JMIR Publications

ABSTRACT

Background:

Surgical training has changed over the past decade. Augmented reality has become one of the more talked-about developments within that space. At its core, AR works by placing digital information over the real-world environment, giving trainees guidance and spatial cues during a procedure as they perform it. What remains uncertain is whether AR moves the needle on technical skill development in trainees. The studies that address this directly are few, and the ones that do exist rarely speak to each other in any meaningful way. Outcome measures shift from paper to paper, the hardware studied spans a wide range of maturity, and methodological consistency is hard to find.

Objective:

This systematic review assesses the impact of AR on the objective technical skills of surgical trainees when compared with traditional methods.

Methods:

We searched PubMed, MEDLINE, Embase, IEEE Xplore, Scopus, and Web of Science for studies published between January 1, 2020, and September 15, 2025. From 4,799 initial records, 1,417 remained after deduplication. Of these, 101 underwent detailed abstract review and 29 were assessed in full text. Eleven studies met the inclusion criteria. Two reviewers (MEA and YA) independently screened all records, with a third senior reviewer (TY) resolving disagreements. We performed a narrative synthesis following SWiM guidelines across five thematic domains to account for study heterogeneity. Scroll down and you will see Results and Conclusions fields too — let me know when you get to those and I'll give you the text for those sections as well.Sonnet 4.6

Results:

The final analysis included 11 studies (347 participants across seven specialties) published between 2021 and 2025. These included nine randomised controlled trials and two prospective cohort studies. The studies used platforms such as the Microsoft HoloLens (1 and 2), Magic Leap One, and Vuzix M300XL. Nine of the eleven studies reported improvements in one or more objective technical metrics. Key findings included consistent error reduction (5/5 studies), faster learning curves (4/11 studies), and lower cognitive workload (3/11 studies). Notably, an expertise reversal effect was observed, where AR provided substantial benefits to novices but diminishing returns for experienced surgeons.

Conclusions:

AR significantly improves technical performance for surgical novices, particularly in tasks involving complex visuospatial reasoning. AR is an effective adjunct in surgical education. Future research should focus on multicentre trials to evaluate long-term skill retention and cost-effectiveness in clinical practice. Clinical Trial: Not prospectively registered. An a priori protocol was developed and followed internally.