2021 - Kaplan Effects of VR

The Effects of Virtual Reality, Augmented Reality, and
Mixed Reality as Training Enhancement Methods: A

Meta-Analysis
Alexandra D. Kaplan‍ ‍, Jessica Cruit, University of Central Florida, Orlando, USA,
Mica Endsley‍ ‍, SA Technologies, Gold Canyon, AZ, USA, Suzanne M. Beers, MITRE
Corporation, Colorado Springs, CO, USA, Ben D. Sawyer, and P. A. Hancock‍ ‍,
University of Central Florida, Orlando, USA
Objective: The objective of this meta- analysis is Keywords: virtual environments, transfer of training,
to explore the presently available, empirical findings on immersive environments, meta-analysis
transfer of training from virtual (VR), augmented (AR),
and mixed reality (MR) and determine whether such ex-
tended reality (XR)-based training is as effective as tradi-
tional training methods. THE PROMISE OF AUGMENTED
Background: MR,VR, and AR have already been used REALITY, VIRTUAL REALITY, AND MIXED
as training tools in a variety of domains. However, the ques- REALITY FOR TRAINING
tion of whether or not these manipulations are effective
for training has not been quantitatively and conclusively an- Training is required in order for humans
swered. Evidence shows that, while extended realities can to develop necessary performance skills (see
often be time-saving and cost-saving training mechanisms, Holding, 1989). Learning protocols can be
their efficacy as training tools has been debated. both expensive and time consuming. Thus, any
Method: The current body of literature was exam- advancement in technology or methodology
ined and all qualifying articles pertaining to transfer of
that might reduce the cost, either in financial or
training from MR,VR, and AR were included in the meta-
analysis. Effect sizes were calculated to determine the
in temporal terms, will be of great relevance to
effects that XR-based factors, trainee-based factors, and many individuals, organizations, and industries.
task-based factors had on performance measures after For this reason, simulation-based training has
XR-based training. shown promise and is gaining acceptance as a
Results: Results showed that training in XR does not means to increase training efficiency (Hancock,
express a different outcome than training in a nonsimulat- 2009). Although simulation-based training can
ed, control environment. It is equally effective at enhanc- be delivered via portable tablets or conven-
ing performance.
tional flat panel displays, we are witnessing an
Conclusion: Across numerous studies in multiple
fields, extended realities are as effective of a training mech- increasing use of augmented reality (AR) and
anism as the commonly accepted methods. The value of virtual reality (VR) displays, and new mixed
XR then lies in providing training in circumstances, which reality (MR) displays, which include both AR
exclude traditional methods, such as situations when dan- and VR. VR technology generally uses a head-
ger or cost may make traditional training impossible. set, blocking out visual stimulus from the real
world. AR allows users to see the real world,
but overlays virtual elements. MR combines the
Address correspondence to Alexandra D. Kaplan, Department two, including aspects of both the real and vir-
of Psychology, University of Central Florida, 4111 Pictor Lane, tual world. Other definitions of the technology
Orlando, FL 32816, USA; e-mail: a dkaplan@knights.ucf.edu employed in those categories, as well as sources,
are listed in Appendix A. Extended reality (XR)
HUMAN FACTORS
is the umbrella term that refers to these three
Vol. 63, No. 4, June 2021, pp. 706–726
DOI:10.1177/0018720820904229
different types of simulations. These technolo-
Article reuse guidelines: sagepub.com/journals-permissions gies promise to reduce some of the costs asso-
Copyright © 2020, Human Factors and Ergonomics Society. ciated with expensive training, especially where
The Effects of VR for Training 707
spatial information is important, such as in the that when the learning environment is suffi-
field of aviation (Salas et al., 1998). XR training ciently different from the environment in which
can also eliminate some of the risks inherent to learning is subsequently measured, performance
high-level training by placing individuals in a tends to suffer (Tulving & Thomson, 1973). This
simulation rather than a real-world dangerous principle was further explored experimentally
situation. by Godden and Baddeley (1975), in which they
Training in XR promises to have benefits found that scuba divers who memorized lists
beyond simply supplementing traditional train- of words on dry land recalled those lists bet-
ing protocols. Whether it is a time-saving, cost- ter above, rather than below, the surface of the
saving measure or not, the benefits that exist ocean. This calls into question whether learning
may still outweigh potential drawbacks. Even can fully transfer from practice to performance
low-fidelity VR contains aspects of the physical when the performance occurs in a different
world that cannot be replicated in the traditional environment from training, such as is the case
classroom settings (Kozak et al., 1993). One when XR is used. In the Godden and Baddeley
can argue that a simulated battlefield has more (1975) example, what if rather than memorizing
in common with a real battlefield than does a words, an individual was learning how to safely
classroom. operate an underwater air tank? In such a sit-
The potential also exists that XR might be uation, training on land for subsequent perfor-
used to help people prepare for situations that mance underwater could prove disastrous if the
do not yet exist, or are not yet safe for humans, training did not transfer effectively. This same
and thus cannot be adequately prepared for in concern can be potentially extended to train-
situ, for example, prospective missions to Mars ing in XR. The situations in which simulation-
(Hancock, 2017). XR allows for training in based training has the most benefit (i.e., risky,
locations and for events where there are no safe expensive, and/or unsafe conditions) also have
and realistic parallels. Additionally, such sim- the highest cost of failure when training proves
ulations can be rapidly and efficiently updated inadequate.
as new information becomes available, unlike
other full-fidelity built environments, which are
much less malleable. Outcomes of Extended Reality and
However, training in XR does not solve all of Simulation-Based Training
the problems that plague current training meth- Simulation-based training has already proven
ods. While simulation may be the solution to advantageous for the military. It has been shown
some issues, it comes with its own set of caveats that pilots who first trained in simulators required
and concerns that have to be balanced against less in-flight training time before reaching an
those of more traditional methods. One such acceptable level of competence (Rantanen &
caveat is the rate of technological innovation, Talleur, 2005). Simulators, as surrogates for
which far exceeds the speed of designing, many of the expensive and limited resources or
implementing, and testing a training regimen dangerous situations encountered by the military,
(Hancock & Hoffman, 2015). Therefore, by the free up equipment (such as runways) that might
time a simulator’s efficacy as a training tool is be unavailable due to other operational demands
fully tested, it is already out of date. The vari- and allow the training of dangerous operations
ability between the technology in use makes it (such as flight and air traffic control) in a safe
difficult (if not impossible) to empirically repli- manner. Additionally, training in simulation
cate an earlier investigation of XR-based train- environments offers the possibility of immedi-
ing effectiveness. ate feedback (Haque & Srinivasan, 2006). Such
In light of these concerns and the numerous immediacy promotes faster and more accurate
benefits of XR-based training, it is important to training by letting the learner self-correct mis-
assess the applicability of the training (in XR) takes before the result of the error is propagated.
to execution of the task (in the real world). The Training in XR appears to hold similar prom-
principle of “encoding specificity” indicates ise as a solution for many of the problems that
708 June 2021 - Human Factors
currently make traditional training difficult and mechanism that might be considered. How,
ineffective. Of course, the question of whether then, can the efficacy of simulator-based (and
or not XR is a suitable medium for training is specifically XR-based) training be explored?
the subject of some debate. Applicability of XR To answer this question we conducted a meta-
as a training platform lacks some of the haptic analysis of the current empirical literature on
feedback that the real world offers. Additionally, the topic.
the variability in visual quality of different XR
products, lag and tracking problems, and the The Present Meta-Analysis
potential for simulator sickness are all sources VR has previously been examined in meta-
of limitation that may diminish training effi- analysis. However, XR is, in general, so broad
cacy. To that end, the success of XR- based a topic, and training so important an area, that
training must be evaluated empirically across not all aspects of training in XR have been
differing applied fields. To accomplish this is addressed in research, and let alone in meta-
not a straightforward task. Learner capacities analysis. One previous meta- analysis exam-
vary, and inherent individual differences have ined only the efficacy of surgical simulators
been shown to affect the transfer of training, (see Haque & Srinivasan, 2006), a vital but
whether from real or simulated sources (Blume small area. Fletcher et al. (2017) examined a
et al., 2010). Additionally, the modes of deliv- broader scope, analyzing the effectiveness of
ery of virtual training vary in fidelity and qual- VR in training. However, their selection criteria
ity. Both of these factors have significant effects were less stringent than for the meta-analysis
on later performance measures. we employ. Fletcher’s analysis allowed arti-
cles where psychological flow and enjoyment
The Transfer Effectiveness Ratio during virtual training represented an outcome
One of the most beneficial aspects of XR variable; additionally, articles were included in
assessment is that transfer of training from sim- their assessment where performance was mea-
ulation to the target environment can be directly sured during the time in the virtual environment
measured. The transfer effectiveness ratio (TER) or with the help of virtual aids. In the present
determines the value of time spent training in a meta-analysis we employed stringent selection
simulator by calculating the efficacy of the (vir- criteria in order to fill an important need for a
tual) training session (and see Roscoe, 1971). tightly controlled, methodologically sound, and
The equation is as follows: comprehensive meta-analysis. We only included
articles if performance measurement took place
‍ TER = Yc Yc
− Yx × 100
‍ after virtual training, but entirely in the non-
virtual world, to demonstrate training transfer.
where Yc indicates the amount of time or num- Our focus is narrower, but no less important;
ber of trials it takes to train an individual on a we look to determine the direct effect that train-
specific task, and Yx indicates the time it takes to ing using XR has on real-world performance.
train someone who has already trained on a sim- These findings will serve to inform the design
ulator, to complete that same task to the same and application of training regimens using XR.
level of competence. Thus, a TER value of 0.5
indicates that training on a simulator can reduce
METHOD
the in-person training time by one-half. Using
this formula, it is possible to specify numeri- Searching the Literature
cally the time saved by training using simula- A literature search was conducted in order
tion in general or a particular XR technology. to identify all published, peer-reviewed articles
However, not all training success factors can be on the topic of training transfer from XR-based
measured in terms of time saved. Further, not all training. Search terms consisted of a primary
domains have the resources or ability to exper- phrase describing forms of XR, combined
iment in order to specify the efficacy of each with a secondary group of phrases pertaining
particular set of simulation content and delivery to training. All possible combinations of the
TABLE 1: Tabulation and Combination of Search

variable measured something other than perfor-
Terms mance after training, such as level of enjoyment
or engagement. Additionally, the performance
Primary Term Secondary Term being measured had to take place in the real
world. Experimental results were rejected if the
Virtual reality Training
outcome variable was performance with the aid
VR Learning
of XR or performance in a simulation. Articles
Augmented reality Encoding specificity were required to include original empirical
Mixed reality data. If a dissertation included a sample, and
Simulation that same data were then later used in a referred
publication or conference proceedings paper,
the sample was only included once in the final
analysis. Determination of inclusion and subse-
search terms were used, and the terms are listed quent coding of the statistical data in the articles
in Table 1. were completed by two individuals.
The 15 search strings were each entered into a If a study examined the appropriate variables
series of search engines (ProQuest, EbscoHost, but did not include sufficient statistical infor-
and Google Scholar). All results were briefly mation to determine an effect size, the authors
examined to determine whether they met inclu- were contacted directly and asked to supply
sion criteria. The search took place in February such information. If the authors did not respond
2019 and included all articles published prior with or could not supply the needed statistics,
to that time. Additionally, prominent schol- the article was not included. While there were a
ars in the area of XR were contacted and variety of different forms of XR used for train-
asked whether they had any relevant research ing, all fell into one of the aforementioned three
approaching fruition, which might fit the crite- categories (AR, VR, or MR).
ria. Identified relevant articles (n = 130) were
then examined more closely and rejected (n =
105) or included (n = 24) in the meta-analysis. Variables
One article was identified that was published The outcome variable, in all included studies,
after the initial search and was included in the was some dimension of performance taken after
analysis (Whitmer et al., 2019). This process is training in XR had occurred. Predictor variables
illustrated in Figure 1. fell into three general categories related to (a)
the simulation, such as immersiveness, (b) the
Inclusion Criteria trainee, such as age, or (c) the task, such as task
Articles met inclusion criteria if at least one difficulty.
of the reported outcome variables measured
performance that took place after training in Immersiveness. Of the XR- related variables,
XR. Articles were also required to be published one often-explored concept involved compari-
in a peer-reviewed journal, the proceedings of sons across differing virtual environments. For
a conference, part of a dissertation or thesis, or example, VR using a headset was considered
a peer-reviewed technical report. Articles were more virtually immersive than desktop VR or
not included if the population was under 18, AR. Each of these differing levels of immersion
such as elementary school-age students. Articles may have been compared to an entirely nonsim-
were also rejected for inclusion if the reported ulated control condition (e.g., real-world train-
statistics did not provide sufficient information ing) or to a less immersive training tool, such as
so as to determine an effect size. Suitable sta- an interactive video or a simple instruction man-
tistics in this analysis were r, d, F, t, or means ual. Here, we call this variable “immersiveness,”
and standard deviations. Finally, it was required and use the word to refer to any comparison
that all articles involved training in MR, AR, or between environments where one is more virtu-
VR. Articles were not included if the outcome ally immersive than the other. Despite the
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram
(Moher et al., 2009).
differences in level of immersiveness of the Pre/post training. The variable “pre/post”

training environment, all studies included in includes any comparison between an individual
this analysis measured final performance in the or a group’s performance before XR- based
real world. training intervention, with performance after
that same intervention. This variable examines
VR vs. control. A subset of the studies where the post-training improvement (or lack thereof).
immersiveness was a factor compared training Regardless of whether or not performance
in a fully immersive VR setting to training in a improvement was the hypothesis of the original
nonvirtually immersive control. Such studies article, if performance was measured and suffi-
were included both in the overall effect size cient statistical information was supplied, then
analysis of immersiveness and in their own spe- the prescore was compared to the post-training
cific subanalysis.
score only for groups where the training was Data Analytic Strategy
virtual. Many of these articles examined both VR and
AR and most reported more than one pairwise
Task Type relationship between variables of interest. Thus,
The data were examined to determine the multiple effect sizes were taken from each.
direct effect on performance of each variable Some articles were included in the number of
described above. The data were also examined studies (k) for multiple predictor variables if
with task type as a moderator. The three types of that article reported enough data to determine
task categories were as follows. an effect size of two different variables (e.g., if
a study reported enough statistical information
to calculate an effect size for both immersive-
Cognitive tasks. Cognitive tasks included sit-
ness and task difficulty, then the two separate
uations in which participants learned informa-
effect sizes were calculated). For variables
tion that later had to be either remembered
where k = 1, only one article reported results
directly, such as in a test of recall, or utilized in
in a method suitable for inclusion in the meta-
a subsequent applied setting.
analysis. The calculated Cohen’s d is provided
here, but, as data only come from one source,
Physical tasks. Physical tasks involved some any confidence intervals surrounding d would
sort of bodily training, such as balance or aero- not be meaningful and thus were not included.
bic activities. The predominance here was on Such information is included to illustrate what
psychomotor skill assimilation. is covered by the current research. Individual
effect sizes are listed in Appendix B.
Mixed tasks. Some tasks included combina- A total of 176 effect sizes were included,
tions of both physical and cognitive require- which were each converted to Cohen’s d and
ments, such as a maintenance task that required weighted, based on the number of participants
participants to use learned physical skills while included. Effects between similar pairs within
simultaneously recalling applicable procedural the same study were combined. Therefore, even
information (see Marras & Hancock, 2014). if any one particular study had several effect
sizes measuring the same variable, results were
Included Articles aggregated in order that each study only had
one overall effect size for each specific pre-
Twenty-five articles met the above-stated dictor. If an article had two separate studies,
criteria and so were included in the analysis. using two different samples, then two effect
Twenty-three articles examined the XR-related sizes were calculated. This was done so that the
factor of immersiveness. The majority of these results from one sample would not dispropor-
included at least one pairwise comparison tionately influence the outcome and to maintain
between a VR training condition and a con- independence.
trol setting (k = 21). A number also examined Although all dependent variables repre-
AR compared to a control setting (k = 5). One sented a performance outcome, the scales used
examined training results after training in VR as to measure performance varied widely. In addi-
compared to AR (k = 1), and two studies looked tion, the concept of “performance” itself varied
at different levels of AR (k = 2). between articles. Therefore, it was not possible
Twelve studies were included in the pre/ to compare directly between studies. As a result
post comparison, one of which focused on we used a random-effects model when calculat-
AR and the rest on VR. Only one article that ing the meta-analytic results. For each study a
met our inclusion criteria examined predictor weighted value d was determined as the effect
variables other than XR (Bier et al., 2018). of the predictor variable on performance, in that
This work included the effects of both age particular study. These weighted effect sizes
and task difficulty on performance after train- were then used to determine the overall effect
ing in VR.
TABLE 2: Overall Effect Sizes of the Associated Variables
Number of Studies 95% Confidence Interval

Predictor (K) Cohen’s d Lower Limit Upper Limit
Immersiveness 23 −.07 −0.22 +0.07

VR compared to control 21 −.13 −0.27 +0.02
Pre/post training 12 .09 −1.05 +1.23
Age 1 −.08
Task difficulty 1 −.15
VR, virtual reality.
TABLE 3: Effect Sizes by Task Type
95% Confidence Interval

Task Type Number of Studies (K) Cohen’s d Lower Limit Upper Limit
Cognitive tasks 9 .01 −0.24 +0.27

Mixed tasks 12 −.07 −0.31 +0.17
Physical tasks 8 .36* +0.01 +0.70
* indicates significant effect beyond p < .05 level.
size and the associated 95% confidence inter- immersiveness, as well as the subset analysis
vals. SPSS was used to compute the effect sizes. of VR compared to control, showed no signif-
The effect sizes determined from this analy- icant difference between levels of performance
sis were not intended to determine whether XR post training, regardless of the virtual immer-
training was effective. Rather, results addressed siveness. While the negative effect sizes (d =
the question of whether it was different from the −.07 and d = −.13, respectively) indicate a slight
other methods of training to which it was being decrement in training effectiveness when a vir-
compared. If the effect size of immersiveness tual environment was used, the fact that the
is both significant and positive, it represents confidence interval included zero indicates that
improvement on traditional training. If the whether one trains in a virtual or a real setting,
effect is both significant and negative, then the the results are essentially equivalent. In essence,
opposite is true. If a zero effect size falls within these findings indicate that XR experiences are
the 95% confidence interval, it would indicate as effective as traditional training approaches.
here that all levels of immersiveness exert an Table 3 shows the effect size based on task
equivalent (or similar) effect on performance type. Results show that XR is a more suitable
outcome. medium for training on physical tasks (d = .36),
but otherwise the type of task learned in simula-
RESULTS tion does not have an effect on the performance
The effect sizes are reported in Table 2. The outcome.
table also indicates the number of separate The overall pattern of effect sizes is com-
studies investigating each respective predic- pared in Figure 2. Additionally, in Figure 2,
tor (k). Some articles included more than one potentially moderating influencers are divided
study. Weighted overall levels of d are included, by task type. While these “interaction” effects
as are 95% confidence intervals for each rela- are interesting, we have to caution against
tionship. Analysis of the associated variable of relying excessively on these results at present.
Figure 2. Forest plot of effect sizes by associated variable; 95% confidence intervals shown.
This is because, with the addition of each mod- two conditions present in each evaluation,
erating factor, the number of applicable studies they are mirror images of each other. Only
is smaller. Thus, there is less between-study their size and magnitude are meaningful; the
variation in the calculations for the smaller value of the average z itself has no real-world
number of studies. For forest plots showing meaning except in indicating the difference
the effects of individual studies by task type/ between scores of participants in each condi-
predictor clusters, see Figures 4 through 6 in tion. The fact that average z-scores were so
Appendix C. small in value serves to highlight the similar-
ity between conditions. The mean z-score for
Additional Analysis and Overlap Between the more immersive condition was lower than
Conditions the less immersive and control conditions, yet
Within each study, performance tended to the overlap between confidence intervals was
be quite similar between immersiveness con- large. These findings indicate that, though a
ditions. To that end, it was important to deter- more virtually immersive training condition
mine the similarity between the conditions results in slightly worse performance than a
beyond simply noting that for immersiveness real training setting, the majority of individuals
variables confidence intervals included zero. will show similar results after training, regard-
For this reason, scores were compared in order less of the level of virtual immersiveness.
to determine overlap. The data could not be
compared directly, as each study used differ- DISCUSSION
ent scales to measure performance. So, the The fact that the zero could not be excluded
mean performance of each training condition from the confidence intervals relating to any
within a study was converted to a z-score. The of the present overall predictors indicates an
average z-score for each condition, as well as apparent equivalency between XR training and
a 95% confidence interval, is shown below traditional instructional techniques employed
in Figure 3. As these z-scores came from the in situations such as a classroom. If we take
Figure 3. Immersiveness variables and confidence intervals by condition.
an optimistic perspective, these results con- after-the-fact. Though it is beyond the quantita-
firm that the use of VR, MR, and AR train- tive scope of this meta-analysis, the use of VR
ing procedures provides at least an equivalent in training has been shown to affect presence
performance result to that which is normally and immersion, as well as the psychological
experienced in traditional instruction methods. dimension of flow (see Lackey et al., 2016).
If this is the case, and performance outcomes All of these are important factors to consider
after XR training are not significantly different in training beyond evaluating performance out-
than outcomes after traditional training, then the come alone.
previously enumerated benefits of XR training In addition to the mean level of the effect
(such as safety, cost, and ease of implementing sizes noted in Figure 2, there proved to be
changes) make it, on the whole, a more valu- unusually large confidence intervals, particu-
able investment of time than traditional training larly concerning the pre/post variable. These
methods. After all, if the performance outcome ranges of variability mean that there were an
is essentially the same, the other benefits of XR approximately equal number of effects report-
training make it a superior option. ing strong transfer, as there were effects indicat-
However, it must be acknowledged that XR ing negative transfer. This range may be viewed
has often been held out to offer superior train- as disturbing. On the principle of “do no harm,”
ing capacities (especially in popular press and it is important to know that an imposed train-
by various vendors). The results of the present ing regimen will not actually cause the trained
meta- analysis indicate that the case for this individual to be less proficient than they would
proposition is at best “not proven.” Though have been with a traditional training approach.
one study did find that training in VR improved At present, because of the associated degree of
speed of a maintenance task, compared to a no- variability we cannot ensure that this is always
training control group (Ganier et al., 2014), the so. It may be that XR provides significant per-
comparison of interest is not between XR and formance benefits but equally we cannot rule out
no training, but XR and traditional training. that such a manipulation may inhibit learning in
Overall performance following XR-based train- some cases. Some studies found large positive
ing is neither better nor worse than performance effects of XR training, but a few did find nega-
following traditional training. tive effects (see Appendix C). The sources were
Of course, the benefit of training can be varied enough that it was not immediately clear
measured in more than just performance whether there were any commonalities between
those finding negative effects. To investigate Many studies examining physical tasks did
further would require a larger body of research show actual performance improvement after
from which to draw conclusions. The fact that XR training. Several of these studies included
XR-based training had the same level of success in the analysis involved special populations
as traditional training indicates that “encoding such as stroke victims, with the virtual train-
specificity” (see Godden & Baddeley, 1975) ing a method to improve their physical abili-
does not pose a problem for XR training. That ties and retrain them in lost skills. Studies on
is, the virtual environments employed in XR healthy populations have occasionally shown
are clearly similar enough to the real environ- that even procedural tasks such as way-finding
ment that transfer can occur effectively. It can can benefit more from virtual training than
therefore be accepted that any negative transfer from standard training (Goldiez et al., 2007).
or otherwise poor performance after XR-based Such findings may have been washed out by
training is not a result of XR itself being an the variability of the populations examined
unsuitable medium, but a result of some other in the included studies. The literature does
factors such as fidelity or individual differences. not yet support a more thorough examination
There are several possibilities as to why of task or population differential as a subpre-
this high degree of variability occurs. First, the dictor. However, these shortfalls can be recti-
actual training tasks represented in the summa- fied with future research. Table 4 shows each
tion here were highly heterogeneous. While each study by task type and population examined.
study examined a separate form of task, the two Here, a typical population refers to any popu-
main categories of tasks were physical (where lation where participants were not selected for
participants were required to practice or learn any specific expertise or illness, but in nearly
some spatial, procedural task) and cognitive every case was an undergraduate or university
(where participants acquired new information, sample.
but did not need to use it in a physical sense). In the analysis of cognitive tasks, one study
Yet, even within these categories, there proved involved adults with autism, and six involved
to be large variations. For example, cognitive samples from the general population (one of
tasks ranged from rote memorization of facts which having age restrictions; Bier et al., 2018).
about planets to conducting simulated medical The mixed tasks involved four populations from
dissections. Physical tasks involved balancing medical school, two groups of experienced
skills, as well as performing a maintenance task technicians, and five typical populations. In
similar to that which a factory worker might do the examination of physical tasks, three studies
on the job. involved typical populations, although one had
While overall XR training was more suc- an age restriction (Prasertsakul et al., 2018), and
cessful on physical tasks than cognitive tasks, four medical samples with specific ailments.
this finding was not consistent. One study The disparity in populations examined in each
included in the analysis of the physical tasks task type is thus fairly clear.
used XR in order to teach the recovery of One other caveat with respect to the find-
balance to stroke patients (Lee et al., 2015). ings of the present meta-analysis is the tech-
Results of this particular study found that a nology used in each study. While some of the
large number of participants performed worse identified studies included information about
in the follow-up assessment. Of course it is the specific model of VR or AR technology
possible that the stroke patients were deterio- used, not all did. Of the studies that did provide
rating in capacity over time, that is, a declining information, many utilized different levels of
baseline. On the other hand, a cognitive task the XR platform (e.g., interactive video games,
study where participants learned mathematics full-motion simulators). This differentiation
showed that scores were consistently higher might help explain some of the performance
after the VR training intervention (Bier et al., differences. While the examined variable of
2018). However, due to the variability in the immersiveness addressed some of the differ-
literature, this question needs further study. ences between the degrees of virtuality, no
TABLE 4: Task Types and Populations
Citation Task Type Population
Andersen et al. (2016) Mixed Otorhinolaryngology residents

Andersen et al. (2018) Mixed Otorhinolaryngology residents
Bailey et al. (2017) Mixed Normal
Bier et al. (2018) Cognitive 27 older and 30 younger adults
Buttussi and Chittaro (2018) Cognitive Normal
Chan et al. (2011) Physical Normal; dancers
Ganier et al. (2014) Mixed Normal
Gavish et al. (2015) Mixed Experienced technicians
Gerson and Van Dam (2003) Mixed Medical residents
Gonzalez-Franco et al. (2016) Mixed Normal
Hamblin (2005) Mixed Normal
Kober et al. (2013) Physical Population: spatial disorientation
Lee et al. (2015) Physical Stroke population
Ma et al. (2011) Physical Parkinson’s population
Macchiarella (2004) Cognitive Normal
Madden et al. (2018) Cognitive Normal
Martín-Gutiérrez et al. (2010) Mixed Normal
Prasertsakul et al. (2018) Physical Adults age 40–60
Rose et al. (2000) Physical Normal
Smith et al. (2014) Cognitive Autistic adults
Valimont et al. (2007) Cognitive Normal
Wang et al. (2014) Mixed Medical students
Webel et al. (2013) Mixed Experienced technicians
Whitmer et al. (2019) Cognitive Normal
Yang et al. (2008) Physical Stroke population
such distinctions can be made in the case of the learner. Nor was there enough information
difference in quality. Not all XR technologies to fully examine the subject of training trans-
are created equal, and to compare two stud- fer from XR, in sufficient depth so that reliable
ies using different XR systems may even be conclusions can be reached. Further, there were
inappropriate to some degree. Disparate tech- insufficient numbers of studies on AR to ana-
nology makes it difficult to determine direct lyze its affects as distinct from those of VR. The
effects of each training intervention with so “count of studies” columns in Tables 2 and 3
few studies being suitable for analysis (see reveal the surprising paucity of research in this
Hancock & Hoffman, 2015). vital area. This then is not simply a case of “more
Finally, it is important to reiterate that results research is needed,” but a case in which more
of the present meta- analysis, as are results diverse research is needed. This may well be an
from all such analyses, are constrained by the issue involved with the impetus and constituen-
limits and extent of the existing body of litera- cies to fund such research. Many organizations
ture. There were insufficient studies to examine “sell” training but frequently do not provide
many of the factors related to either the task or robust quantitative evidence of the value of that
training in their promotional literature. The goal population factors such as experience or com-
here is not to simply point out shortcomings in fort with XR technology.
the existing field of research, but to identify The second critical, but varying influence
those points where future research should be is the technology in use. At present there is a
conducted in order to best examine quantifiable wide range of VR headsets and simulated envi-
antecedents of training efficacy in XR. ronments used in studies. These are potentially
of very different quality, although quality was
rarely reported in the methods of each study.
LIMITATIONS AND CONCLUSIONS
“Fidelity” is a word which was used with some
Although the current literature is surpris- regularity, but in the absence of consideration
ingly sparse, posing some limitations for the of how the affordances of a virtual environment
present meta-analysis, our present results are or of a simulation used met the needs of those
not inconclusive. However, due to this pres- being trained. In this endeavor, a useful set of
ent paucity, certain analyses cannot be effec- dimensions have already been defined in Extent
tively performed. For example, it might be of World Knowledge, Reproduction Fidelity, and
useful and insightful to consider the ways in Extent of Presence Metaphor (see Milgram et al.,
which the variables associated specifically 1995). Researchers would do well to complete
with training per se are nested within those any simulation studies multiple times with differ-
particularly focused upon the state of the ent display technologies, especially when the dif-
technology in each of AR, VR, and XR. To ference in quality is already quantified (Hancock
date, insufficient information has been col- et al., 2015).
lected upon these combinations such that we The third area which requires more speci-
may be confident of the outcome. As with this fication is the task designation. It may be that
and other current shortfalls, we have high- training sessions were entirely different as
lighted important gaps in the literature that they were meant to train unique tasks. Indeed,
need to be addressed if this important field is the present body of evidence suggests that not
to move forward. For any meaningful effects all task types benefit equally and the physical/
to be determined from future comprehensive cognitive division may not be the most criti-
studies (meta or otherwise), the questions cal one. What makes tasks amenable to con-
raised in our present work must be addressed. sistently efficacious XR training is presently
One of the most pressing areas needing more not well understood. Indeed, all three of these
research is individual differences; soldiers factors, and any interactions between them,
are a very different population from elderly make it difficult to determine the effect of vir-
stroke victims. Studies are needed that enable tual training on later performance. What the
performance comparisons between popula- literature does support, currently, is the fact
tions by holding variables such as simulation that XR training has similar performance out-
platform, task, and performance measures comes to traditional training. In the absence
constant and studying performance by differ- of any significant differences between XR and
ent population groups. This is essential for traditional training, there is a bright future in
understanding which differences in results considering the many benefits that XR training
can be attributed directly to the effect of promises.
APPENDIX A: Definitions of AR, VR, and MR
Type of
Simulated
Reality Definition Source
Augmented Any system that has the following three characteristics: Azuma (1997)
reality 1. Combines real and virtual
2. Is interactive in real time
3. Is registered in three dimensions
All cases in which the display of an otherwise real environment is Milgram and
augmented by means of virtual (computer graphic) objects Kishino (1994)
Augmenting natural feedback to the operator with simulated cues Milgram et al.
(1995)
The enhancement of the real world by a virtual world, which subsequently Feiner et al.
provides additional information (1993)
AR displays are those in which the image is of a primarily real environment, Drascic and
which is enhanced, or augmented, with computer-generated imagery Milgram
(1996)
Virtual reality VR can be defined as a three-dimensional computer-generated environment, Boud et al.
updating in real time, and allowing human interaction through various (1999)
input/output devices
Strictly the term virtual reality describes something that is “real in effect Wilson (1997)
although not in fact” [virtual] and which “can be considered capable of
being considered fact for some purposes” [reality]. A virtual environment,
put simply, is an environment other than the one in which the participant is
actually present; more usefully it is a computer-generated model, where a
participant can interact intuitively in real time with the environment
A “virtual reality” is defined as a real or simulated environment in which a Steuer (1992)
perceiver experiences telepresence
Virtual reality is an alternate world filled with computer-generated images Greenbaum
that respond to human movements. These simulated environments (1992)
are usually visited with the aid of an expensive data suit which features
stereophonic video goggles and fiber-optic data gloves
It is a new emergent mode of reality in its own right, that comes together Yoh (2001)
with actual reality to construct an extended world of human experience
Virtual reality is a technology that convinces the participant that he or she Heim (1998)
is actually in another place by substituting the primary sensory input with
data produced by a computer
A computer-generated display that allows or compels the user (or users) to Schroeder
have a sense of being present in an environment other than the one they (1996)
are actually in, and to interact with that environment
Mixed reality Mixed reality refers to the class of all displays in which there is some Drascic and
combination of a real environment and virtual reality Milgram
(1996)
Mixed reality environment is one in which real-world and virtual world Milgram et al.
objects are presented together within a single display (1995)
APPENDIX B: Effect Sizes by Study
Effect
Source N Task Type Associated Variable Size
Andersen et al. (2018) 37 Mixed Immersiveness −0.54

Andersen et al. (2016) 20 Mixed Pre/post 0.54
Andersen et al. (2016) 20 Mixed Pre/post 0.07
Andersen et al. (2016) 20 Mixed Pre/Ppost 0.47
Bailey et al. (2017) 83 Mixed Immersiveness 0.27
Bailey et al. (2017) 83 Mixed Immersiveness 0.06
Bier et al. (2018) 27 Cognitive Task difficulty −0.92
Bier et al. (2018) 27 Cognitive Task difficulty 0.28
Bier et al. (2018) 57 Cognitive Age 3.83
Bier et al. (2018) 57 Cognitive Age 0.61
Bier et al. (2018) 57 Cognitive Age −0.08
Bier et al. (2018) 14 Cognitive Pre/post 0.98
Bier et al. (2018) 15 Cognitive Pre/Post −0.51
Bier et al. (2018) 15 Cognitive Pre/post −0.54
(continued)
Effect
Buttussi and Chittaro (2018) 96 Cognitive Immersiveness 0.12
Buttussi and Chittaro (2018) 96 Cognitive Immersiveness 1.00
Buttussi and Chittaro (2018) 96 Cognitive Immersiveness −0.88
Buttussi and Chittaro (2018) 96 Cognitive Pre/post 6.26
Buttussi and Chittaro (2018) 96 Cognitive Pre/post 5.62
Buttussi and Chittaro (2018) 96 Cognitive Pre/Post 6.50
Chan et al. (2011) 8 Physical Immersiveness 1.65
Chan et al. (2011) 4 Physical Pre/post −2.07
Ganier et al. (2014) 42 Mixed Immersiveness 1.17
Ganier et al. (2014) 42 Mixed Immersiveness −1.14
Gavish et al. (2015) 20 Mixed Immersiveness 0.28
Gavish et al. (2015) 20 Mixed Immersiveness −0.21
Gerson and Van Dam (2003) 16 Mixed Immersiveness −1.12
Gonzalez-Franco et al. (2016) 24 Mixed Immersiveness −0.12
Gonzalez-Franco et al. (2016) 24 Mixed Immersiveness −0.58
Hamblin (2005) 18 Mixed Immersiveness 0.06
Hamblin (2005) 18 Mixed Immersiveness −1.67
Martín-Gutiérrez et al. (2010) 49 Mixed Immersiveness 0.63
Martín-Gutiérrez et al. (2010) 49 Mixed Immersiveness 0.51
Martín-Gutiérrez et al. (2010) 25 Mixed Pre/post 1.02
Martín-Gutiérrez et al. (2010) 25 Mixed Pre/post 1.27
Kober et al. (2013) 11 Physical Pre/post 0.21
Kober et al. (2013) 11 Physical Pre/post 2.92
Lee et al. (2015) 24 Physical Immersiveness 0.07
(continued)
Effect
Lee et al. (2015) 12 Physical Pre/post −0.38
Lee et al. (2015) 12 Physical Pre/pst −0.51
Lee et al. (2015) 12 Physical Pre/post 1.41
Ma et al. (2011) 33 Physical Immersiveness −0.73
Ma et al. (2011) 33 Physical Immersiveness 0.45
Ma et al. (2011) 33 Physical Pre/post −0.71
Ma et al. (2011) 33 Physical Pre/post 0.61
Ma et al. (2011) 33 Physical Pre/ppost 0.38
(continued)
Effect
Macchiarella (2004) 96 Cognitive Immersiveness −0.05
Madden et al. (2018) 172 Cognitive Immersiveness 0.11
Madden et al. (2018) 172 Cognitive Immersiveness 0.24
Madden et al. (2018) 56 Cognitive Pre/post 1.48
Prasertsakul et al. (2018) 8 Physical Immersiveness 0.61
Prasertsakul et al. (2018) 8 Physical Immersiveness −0.01
Prasertsakul et al. (2018) 4 Physical Pre/post 0.11
Prasertsakul et al. (2018) 4 Physical Pre/post −0.57
Prasertsakul et al. (2018) 4 Physical Pre/Post −0.15
Rose et al. (2000) 100 Physical Immersiveness 0.17
Smith et al. (2014) 26 Cognitive Immersiveness 0.72
Smith et al. (2014) 16 Cognitive Pre/post 0.56
Valimont et al. (2007) 32 Cognitive Immersiveness 0.45
(continued)
Effect
Wang et al. (2014) 16 Mixed Immersiveness 0.35
Wang et al. (2014) 16 Mixed Immersiveness −1.51
Webel et al. (2013) 20 Mixed Immersiveness −1.51
Whitmer et al. (2019) 41 Cognitive Immersiveness −0.89
Yang et al. (2008) 20 Physical Immersiveness 1.08
Yang et al. (2008) 20 Physical Immersiveness −0.99
Yang et al. (2008) 20 Physical Immersiveness −0.89
APPENDIX C: Forest plot of individual studies by task type/predictor clusters
Figure 4. Studies involving cognitive tasks.

Figure 5. Studies involving mixed tasks.
Figure 6. Studies involving physical tasks.

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augmented reality. Communications of the ACM, 36, 53–62.
●● Performance after training in VR/AR is generally Fletcher, JD., Belanich, J., Moses, F., Fehr, A., & Moss, J. (2017).
Effectiveness of augmented reality & augmented virtuality
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Ergonomics, 57, 828–843.
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Godden, D. R., & Baddeley, A. D. (1975). Context-dependent
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ORCID iD British Journal of Psychology, 66, 325–331.
Goldiez, B. F., Ahmad, A. M., & Hancock, P. A. (2007). Effects
of augmented reality display settings on human wayfinding
Alexandra D. Kaplan ‍ ‍ https://orcid.org/000 performance. IEEE Transactions on Systems, Man and
0-0003-0051-0150 Cybernetics, Part C, 37, 839–845.
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The Effects of Virtual Reality, Augmented Reality, and

Mixed Reality as Training Enhancement Methods: A

TABLE 1: Tabulation and Combination of Search

differences in level of immersiveness of the Pre/post training. The variable “pre/post”

TABLE 2: Overall Effect Sizes of the Associated Variables

Number of Studies 95% Confidence Interval

Immersiveness 23 −.07 −0.22 +0.07

VR, virtual reality.

TABLE 3: Effect Sizes by Task Type

95% Confidence Interval

Cognitive tasks 9 .01 −0.24 +0.27

* indicates significant effect beyond p < .05 level.

Figure 3. Immersiveness variables and confidence intervals by condition.

TABLE 4: Task Types and Populations

Citation Task Type Population

Andersen et al. (2016) Mixed Otorhinolaryngology residents

APPENDIX A: Definitions of AR, VR, and MR

APPENDIX B: Effect Sizes by Study

Andersen et al. (2018) 37 Mixed Immersiveness −0.54

APPENDIX C: Forest plot of individual studies by task type/predictor clusters

Figure 4. Studies involving cognitive tasks.

Figure 5. Studies involving mixed tasks.

Figure 6. Studies involving physical tasks.

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