Immersive virtual reality learning environments (IVRLEs) are increasingly used in medical education, yet the role of environmental fidelity-particularly scene design-remains underexplored. This study examines how varying levels of fidelity and contextualization affect motivational and cognitive outcomes. Eighty-seven medical students were randomly assigned to one of three scene conditions: a minimalistic "Blank Scene," a "Reconstructed Classroom Scene", or an "Inside-Human Scene". All students used a custom-developed application to learn about embryonic heart development. We measured virtual presence, intrinsic motivation, cognitive load, learning outcomes, and usability. Results showed that scene design influenced virtual presence, selected aspects of intrinsic motivation, cognitive load, and learning outcomes. The Inside-Human Scene elicited higher physical and self-presence as well as higher comprehension scores compared to the Reconstructed Classroom Scene. The Reconstructed Classroom Scene was associated with higher extraneous cognitive load. Intrinsic cognitive load was rated higher in the Inside-Human Scene, while germane cognitive load did not differ between conditions. No significant differences were found for task performance or factual recall. Overall, the findings indicate that scene design in IVRLEs affects how learners engage with complex content and may support deeper understanding when perceptual and contextual properties are coherent, while visually detailed environments may increase extraneous cognitive demands without improving learning.

Where traditional media and methods reach their limits in anatomy education, mixed-reality (MR) environments can provide effective learning support because of their high interactivity and spatial visualization capabilities. However, the underlying design and pedagogical requirements are as diverse as the technologies themselves. This paper examines the effectiveness of individual- and collaborative learning environments for anatomy education, using embryonic heart development as an example. Both applications deliver the same content using identical visualizations and hardware but differ in interactivity and pedagogical approach. The environments were evaluated in a user study with medical students (n = 90) during their examination phase, assessing usability, user experience, social interaction/co-presence, cognitive load, and personal preference. Additionally, we conducted a knowledge test before and after an MR learning session to determine educational effects compared to a conventional anatomy seminar. Results indicate that the individual learning environment was generally preferred. However, no significant difference in learning effectiveness could be shown between the conventional approach and the MR applications. This suggests that both can effectively complement traditional seminars despite their different natures. Our study contributes to understanding how different MR settings could be tailored for anatomical education.

Virtual surgical training systems are crucial for enabling mental preparation, supporting decision-making, and improving surgical skills. Many virtual surgical training environments focus only on training for a specific medical skill and take place in a single virtual room. However, surgical education and training include the planning of procedures as well as interventions in the operating room context. Moreover, collaboration among surgeons and other medical professionals is only applicable to a limited extent. This work presents a collaborative VR environment similar to a virtual teaching hospital to support surgical training and interprofessional collaboration in a co-located or remote environment. The environment supports photo-realistic avatars and scenarios ranging from planning to training procedures in the virtual operating room. It includes a lobby, a virtual surgical planning room with four surgical planning stations, laparoscopic liver surgery training with the integration of laparoscopic surgical instruments, and medical training scenarios for interprofessional team training in a virtual operating room. Each component was evaluated by domain experts as well as in a series of user studies, providing insights on usability, usefulness, and potential research directions. The proposed environment may serve as a foundation for future medical training simulators.

Recent developments and research advances contribute to an ever-increasing trend towards quality levels close to what we experience in reality. In this work, we investigate how different degrees of these quality characteristics affect user performance, qualia of user experience (UX), and sense of presence in an example medical task. To this end, a two-way within-subjects design user study was conducted, in which three different levels of visual fidelity were compared. In addition, two different interaction modalities were considered: (1) the use of conventional VR controllers and (2) natural hand interaction using 3D-printed, spatially-registered replicas of medical devices, to interact with their virtual representations. Consistent results indicate that higher degrees of visual fidelity evoke a higher sense of presence and UX. However, user performance was less affected. Moreover, no differences were detected between both interaction modalities for the examined task. Future work should investigate the discovered interaction effects between quality levels and interaction modalities in more detail and examine whether these results can be reproduced in tasks that require more precision. This work provides insights into the implications to consider when studying interactions in VR and paves the way for investigations into early phases of medical product development and workflow analysis.

In the embryonic human heart, complex dynamic shape changes take place in a short period of time on a microscopic scale, making this development difficult to visualize. However, spatial understanding of these processes is essential for students and future cardiologists to properly diagnose and treat congenital heart defects. Following a user centered approach, the most crucial embryological stages were identified and translated into a virtual reality learning environment (VRLE) to enable the understanding of the morphological transitions of these stages through advanced interactions. To address individual learning types, we implemented different features and evaluated the application regarding usability, perceived task load, and sense of presence in a user study. We also assessed spatial awareness and knowledge gain, and finally obtained feedback from domain experts. Overall, students and professionals rated the application positively. To minimize distraction from interactive learning content, such VRLEs should consider features for different learning types, allow for gradual habituation, and at the same time provide enough playful stimuli. Our work previews how VR can be integrated into a cardiac embryology education curriculum.

We present a Virtual and Augmented Reality multi-user prototype of a learning environment for liver anatomy education. Our system supports various training scenarios ranging from small learning groups to classroom-size education, where students and teachers can participate in virtual reality, augmented reality, or via desktop PCs. In an iterative development process with surgeons and teachers, a virtual organ library was created. Nineteen liver data sets were used comprising 3D surface models, 2D image data, pathology information, diagnosis and treatment decisions. These data sets can interactively be sorted and investigated individually regarding their volumetric and meta information. The three participation modes were evaluated within a user study with surgery lecturers (5) and medical students (5). We assessed the usability and presence using questionnaires. Additionally, we collected qualitative data with semistructured interviews. A total of 435 individual statements were recorded and summarized to 49 statements. The results show that our prototype is usable, induces presence, and potentially support the teaching of liver anatomy and surgery in the future.

Complex bi-manual tasks often benefit from supporting visual information and guidance. Controlling the system that provides this information is a secondary task that forces the user to perform concurrent multitasking, which in turn may affect the main task performance. Interactions based on natural behavior are a promising solution to this challenge. We investigated the performance of these interactions in a hands-free image manipulation task during a primary manual task with an upright stance. Essential tasks were extracted from the example of clinical workflow and turned into an abstract simulation to gain general insights into how different interaction techniques impact the user's performance and workload. The interaction techniques we compared were full-body movements, facial expression, gesture and speech input. We found that leaning as an interaction technique facilitates significantly faster image manipulation at lower subjective workloads than facial expression. Our results pave the way towards efficient, natural, hands-free interaction in a challenging multitasking environment.