A Systematic Review of Augmented Reality in Health Sciences: A Guide to Decision-Making in Higher Education
- What kind of augmented reality interventions are used in health sciences higher education?
- What impact does the use of augmented reality have on the educational outcomes and skills of these students?
- What are the main advantages, disadvantages and challenges of this technology during the teaching-learning process?
2.2. Search Methods
2.3. Search Outcomes
2.4. Data Abstraction & Synthesis
2.5. Quality Appraisal
3.1. Characteristics of the Studies
3.2. Convergent Synthesis of Studies
3.2.1. Technical and Pedagogical Usability of AR in Health Sciences Higher Education
- Technical usability involves techniques for ensuring a trouble-free interaction (readability and ease of use), and pedagogical usability aims to support the learning process; both terms should not be considered independently [22,23]. Taking this into account, contributions of AR in Health Sciences Higher Education in our review were diverse:
- In the development of skills oriented to decision-making and performance of practical procedures, especially in inexperienced individuals .
- In making learning more flexible, by allowing access to content at any time regardless of location .
- In the teaching-learning of human anatomy, since the three-dimensional vision provided by AR facilitates spatial understanding, and, therefore, the acquisition of knowledge .
Electronic Applications and Devices for the Creation and Visualization of Virtual Content
3.2.2. Specific Psychopedagogical Outcomes of the Studies
Influence of AR on Motivational Aspects
- Academic performance
- Acquisition of clinical competencies
- Acquisition of cognitive skills
Benefits of Engaging on AR Experiences
3.2.3. Pros and Cons of Using AR in Health Science Education
4.1. Relevance to Clinical and Teaching-Learning Practice
4.2. Strengths and Limitations
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|(MH “Augmented Reality”) AND (MH “Students, Health Occupations+”) OR ((“augmented reality”) AND (“higher education *” OR “university * education *”)) TI OR ((“augmented reality”) AND (“higher education *” OR “university * education *”)) AB|
|Academic Degree & Academic Year |
& Sample Size
|Aims||Measuring Instruments||Results||MMAT Rating|
|Bogomolova et al. |
1st and 2nd year Anatomy
N = 58 students
|To evaluate the effectiveness of stereoscopic visualization of AR and the effect of spatial vision skills on learning.||Mental Rotation Test (MRT), consisting of 30 questions validated by experts to assess knowledge of anatomy. A self-reported questionnaire to evaluate the learning experience (study time, perception of the knowledge acquired, degree of satisfaction with the materials used, etc.)||Significant differences were found in the learning effect between the groups that used 2D teaching material and those that used the 3D stereoscopic vision of AR among the students with low spatial visual abilities measured through the MRT. |
Group members who viewed the teaching content using AR stereoscopic vision technology enjoyed the session more than those who viewed it in 2D or monoscopic 3D AR.
|Rochlen et al. |
3rd and 4th year.
N = 40 students, faculty, and nurse anesthetists.
|To evaluate the usefulness of AR in the placement of a central venous catheter||Likert scale online questionnaire. Questions about previous experience in performing the technique, satisfaction with the use of AR and perception about the use of AR in medical procedures.||According to participants, AR technology is realistic, easy to use, fun, and promotes learning. They perceive that AR is useful in improving their skills and that it would be a useful adjunct to medical training.||High|
|Borges et al. |
|Nursing, Physiotherapy and Medicine |
N = 135 students
|To evaluate the adequacy of teaching materials based on AR games applied to the teaching of home visits||Questionnaire designed ad hoc.||AR-based educational games were highly rated by the participants.||Moderate|
|Henssen et al. |
N = 31 students
|To investigate differences in the test score, cognitive load and motivation between the experimental group (AR-based teaching methodology) and the control group (non-AR teaching methodology)||Pre- and post-experience questionnaires with questions on neuroanatomy in control and AR group. MRT. Instructional Materials Motivation Survey (IMMS).||No significant differences in knowledge test scores between both groups were found. There were no significant differences in terms of cognitive load between both groups, although the cognitive load of the group that used AR was lower. There were no significant differences in the different dimensions of the IMMS.||Moderate|
|Nørgård et al. |
Not indicated Anatomy
N = 110 students
|To examine the effectiveness of a teaching methodology with AR on short- and long-term learning compared to a methodology without AR.||Questionnaires before and after the experience with questions about Anatomy of the mediastinum. Adaptation of “Motivated Strategies Learning Questionnaire” (MSLQ).||There were no significant differences between the groups (control and experiemental -AR group) in terms of motivation and test scores. |
The mean self-efficacy was significantly higher for the group with AR teaching methodology.
|Khan et al. (2019) |
Not indicated Anatomy
N = 78 students
|To measure the impact of the AR mobile application on motivation for learning in Health Sciences students.||Modified IMMS. |
Online open-question survey designed ad hoc.
|The use of an AR mobile application increased students’ motivation.||High|
|Bork et al. (2019) Germany||Medicine |
N = 72 students
|To quantitatively compare a teaching methodology with AR and a teaching methodology without AR for the learning of Human Anatomy.||Initial knowledge questionnaire. |
Final knowledge questionnaire with questions other than the initial questionnaire MRT. Survey designed by experts in medical education on perception with the teaching methodology used.
|The group that used an AR teaching methodology (experimental group) obtained significantly better results. Results of the MRT were similar in both groups. |
The AR-based system is considered by students as a valuable addition to the study of Anatomy, increasing spatial understanding.
|Barmaki et al. |
N = 288 students
|To assess the degree of engagement and retention of knowledge of students in a collaborative learning intervention based on AR||Pre- and post- intervention knowledge questionnaire in control and AR group||The interactive AR system significantly improved retention of knowledge and increased the level of engagement||High|
|Cabero et al. |
N = 50 students
|To determine the degree of motivation and acceptance of AR in Medicine students and to evaluate the teaching materials.||IMMS for motivation analysis. |
The Technology Acceptance Model (TAM).
Likert scale questionnaire developed ad hoc to evaluate teaching materials.
|The interaction with the AR objects greatly increased motivation of the students. |
The students showed a high degree of acceptance of this technology. The teaching materials with AR were valued positively.
N = 880 students
|To find out if an educational intervention based on AR can be a valuable addition to the traditional methodology in the teaching-learning of Human Anatomy.||Anonymous and voluntary Likert-type scale questionnaire and open questions.||The educational intervention with AR obtained a positive evaluation of the students, increasing their motivation and considering it beneficial for learning.||High|
|Quqandi et al. |
Clinical training Not indicated
N = 4 students
|To assess how mobile AR enhances the self-regulation skills of Nursing students in a clinical training laboratory.||Questionnaire administered before and after the intervention.||The students were satisfied and declared that they enjoyed using mobile AR. Mobile AR increased their confidence and competence in learning basic clinical nursing skills.||Low|
|Hoang et al. |
|Physiotherapy Postgraduate Anatomy |
N = 9 students
|To know how an immersive technology such as AR can improve the teaching-learning of Physiotherapy.||Questionnaire before and after the intervention. Informal conversations.||AR applied to the teaching-learning of Physiotherapy was valued positively in the analyzed spheres, highlighting satisfaction, fun and understanding of the Anatomy.||Moderate|
|Moro et al. |
Not indicated Anatomy
N = 59 students
|To analyze if AR is as effective as the use of tablets in learning the Anatomy||Likert-style questionnaire after the intervention.||There were no significant differences between the two methodologies, but the AR-based methodology provided benefits such as a greater degree of immersion and student participation.||High|
|Ferrer-Torregrosa et al. |
|Medicine, Physiotherapy, Chiropody |
N = 171 students
|To assess if a teaching methodology based on AR provides a higher degree of learning than a teaching methodology based on videos and traditional notes when the student uses it through distance learning.||Questionnaire to collect the time dedicated to the experience. |
Assessment questionnaire on the knowledge acquired through autonomous learning.
Closed and validated questionnaire to measure metacognitive variables (attention and motivation, autonomous learning and three-dimensional understanding) in relation to the use of teaching materials and expectations related to learning in the use of AR.
|The group with AR teaching methodology devoted more study time to the educational intervention. |
AR helped students maintain attention and increased student motivation.
Regarding the autonomous learning dimension, the evaluations made by the students who used AR were statistically higher than those of the rest of the groups. They considered that AR improved 3D understanding and that it was an ideal complement to the study of Anatomy.
Regarding the expectations, a large majority considered that AR-based teaching methodology it is effective to study, that it increases motivation and interest and that their grades would improve if the teachers used it.
|Vaughn et al. |
N = 12 students
|To evaluate if RA increases the students’ perception of realism in a clinical training laboratory.||Online survey based on the “Simulation Design Scale” (SDS) and the “Self-Confidence in Learning Scale” (SCLS).||Most students strongly endorsed that AR improves realism in a clinical simulation, contributes to autonomous problem solving, is motivating, and beneficial for a simulation-based learning environment.||High|
|Küçüc et al. |
N = 70 students
|To determine the effect of mobile AR on students’ learning outcomes and cognitive load.||Pre and post academic performance test developed by experts. Cognitive Load Scale.||The experimental research group (Mobile AR) obtained a higher academic performance with a lower cognitive load.||High|
|Jamali et al. (2015) Australia||Medicine |
Not indicated Anatomy
N = 30 students
|To describe the process of developing a learning environment based on Mobile AR. |
To measure the changes in the knowledge, behavior and attitudes of the participants after using the mobile AR-based application.
|Knowledge test before and after the intervention in control and experimental research group (AR group). Likert scale questionnaire on the functionality of the mobile application.||Mobile AR increased understanding of content, motivation in the learning process and improved student learning performance.||High|
|Agudelo et al. |
|Speech Therapy |
General Processes of Speech Therapy
N = 61 students
|To describe the perception of students regarding the contribution of AR to the acquisition of skills defined in the curriculum of the course.||Perception survey prepared ad hoc consisting of three dimensions: contributions to training, collaborative learning and motivation with AR.||Good evaluations were obtained in all three dimensions. |
AR encourages the development of curricular competencies.
|Jorge et al. (2016) |
Chronic wound care
N = 54 students
|To assess if AR improves the development of clinical decision-making skills in relation to the diagnosis and treatment of chronic wounds.||Knowledge tests before and after the intervention consisting of solving practical cases.||AR significantly improved the results of the students in the phase of “diagnosis of chronic wounds”. In the “treatment” phase, no significant differences were found.||High|
|Authors (Year) |
|Application Used to Develop AR Content||AR Display Devices||AR Level 1|
|Jorge et al. |
|Autodesk 123D & ViewAR||Mobile devices||2|
|Jamali et al. |
|Unity®3D, Vuforia®, & Human Anatomy in Mobile Augmented Reality (HuMAR)||Mobile devices||2|
|Küçüc et al. |
|Axiom Neuro 1.0, Neuromatiq 1.0, Anatomy 4D & Aurasma||Mobile devices||2|
|Vaughn et al. |
|Moro et al. |
|Unity® & Vuforia®||Mobile devices||2|
|Hoang et al. |
|Unity® 3D & Augmented Anatomy||Smartglasses||3|
|Quqandi et al. |
|Unity®, Vuforia®||Mobile devices||2|
|Kugelmann et al. |
|Cabero et al. |
|Layar, Metaio Creator, Metaio SDK, Augment & Aurasma||Mobile devices||2|
|Barmaki et al. |
|CMake, Open Graphics Library & Microsoft Kinect Software Development.||Screen||2|
|Bork et al. |
|Khan et al. |
|Anatomy 4D||Mobile devices||2|
|Nørgård et al. |
|Henssen et al. |
|Unity® & Grey-Mapp.||Mobile devices||1|
|Borges et al. |
|Rochlen et al. |
|Unity® Game Engine & Vuforia®||Smartglasses||3|
|Bogomolova et al. |
|Ferrer Torregrosa et al. |
|Not indicated||Mobile devices||2|
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Rodríguez-Abad, C.; Fernández-de-la-Iglesia, J.-d.-C.; Martínez-Santos, A.-E.; Rodríguez-González, R. A Systematic Review of Augmented Reality in Health Sciences: A Guide to Decision-Making in Higher Education. Int. J. Environ. Res. Public Health 2021, 18, 4262. https://doi.org/10.3390/ijerph18084262
Rodríguez-Abad C, Fernández-de-la-Iglesia J-d-C, Martínez-Santos A-E, Rodríguez-González R. A Systematic Review of Augmented Reality in Health Sciences: A Guide to Decision-Making in Higher Education. International Journal of Environmental Research and Public Health. 2021; 18(8):4262. https://doi.org/10.3390/ijerph18084262Chicago/Turabian Style
Rodríguez-Abad, Carlos, Josefa-del-Carmen Fernández-de-la-Iglesia, Alba-Elena Martínez-Santos, and Raquel Rodríguez-González. 2021. "A Systematic Review of Augmented Reality in Health Sciences: A Guide to Decision-Making in Higher Education" International Journal of Environmental Research and Public Health 18, no. 8: 4262. https://doi.org/10.3390/ijerph18084262