Exploring the metaverse in the education of healthcare students: A scoping review

Bernardes, Andrea; Gardim, Lucas; Araújo, Agostinho A C; Jensen, Rodrigo; Motta, Raquel Acciarito; Almeida, Denise Maria de; Lima, Roberta Rubia de; Peres, Heloísa Helena Ciqueto

doi:10.1590/1518-8345.7256.4347

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Review Article • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.7256.4347 linkcopy

Exploring the metaverse in the education of healthcare students: A scoping review ^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to map the literature on the incorporation of the metaverse in the education of undergraduate healthcare students.

Method: scoping review following the recommendations of the JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), performed on Web of Science, Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Latin American and Caribbean Health Sciences Literature (LILACS) and ProQuest.

Results: a total of 23 records were included, published between 2020 and 2023, and developed in 10 countries. The metaverse allows the simulation of hypothetical cases, making education interactive and attractive. However, it faces limitations, including the possibility of depersonalizing students, concerns about data security and privacy, and the high cost of implementing and maintaining its infrastructure.

Conclusion: the metaverse enables the development of clinical competencies that support the construction of students’ professional identity. However, it may not be equitable, as it requires resources and knowledge from educators to implement it, contributing to increasing inequality in the education of healthcare students.

Descriptors:
Education; Teaching; Students, Health Occupations; Technology; Educational Technologies; Virtual Reality

(1) The metaverse is promising in the education of undergraduate healthcare students.

(2) The metaverse makes education interactive and attractive.

(3) It promotes the protagonism of students in the teaching-learning process.

(4) It presents risks related to data security and privacy.

(5) High cost of implementing and maintaining its infrastructure.

Authors, year of publication, and country	Type of publication	Design	Population	Main findings
van Weelderen, 2022 ⁽ ²⁰ ⁾ Australia	Discussion	Opinion article	Not applicable	It points out that, with the progress of technology, education has advanced and, as a result, the role of nursing has changed exponentially.
Mah, 2023 ⁽ ²¹ ⁾ Australia	Discussion	Editorial	Not applicable	It highlights that the integration of Artificial Intelligence (AI) into education, training, and research is expected to revolutionize medical education and practice, providing better outcomes for patients.
Moro, 2023 ⁽ ²² ⁾ Australia	Discussion	Opinion article	Not detailed	It demonstrates that the metaverse can offer opportunities for teaching and learning anatomy and physiology, although there are some risks to consider.
Chen, Zou, Xie, Wang, 2023 ⁽ ²³ ⁾ China	Research study	Review study	Not applicable	It evidences that the metaverse promotes collaborative and playful experiences, as well as the development of skills, although challenges need to be resolved. The findings highlight the need for safety measures and technological training for instructors, in addition to exploring the metaverse in monitoring and analyzing student behavior.
Yang, Kang, 2022 ⁽ ²⁴ ⁾ South Korea	Research study	Quasi-Experimental	58 third-year nursing students who completed theoretical classes on schizophrenia and mental health related to therapeutic communication, 29 students for the experimental group, and 29 students for the control group.	It shows that the metaverse presents positive results that indicate its usefulness as an alternative in nursing education, overcoming the space-time limitations of clinical practice. However, it also shows that current technological limitations affect the naturalness of interactions.
Musamih, Yaqoob, Salah, Jayaraman, Al-Hammadi, Omar, et al., 2023 ⁽ ²⁵ ⁾ United Arab Emirates	Research study	Review study	Not applicable	It reiterates the likely application of the metaverse in various healthcare fields, such as telemedicine, medical education, healthcare marketing, supply chain, healthcare facilities, and wellness. However, it shows that widespread adoption faces significant challenges.
Al-Kfairy, Al-Fandi, Alema, Altaee, 2023 ⁽ ²⁶ ⁾ United Arab Emirates	Research study	Qualitative study	84 higher education students. However, there were no details of the respective courses to which they were linked.	It points out that learning flexibility is the main incentive for using metaverse-based classrooms, with other motivations including concern for the environment and the interactivity offered by this form of technology. However, concerns about possible health problems are highlighted, as well as privacy and security issues.
Gonzalez-Moreno, Andrade-Pino, Monfort-Vinuesa, Piñas-Mesa, Rincon, 2023 ⁽ ²⁷ ⁾ Spain	Research study	Systematic review	Not applicable	It emphasizes that to implement successful metaverse-related strategies in education, it is necessary to consider the various mixed reality techniques that have been developed, addressing their potential and weaknesses.
Román-Belmonte, Rodríguez-Merchán, Corte-Rodríguez, 2023 ⁽ ²⁸ ⁾ Spain	Research study	Review study	Not applicable	It points to the use of the metaverse in musculoskeletal pathology education as promising for improving knowledge acquisition and promoting independent learning. It also highlights clinical applications under development that could add significant value to the field of osteoarticular medicine. Furthermore, it highlights the use of the metaverse as promising, despite clinical, technological, educational, and legal issues that still need to be addressed.
Méndez, Marcos-Pablos, Izard, 2023 ⁽ ²⁹ ⁾ Spain	Research study	Proceedings of the 2022 Tenth International Conference on Technological Ecosystems for Enhancing Multiculturality (TEEM-2022) Survey	Not detailed	It points out that the metaverse is effective in enhancing the visualization of real images in virtual learning environments. The study presents several immersive and augmented virtual environments, using stereoscopic models to create a metaverse where knowledge can be shared to improve medical training.
López-Ojeda, Hurley, 2023 ⁽ ³⁰ ⁾ United States of America (USA)	Discussion	Commentary	Not applicable	It points out that three-dimensional printing technology, combined with AI, is developing rapidly in the context of the metaverse, driving advances in medical education and health care. Although it cannot yet completely replace the use of human cadavers in medical training, the study highlights the metaverse as an innovative complement to disciplines such as clinical neuroscience.
Ford, Buchanan, Azeez, Benrimoh, Kaloiani, Bandeira, et al., 2023 ⁽ ³¹ ⁾ United States of America (USA)	Discussion	Perspective	Not applicable	It emphasizes that the metaverse has emerged on the medical education scene as an educational environment that allows students to experience situations that are close to reality, corroborating their clinical reasoning.
Ahuja, Polascik, Doddapaneni, Byrnes, Sridhar, 2022 ⁽ ³² ⁾ United States of America (USA)	Discussion	Commentary	Not applicable	It points out that the metaverse contributes to revolutionizing medical education when combined with AI, AR, and VR. It also points out that, although there is still room for growth and consideration of disadvantages, its adoption can expand access to medical education for underserved populations.
De Gagne, Randall, Rushton, Park, Cho, Yamane, et al., 2022 ⁽ ³³ ⁾ United States of America (USA)	Research study	Umbrella review	Not applicable	It highlights the metaverse as a versatile and constantly evolving pedagogical tool with the potential to boost learning outcomes in nursing education, opening up fascinating opportunities and important considerations for educators.
Bhatia, Joshi, 2023 ⁽ ³⁴ ⁾ India	Research study	Anais do International Conference on Innovation Data Communication Technologies and Application 2023 (ICIDCA-2023) Review study	Not detailed	It highlights that medical students’ practice in the metaverse transforms medical training, saving time and resources.
Kawarase, Anjankar, 2022 ⁽ ³⁵ ⁾ India	Research study	Review study	Not applicable	It highlights that considering cultural differences in the global context, the metaverse can offer an educational environment that provides quality and uniformity in medical education.
Pandey, Chirputkar, Ashok, 2023 ⁽ ³⁶ ⁾ India	Research study	Review study	Not applicable	It emphasizes that the metaverse corresponds to an educational approach that will influence medical education in the future, even if it is related to improving some personal characteristics.
Mohamed, Naqishbandi, Veronese, 2023 ⁽ ³⁷ ⁾ India	Research study	Review study	Not applicable	It highlights the metaverse as a new and exceptional environment for education. It also shows that the topic is increasingly developing, especially in terms of applications, the importance of which has increased significantly due to the COVID-19 pandemic.
Bhugaonkar, Bhugaonkar, Masne, 2022 ⁽ ³⁸ ⁾ India	Research study	Review study	Not applicable	It points out that the metaverse is intrinsically associated with AR and can therefore be applied to the educational process of medical students.
Garavand, Aslani, 2022 ⁽ ³⁹ ⁾ Iran	Research study	Scope review	Not applicable	It highlights that, in medical education, the use of the metaverse can revolutionize the way students learn and practice medicine, benefiting public health.
Petrigna, Musumeci, 2022 ⁽ ⁴⁰ ⁾ Italy	Research study	Scope review	Not applicable	It emphasizes that the metaverse reduces the discrepancy in medical training, considering the elimination of geographical and time barriers through virtual learning rooms.
Massetti, Chiariello, 2023 ⁽ ⁴¹ ⁾ Italy	Research study	Review study	Not applicable	It points out that, in education, the metaverse enables students to experience clinical situations safely, gaining experience in the teaching-learning process.
Bansal, Rajgopal, Chamola, Xiong, Niyato, 2020 ⁽ ⁴² ⁾ Singapore	Research study	Review study	Not applicable	It shows that the metaverse has emerged as an alternative for developing and improving existing educational systems, enabling an experience that resembles reality.

Authors and year of publication	Applicability of the metaverse	Limitations of the metaverse
van Weelderen, 2022 ⁽ ²⁰ ⁾	Development of skills through the execution of clinical procedures; Reduces the risk of injury to students by providing a safe environment for practicing and learning to make critical decisions before interacting with real patients; Reduces stress and improves staff retention rates.	Not described
Mah, 2023 ⁽ ²¹ ⁾	Simulates real-life surgical scenarios in medical education; Allows repeated practice with unlimited resources.	It can confuse students’ understanding of the difference between the metaverse and real life. Encourages academic fraud through cheating on exams.
Moro, 2023 ⁽ ²² ⁾	Virtual dissections; Consultation with expert instructors from anywhere in the world; Understanding anatomy through the representation of 3D organs from different anatomical models.	Cost of implementation; Demand for stable connectivity; Data protection, privacy and security; Difficulty in monitoring students in the virtual world.
Chen, Zou, Xie, Wang, 2023 ⁽ ²³ ⁾	Enables the expansion of students’ clinical skills, based on real-life situations.	Difficulties in security and privacy protection; May confuse students’ understanding of what is real and virtual.
Yang, Kang, 2022 ⁽ ²⁴ ⁾	Enables students to improve their therapeutic communication with psychiatric patients.	Facial expressions and body postures of the avatars are limited and far from natural compared to the patients; Exposure of the programs to problems that may occur in the operational process during use.
Musamih, Yaqoob, Salah, Jayaraman, Al-Hammadi, Omar, et al., 2023 ⁽ ²⁵ ⁾	Enables surgical training; Facilitates collaboration between educators and students from different locations.	Requires advanced and expensive technologies; Requires resources relating to the interoperability and compatibility of systems; Exposes to the risk of cybercrime (identity theft and data breaches, cyberbullying and harassment); Exposes the risk of virtual addiction.
Al-Kfairy, Al-Fandi, Alema, Altaee, 2023 ⁽ ²⁶ ⁾	Not described	Difficulty in accessing and handling the technology; Usability problems * ; Data security and privacy.
Gonzalez-Moreno, Andrade-Pino, Monfort-Vinuesa, Piñas-Mesa, Rincon, 2023 ⁽ ²⁷ ⁾	Enables the reproduction of Health Digital Twins (HDT) † .	Not described
Román-Belmonte, Rodríguez-Merchán, Corte-Rodríguez, 2023 ⁽ ²⁸ ⁾	Provides training in orthopedic surgical skills by recognizing anatomical structures and performing fluoroscopic techniques and surgical sutures, as well as access to various surgical environments via a 360º camera; Provides training for students in situations considered rare, such as multiple victim simulations; Reduces the risk of accidental injuries with needles, scalpels or other sharp instruments, improving safety in invasive procedures.	Not described
Méndez, Marcos-Pablos, Izard, 2023 ⁽ ²⁹ ⁾	Enables spatial visualization of real environments in the virtual world (e.g. operating rooms, anatomical dissection rooms, clinical examination rooms); Enables learning about the structures of the human body, such as the skeletal system and body musculature; Allows health science students to obtain information complementary to the regular content of their studies, becoming active participants in the learning process, and encouraging them during their educational progress.	Technical aspects still need to be solved to make the user’s subjective feeling of being physically present a reality.
López-Ojeda, Hurley, 2023 ⁽ ³⁰ ⁾	Supports the training of surgical procedures in neurosurgery; Enables the printing of 3D anatomical models; Enables enhanced presentation of complex anatomical regions, organs, and structures.	Not described
Ford, Buchanan, Azeez, Benrimoh, Kaloiani, Bandeira, et al., 2023 ⁽ ³¹ ⁾	Promotes performance feedback; Promotes specialized teaching (neurosimulation); Promotes simulated teaching (collecting a previous history; carrying out a physical examination; generating diagnostic hypotheses and proposing therapeutic management for various diseases, including those considered rare); Promotes the improvement of clinical knowledge and ensures patient safety through learning opportunities.	Ethical implications related to accessibility and equity.
Ahuja, Polascik, Doddapaneni, Byrnes, Sridhar, 2022 ⁽ ³² ⁾	Enables the teaching of anatomy and radiology; Provides opportunities to improve clinical skills; Enables surgical training.	High implementation costs; Data security vulnerabilities.
De Gagne, Randall, Rushton, Park, Cho, Yamane, et al., 2022 ⁽ ³³ ⁾	Not described	Risks of technology malfunction.
Bhatia, Joshi, 2023 ⁽ ³⁴ ⁾	Enables surgical training (handling equipment, complex manual skills, practice on simulated patients with real patient data); Provides opportunities for remote communication and interaction with other students and patients; Simulation of real-life cases in the area of neurosurgical emergencies; Opportunities to connect people from different regions.	High cost of implementation; Risk to patient data privacy.
Kawarase, Anjankar, 2022 ⁽ ³⁵ ⁾	Enables the simulation of scenarios and case conditions that resemble real life; Enables training in surgical procedures; Enables the teaching of anatomy of specific structures, such as lymph nodes, blood vessels, nerves, microscopic structures, and pathologies.	Costly to implement (infrastructure and personnel); Risk of security and data privacy breaches.
Pandey, Chirputkar, Ashok, 2023 ⁽ ³⁶ ⁾	Supports the teaching of human anatomy; Simulates surgical procedures.	Not described
Mohamed, Naqishbandi, Veronese, 2023 ⁽ ³⁷ ⁾	Provides an assimilation between the real and virtual worlds.	Complex and not fully understood technologies with the potential to profoundly influence life.
Bhugaonkar, Bhugaonkar, Masne, 2022 ⁽ ³⁸ ⁾	Enables visualization of the anatomical structure of the human body; Enables training in surgical techniques; Makes it possible to simulate high-cost surgical procedures.	Difficulty or impossibility of exporting content between metaverses; Risks related to the privacy and protection of patient data; High cost of implementation; Environment vulnerable to cyber-attacks.
Garavand, Aslani, 2022 ⁽ ³⁹ ⁾	Provided opportunities for non-face-to-face education in the context of the COVID-19 pandemic.	Need for infrastructure to apply the metaverse in different areas.
Petrigna, Musumeci, 2022 ⁽ ⁴⁰ ⁾	Enables training in cardiology and neurology surgeries; Enables visualization of anatomical structures of the human body.	Weakens social connections compared to real life.
Massetti, Chiariello, 2023 ⁽ ⁴¹ ⁾	Enables interactive digital anatomy classes, to understand the evolution of the pathological process and simulate procedures; Simulates clinical and diagnostic activities on virtual models using virtual patients with similar characteristics to real patients.	Not described
Bansal, Rajgopal, Chamola, Xiong, Niyato, 2020 ⁽ ⁴² ⁾	Simulated cases with screen projections that allow monitoring of what students are doing; Teaching about the positioning of the placenta and the stages of childbirth; Dental simulators that respond to the force applied by the student when simulating the procedure and allow them to train procedures and dexterity; Teaching about emergency care such as cardiopulmonary resuscitation, use of a defibrillator, collecting tests, studying anatomy and dissection, surgical training.	Issues relating to privacy and data security, laws, and jurisdiction; Risks related to addiction and mental health.

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[TFN1] ^*
Usability = Refers to the ease of using new technology ⁽ ²⁶ ⁾ ;

[TFN2] ^†
Health Digital Twins (HDT) = A virtual representation (digital twin) of a patient (physical twin) that is generated from multimodal patients ⁽ ²⁷ ⁾

Exploring the metaverse in the education of healthcare students: A scoping review *

Exploring the metaverse in the education of healthcare students: A scoping review ^*