Abstract / Summary
Abstract Background The integration of extended reality (XR) modalities in medical curricula requires a comprehensive evaluation of pedagogical value, user experience, and institutional sustainability. This study evaluates the technical and experiential variations between virtual reality (VR) full synthetic immersion and mixed reality (MR) holographic transparency frameworks in high-fidelity emergency medical training. Methods Utilizing a mixed-methods crossover study design at the Simulation and Interprofessional Development Centre (SIDC), 60 Year 4 undergraduate medical students completed an identical ‘Level 1 and 2 Approach to Bronchial Asthma’ simulation across two distinct configurations: Meta Quest 3 headsets (VR) and Microsoft HoloLens units (MR). Each deployment featured a strict timeline consisting of a 2-minute technical setup followed by 7 minutes of active simulation, separated by a 7-day washout period. Following student tracks, an expert panel of 20 clinical faculty members completed structured evaluative appraisals. Results Quantitative evaluation via paired Wilcoxon signed-rank tests revealed that VR consistently and significantly outperformed MR across all ten evaluated dimensions (p < 0.05). VR achieved superior scores in ease of use (4.18 vs. 2.72), physical comfort (4.23 vs. 3.40), and perceived learning outcomes (4.30 vs. 3.17). Qualitative thematic analyses confirmed that VR’s physical controllers and haptic feedback offered critical interaction precision under pressure, driving an 88.3% student recommendation rate for future curriculum integration. Conversely, the expert panel strongly prioritized the open-boundary format of MR for environmental safety and direct peer communication, exposing a clear generational demographic split where 30.0% of expert educators advocated for MR despite its current gesture-tracking latencies and content constraints. Conclusion While VR stands out as the preferred, operationally reliable medium for independent high-fidelity diagnostic mastery, MR preserves essential ambient awareness for multi-user classroom management during medical emergency training.