Effectiveness of augmented reality-assisted teaching in orthopedic clinical education:a meta-analysis_West China Medical Journal

Authors：

ZHU Yuhao ^1,2 , LI Ting ¹ , MA Peiting ¹ , WANG Wei ¹ , LU Zhangyu ^1,2 ,  LIU Yuan ¹ , SHEN Bin ¹

1. Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIU Yuan, Email: yihaoliuyuan@163.com

Keywords：

Augmented reality; orthopedics; clinical education; medical education; meta-analysis

DOI：

10.7507/1002-0179.202608003

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the effectiveness of augmented reality (AR)-assisted teaching in orthopedic clinical education. Methods PubMed, Embase, Scopus, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were searched by computer from database inception to July 2026 for randomized controlled trials (RCTs) of AR-assisted teaching in orthopedic clinical education. Meta-analysis was performed using RevMan 5.4. The Cochrane Risk of Bias 2 (RoB 2) tool and the GRADE approach were used to assess risk of bias and certainty of evidence, respectively. Results Five RCTs were included, involving 235 learners directly compared between the AR-assisted teaching group and the traditional teaching group. Meta-analysis showed that the AR-assisted teaching group had higher theoretical scores [standardized mean difference (SMD)=3.68, 95% confidence interval (CI) (0.58, 6.78), P=0.02], clinical reasoning ability [SMD=1.75, 95%CI (0.82, 2.68), P=0.000 2], learning interest [SMD=1.87, 95%CI (1.00, 2.75), P<0.000 1], knowledge mastery [SMD=1.64, 95%CI (0.70, 2.58), P=0.000 6], and overall teaching evaluation [SMD=3.05, 95%CI (0.88, 5.22), P=0.006] than the traditional teaching group. Heterogeneity was substantial across outcomes (I² values ranged from 76% to 98%). Sensitivity analyses showed that the directions of effect for clinical reasoning, learning interest, and knowledge mastery were relatively stable, whereas theoretical scores and overall teaching evaluation were more sensitive to individual studies. GRADE assessment indicated low or very low certainty of evidence for all outcomes. Conclusions Current low- or very-low-certainty evidence suggests that AR-assisted teaching may have beneficial effects on some short-term outcomes in orthopedic clinical education; however, the magnitude and generalizability of these effects remain uncertain. Given the limited number of studies, substantial heterogeneity, and low certainty of evidence, the current evidence is insufficient to support routine implementation of AR in orthopedic clinical education. Further large-scale, multicenter, well-designed RCTs with standardized teaching protocols and assessment criteria, objective skills assessment, and medium- to long-term follow-up are needed.

Citation： ZHU Yuhao, LI Ting, MA Peiting, WANG Wei, LU Zhangyu, LIU Yuan, SHEN Bin. Effectiveness of augmented reality-assisted teaching in orthopedic clinical education:a meta-analysis. West China Medical Journal, 2026, 41(9): 1505-1510. doi: 10.7507/1002-0179.202608003 Copy

1.	Tene T, Vique López DF, Valverde Aguirre PE, et al. Virtual reality and augmented reality in medical education: an umbrella review[J]. Front Digit Health, 2024, 6: 1365345.
2.	Barteit S, Lanfermann L, B?rnighausen T, et al. Augmented, mixed, and virtual reality-based head-mounted devices for medical education: systematic review[J]. JMIR Serious Games, 2021, 9(3): e29080.
3.	Dhar P, Rocks T, Samarasinghe RM, et al. Augmented reality in medical education: students’ experiences and learning outcomes[J]. Med Educ Online, 2021, 26(1): 1953953.
4.	El Ashry M, El Ashry A, Khalique H, et al. Augmented reality in surgical training: systematic review of its impact on technical performance in surgical trainees[J]. JMIR Med Educ, 2026, 12: e71572.
5.	Baashar Y, Alkawsi G, Ahmad WNW, et al. Effectiveness of using augmented reality for training in the medical professions: meta-analysis[J]. JMIR Serious Games, 2022, 10(3): e32715.
6.	Zhang R, Jin X, Liu M, et al. The effectiveness of augmented reality/mixed reality in medical education: a meta-analysis[J]. BMC Med Educ, 2025, 25(1): 1586.
7.	Li T, Yan J, Gao X, et al. Using virtual reality to enhance surgical skills and engagement in orthopedic education: systematic review and meta-analysis[J]. J Med Internet Res, 2025, 27: e70266.
8.	Su S, Wang R, Zhou R, et al. The effectiveness of virtual reality, augmented reality, and mixed reality training in total hip arthroplasty: a systematic review and meta-analysis[J]. J Orthop Surg Res, 2023, 18(1): 121.
9.	Molina VM, Medina RAB, Mora JSM, et al. Extended reality and emerging artificial intelligence in orthopedic surgical training: a scoping review of educational outcomes[J]. J Robot Surg, 2026, 20(1): 526.
10.	Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range[J]. Stat Methods Med Res, 2018, 27(6): 1785-1805.
11.	Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range[J]. BMC Med Res Methodol, 2014, 14: 135.
12.	Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials[J]. BMJ, 2019, 366: l4898.
13.	謝亮文, 陳青植, 葉佳亮, 等. 3D 打印與增強現實技術在髖臼骨折臨床教學中的應用研究[J]. 中國醫藥科學, 2025, 15(21): 174-178.
14.	Liu S, Yang J, Jin H, et al. Exploration of the application of augmented reality technology for teaching spinal tumor’s anatomy and surgical techniques[J]. Front Med (Lausanne), 2024, 11: 1403423.
15.	陳宣煌, 高小強, 林海濱, 等. 增強現實技術在住培醫師脊柱外科手術學教學中的效果[J]. 中國繼續醫學教育, 2022, 14(10): 87-91.
16.	唐茁棟, 李亭燕, 王應兵, 等. AR 技術在骨科臨床教學中的應用[J]. 中國繼續醫學教育, 2023, 15(12): 56-60.
17.	李威, 郭衛春, 夏可周, 等. 增強現實技術在研究生脊柱外科手術學教學中的應用效果[J]. 中華醫學教育雜志, 2020, 40(12): 988-991.
18.	Moro C, Birt J, Stromberga Z, et al. Virtual and augmented reality enhancements to medical and science student physiology and anatomy test performance: a systematic review and meta-analysis[J]. Anat Sci Educ, 2021, 14(3): 368-376.
19.	García-Robles P, Cortés-Pérez I, Nieto-Escámez FA, et al. Immersive virtual reality and augmented reality in anatomy education: a systematic review and meta-analysis[J]. Anat Sci Educ, 2024, 17(3): 514-528.
20.	Salimi S, Asgari Z, Mohammadnejad A, et al. Efficacy of virtual reality and augmented reality in anatomy education: a systematic review and meta-analysis[J]. Anat Sci Educ, 2024, 17(9): 1668-1685.
21.	Miguel-Alonso I, Checa D, Guillen-Sanz H, et al. Evaluation of the novelty effect in immersive virtual reality learning experiences[J]. Virtual Real, 2024, 28: 27.
22.	Savovi? J, Jones HE, Altman DG, et al. Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials[J]. Ann Intern Med, 2012, 157(6): 429-438.
23.	Miller GE. The assessment of clinical skills/competence/performance[J]. Acad Med, 1990, 65(9 Suppl): S63-S67.
24.	Norcini J, Anderson B, Bollela V, et al. Criteria for good assessment: consensus statement and recommendations from the Ottawa 2010 Conference[J]. Med Teach, 2011, 33(3): 206-214.

1. Tene T, Vique López DF, Valverde Aguirre PE, et al. Virtual reality and augmented reality in medical education: an umbrella review[J]. Front Digit Health, 2024, 6: 1365345.
2. Barteit S, Lanfermann L, B?rnighausen T, et al. Augmented, mixed, and virtual reality-based head-mounted devices for medical education: systematic review[J]. JMIR Serious Games, 2021, 9(3): e29080.
3. Dhar P, Rocks T, Samarasinghe RM, et al. Augmented reality in medical education: students’ experiences and learning outcomes[J]. Med Educ Online, 2021, 26(1): 1953953.
4. El Ashry M, El Ashry A, Khalique H, et al. Augmented reality in surgical training: systematic review of its impact on technical performance in surgical trainees[J]. JMIR Med Educ, 2026, 12: e71572.
5. Baashar Y, Alkawsi G, Ahmad WNW, et al. Effectiveness of using augmented reality for training in the medical professions: meta-analysis[J]. JMIR Serious Games, 2022, 10(3): e32715.
6. Zhang R, Jin X, Liu M, et al. The effectiveness of augmented reality/mixed reality in medical education: a meta-analysis[J]. BMC Med Educ, 2025, 25(1): 1586.
7. Li T, Yan J, Gao X, et al. Using virtual reality to enhance surgical skills and engagement in orthopedic education: systematic review and meta-analysis[J]. J Med Internet Res, 2025, 27: e70266.
8. Su S, Wang R, Zhou R, et al. The effectiveness of virtual reality, augmented reality, and mixed reality training in total hip arthroplasty: a systematic review and meta-analysis[J]. J Orthop Surg Res, 2023, 18(1): 121.
9. Molina VM, Medina RAB, Mora JSM, et al. Extended reality and emerging artificial intelligence in orthopedic surgical training: a scoping review of educational outcomes[J]. J Robot Surg, 2026, 20(1): 526.
10. Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range[J]. Stat Methods Med Res, 2018, 27(6): 1785-1805.
11. Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range[J]. BMC Med Res Methodol, 2014, 14: 135.
12. Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials[J]. BMJ, 2019, 366: l4898.
13. 謝亮文, 陳青植, 葉佳亮, 等. 3D 打印與增強現實技術在髖臼骨折臨床教學中的應用研究[J]. 中國醫藥科學, 2025, 15(21): 174-178.
14. Liu S, Yang J, Jin H, et al. Exploration of the application of augmented reality technology for teaching spinal tumor’s anatomy and surgical techniques[J]. Front Med (Lausanne), 2024, 11: 1403423.
15. 陳宣煌, 高小強, 林海濱, 等. 增強現實技術在住培醫師脊柱外科手術學教學中的效果[J]. 中國繼續醫學教育, 2022, 14(10): 87-91.
16. 唐茁棟, 李亭燕, 王應兵, 等. AR 技術在骨科臨床教學中的應用[J]. 中國繼續醫學教育, 2023, 15(12): 56-60.
17. 李威, 郭衛春, 夏可周, 等. 增強現實技術在研究生脊柱外科手術學教學中的應用效果[J]. 中華醫學教育雜志, 2020, 40(12): 988-991.
18. Moro C, Birt J, Stromberga Z, et al. Virtual and augmented reality enhancements to medical and science student physiology and anatomy test performance: a systematic review and meta-analysis[J]. Anat Sci Educ, 2021, 14(3): 368-376.
19. García-Robles P, Cortés-Pérez I, Nieto-Escámez FA, et al. Immersive virtual reality and augmented reality in anatomy education: a systematic review and meta-analysis[J]. Anat Sci Educ, 2024, 17(3): 514-528.
20. Salimi S, Asgari Z, Mohammadnejad A, et al. Efficacy of virtual reality and augmented reality in anatomy education: a systematic review and meta-analysis[J]. Anat Sci Educ, 2024, 17(9): 1668-1685.
21. Miguel-Alonso I, Checa D, Guillen-Sanz H, et al. Evaluation of the novelty effect in immersive virtual reality learning experiences[J]. Virtual Real, 2024, 28: 27.
22. Savovi? J, Jones HE, Altman DG, et al. Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials[J]. Ann Intern Med, 2012, 157(6): 429-438.
23. Miller GE. The assessment of clinical skills/competence/performance[J]. Acad Med, 1990, 65(9 Suppl): S63-S67.
24. Norcini J, Anderson B, Bollela V, et al. Criteria for good assessment: consensus statement and recommendations from the Ottawa 2010 Conference[J]. Med Teach, 2011, 33(3): 206-214.

West China Medical Journal

Effectiveness of augmented reality-assisted teaching in orthopedic clinical education:a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content