The role of immersive extended reality for the development and evaluation of clinical reasoning in health professions education: A scoping review.

Authors

Sophie Lansley, Jared McSweeney, Jasmine Rutere, Harish Thampy

Published in

Medical teacher. Pages 1-19. Jun 22, 2026. Epub Jun 22, 2026.

Abstract

Immersive extended reality (iXR) technologies are increasingly adopted within health professions education. However, existing evidence has largely focused on technical skill acquisition or learner satisfaction, with limited examination of how iXR supports the development of clinical reasoning (CR) as a cognitive process.
A scoping review was conducted using the Arksey and O'Malley framework and reported in accordance with PRISMA ScR guidance. Searches were undertaken across MEDLINE, CINAHL, Scopus, and Embase. Studies were included if they examined iXR interventions and reported outcomes related to CR across health profession disciplines at Kirkpatrick Level 2 or above. Studies limited to reaction-level outcomes were excluded. Data were charted and synthesised to identify iXR modalities, targeted components of CR, evaluative approaches, and impact.
Twenty-four studies published between 2018 and 2026 were included, most involving nursing students. Eleven studies used self-reported measures of CR or related constructs (level 2a), while thirteen used observed or performance-based approaches (level 2b). Of the 2b studies, most inferred reasoning from task performance, structured outputs, or construct-aligned tools, while only two explicitly elicited learners' reasoning processes. No studies examined sustained behavioural change or transfer of CR to practice. Across the full dataset, sixteen studies reported findings supportive of iXR for CR-related outcomes or for making learners' reasoning processes more visible, seven reported no significant difference over comparator approaches and one reported negative findings. All studies reporting neutral or negative findings included comparator instructional approaches, whereas only a minority of studies reporting supportive findings included comparators.
Current evidence does not demonstrate sustained or transferable improvements in CR using iXR. However, interpretation is constrained by inconsistent construct definitions and reliance on short-term, self-reported, or task-specific outcome measures. iXR may be more useful for eliciting and evaluating learners' reasoning processes within simulation, than for demonstrating durable improvement in CR.

PMID:
42325082
Bibliographic data and abstract were imported from PubMed on 22 Jun 2026.

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