The Future is now, so come play! Use of Virtual Reality and Augmented Reality in Anesthesiology Education
Alan Jay Schwartz, MD, MSEd, Justin L Lockman, MD, MSEd, Lenard W Babus, MD
Original Article
Caruso TJ, Rama A, Uribe-Marquez S, Mitchel JD. Pro-Con Debate: Virtual Reality Compared to Augmented Reality for Medical Simulation. Anesth Analg 2025; 140: 1264–72 DOI: 10.1213/ANE.0000000000007057
Editorial
Gaiser RR. A Beautiful Tomorrow in the World of Graduate Medical Education and Assessment. Anesth Analg. 2025 Feb 13. doi: 10.1213/ANE.0000000000007089. Epub ahead of print. PMID: 39946270.
Today’s PAAD is designed to be provocative and futuristic, not to provide data or offer evidence-based answers to clinical care questions. But provocative and futuristic about what? Education!
What are the best ways to teach? What best impacts learning? How can we harness novel technologies like Virtual Reality (VR) and Augmented Reality (AR) to enhance training? Is now the time to re-think best practices in anesthesiology education?
The issue is characterized quite well in Robert Gaiser’s Editorial1 companion to Caruso, Rama, Uribe-Marquez, and Mitchel’s Pro-Con Debate2 and Nathan’s Infographic3.
VR and AR for Medical Simulation, two cutting edge educational strategies, are compared in the Pro-Con text2 and displayed in the Infographic3. Gaiser borrowed the concept of Walt Disney World’s “Carousel of Progress,” that displayed the evolution of human progress, to capture the evolution of anesthesiology education.
“If one were to design the Carousel of Progress for assessments by the ABA [American Board of Anesthesiology], the initial scene would be of a candidate with a number 2 pencil completing the assessment in a hospital auditorium. The next scene would be the candidate answering questions on a computer screen, while the next would be the current Applied [examination], which includes the OSCE [objective structured clinical examination]. The final scene, the one of the futures, would closely mirror the one in Disney World where VR and AR do play a role.”1
For the Trekkies out there (like us), perhaps the final scene might actually be a high-fidelity “Holodeck” like that imagined in Star Trek: The Next Generation.
The future is now! Our children and grandchildren (and even some of us) are already active participants using VR (e.g., PlayStation) and AR (e.g., Pokémon Go) as they play. What Caruso, Rama, Uribe-Marquez, and Mitchel and Nathan have done with their Pro-Con and Infographic articles is whet our appetites to extended reality’s ability to dramatically alter the education landscape. Although the winner of the VR versus AR debate has not yet been decided, the authors’ arguments encourage us to be like kids and employ play as a teaching methodology.
Can these two technological modalities be used as part of a valid teaching strategy applied to anesthesia patient care? Absolutely! Gamified simulation and play afford at least two advantages for our students and teachers. Playing risky games intended to mimic high acuity anesthesiology scenarios is just what the doctor ordered. American writer Caroline Paul vividly explained the advantages of risky child’s play:
"Risky play is really important for kids—all kids [all anesthesiology trainees too]—because it teaches hazard assessment, it teaches delayed gratification, it teaches resilience, it teaches confidence. When kids get outside and practice bravery, they learn valuable life lessons.”4
Plato also advocated play to assess behavior and character:
"You can learn more about a child in one hour of play than you can in one year of conversation."4
The other reason play is absolutely an essential and valid teaching strategy applied to anesthesia patient care is that there is no harm to either the simulated patient or the trainee when inevitable mistakes occur during the simulation5. We do not want to minimize the risk of psychological trauma for trainees when undesirable/unanticipated outcomes occur in real patients – indeed, we have seen damaging impacts even from simulated poor outcomes when not properly debriefed in a psychologically safe environment.
What do you know about VR and AR? Do you utilize VR and AR in your resident and fellow teaching and CME? What about for patient care? What factors affected your choice of software and hardware? Is there institutional or clinical practice support for these mixed reality educational endeavors? Send you experiences to Myron (myasterster@gmail.com) who will include them in a Friday reader response.
References
1. Gaiser RR. A Beautiful Tomorrow in the World of Graduate Medical Education and Assessment. Anesth Analg 2025; 140: 1249-1251 DOI: 10.1213/ANE.0000000000007089
2. Caruso TJ, Rama A, Uribe-Marquez S, Mitchel JD. Pro-Con Debate: Virtual Reality Compared to Augmented Reality for Medical Simulation. Anesth Analg 2025; 140: 1264–72 DOI: 10.1213/ANE.0000000000007057
3. Nathan N. The Future of Clinical Simulation: VR vs. AR (Infographic). Anesth Analg 2025; 140: 1263 DOI: 10.1213/ANE.0000000000007555
4. https://www.sticksandstoneseducation.com.au/blogs/ourstories/the-most-quotable-quotes-about-play-learning?srsltid=AfmBOoowlR2OU3y08DpbbWp3jVdOP9jq4gOWp9q5317f1-6ytdiDTVxq (accessed 06/09/2025)
5. Elendu C, Amaechi DC, Okatta, AU, Amaechi EC, Elendu TC, Ezeh, CP, Elendu ID. The impact of simulation-based training in medical education: A review. Medicine 2024; 103(27): e38813, DOI: 10.1097/MD.0000000000038813