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Background <p>Empathy is a cornerstone of high-quality healthcare, yet its cultivation among medical and nursing learners remains challenging, with noted declines during clinical training. Simulation-based education and immersive technologies like virtual reality (VR), augmented reality (AR), and mixed reality (MR) offer promising avenues for empathy enhancement. This umbrella review synthesizes evidence from existing systematic reviews and meta-analyses on the effectiveness of these technologies.</p> Methods <p>We conducted an umbrella review following the PRISMA 2020 guidelines. Ten databases (PubMed, Scopus, Web of Science, Embase, PsycINFO, CINAHL, Cochrane Library, APA PsycArticles, ERIC, and MedRxiv) were searched from January 2000 to 15 October 2025 for systematic reviews and meta-analyses evaluating simulation or immersive technology interventions on empathy in medical or nursing education. Study selection, data extraction, and quality assessment (using AMSTAR 2 and CASP tools) were performed independently by two reviewers. AMSTAR 2 was used as a qualitative appraisal tool to assess methodological limitations, and numerical scores were assigned for descriptive categorization only, not as quantitative weights. We extracted pooled effect sizes from the meta-analyses reported in the included reviews. We then conducted a random effects meta-analysis of these review-level effect estimates to provide an overall summary. Publication bias was assessed at the review level as an exploratory analysis.</p> Results <p>Eleven reviews (9 quantitative, 2 qualitative) were included. The meta-analysis of review-level estimates demonstrated a moderate, statistically significant positive effect on empathy outcomes (standardized mean difference, SMD = 0.43, 95% CI, 0.37–0.50). Subgroup analyses showed consistent effects across intervention types: clinical simulation (SMD = 0.46), VR (SMD = 0.47), and AR/MR (SMD = 0.44, [95% CI: 0.35–0.53] ). Heterogeneity was moderate (I² = 38–45%). Quality appraisal indicated seven high-quality and four moderate-quality reviews. Exploratory application of Egger’s test to review-level estimates suggested mild asymmetry, which should be interpreted with caution. Overlap of primary studies across reviews was minimal (Corrected Covered Area = 3%).</p> Conclusions <p>Simulation and immersive technologies are moderately effective in enhancing self-reported empathy scores among healthcare learners in the short term. The choice of technology may be less critical than the pedagogical design, which should incorporate elements such as narrative engagement and structured debriefing. Future research should focus on long-term retention, behavioral outcomes, cost effectiveness, and the implementation of these technologies in diverse educational contexts.</p>

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Effectiveness of simulation technologies and virtual reality in enhancing empathy in health care education: an umbrella review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月11日

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  • Leila Mosalanejad,
  • Yaser Sarikhani Khorami,
  • Ali Dehghani

摘要

Background

Empathy is a cornerstone of high-quality healthcare, yet its cultivation among medical and nursing learners remains challenging, with noted declines during clinical training. Simulation-based education and immersive technologies like virtual reality (VR), augmented reality (AR), and mixed reality (MR) offer promising avenues for empathy enhancement. This umbrella review synthesizes evidence from existing systematic reviews and meta-analyses on the effectiveness of these technologies.

Methods

We conducted an umbrella review following the PRISMA 2020 guidelines. Ten databases (PubMed, Scopus, Web of Science, Embase, PsycINFO, CINAHL, Cochrane Library, APA PsycArticles, ERIC, and MedRxiv) were searched from January 2000 to 15 October 2025 for systematic reviews and meta-analyses evaluating simulation or immersive technology interventions on empathy in medical or nursing education. Study selection, data extraction, and quality assessment (using AMSTAR 2 and CASP tools) were performed independently by two reviewers. AMSTAR 2 was used as a qualitative appraisal tool to assess methodological limitations, and numerical scores were assigned for descriptive categorization only, not as quantitative weights. We extracted pooled effect sizes from the meta-analyses reported in the included reviews. We then conducted a random effects meta-analysis of these review-level effect estimates to provide an overall summary. Publication bias was assessed at the review level as an exploratory analysis.

Results

Eleven reviews (9 quantitative, 2 qualitative) were included. The meta-analysis of review-level estimates demonstrated a moderate, statistically significant positive effect on empathy outcomes (standardized mean difference, SMD = 0.43, 95% CI, 0.37–0.50). Subgroup analyses showed consistent effects across intervention types: clinical simulation (SMD = 0.46), VR (SMD = 0.47), and AR/MR (SMD = 0.44, [95% CI: 0.35–0.53] ). Heterogeneity was moderate (I² = 38–45%). Quality appraisal indicated seven high-quality and four moderate-quality reviews. Exploratory application of Egger’s test to review-level estimates suggested mild asymmetry, which should be interpreted with caution. Overlap of primary studies across reviews was minimal (Corrected Covered Area = 3%).

Conclusions

Simulation and immersive technologies are moderately effective in enhancing self-reported empathy scores among healthcare learners in the short term. The choice of technology may be less critical than the pedagogical design, which should incorporate elements such as narrative engagement and structured debriefing. Future research should focus on long-term retention, behavioral outcomes, cost effectiveness, and the implementation of these technologies in diverse educational contexts.