A significant advantage of VR training is its ability to provide a safe and controlled setting that closely mirrors the real-world environment—a feat difficult to achieve in situ. In situ simulation-based training, is defined as simulated encounters in the exact setting where they are expected to occur, as opposed to dedicated simulation labs or centers (Goldshtein et al., 2020). The realism of a virtual environment hinges more on interaction fidelity than visual accuracy. A simple virtual space with basic graphics but realistic interactions can be more effective than a visually realistic one lacking interactivity. It is this preservation of the perception-action loop; how we navigate and interact within an environment; and how that navigation affords new opportunities for interaction hat significantly enhances functional fidelity (Craig, 2013). Realism allows skills trained in VR to transfer to real-life settings and studies have shown that skills trained in VR can be effectively applied in vivo (Dobrowolski et al., 2021; Gopher et al., 1994; Kanade & Duffy, 2024; Levac et al., 2019; Munz et al., 2007; Sibert et al., 2008).

Realism is enhanced by arranging fully immersive simulations where trainees feel more completely present in the virtual environment (Radhakrishnan et al., 2021; Schwarz et al., 2020). The concept of presence, or telepresence, can be enhanced by blending virtual elements with real-world components during training making the virtual experience feel more authentic (Bideau et al., 2010). For example, Bideau et al. designed a training environment in which goalkeepers stood in a real goal in front of a screen that displayed a virtual stadium and opposing player throwing a ball. The combined virtual and physical setting improved the ability to intercept a ball when facing different throwing actions and ball trajectories.

Another important element of the perception-action loop is perspective. VR empowers users to actively explore and discover new information from different angles unlike static media where perspectives are fixed (Craig, 2013). VR also offers unique perspectives unattainable through other training methods. For example, one project allowed users to experience age-related conditions from an elderly person’s viewpoint, enhancing medical students’ empathy and understanding of these health issues (Dyer et al., 2018). Similarly, police officers reported increased efficacy in de-escalation training when provided with multiple perspectives of a scenario including their own, a bird’s eye view, and the suspect’s (Kleygrewe et al., 2024).

VR also has the ability to emphasize features of the virtual environment or scenario to ensure that critical information is highlighted for the trainee (Levac et al., 2019). This is especially useful for teaching complex motor skills such as in rehabilitation, by highlighting errors, guiding appropriate responses with different stimuli (i.e. visual, haptic, auditory), and increasing or decreasing variation in responses as needed (for review see Levac et al., 2019).

VR is not limited to physical skills and can extend to social interactions as well virtual scenarios can provide controlled, reproducible social exposures, enabling therapists to vary contexts (e.g. shops, restaurants) without leaving their office. This not only ensures confidentiality but also maximizes learning transfer. Patients often find virtual exposure less intimidating than real-world encounters, enhancing its utility in clinical applications like exposure therapy (Bouchard et al., 2017).

VR technology in training also allows enhanced capabilities for measuring/monitoring important performance-related outcomes. One of the inherent challenges with complex skill acquisition is measuring the simultaneous biomechanical, physiological, and psychological responses that occur during training (Bideau et al., 2010).

VR allows for the integration of physiological metrics with performance data to offer a more comprehensive approach to skill development. For example, objective measures like galvanic skin response (GSR) and heart rate variability (HRV) as additional measures are important because of their relationship to stress and burnout—a significant concern impacting both patient care and organizational outcomes (Buckley et al., 2020; Jun et al., 2021). For instance, Chao et al. used GSR and HRV in a study with university students in Taiwan comparing VR training with traditional methods such as film-watching and manual-reading (Chao et al., 2017). They found that VR not only improved task performance but also reduced mental workload, particularly in complex tasks as evidenced by both subjective survey assessments and the objective physiological measures. Similarly, measures of physiological activity (i.e. EMG), mental workload, and task performance have been used in VR trainings for peri-care activities with nursing students (Stone et al., 2024). Moreover, techniques like eye-gaze tracking can help assess where individuals focus their attention during simulations—important data that has been gathered in medical crisis events in previous VR research (Anbro et al., 2020). This ability to measure situational awareness could be invaluable for WVP training.

Another significant advantage of VR compared to traditional training methods is standardization. Its capacity to consistently gather data across multiple sessions ensures that trainees can achieve mastery through uniform practice. For instance, VR surgical training programs provide unlimited practice opportunities, each followed by detailed statistical performance analyses (Li et al., 2017).

VR training also excels in offering immediate performance feedback. For example, studies have shown that VR training for tasks like street crossing safety can include features like session pausing and repetition, allowing multiple attempts with feedback to reinforce learning (Coban et al., 2022; Sacks et al., 2013; Thomson et al., 2005). Similar methods of pausing and repeating steps are currently used in healthcare simulation training methods, like Rapid Cycle Deliberate Practice (RCDP) for pediatric resuscitation skills (Hunt et al., 2014), and could be adapted to virtual delivery modes. VR provides the ability for nurses to refine their skills without resorting to trial-and-error methods during live patient interactions. This is especially important in high-stakes scenarios where errors can have serious consequences. For example, VR has recently been shown to significantly reduce errors in arterial blood gas (ABG) assessment compared to training as usual (Kennedy et al., 2023).

Repetition and other fluency building strategies are already being utilized in applications of VR training. For example, Clay et al. (2021) successfully used VR to train pre-service clinicians in delivering behavioral treatments under challenging conditions, such as dealing with aggressive behavior. Participants repeated scenarios until they achieved a mastery criterion of 90% or higher across all components of behavioral skills training (BST), including instruction, modeling, rehearsal, and feedback (Clay et al., 2021).

VR can also promote transfer of skills beyond the training context to real-world environments and novel situations. For example, basketball players who trained decision-making skills within a VR simulation translated those improvements in game-time performances more effectively than those who trained using only video playback (Pagé et al., 2019). In surgical skills training, intracorporeal knot-tying was trained using VR, and not only showed improvements in quality and efficiency but also transferred effectively to video-trainer exercise that are an accepted proxy for real surgical procedures (Kanade & Duffy, 2024; Munz et al., 2007).

Finally, VR allows for repeated practice without risk. For example, VR simulations could allow staff to safely practice managing various mental health crises repeatedly without direct contact with patients or trainers. VR has already been used to effectively train healthcare workers in client communication skills (Moser et al., 2024), the assessment of mental health disorders (Cieslowski et al., 2023) and delivering behavioral treatments to patients with aggressive behavior (Clay et al., 2021).

A key advantage of VR training is its portability and scalability. Portability allows for the use of VR devices in various locations, enhancing scalability by facilitating widespread adoption across an organization or industry. This means VR can be deployed across extensive networks and organizations. For instance, VR training for Walmart resulted in employees scoring higher on knowledge tests, demonstrating better knowledge retention, and providing higher satisfaction scores. Walmart expanded this success by distributing 18,000 Oculus Go headsets to its academies and expanding to over 30 active VR training modules (Gale, 2021).

One of the key advantages of virtual learning is its accessibility; trainees only need the relevant hardware, such as headsets or monitors, available on-site. This eliminates the costs associated with transporting trainers and trainees. Moreover, VR’s asynchronous delivery model allows training to occur on-demand without waiting for an instructor or group sessions—training can be tailored to individual needs and schedules. In fact, the flexibility of this delivery method has already been used to effectively facilitate Just-in-Time, Just-in-Place trainings for clinical assessments in emergency departments (Shah et al., 2023).

Another feature of VR that follows from its scalability is its cost-effectiveness. Technological advancements have made gyroscopes, motion sensors, high-definition screens, and processors more affordable and effective for training purposes (Institute of Medicine, 2013; Zendejas et al., 2013), driving down hardware costs while improving user experiences. Cost savings for hospitals are another significant outcome. Farra et al. (2019) conducted a cost-benefit analysis comparing virtual reality with live disaster exercises for neonatal intensive care unit evacuation training. While initial costs were higher for VR ($327.78 per participant) compared to live drills ($229.79 per participant), over three years of repeated trainings, VR became more economical ($115.43 per participant) due to scalable development costs versus fixed costs associated with live exercises (Farra et al., 2019). Simulation training exercises typically aim to replicate a hands-on environment outside the actual workplace. In medical education, role-playing with professional actors or using costly medical mannequins (sometimes exceeding $10,000) are common methods for teaching and assessing clinical competence. However, these approaches come with challenges such as actor availability, transportation logistics, and potential risks like confidentiality breaches and exposure to pathogens. For example, a comparison of VR to simulation-based training in nursing students across four modules (i.e. verbal aggression, deteriorating patient, cognitive impairment, and palliative care) found no difference in knowledge, motivation, or self-efficacy post clinical placement, but the VR cost $3,350 per semester as opposed to $18,670 for the simulation training (Kiegaldie & Shaw, 2023). Moreover, the VR training allowed for more than 95% of students to actively engage in the training, whereas only 15% were able to participate in the simulation while most only observed.

Research indicates that technology-assisted simulations can improve patient outcomes—including discomfort levels, survival rates, complication rates, and procedural success (Cook et al., 2011). Similarly, de-escalation trainings have shown reductions in physical and clinical restraints (Krull et al., 2019), suggesting that VR technology could further benefit patients by potentially decreasing the need for restraint and seclusion, reducing injuries, and enhancing customer service and quality of care.

As training demands grow, VR’s potential to scale up to meet these needs becomes increasingly significant, especially in light of the bottleneck of supervisory resources. Traditionally, junior doctors have learned technical skills in the operating room under the guidance of senior surgeons. However, with the rise in trainee numbers, opportunities for hands-on experience have dwindled due to higher costs, ethical concerns, and reduced resident work hours. These policies have led to a decline in independent surgical experience for trainees. Moreover, as surgical techniques become more advanced, mere observation is no longer sufficient for mastering certain skills. In this context, VR training has emerged as an indispensable tool for junior doctors, providing them with essential practice before participating in actual surgeries (Li et al., 2017).

VR technology is also efficient. For instance, in an industrial ozone generator isolation training that compared VR to traditional lecture training, there was no difference in knowledge gain or retention (Stefan et al., 2023). However, VR training required approximately half as long (Stefan et al., 2023). Similarly, a recent study compared nursing students trained in VR (4 h per week, for 4 wk) to traditional inpatient clinical practice (9–10 h per week, for 4 wk) on a pediatric asthma simulation scenario. There were no differences in focused assessment, medication administration and evaluation, but the VR group performed significantly better infection control, initial assessment, and oxygen therapy (Cieslowski et al., 2023).

As VR technology continues to advance there are important future considerations. For instance, as VR training becomes more immersive and realistic, ethical concerns may arise, such as the potential for desensitization to violence or the unintended reinforcement of biases (Rovira, 2016; Rovira et al., 2021). Furthermore, there is the risk of emotional traumatization as technology becomes more lifelike. Researchers must address these ethical challenges and develop guidelines for responsible use of VR training. Researchers, consumers, and creators of VR should consider the risks and follow ethical recommendations from experts (Madary & Metzinger, 2016; Spiegel, 2018). Specifically, consumer input into training should be considered for quality and trauma-informed care as one of the bases for effective intervention and de-escalation of aggressive situations (e.g. Hall et al., 2018). Additionally, there should be actions taken to decrease risk such as the potential for motion sickness (Madary & Metzinger, 2016).

WVP efforts also will benefit from cross-disciplinary collaboration among experts in VR technology, healthcare professionals, safety professionals, security experts, organizational leadership including quality assurance/performance management personnel, and other fields. These collaborative efforts can lead to the development of realistic training scenarios of different types of workplace violence in which various healthcare personnel can practice their specific roles and responsibilities, such as in active-threat drills that are now commonplace in healthcare settings (Brown et al., 2018; Feinstein, 2014; Feinstein & Yager, 2018).

Additionally, expanding the capabilities of remote and distributed VR training is important, especially in scenarios where physical presence is challenging or dangerous. This includes improving network infrastructure, reducing latency, and developing collaborative training platforms. Providing remote access to effective training technologies, including VR, is particularly important as rates of workplace violence have been seen to be higher in rural areas (Pompeii et al., 2016), and healthcare workers in rural settings may not have access to or be in close proximity to state-of-art simulation training centers found usually in large urban university-based healthcare centers. Furthermore, it may be useful to incorporate VR more widely in prelicensure nursing curricula (Moyer, 2023; Wilson & Hungerford, 2015). This could help to ensure that nursing students have experience with this technology and proficiency in the necessary skills as they move into a range of care settings and specialty areas throughout their careers, while supplementing the limited pool of educational and supervisory resources.

Lastly, incorporating dynamic social interactions into VR training environments is an important future direction to be explored. Multiplayer roles and social dynamics are particularly relevant in settings where teamwork is critical, such as in healthcare, emergency response, and military exercises. Rapid advances in artificial intelligence technology are likely to make this possible in the near future.