# Learning components for mixed reality mass casualty incident training: a modified Delphi study

## TL;DR

This study identifies key learning components for mixed reality training used by first responders during mass casualty incidents.

## Contribution

The study uses a modified Delphi method to establish consensus on essential learning components for mixed reality training in mass casualty scenarios.

## Key findings

- Learner experience, collaborative interaction, system adaptability, and training environment were identified as important components.
- Skills development and learner engagement were prioritized over knowledge improvement or retention.
- A consensus rating of 75% was achieved for most statements across two survey rounds.

## Abstract

Mixed reality training encourages experiential learning to enhance skill acquisition and improve knowledge for medical first responders. The essential learning components for mixed reality innovations in the context of mass casualty incident training have yet to be explored. This modified Delphi study aimed to identify learning components for mixed reality training for mass casualty incident first responders.

A modified Delphi method was undertaken comprising of three stages. In stage one, a literature search was conducted to generate statements regarding learning components for mixed reality training in mass casualty incidents. In stage two, participants rated the statements and contributed further ideas in relation to whether statements should be revised, added, or removed. In stage three, participants re-appraised their ratings in view of the group consensus. A consensus rating of 75% was set a priori. Descriptive statistical analysis was undertaken following each survey round.

In stage one, a total of 34 statements were derived from the literature. Eighteen experts were invited to participate. Of these, 14 provided ratings in stage two (response rate, 78%) and 8 provided ratings in stage three (response rate, 57%). Consensus was achieved for 27 of 34 statements (79%) in the first survey, and 29 of 30 statements (97%) in the second survey. Written comments from participants emphasised the importance of context in relation to the learner, the trainer, and the mixed reality system technology.

This study identified learning components that achieved consensus for mixed reality training for mass casualty incident first responders. The learner experience, collaborative interaction, system adaptability, and training environment were important components for mixed reality training. Skills development and learner engagement were given higher priority than knowledge improvement or retention. These findings can be used to inform the planning and development of future trainings that use mixed reality modalities.

The online version contains supplementary material available at 10.1186/s12909-026-08727-5.