# Setting a research agenda for the use of extended reality in healthcare simulation: an Utstein style meeting

## TL;DR

Experts created a research plan to better understand how to effectively use extended reality in healthcare training.

## Contribution

The first international consensus-based research agenda for integrating extended reality in healthcare simulation education.

## Key findings

- XR adoption in healthcare education requires addressing technological, economic, and human resource barriers.
- Faculty development and institutional investment are critical for sustainable XR implementation.
- A structured research agenda was developed using the NASSS framework to guide future studies.

## Abstract

Extended reality (XR), encompassing virtual, augmented, and mixed reality, is increasingly integrated into healthcare simulation-based education and training. While XR offers immersive, scalable, and potentially cost-effective learning environments, evidence of its educational effectiveness and implementation remains fragmented. To address this gap, an Utstein-style consensus meeting was convened to establish an international research agenda that advances the evidence-based integration of XR in healthcare education.

The meeting, held in Copenhagen, Denmark, in November 2024, brought together 24 international experts representing diverse disciplines, geographic regions, and simulation expertise. A Delphi-informed pre-meeting survey, based on a targeted review of XR-focused literature, identified key topics across five initial domains. Using an implementation science–informed approach guided by the NASSS (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) framework, participants engaged in structured breakout and plenary discussions to explore barriers, facilitators, and research priorities related to XR adoption and sustainability.

Through consensus deliberation, the original five domains were refined into three overarching themes: (1) uses and adoption of XR, (2) barriers to XR adoption and implementation, and (3) facilitators of XR implementation and sustainability. Each theme comprised multiple subthemes addressing critical issues such as technological definitions, economic and infrastructure needs, human resource and faculty development, usability, educational quality, customization, and ethical considerations. Research questions within each subtheme were classified as descriptive, justificatory, or clarificatory to guide future study design and methodological rigor.

This Utstein Style meeting represents the first international, consensus-based effort to develop a structured research agenda for XR in healthcare simulation. Informed by implementation science, particularly the NASSS framework, the resulting agenda provides a roadmap for future research, policy, and practice. It emphasizes faculty readiness, institutional investment, and data-driven evaluation as prerequisites for sustainable integration. By addressing barriers and leveraging facilitators, the healthcare simulation community can advance the responsible adoption of XR technologies, enhancing competency, equity, and innovation in health professions education worldwide.

The online version contains supplementary material available at 10.1186/s41077-026-00409-y.