Virtual and Augmented Reality: Where They Fit in Anesthesia Training

Inside the Virtual OR: The Tools Preparing Tomorrow’s CRNAs Today

As nurse anesthesia education continues to evolve in response to complex healthcare demands, immersive technologies like virtual reality (VR) and augmented reality (AR) are moving from novelty to necessity. These tools are redefining how SRNAs learn, practice, and apply anesthesia knowledge and bridging the gap between didactic learning and real-world clinical performance. For educators, understanding how and where VR and AR fit into the curriculum is essential for preparing the next generation of CRNAs.

VR vs. AR: Clarifying the Difference

Although often mentioned together, virtual reality (VR) and augmented reality (AR) are distinct technologies with different strengths in anesthesia education. Let’s dive into the distinctions between the two.

• Virtual Reality (VR):
  VR immerses learners in a completely simulated, computer-generated environment using a headset and controllers. Everything in the scenario including the patient, monitors, instruments, and OR is virtual. This allows students to practice high-risk, low-frequency events (e.g., malignant hyperthermia, cardiac arrest during induction) or step-by-step procedures without any patient risk. VR is ideal for developing clinical reasoning, decision-making under pressure, and psychomotor coordination in a controlled, repeatable environment.

• Augmented Reality (AR):
  AR, by contrast, overlays digital elements onto the real-world environment, (enhancing but not replacing) reality. Learners might wear AR glasses or use tablets to see anatomy projected onto a mannequin, real-time pharmacokinetic models during an induction, or guided needle pathways during a regional block. AR is particularly valuable for enhancing procedural skills, spatial understanding, and visualization of complex concepts while still interacting with real equipment, patients, or mannequins.

In short, VR is about immersion in a new world, while AR is about enhancing the real one. Most anesthesia programs will benefit from integrating both, as they complement different aspects of training.

Where VR and AR Fit in the Curriculum

Immersive technologies should be seen as curricular supplements rather than replacements for clinical experience or traditional simulation. Their value lies in extending the reach and depth of learning across several stages of anesthesia education:

• Pre-Clinical Phase – Building Foundations:
  VR can immerse students in the OR environment early, teaching them to navigate monitors, machines, and workflows before clinical rotations. AR can overlay anatomy on models to teach airway structures or vascular pathways, reinforcing foundational physiology and anatomy.

• Didactic Phase – Deepening Understanding:
  Concepts like gas exchange, neuromuscular blockade, or pharmacodynamics can be visualized in AR to make abstract physiology more concrete. VR scenarios can demonstrate the impact of clinical decisions in real time — for example, showing how a delayed induction agent impacts hemodynamics.

• Simulation and Skills Labs – Bridging Knowledge and Practice:
  AR-guided procedures help students visualize ultrasound-guided regional blocks or central line placement. VR crisis simulations provide decision-making practice in scenarios like local anesthetic systemic toxicity (LAST), anaphylaxis, or failed airway management.

• Clinical Transition – Bridging the Gap to Real Patients:
  Repeated VR exposure to rare events prepares students for their first real-world encounters. AR can enhance clinical debriefings by projecting anatomical or pharmacologic data relevant to actual patient cases.

• Continuing Education – Lifelong Learning:
  Even beyond graduation, CRNAs can use VR for low-frequency, high-risk refreshers or AR for learning new procedures and technologies, supporting ongoing professional competence.

Evidence for Effectiveness: What the Research Shows

A growing body of research supports the use of VR and AR in anesthesia and procedural training. Across multiple studies in healthcare education:

• Improved Knowledge Retention:
  Immersive learning environments improve long-term retention of complex material compared to traditional lecture-based teaching. In one study, anesthesia trainees who completed VR crisis management scenarios scored significantly higher on post-tests than peers who received standard case discussions.

• Enhanced Psychomotor Skills:
  AR-guided regional anesthesia training has been shown to improve needle placement accuracy, shorten learning curves, and increase confidence compared to traditional ultrasound-only instruction. Learners better visualize anatomical targets and spatial relationships, leading to more precise performance.

• Better Clinical Reasoning and Decision-Making:
  VR scenarios replicate cognitive load and time pressure, requiring students to synthesize information and act quickly. Evidence suggests this leads to more robust situational awareness and decision-making when transitioning to real clinical settings.

• Increased Learner Engagement and Confidence:
  Immersive tools are consistently rated by students as more engaging, motivating, and confidence-building than traditional formats. Engagement translates into increased deliberate practice which is a key driver of mastery.

• Standardization Across Training Sites:
  VR ensures all students encounter the same high-risk scenarios, regardless of the variability in clinical site case mix. This helps reduce disparities in clinical exposure and ensures more uniform competency outcomes.

For anesthesia educators, this evidence supports integrating immersive technologies as a validated strategy to improve learning outcomes, skill acquisition, and preparedness for clinical practice.

The Future of Immersive Learning in Anesthesia is NOW

The future of anesthesia education is undoubtedly more immersive, interactive, and technology-enhanced. Several trends are shaping how VR and AR will continue to evolve in our field:

• Increased Accessibility and Affordability:
  As hardware becomes more cost-effective and content creation tools become more user-friendly, even smaller programs will be able to integrate immersive modules without prohibitive costs.

• More Realistic, AI-Driven Scenarios:
  Artificial intelligence will power adaptive VR scenarios that respond to learners’ decisions in real time, offering personalized feedback and branching case pathways that mimic real clinical complexity.

• Integration with Wearable Technology and Haptics:
  Emerging systems will include haptic feedback, replicating the tactile feel of airway manipulation or needle resistance, further bridging the gap between virtual and physical practice.

• Expanded Use in Competency Assessment:
  VR-based simulations will increasingly be used not just for teaching but also for formative and summative assessment, evaluating readiness for clinical practice or ongoing competency in high-risk procedures.

• Global and Remote Learning Opportunities:
  Immersive platforms will allow students and educators across the country — or the world — to participate in shared simulations, collaborate in virtual ORs, and learn from each other without geographic barriers.

For nurse anesthesia educators, embracing these tools is about more than adopting new technology……it’s about future-proofing education and preparing SRNAs for the realities of modern anesthesia practice.

Key Takeaway: Virtual and augmented reality are no longer optional add-ons; they are becoming core components of a comprehensive anesthesia curriculum. By understanding their differences, evidence base, and best-fit applications, educators can create richer, more equitable, and more effective learning experiences that better prepare future CRNAs for the complex, high-stakes environments they will face.