Integration of Immersive and Simulation Technologies in Medical Education: Student Perspectives in a Colombian University

doi:10.21203/rs.3.rs-7774421/v1

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Integration of Immersive and Simulation Technologies in Medical Education: Student Perspectives in a Colombian University

https://doi.org/10.21203/rs.3.rs-7774421/v1

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Introduction: Immersive and simulation technologies (ISTs) have transformed medical education by facilitating the safe practice of procedures and access to rare cases. Its effective implementation in the Colombian context requires specific technical, pedagogical, and socioeconomic factors to be considered.

Methods: This is a qualitative study developed in three phases: (1) literature review; (2) observation in simulation laboratories with fifth, seventh, and eighth semester students, complemented with surveys (n = 84) and semi-structured interviews (n = 9); and (3) thematic analysis with Atlas.ti, validated by a focus group.

Results: Students perceive that ISTs strengthen practical skills, allow repetitive training in controlled environments, provide immediate feedback, and enable learning of infrequent pathologies. However, limitations are identified, including poor development of communication skills and empathy, simplification of clinical scenarios, inequalities in access, and technical problems. Expectations regarding its use are influenced by the perception of technological modernization as an indicator of academic quality.

Conclusions: ISTs are valued as a complement and not a substitute for clinical practice. Integrating it into Colombian medical education requires contextualization, ongoing assessment, teacher training, equitable access, and coherence with the realities of the health system.

Immersive technologies

simulation

medical education

Colombia

qualitative methods

Immersive and simulation technologies (ISTs) have transformed medical education in the past two decades (1). Although its adoption gained popularity at the beginning of the 21th century, the COVID-19 pandemic accelerated its adoption due to the suspension of face-to-face classes and the need to implement new pedagogical strategies allowing for the adequate development of clinical training (2,3). Currently, these technologies are integrated into the different stages of the curriculum of most undergraduate programs, complementing medical training both cross-sectionally and in an ongoing manner.

Although there are various ISTs, their differentiating feature is the ability to enable interaction with digital environments, creating immersive experiences that blur the boundaries between the physical and virtual (1,4). These include virtual reality (VR), which fully immerses the user in a digital environment; augmented reality (AR), which overlaps digital information with the physical world; and mixed reality (MR), which allows real-time interaction between the two worlds (1,5). Moreover, simulation technologies, both physical and digital, constitute an educational strategy that allows students to practice medical skills in controlled environments, thereby minimizing risks for patients, optimizing their performance, and evaluating the students before they face real clinical scenarios (6,7).

Several studies have shown that ISTs are effective tools for knowledge acquisition and clinical skill development. Their use in training contexts is linked to increased knowledge retention and clinical assessment skills (8). Further, ISTs encourage student participation and engagement, which contributes to a more interactive and motivating learning experience, even when knowledge gains are comparable to traditional methods (4).

However, the adoption of these technologies in medical education has certain limitations. The available evidence shows significant effectiveness heterogeneity in the different studies, which makes it difficult to draw final conclusions on long-term impact (9). Economic and technical barriers add to this, including the high cost of the equipment and need for trained personnel to implement it. This limits access in many contexts where resources are insufficient, both at the educational and professional levels (10). Finally, these technologies can disconnect from clinical reality, affecting the development of communication and empathy skills (11). By oversimplifying some scenarios, processes, and situations, the use of ISTs can distort the complexity of medical practice as they cannot replace the experience of interacting with real patients and environments (4,12).

Despite the vast literature on the use of ISTs in medical education globally, studies focused on Colombia are still scarce. Several studies have documented the benefits of tools such as telesimulation, clinical simulators, and mobile platforms for clinical skills development, especially in areas such as laparoscopic surgery (13,14). Other theoretical reviews have highlighted that several Colombian universities began to incorporate subjects related to cyber-medicine and telemedicine in their curricula (15). However, these statements lack a solid empirical basis and fail to specify which institutions are leading these processes or how these technologies are being implemented in teaching practice. This lack of evidence is especially relevant in a context where the digital transformation of medical education has accelerated, driven by technological developments and emerging needs in clinical education.

Moreover, as mentioned by several authors, the effectiveness of ISTs in educational settings largely depends on contextual analysis (9,16). Factors such as user familiarity with digital tools, platform usability, and device and Internet access conditions can become major obstacles. Overlooking these variables may cause a gap in implementation, in which technologies, although available, are not effectively integrated into training processes (17). Therefore, it is essential to understand the local conditions, the students' and teachers' perceptions, and the specific challenges faced by educational institutions in Colombia.

Therefore, this study seeks to contribute to closing this gap through a contextualized analysis of the use of ISTs in medical education in Colombia. Based on this analysis, the goal is to produce empirical evidence on current practices and identify opportunities for the design of pedagogical strategies integrating these technologies in a relevant manner, considering both the local context of medical education and the specific challenges faced by the country's educational institutions.

A three-stage qualitative study was conducted. In the first study stage, a literature search was conducted in PubMed, Cochrane Library, and Scopus databases, using the descriptors "immersive technologies," "simulation technologies," and "medical education" in English and Spanish. Studies addressing the implementation of immersive and simulation technologies in medical education, both globally and in the Colombian context, were selected. Subsequently, the search was complemented by the snowball technique. A total of 639 articles were found, of which 48 were selected based on the following inclusion criteria: explicitly referred to immersive technologies (such as VR, AR, or MR) or simulation technologies applied in medical training contexts; emphasized formal medical education; and presented empirical evidence through original studies, applied research, or systematic reviews on their use, implementation, or evaluation.

This review aims not to conduct a systematic study but to build a state of the art to identify the benefits and challenges linked to the use of these technologies in training medical professionals, as well as to compile the available evidence of research conducted in Colombia.

The second stage comprised an observational study in the simulation laboratories of Universidad El Bosque, in which three cohorts of fifth, seventh, and eighth semester medical students participated. These cohorts were selected according to their basic experience with ISTs (fifth semester) and with experiences that could be compared to hospital practice (seventh and eighth semesters). Following these sessions, a survey was sent to students using the ArcGIS Survey123 platform to explore their ISTs use perceptions and experiences in their education process, from which 84 valid responses were obtained. Subsequently, those students who agreed to participate in follow-up interviews were contacted, and nine semi-structured interviews were conducted via Google Meet. The interviews were recorded and transcribed. The sample was based on convenience and was not statistically representative.

The analysis of the interviews was carried out using the Atlas.ti software. Three independent reviewers conducted a close reading of the transcripts and proposed codes related to the benefits, limitations, and prospects for the use of immersive technologies in medical education. Subsequently, the final codes were discussed and agreed upon. To deepen students' opinions and attitudes toward ISTs, as well as to validate the findings from the interviews, a focus group was developed with the same participants.

Emerging categories focused on the learning experience, perceived benefits, and limitations. Once the codes were defined, the interviews were coded in the software, and based on this systematization, the results were prepared for analysis. To conceal participants' identity, each interview was assigned a consecutive number in the order in which it was conducted. Therefore, students' interventions are identified in the text with an alphanumeric code (E1, E2, E3, and so on), without referring to their names or personal information that could reveal their identity. This strategy allowed keeping the data confidential and organizing the material during the qualitative analysis process.

This study was approved by the Institutional Ethics Committee of Universidad El Bosque, and all participants signed an informed consent form.

The students interviewed in this study perceive that the use of ISTs in medical education has both positive and negative impacts. From their accounts, it is not easy to draw a clear boundary between the factors that favor learning and skill development and those that could hinder them, as students' assessments are influenced by nuances, contradictions, and ambivalences that require a more in-depth analysis. Nevertheless, the interviews show a general accepting attitude of these technologies, which are seen as part of the inevitable development of the medical profession and scientific technical progress. Moreover, participants agree in identifying certain benefits associated with its use, plus some limitations and challenges. The primary findings of the study are presented below.

Learning, Practicing, and Trusting: The Positive Impact of ISTs on Medical Education

One of the most salient aspects of students' accounts is the positive impact of ISTs on the development of practical and clinical skills. These technologies give them the opportunity to practice techniques and procedures in a safe and controlled environment, allowing users to repeat them several times without any risks for patients. This possibility boosts their confidence from early education stages, and helps them feel more comfortable and perfect the skills they are acquiring. According to accounts, this is especially relevant when performing invasive procedures, where the possibility of pre-training reduces anxiety and improves accuracy in real clinical scenarios.

Additionally, ISTs offer the opportunity to explore rare or difficult-to-access pathologies during clinical rotations. As mentioned by one of the students, "using these technologies is beneficial because it is not always easy to find patients with the conditions we need to see" (E1). Thus, simulation enables access to complex or unusual clinical scenarios, providing learning opportunities that would otherwise be limited. In this regard, another student said, "In real life, I have never seen, for example, papilledema in a fundus in any patient, but I could treat it in the simulation" (E1).

The students interviewed also agreed that using simulators boosts learning in areas such as clinical semiology, where repeated exposure is essential to acquire diagnostic skills. A student made the following remark in relation to auscultation: "If I had been told that this is what a diastolic mitral murmur sounds like in the clinic, I would probably have heard it only once, and then, I would have had trouble remembering it. However, with the simulators and features provided by the simulation labs, you can learn more about those experiences" (E2). Simulation also allows students to better prepare for their clinical rotations. Another account reflects this usefulness in practical skills training: "Also, channeling has been quite useful to me for rotation before it comes my way" (E5).

Moreover, interactive digital tools complement the teaching of anatomy by facilitating the understanding of complex structures through visualization in different formats. Students highlight its usefulness for memorizing and analyzing anatomical structures through virtual screens and 3D devices, allowing them to explore the human body from different perspectives, in a more intuitive and didactic manner. A student highlighted the value of these resources as follows: "In the amphitheater, there is a platform where you can select what you want to see of body anatomy. It's a giant screen where you can see muscles, bones, arteries, etc., and teachers use it to help us understand better" (E3).

In addition to the development of practical and clinical skills, students mention that ISTs provide a controlled environment where they can make mistakes, get feedback, and learn from mistakes without any fatal consequences to patients or any legal risks. As a student mentioned, "we have a controlled environment where we can, fortunately, make a mistake and be corrected without any legal consequences or more serious results" (E5).

The difference between practicing in a simulated environment and directly facing a real patient is significant for several of the interviewees. One student put it this way: "You do the procedures, one, two, three, four, five, six steps, done, you memorize them. But I think that when you memorize them and then move on to a real patient, who is flesh and blood and who feels, you are already under much more pressure and can make a mistake. In turn, when practicing with a mannequin, there is no error that could be life-damaging" (E7).

By practicing in a simulated environment, students become familiar with clinical scenarios and are better prepared to deal with the uncertainty of medical care. This reduces the stress of interacting with real patients, boosting their confidence as well. It also allows to let go of the fear and insecurity that can arise in sensitive procedures, as mentioned in another account: "We learn primary health care of pregnant women and carry out a gynecology practice. I feel that doing that on the mannequin is less traumatic than doing it with a patient" (E7).

One of the aspects most valued by students in the use of ISTs is the possibility of receiving immediate feedback from teachers, something that is usually more difficult to achieve in real clinical scenarios. This allows them to correct mistakes in a timely manner and turns the error into a learning opportunity, thereby strengthening the development of practical and clinical skills.

When Technology Is Not Enough: Empathy, Realism, and Equitable Access

Along with the advantages identified, the accounts also show some difficulties related to the use of ISTs in medical education. These limitations are associated with the impairment of communication skills and empathy generation, oversimplification of clinical reality, inequalities and difficulties in accessing technologies, and technical and digital literacy problems.

One of the most frequent concerns expressed by the students interviewed is that although ISTs boost certain technical skills, they fail to reproduce the emotional and interpersonal complexity of the doctor–patient relationship. This difficulty is regarded as an obstacle in the development of communication skills necessary to understand the patient and address the situation in a comprehensive and problem-solving manner. One of the students interviewed summed it up as follows: "Clearly, these technologies do not allow us, as physicians, to develop empathy or to be more humans with patients because, at the end of the day, we practice with a machine, a robot that cannot feel, does not communicate, or have feelings" (E5).

Along the same lines, several students agree that clinical rotations are the most appropriate learning space to develop social and communication skills, which are key for patient interaction. As one student explained: "I think [technology] does not help to improve communication with patients at all, nor does it help with empathy; I even think it is the opposite. The clinic has really helped me a lot to develop my communication skills and to adapt very well to patients, in the way I speak and the way I express myself" (E8). For the interviewees, recognizing these limitations does not mean denying the advantages of ISTs but emphasizing that their use should be a complement and not a substitute for learning in real clinical settings, which involve direct contact with people and with the different stakeholders in the healthcare system such as physicians, the nursing staff, residents, interns, and family members.

Another difficulty mentioned is that ISTs tend to simplify clinical reality. Although students noted that their use prepares them to perform certain procedures with greater skills, such as auscultation and simple surgical interventions, they are not always adapted to the diversity of situations faced by physicians in daily practice because they overlook significant differences in human anatomy. Regarding the use of CardioLink, one of the students interviewed commented: "The practice is with a slim man, which makes the use of the stethoscope easier, but in women, for example, it does not resemble the large breasts of many of them. This is something that can affect us when it comes to locating the stethoscope and listening correctly" (E1).

These technological resources are thought to omit some essential aspects of clinical interaction, such as discomfort management, body posture, communication about the procedure or the need to adapt to patients' reactions. In the interview, a student said, "We are taught to listen here or access the eye this way, but we need further instruction on how to do it with a real patient, explaining what we are going to do, what may bother them, and how to face them" (E1). Thus, students' perception is that ISTs can generate an idealized or incomplete image of medical practice, thereby reducing exposure to practices and situations that only emerge in real clinical contexts.

An example of this is the difficulty ISTs have in representing situations of high emotional stress or urgency, where students must make quick decisions, sometimes under pressure. In this regard, one student highlighted, "When you have an emergency in real life, if someone is bleeding to death, you run, you do one thing, then another, and all at the same time. But in this [simulated] activity, you cannot do everything at once, without conducting each step separately. I think this was negative, because you have to learn to do those things simultaneously, not in isolation" (E3).

Students also perceive that the use of ISTs in medical education may be mediated by gaps in access. Specifically, they point out the difference between low- and middle-income countries and high-income ones, which translates into a delay in innovation implementation and equipment update, generally developed in more technologically advanced contexts. This inequality is also observed at the local level, as students compare their experience with that of other institutions that, in their opinion, have greater resources. Thus, they express concern about the impact that these differences may have on their educational process.

The interviewees' expectations regarding the use of ISTs are also mediated by a return-on-investment logic associated with the costs of higher education. Students value their academic experience in terms of the services offered by the university and are especially sensitive to infrastructure and equipment inequalities. Comparisons with other institutions which, from their viewpoint, have better conditions, reinforce the demand for constant updating of training facilities. In some cases, they even suggest the need for laboratories equipped with advanced technologies.

These gaps can also be seen in equipment availability, which, as per interviewees, is conditioned by the time and space allocated by the university for internships. As one student said, "As there are so many of us, time is limited. They make us practice in order, but we can't take all the time" (E1). In view of this situation, they identify the need to organize and streamline the use of these technologies, allowing their use at times other than those initially established in the micro-curriculum.

Finally, other limitations mentioned include technical failures that interrupt practices and cause students to lose time. Sometimes, teachers cannot solve these problems, thereby requiring the assistance of specialized technical personnel. Deteriorated equipment due to wear and tear or equipment unavailable due to maintenance or with recurrent failures is also mentioned.

The results show varied viewpoints among students regarding the impact of ISTs on medical education. The accounts reveal the different perspectives and conflicts illustrating the complex relation between humans and technologies, especially in areas traditionally considered to be the domain of human action. This plurality of perspectives suggests that ISTs should not be conceived as a universal or final solution to the current challenges of medical training. Rather, they should be understood as complementary tools, whose implementation requires contextualization, evaluation, and adaptation to the social, economic, and cultural realities of each environment.

ISTs as Complementary Tools

In line with previous studies, the findings of this research confirm that ISTs are valued by students as useful and relevant tools for certain tasks and activities in medical education. Several authors have pointed out that these technologies improve the understanding of content, provide safer clinical practice through realistic simulations and allow real-time feedback from teachers (18,19). Furthermore, its use in educational contexts has been shown to be effective in anatomical learning, mainly in settings where access to dead bodies and dissection practices is restricted (11,20,21). The results of this study are in line with these findings.

Students agree that, although simulated environments do not replace contact with real patients, they do contribute to their clinical preparation by providing them with greater safety and autonomy. ISTs enable in-depth exploration of the human anatomy (often inaccessible in regular clinical settings) and allows to practice medical procedures in controlled environments. The possibility of making mistakes without direct consequences favors skills development, boosts self-confidence and fosters the progressive acquisition of clinical skills, with ultimately a positive impact on the quality of medical care.

Limitations and Tensions in ISTs Implementation

Despite the benefits identified, the interviews also revealed that there are limitations and tensions associated with the use of ISTs in training environments. Among the main concerns are the possible depersonalization of the medical act and the difficulty of these technologies to faithfully reproduce emotional aspects, social relationships and other situations inherent to real human interaction. These concerns are consistent with previous findings warning about the challenges of promoting empathy through digital media, and about the risk of depersonalization of the medical act when technology mediates the relationship between the healthcare professional and the patient (6,11,22).

Moreover, although ISTs can enable accessibility and reduce some educational costs, their implementation is not free from obstacles, such as high purchasing and maintenance costs, technological dependence, and the emergence of training gaps between teachers and students (23,24). Some study participants pointed out that these tools fail to replicate the level of immersion offered by hospital practice, where direct contact with real situations provides a wealth of nuances, meanings and learning that are hard to reproduce with ISTs. This limitation highlights the fact that medical practice takes place in situated contexts, affected by specific social and health care dynamics (25). Consequently, ISTs face the challenge of improving their contextualization capabilities to better resemble the complexities of real clinical settings.

Student Expectations and the Logic of the Educational Marketplace

A relevant finding of this study is the relationship between students' expectations about the use of ISTs and the competitive environment of professional practice. Many interviewees consider that acquiring the skills to use these technologies represents a long-term investment, as they see them as tools strengthening their job profiles after graduating from medical school. Thus, their expectations are impacted by a logic of return on investment, in a context marked by high competition for access to medical-surgical specialties, the growing globalization and competitiveness of the labor market, and the constant increase in the cost of higher education.

The accounts analyzed indicate an interest on the part of students regarding technological updating in educational institutions. This concern can be understood in two dimensions. Firstly, the contemporary educational market —especially private higher education— demands a high economic investment on the part of students and their families, which generates high expectations regarding the quality of the education received. In this context, state-of-the-art technologies are regarded as a tangible indicator of the value of such investment (26)Students tend to associate educational quality with technological modernization and often compare the resources available at their institutions with those of other universities.

Secondly, the perceived value of training is no longer limited to curricular content, faculty or physical infrastructure —such as classrooms, laboratories or practice sites— but extends to the availability and constant updating of simulation and immersion technologies. Thus, ISTs acquire symbolic value as a sign of institutional prestige and become a criterion of comparison used by students when assessing the quality of academic programs based on their own expectations. This logic transforms the relationship between students and institutions, creating dynamics of speculation, overvaluation and demands affecting the educational experience.

Moreover, it is important to note that this phenomenon may put additional financial pressure on educational institutions. By investing in state-of-the-art technologies to respond to the demands of an increasingly competitive market, universities run the risk of relegating other equally important components to ensure comprehensive and quality education. Additionally, incorporating technology in education can become an exclusion factor, especially in middle and low-income countries, either because of the high cost of tools or because of the digital illiteracy existing in some population segments (27)

In this scenario, pedagogical goals may conflict with market demands, thereby causing tension between educational and economic logic. Although several studies have documented the benefits of technology use in higher education —and specially in medical education— (11,21,26) it is necessary to deepen research on the financial impact of ISTs implementation, in relation to the benefits obtained (28).

Impact in the Colombian Context

The conversation with students also allowed for identifying specific opinions that shed some light on the ISTs implementation process in the national context. In Colombia, the generalized use of these technologies in medical education involves recognizing regional gaps, budget limitations, and heterogeneous epidemiological and healthcare realities. Some studies have shown that this reality is similar in the rest of Latin America (26,29). Thus, relevance is not a secondary criterion, but a main axis in implementation decisions. This should not be understood as the exclusion of peripheral regions, but rather as a call to carefully choose technologies that generate real value in local contexts, thereby helping to close territorial gaps.Thus, relevance is not a secondary criterion, but a main axis in implementation decisions. This should not be understood as the exclusion of peripheral regions, but rather as a call to carefully choose technologies that generate real value in local contexts, thereby helping to close territorial gaps.

Moreover, incorporating ISTs effectively is not limited to acquiring new equipment and tools; such acquisition must be accompanied by a preparation plan including teachers and students. The availability of technologies is meaningless if teachers lack the pedagogical and technical skills to integrate them into educational practice. It is therefore important to understand that the gap is not only technological, but also educational, and overcoming it requires training processes that are sensitive to the characteristics of medical education in each territory (29).

To understand the relevance of ISTs in medical education, it is key to contextualize them within the Colombian health system and the provision of medical services. Although these technologies have emerged as promising alternatives to support the training of medical professionals, their effectiveness cannot be assessed in isolation but rather considering the structural, financial and social realities shaping the country's healthcare system.

The Colombian health system faces structural challenges, such as a deficit in the generation of resources for infrastructure, personnel, technologies and medicines; an asymmetric distribution of services; and institutional fragmentation weakening governance and comprehensive care (30–32)These factors are worsened by the epidemiological transition to chronic diseases, the impact of epidemics and the growing expectations of users regarding quality and access. As a result, health professionals are overloaded with tasks in precarious contexts, with scarce resources, and in scenarios marked by cultural diversity, technological pressure and disarticulation between care levels.

In this scenario, ISTs could offer useful alternatives to reduce education gaps, improve access to content and strengthen clinical skills. However, implementation cannot be guided solely by innovation or standardization promises, but must be subject to a rigorous analysis of relevance and feasibility. Technology incorporation must be adapted to the real conditions of the healthcare system, territories and educational institutions. Beyond technological enthusiasm, what is at stake is the capacity of medical education to train ethically committed professionals who are technically competent and sensitive to the social conditions in which they will practice. It is therefore essential for educational institutions and the agencies in charge of guaranteeing education to constantly assess contents, pedagogical strategies, and professional profiles, checking their relevance and alignment with an environment facing local and global challenges. The implementation of ISTs will make sense and create value to the extent that it is articulated with these challenges.

The integration of ISTs in medical education opens a window of opportunity to boost professional training. However, it also poses significant challenges that must be considered. More than a final solution to the challenges of contemporary education, ISTs should be understood as complementary tools whose effectiveness depends on their adequate contextualization, pedagogical relevance and alignment to the social, economic and cultural conditions of the environment in which they are implemented.

The findings of this study show that ISTs offer several benefits in medical training, including: strengthened practical skills, the ability to train in safe environments, immediate feedback, access to rare clinical cases, and in-depth visualization of complex anatomical structures. However, significant limitations are also identified, especially regarding the development of communication skills, empathy, the realistic reproduction of complex clinical scenarios and the representation of specific sociocultural contexts.

To achieve an effective integration of ISTs in training contexts, it is necessary to make progress in several areas. First, relevance must be assessed in terms of the needs and possibilities of each educational environment, considering factors such as the conditions of the health system, local demands, graduate profiles, and student expectations. Second, it is essential to establish continuous evaluation mechanisms to assess their impact and cost-benefit ratio, so that institutional decisions (often tied to significant investments) are based on specific evidence and not only on technological innovation promises.

Third, it is necessary to foster teacher training processes that ensure an adequate pedagogical integration of technologies, avoiding a merely instrumental use. Technology should not be an end in itself, but a means to enrich the teaching-learning processes. Finally, it is crucial to ensure equitable access and constant updating of technological resources, both for institutions and students, to prevent ISTs from becoming factors of exclusion or inequality. It would be paradoxical if one of the promises of technology (to reduce gaps) ended up widening them.

In short, ISTs respond to the demands of a world under constant transformation, where technology plays an increasingly important role in education and healthcare. However, its implementation must be guided by principles of quality, ethics and equity, aimed at training technically skilled professionals sensitive to local realities and committed to patients and society.

This study was supported by Universidad El Bosque through the research project PCI-2023-019. The authors declare that they have no financial or non-financial competing interests. They also acknowledge Crimson Interactive Pvt. Ltd. (Enago, https://www.enago.com/es/) for their assistance with manuscript translation and editing.

Ethics approval and consent to participate: This study was approved by the Institutional Ethics Committee of Universidad El Bosque (Approval No. PCI-2023-019). All participants provided written informed consent prior to participation in accordance with institutional guidelines.
Consent for publication: Not applicable.
Availability of data and materials: The datasets generated and analyzed during the current study are not publicly available due to confidentiality agreements with participants but are available from the corresponding author on reasonable request.
Competing interests: The authors declare that they have no financial or non-financial competing interests.
Funding: This study was supported by Universidad El Bosque through the internal research project PCI-2023-019.
Authors’ contributions: All authors contributed equally to the conception and design of the study, data collection, analysis, and manuscript preparation. All authors read and approved the final manuscript.
Acknowledgments: The authors would like to thank the medical students of Universidad El Bosque who participated in this study, and Crimson Interactive Pvt. Ltd. (Enago, https://www.enago.com/es/) for their assistance with English translation and language editing.
Authors’ information:
1. Santiago Galvis-Villamizar, PhD in Anthropology, Full Professor, School of Medicine, Universidad El Bosque, Bogotá, Colombia.
2. Víctor Manuel García, PhD in History, Assistant Professor, Department of Humanities, Universidad El Bosque, Bogotá, Colombia.
3. Juan C. Arias, MD, MS, MPH, Assistant Professor, School of Medicine, Universidad El Bosque, Bogotá, Colombia.

Tang YM, Chau KY, Kwok APK, Zhu T, Ma X. A systematic review of immersive technology applications for medical practice and education - Trends, application areas, recipients, teaching contents, evaluation methods, and performance. Educ Res Rev. el 1 de febrero de 2022;35:100429.
Currie G, Hewis J, Nelson T, Chandler A, Nabasenja C, Spuur K, et al. COVID-19 impact on undergraduate teaching: Medical radiation science teaching team experience. J Med Imaging Radiat Sci. el 1 de diciembre de 2020;51(4):518–27.
Pears M, Yiasemidou M, Ismail MA, Veneziano D, Biyani CS. Role of immersive technologies in healthcare education during the COVID-19 epidemic. Scott Med J. noviembre de 2020;65(4):112–9.
Ryan G V., Callaghan S, Rafferty A, Higgins MF, Mangina E, McAuliffe F. Learning Outcomes of Immersive Technologies in Health Care Student Education: Systematic Review of the Literature. J Med Internet Res. el 1 de febrero de 2022;24(2).
Lowe S, Mares K, Khadjesari Z. Immersive technology in ophthalmology education: a systematic review. BMJ Simul Technol Enhanc Learn [Internet]. el 1 de julio de 2021 [citado el 27 de febrero de 2025];7(6):600. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8936631/
Macnamara AF, Bird K, Rigby A, Sathyapalan T, Hepburn D. High-fidelity simulation and virtual reality: an evaluation of medical students’ experiences. BMJ Simul Technol Enhanc Learn [Internet]. el 1 de julio de 2021 [citado el 2 de marzo de 2025];7(6):528. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8936672/
Wu Q, Wang Y, Lu L, Chen Y, Long H, Wang J. Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice. Front Med (Lausanne) [Internet]. el 30 de marzo de 2022 [citado el 16 de abril de 2023];9:855403. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/35433717
Chen S, Zhu J, Cheng C, Pan Z, Liu L, Du J, et al. Can virtual reality improve traditional anatomy education programmes? A mixed-methods study on the use of a 3D skull model. BMC Med Educ [Internet]. el 1 de diciembre de 2020 [citado el 27 de febrero de 2025];20(1). Disponible en: https://pubmed.ncbi.nlm.nih.gov/33129310/
Moo-Young J, Weber TM, Kapralos B, Quevedo A, Alam F. Development of Unity Simulator for Epidural Insertion Training for Replacing Current Lumbar Puncture Simulators. Cureus [Internet]. el 18 de febrero de 2021 [citado el 27 de febrero de 2025];13(2). Disponible en: https://pubmed.ncbi.nlm.nih.gov/33758704/
Morimoto T, Hirata H, Ueno M, Fukumori N, Sakai T, Sugimoto M, et al. Digital Transformation Will Change Medical Education and Rehabilitation in Spine Surgery. Medicina (Kaunas) [Internet]. el 1 de abril de 2022 [citado el 27 de febrero de 2025];58(4). Disponible en: https://pubmed.ncbi.nlm.nih.gov/35454347/
Aiello S, Cochrane T, Sevigny C. The affordances of clinical simulation immersive technology within healthcare education: a scoping review. Virtual Real [Internet]. el 1 de diciembre de 2023 [citado el 27 de febrero de 2025];27(4):3485–503. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36686614/
Alaraj A, Lemole M, Finkle J, Yudkowsky R, Wallace A, Luciano C, et al. Virtual reality training in neurosurgery: Review of current status and future applications. Surg Neurol Int [Internet]. 2011 [citado el 27 de febrero de 2025];2(1):52. Disponible en: https://pubmed.ncbi.nlm.nih.gov/21697968/
Bray K, Bray L, Sathyapalan T, Rigby AS, Hepburn D. A pilot study comparing immersive virtual reality simulation and computerized virtual patient simulation in undergraduate medical education. International Journal of Healthcare Simulation. 2023;
Ilgen JS, Sherbino J, Cook DA. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis. Acad Emerg Med [Internet]. febrero de 2013 [citado el 2 de marzo de 2025];20(2):117–27. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23406070/
Tene T, Vique López DF, Valverde Aguirre PE, Orna Puente LM, Vacacela Gomez C. Virtual reality and augmented reality in medical education: an umbrella review. Vol. 6, Frontiers in Digital Health. 2024.
Ahuja AS, Polascik BW, Doddapaneni D, Byrnes ES, Sridhar J. The Digital Metaverse: Applications in Artificial Intelligence, Medical Education, and Integrative Health. Integr Med Res [Internet]. el 1 de marzo de 2023 [citado el 5 de marzo de 2025];12(1). Disponible en: https://pubmed.ncbi.nlm.nih.gov/36691642/
Wickramasinghe N, Thompson BR, Xiao J. The Opportunities and Challenges of Digital Anatomy for Medical Sciences: Narrative Review. JMIR Med Educ [Internet]. el 20 de mayo de 2022;8(2):e34687. Disponible en: https://mededu.jmir.org/2022/2/e34687
Cuevas López L, Murgueitio NC, Castrillón CED, Germán FP, Molina R. Experiencia y curva de aprendizaje de apendicectomía y colecistectomía laparoscópica de los residentes de cirugía general en un hospital latinoamericano. Universitas Medica [Internet]. el 10 de abril de 2019 [citado el 16 de marzo de 2025];60(2):1–10. Disponible en: https://revistas.javeriana.edu.co/index.php/vnimedica/article/view/22725
Henao O, Escallón J, Green J, Farcas M, Sierra JM, Sánchez W, et al. Fundamentos de cirugía laparoscópica en Colombia con telesimulación: una herramienta adicional para la formación integral de cirujanos. Biomédica [Internet]. el 1 de marzo de 2013 [citado el 16 de marzo de 2025];33(1):107–14. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/1425/1776
Agámez Luengas S, Aldana Bolaño M, Barreto Arcos V, Santana Goenaga A. Aplicación de nuevas tecnologías de la información en la enseñanza de la medicina. Revista Salud Uninorte. 2009;25:150–71.
Lie SS, Helle N, Sletteland NV, Vikman MD, Bonsaksen T. Implementation of Virtual Reality in Health Professions Education: Scoping Review. JMIR Med Educ [Internet]. el 24 de enero de 2023 [citado el 9 de abril de 2025];9(1):e41589. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/36692934
Pulijala Y, Ma M, Pears M, Peebles D, Ayoub A. Effectiveness of Immersive Virtual Reality in Surgical Training—A Randomized Control Trial. Journal of Oral and Maxillofacial Surgery. el 1 de mayo de 2018;76(5):1065–72.
Richards S. Student Engagement Using HoloLens Mixed-Reality Technology in Human Anatomy Laboratories for Osteopathic Medical Students: an Instructional Model. Med Sci Educ [Internet]. el 1 de febrero de 2023 [citado el 18 de mayo de 2025];33(1):223–31. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36691419/
Gloy K, Weyhe P, Nerenz E, Kaluschke M, Uslar V, Zachmann G, et al. Immersive Anatomy Atlas: Learning Factual Medical Knowledge in a Virtual Reality Environment. Anat Sci Educ. el 1 de marzo de 2022;15(2):360–8.
Moro C, Štromberga Z, Raikos A, Stirling A. The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ [Internet]. el 1 de noviembre de 2017 [citado el 18 de mayo de 2025];10(6):549–59. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28419750/
Kyaw BM, Saxena N, Posadzki P, Vseteckova J, Nikolaou CK, George PP, et al. Virtual reality for health professions education: Systematic review and meta-analysis by the digital health education collaboration. J Med Internet Res. el 1 de enero de 2019;21(1).
Dhar P, Rocks T, Samarasinghe RM, Stephenson G, Smith C. Augmented reality in medical education: students’ experiences and learning outcomes. Med Educ Online [Internet]. el 1 de enero de 2021 [citado el 16 de abril de 2023];26(1). Disponible en: https://www.tandfonline.com/doi/full/10.1080/10872981.2021.1953953
Mol Annemarie. The logic of care : health and the problem of patient choice. Routledge; 2008. 129 p.
Okoye K, Hussein H, Arrona-Palacios A, Quintero HN, Ortega LOP, Sanchez AL, et al. Impact of digital technologies upon teaching and learning in higher education in Latin America: an outlook on the reach, barriers, and bottlenecks. Educ Inf Technol (Dordr) [Internet]. el 1 de febrero de 2022 [citado el 21 de julio de 2025];28(2):2291. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9376914/
UNESCO. Global Education Monitoring Report Summary 2023: Technology in education: A tool on whose terms? . Paris; 2023.
Toit J du, Verhoef AH. Embodied digital technology and transformation in higher education. Transformation in Higher Education [Internet]. el 23 de octubre de 2018 [citado el 21 de julio de 2025];3(0):8. Disponible en: https://thejournal.org.za/index.php/thejournal/article/view/52/154
Useche AC, Galvis ÁH, Díaz-Barriga Arceo F, Patiño Rivera AE, Muñoz-Reyes C. Reflexive pedagogy at the heart of educational digital transformation in Latin American higher education institutions. International Journal of Educational Technology in Higher Education [Internet]. el 1 de diciembre de 2022 [citado el 21 de julio de 2025];19(1):62. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9592123/
Comisión Para la Transformación de la Educación Médica en Colombia. Documento de recomendaciones para la transformación de la educación médica en Colombia. Bogotá; 2017.
Forero DA, Majeed MH, Ruiz-Díaz P. Current trends and future perspectives for medical education in Colombia. Med Teach. el 2 de enero de 2020;42(1):17–23.
Patiño-Giraldo S. Desafíos para las generaciones en la educación superior en salud. Acta Médica Colombiana [Internet]. el 19 de febrero de 2020 [citado el 17 de enero de 2024];45(2). Disponible en: https://www.actamedicacolombiana.com/ojs/index.php/actamed/article/view/1649/1538

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Integration of Immersive and Simulation Technologies in Medical Education: Student Perspectives in a Colombian University

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Version 1

Abstract

Introduction

Materials and Methods

Results

Learning, Practicing, and Trusting: The Positive Impact of ISTs on Medical Education

When Technology Is Not Enough: Empathy, Realism, and Equitable Access

Discussion

ISTs as Complementary Tools

Limitations and Tensions in ISTs Implementation

Student Expectations and the Logic of the Educational Marketplace

Impact in the Colombian Context

Conclusions

Statements and Declarations

References

Additional Declarations

Status:

Version 1