed of the airway onto the field of view,¹⁸ whereas the other four applied VR.^17,19, 20, 21 These used the HMD to create virtual spaces, display additional information, or show underlying anatomy (Fig. 2).

Fig 2.

Diagrammatic representation and comparison of the various ways reality is extended with head-mounted devices in airway management. (a) Standard manikin-based simulation. (b) Using augmented reality (AR) to display video feeds from the video laryngoscope. (c) Using AR to show previously captured underlying airway anatomy. (d) Using virtual reality (VR) to fully simulate the manikin, anatomy, and hands with transparency or cut-away.

In paediatric airway teaching, 41 participants, from medical students to faculty, used a HoloLens 1 (Microsoft Corp., Redmond, WA, USA) to view interactive 3D instructional videos. With HMD use, test scores improved for anatomy, aspiration, and anaphylaxis understanding while maintaining engagement, though subgroup analysis was limited by its small size.¹⁷ The 3D interactivity presents a unique teaching avenue, such as for practical physiology teaching.

For infant intubation, 45 neonatal intensive care nurses used an unspecified HMD overlaying a manikin laryngoscopy video feed, comparing it with conventional video laryngoscopy and direct laryngoscopy. HMD-assisted video laryngoscopy reduced gaze shifts but showed no difference in the oesophageal intubation rate and procedure time. Both video laryngoscopy techniques outperformed direct laryngoscopy, demonstrating its comparative usefulness.¹⁸

Two articles applied immersive VR for intubation scenarios. In one, junior trainees who completed an Oculus Rift S (Meta Platforms, Menlo Park, CA, USA) VR tutorial performed comparatively to experienced clinicians, without prior tutorial, on a 24-point paediatric equipment preparation checklist. However, junior trainees performed the simulated intubation on a manikin, and the experienced trainees only recalled the preparatory steps without a simulation manikin.¹⁹ Differences in experience, tasks, and prior tutorial meant that any difference in recall cannot be solely attributed to HMD use. Another study involved 21 novice nursing students who completed tests before and after six VR intubation lessons, without a control group, doubling post-test results while being immersive and without motion sickness.²⁰ Both studies’ methodologies were unable to demonstrate HMDs’ effects on learning compared with conventional methods at similar experience levels.

A final study compared face-to-face (F2F), hybrid and fully virtual tracheostomy training for 81 participants. Simulations from the F2F session were substituted with 360-degree videos and virtual interactive sandbox environments for the HMD courses. Knowledge retention at 4 weeks was similar between the F2F and HMD-only groups, supporting the use of HMDs for remote learning.²¹

Section summary (Table 1)

Table 1.

Comparison of head-mounted device (HMD) applications for different anaesthetic skills.

In airway management
	Advantages	Disadvantages
Standard training	Well-understood benchmarks for procedural competence Technically reliable and familiar to learners	Effectiveness and retention depend on repetition and instructor engagement Requires in-person attendance and physical resources
HMD-assisted training	Improves understanding of airway management Retention for tracheostomy training proven to 4-week mark Enables remote participation	Small heterogenous samples, few control groups, varying Unclear impact on clinical competency Unclear impact of experience on effect
Neuraxial anaesthetic procedures
	Advantages	Disadvantages
Standard training	Direct tissue feel enhances procedural realism Well-established efficacy in skill development	Reliant on 2D diagrams to demonstrate concepts Equipment deteriorates after repeated use
HMD-assisted training	Faster learning curve for epidural procedures at ∼10 attempts vs ∼44 attempts Improved 3D visualisation of spinal anatomy Improved procedural accuracy with augmented reality visualisation Higher focus and satisfaction	Cost of haptic devices and headset may slow adoption if preexisting equipment is being used Fidelity of simulation is limited by detail of models and equipment used
Regional anaesthetic procedures
	Advantages	Disadvantages
Standard training	Learning curves are known in the current literature Well-established and widely used	Faculty-to-student ratio may be higher
HMD-assisted training	Reduced faculty supervision while maintaining performance and mental workload Comparable or superior performance in nerve blocks	Feasibility and RCT studies hold promise but are small Failed to improve theoretical knowledge
Peripheral venous access procedures
	Advantages	Disadvantages
Standard training	Available at most hospitals and teaching centres Fewer pieces of technology used, reducing points of failure	Less flexible to adapt Repeated practices may be limited by equipment or availability
HMD-assisted training	Higher first-attempt success rate in novices Time saving for both novices and experienced practitioners	Impact on performance varies by experience levels Small studies, no learning curves reported Effects on long-term competence unclear Small studies with no learning curves reported
Central venous access procedures
	Advantages	Disadvantages
Standard training	Well-established efficacy and acceptability Skill acquisition and competency milestones are known	Quality of simulation dependent on equipment Limited ability to simulate variation in anatomy quickly
HMD-assisted training	May improve adherence to procedural steps Improved comfort, reduced head movements High satisfaction and perceived immersion May be useful for procedural compliance	Mixed effect on success rate, needle redirection, or completion time Heterogenous studies, small sample sizes Higher rate of carotid artery puncture with HMD use

Overall, HMDs appear to support knowledge acquisition for laryngoscopy,¹⁸ intubation,^19,20 remote tracheostomy teaching,²¹ and airway management.¹⁷ However, most studies lacked a control group of conventional teaching,^17,19,20 with inconsistent populations and inadequately described methodologies, limiting generalisability or comparison with traditional approaches.17, 18, 19, 20, 21 HMD-assisted learning curves for intubation were not reported. Comparing these with traditional training is warranted, as competence is usually attained after about 50 intubations.²² Further research is needed to validate their potential in these areas.

Needle-based procedures

A broad category of HMD uses was to enable learning for needle-based procedures, split across anaesthetic and vascular access procedures. These could be further broken down to neuraxial and peripheral nerve blocks, or central and peripheral venous access. These cases commonly used the HMD to enable better ergonomics, by displaying information directly in the field of view, showing underlying anatomy or completely simulating the environment (Fig. 3).

Fig 3.

Diagrammatic representation and comparison of the various ways reality is extended with head-mounted devices in needle-based procedures. (a) Standard manikin-based simulation. (b) Using augmented reality (AR) to display ultrasound video feeds to improve ergonomics and reduce head movements. (c) Using AR to show previously captured underlying anatomy. (d) Using virtual reality (VR) to fully simulate the manikin, anatomy, and hands with transparency or cut-away.

Neuraxial anaesthetic procedures

Three articles used HMDs for teaching spinal access procedures with either haptic feedback tools in full VR,²³ or AR overlays on spinal phantoms.^24,25

One VR study taught epidural anaesthesia using HTC Vive (HTC Corp., Taoyuan City, Taiwan) and a Geomagic Touch X (3D Systems Corp., Rock Hill, SC, USA) three-axis haptic device for tactile simulation. Twenty anaesthesia interns performed 30 punctures, with performance scores rapidly improving, plateauing after 10 attempts.²³ No control group was included, but skill acquisition appeared faster than with traditional methods, where competence typically plateaus after approximately 44 attempts.^23,26

Two studies used AR overlays for epidural training. One feasibility study with six anaesthetists using a HoloLens 1 found improved focus, satisfaction, and learning, but had limited realism.²⁴ Another enrolled 30 medical students in three intervention groups that did two epidurals each. The first epidural was done under continuous HoloLens 2 (Microsoft Corp.) use, brief anatomical viewing via HMD, then an unassisted puncture, or a completely unassisted puncture. The second puncture was done without the HMD across all groups. Both HMD groups achieved more accurate needle angles and puncture points initially, and the brief-viewing group maintained accuracy on the repeated attempt without the HMD.²⁵ HMD visualisation of underlying anatomy may hold the key to improving procedure performance in other areas.

Section summary (Table 1)

Collectively, these studies suggest that HMD-based VR and AR may accelerate skill quality and acquisition as reflected in their improved learning curve.^23,25 However, small sample sizes without control groups restrict generalisability, requiring higher-quality studies to confirm these benefits.23, 24, 25

Regional anaesthetic procedures

Three articles applied HMD-based VR for ultrasound-guided regional anaesthesia.27, 28, 29 An initial feasibility study of 21 novices and 17 experts used an Oculus Rift S to perform virtual nerve blocks, demonstrating construct validity through the variability of performance by experience level observed and by reproducing expected learning curves.²⁷ Subsequently, two randomised clinical trials were conducted.^28,29

Using the same setup in a randomised controlled trial (RCT), 45 students compared VR-based instruction, supervised 2:1 by faculty, with traditional phantom-based teaching, supervised 1:1 by faculty. All participants then completed a scored final attempt on a porcine phantom without HMD involvement, finding comparable final scores but with half the supervision requirements. Participants found it immersive while maintaining comparable mental workloads.²⁸ This study identifies supervision as a possible systemic area of improvement by HMDs.

Another study of 21 anaesthesia trainees or final-year medical students with no prior experience compared VR-based anatomy instruction using an Oculus Quest 2 with standard didactic teaching before attempting brachial plexus blocks on patients the next day. VR-trained participants performed significantly better, as reflected by task-specific checklists, but not on tested theoretical knowledge.²⁹ As one of the few human studies, it also tentatively demonstrated that HMD learning can be applied to real patient scenarios.

Section summary (Table 1)

VR training for peripheral nerve blocks shows construct validity,²⁷ and resulted in comparable or superior outcomes in porcine or human subjects with greater immersion and resource-efficiency.^28,29 Additionally, evidence suggests that it may take 8–10 attempts to learn the sonographic skills required for certain peripheral nerve blocks, with 28 trials needed for procedural competence.^30,31 Further research could identify whether HMDs speed up this process. These positive results warrant investigation with larger RCTs.

Peripheral venous access procedures

Two studies explored HMD-assisted ultrasound-guided peripheral venous access, both projecting the ultrasound view into the user’s field of vision.^32,33

In one, 22 experts and 12 novices performed multiple phantom venipunctures using a HoloLens 2 over several weeks. Participants initially had practice using the HMD before being randomised to conventional ultrasound or HMD-assisted attempts first with crossover before a final HMD-assisted attempt several weeks later. Only experienced participants were faster during the delayed trial, whereas all participants had reduced head movements. Needle redirection and visualisation rates were unchanged.³² This suggests that experience amplifies the HMDs effect on procedural performance in the long term, though all users benefited from improved ergonomics.

In another, 49 novice nurse anaesthetists performed 20 phantom cannulations with progressively smaller lumens using either conventional ultrasound or the HMD included with the Vascoscope (Envision Medical, Utrecht, The Netherlands). HMD users achieved a higher first-attempt success rate and were faster, though these differences diminished over repeated attempts.³³

Section summary (Table 1)

Together, HMDs improved ergonomics for all, early performance for novices, and improved delayed performance in experienced individuals.^32,33 It may be that HMDs in this application have an initial positive effect for novices that wears off over time but a sustained positive effect for experts, which requires further exploration to clarify. Further, no learning curve was reported to demonstrate superior skill acquisition speed, but comparative non-HMD-assisted cannulation teaching is known to take up to 10 encounters for proficiency.³⁴

Central venous access procedures

Five studies evaluated the HMD use for central venous catheterisation, using diverse approaches to displaying digital information in the field of view: for overlaying anatomy over a phantom,³⁵ ultrasound projection,^36,37 instructional prompts,³⁸ or full VR.³⁹

One study used a 3D neck model on a manikin using a Moverio BT-200 (Seiko Epson Corp., Nagano, Japan) for 40 medical students and anaesthetic trainees. Although there was no comparator group, participants found it helpful and realistic. Task performance remained similar across experience levels, though students were more likely to puncture the carotid artery.³⁵ This highlights the importance of measuring adverse outcomes relevant to the procedure for future HMD studies.

Two studies projected ultrasound views through HMDs during phantom-based training. Forty participants, ranging from first-year medical students to third-year emergency medicine residents, had fewer head movements and greater comfort but took longer and required more needle redirections when using the Google Glass (Google Inc., Mountain View, CA, USA), compared with conventional means.³⁶ In another crossover study of 47 trainees and students who completed an ultrasound-guided central line training course, HMD use reduced instructor intervention but did not shorten procedure time compared with conventional ultrasound methods. Similar cognitive workloads across both groups implied that the educational experience was similar.³⁷

Thirty-two novices were randomised into an HMD group where procedural steps were displayed during catheterisation or a control group where no prompts were provided. This improved procedural adherence but not speed, likely reflecting the advantage of real-time prompts that were unavailable to the control group.³⁸ This points towards =HMDs' feasibility to be used as a non-distracting visual prompts for other complex procedures.

Finally, a study assessed VR-guided catheterisation. Seventeen novices and eight anaesthetic trainees found the VR model more engaging and effective for spatial and procedural learning, with similar completion times to manikin training and fewer missed critical steps, though statistical significance was not reported.³⁹ It appears that HMDs aid procedural compliance across both AR and VR.

Section summary (Table 1)

Across central venous catheterisation studies, HMD use increased satisfaction, ergonomics, and decreased interventions from supervisors,^36,37 but their effect on procedure speed and accuracy was mixed.36, 37, 38 Approximately eight attempts are required with conventional ultrasound-guided central catheterisation,⁴⁰ so further exploration should also involve identifying the learning curve with HMD. Current evidence remains limited and heterogenous, warranting larger standardised evaluations to find consistency.

Simulating or augmenting scenario-based learning

Four articles explored HMDs in immersive clinical scenarios, either using VR or AR for emergency simulation41, 42, 43 or to enable remote learning.⁴⁴ All had small sample sizes and lacked power calculations.41, 42, 43, 44

Two used a Magic Leap 1 (Magic Leap, Plantation, FL, USA) to overlay holographic elements onto chest trainers, creating an immersive emergency scenario.^{41 42} The first simulated paediatric hyperkalaemia assessing 27 clinicians across a range of experience levels, testing their advanced paediatric life support skills. Although participants were satisfied and the costs were lower than conventional manikins, A-PALS scores and rhythm recognition times were unchanged despite differing experience levels.⁴¹ This implies that this application of HMDs only tested underlying fundamental skills. Another study tested 18 clinicians in a cardiac arrest scenario, with most rating the simulation as realistic, easy to set up, and comparable with regular simulations. However, around a third of participants reported difficulty differentiating between real and holographic objects, conceptualising time during the simulation, and difficulties with virtual object interactivity.⁴² However, neither study had a control group, so future research should focus on comparing the use of HMDs to standard simulation teaching.

One article used an Oculus Rift S for a VR simulation of paediatric supraventricular tachycardia, comparing it with a conventional manikin, in 26 anaesthesia trainees, crossing over to redo the simulation using the other method 6 months later. Clinical scores were equivalent, though cognitive workload was lower with HMD use. It required more technical support, which raises an important point of consideration for future studies.⁴³

Finally, another study used a HoloLens 2 for remote teaching, streaming a clinician’s first-person view of real airway assessments on patients to 47 medical students with a two-way video link, with no comparator group. AR artifacts, such as a Mallampati score scale, were displayed beside the patient for enhanced learning. Students found the experience engaging and superior to didactic teaching, and patients preferred it to in-person group instruction, though significant technical problems occurred.⁴⁴ The increased interactivity for medical students and decreased crowding for patients present an interesting area of improvement that could be used in other small-group teaching opportunities.

Section summary (Table 2)

Table 2.

Comparison of head-mounted device (HMD) applications in scenario-based learning.

	Advantages	Disadvantages
Standard training	Widely validated for skill retention and progression Physical manikins provide consistent tactile and visual cues	Limited by faculty availability, manikin access, and group size In-person attendance required Minimal technical issues, simpler to implement
HMD-assisted training	Enables remote participation Repeatable simulations without patient exposure Easier variation in simulation with same equipment Generally immersive and realistic	Lower cognitive workload, unclear impact on long-term retention Difficulty with interactivity and disorientation Some small, uncontrolled studies

Overall, HMDs are novel, engaging approaches to emergency simulation41, 42, 43 and enable remote learning.⁴⁴ However, technical limitations, user difficulties, and small uncontrolled studies constrain current evidence.42, 43, 44 Larger comparative trials are needed to confirm efficacy.

Discussion

This review explored the use of HMDs in anaesthesia education, with most applications focusing on simulation-based learning. For airway management, HMDs increased engagement and supported knowledge retention.17, 18, 19, 20, 21 For nerve block education, HMD-assisted teaching accelerated skill acquisition and produced comparable or better results to conventional teaching.23, 24, 25^,27, 28, 29 Vascular access procedures with HMD consistently demonstrated improved ergonomics through decreased head movements, though their effect on procedure quality or duration was inconsistent.^32,33,35, 36, 37, 38 Scenario-based teaching using HMDs was engaging and often equivalent or superior to traditional simulation learning.41, 42, 43, 44 Many studies did not have effective control groups, which heavily limits the strengths of these conclusions.

However, HMD implementation did require more technical support and suffered from technical crashes and difficulties with interactivity.^43,44 Although immersion was generally high for participants, a subset of people struggled with differentiating between real and virtual objects and orientation.^42,43 As most reports did not explicitly comment on these elements, it is difficult to know the extent of these limitations. Ongoing technical advances in HMD technology may address these issues. Collaboration between developers, educators, and participants is essential.

Common applications of HMD were for displaying ultrasound views, 3D anatomy, and immersive simulations. Some unique applications raised in the literature include HMD-enabled remote teaching, which had positive outcomes in the current literature and could improve educational access,^21,44 and to present relevant procedural instructions,³⁸ which has been preliminarily explored in clinical anaesthesia settings.^45,46 Additionally, HMD’s ability to synchronise with each other in virtual environments may open up opportunities for team-based training or interdisciplinary collaboration that remains unexplored.

Some scenarios may be difficult to emulate with HMDs, even with technological advancements. Doing a clinical technical procedure will often induce anxiety, even with prior simulation. Some clinical situations, such as unique anatomical variation or comorbidities complicating an acute clinical deterioration, or rare paediatric conditions such as meconium aspiration, may struggle to be adequately simulated with an HMD, which emphasises the need for rigorous conventional clinical training in addition to simulated training.

HMDs appear best suited as complementary tools rather than replacements for conventional training, particularly where immersive visualisation enhances understanding such as for complex anatomy, remote learning, or high-stress environments. They could potentially be used as an educational stepping stone, serving to mediate learning between the classroom and full simulations to acclimatise participants.

Limitations

The evidence quality remains mixed owing to the lack of standardised methodologies, control groups, learning curves, or long-term assessments. These limitations prevent the superiority of this approach over didactic or conventional manikin-based teaching from being established despite the encouraging results. Further, no links have yet been made to HMD training and its effect on patient outcomes post-training. This demonstrates a widespread lack of standardisation of scenarios, comparisons, assessments, and measurement outcomes that is apparent across all use cases.

Other non-clinical limitations persist, which were infrequently noted in the reviewed literature. Although several studies commented on the reduction in supervision requirements,^28,37 none considered the total cost of implementation or the cost-effectiveness and scalability of HMD implementation. Additionally, few comments were made on battery life, weight, network connectivity, information security, adaptability for those with glasses or other needs, and side-effects from its use in an educational setting. In a clinical anaesthesia setting, battery life concerns,⁴⁷ issues with text legibility,⁴⁸ and heaviness,48, 49, 50, 51 have been noted in some HMD models. The impact of these in an educational setting remains untested and should be further explored in future research.

Conclusions

HMD use in anaesthesia education offers promising potential for teaching a wide variety of skills to students, trainees, and clinicians that can serve to hasten learning, improve practical outcomes, and increase immersion. However, current studies lack the quality necessary to inform widespread use, pointing towards a need for better designed studies.

Future study designs should focus on having a comparable conventional teaching approach, appropriate randomisation, larger participants numbers, a consistent experience level across participants, and similar information exposure before and during the implementation in question. Additionally, the measured outcomes should not only include procedural competence but also include competency learning curves across repeated assessments, adverse outcomes for both patients and participants, ergonomic feedback, and technical feedback of HMD implementation. These should ideally measure across longer time scales, to appropriately measure knowledge retention. Finally, comments on cost-effectiveness of its implementation provide another useful measure of HMDs’ educational potential.

By tackling these gaps and addressing the current shortcomings in the literature, HMDs could be valuable tools in medical education and remote learning, bridging gaps between simulation and real-world clinical practice while also improving outcomes for students and patients alike.

Authors’ contributions

Conceptualisation: TFEDB, BSvUS

Methodology: TFEDB, BSvUS

Investigation: MJK, TFEDB, BSvUS

Project administration: TFEDB, BSvUS

Funding: BSvUS

Writing - original draft: MJK

Writing - review and editing: MJK, TFEDB, BSvUS

Supervision: BSvUS

Funding

Stan Perron Charitable Foundation (to TFEDB and BSvUS) and National Health and Medical Research Council (Investigator Grant 2009322 to BSvUS).

Declaration of interests

The authors declare that they have no conflicts of interest.

Handling Editor: Susan M. Goobie

Appendix A. Supplementary data

The following is the Supplementary data to this article: