J. Comput. Educ.

https://doi.org/10.1007/s40692-020-00169-2

Immersive virtual reality as a pedagogical tool

in education: a systematic literature review
of quantitative learning outcomes and experimental
design

D. Hamilton1   · J. McKechnie1 · E. Edgerton1   · C. Wilson1 

Received: 21 October 2019 / Revised: 16 June 2020 / Accepted: 2 July 2020

© The Author(s) 2020

Abstract  The adoption of immersive virtual reality (I-VR) as a pedagogical

method in education has challenged the conceptual definition of what constitutes
a learning environment. High fidelity graphics and immersive content using head-
mounted-displays (HMD) have allowed students to explore complex subjects in a
way that traditional teaching methods cannot. Despite this, research focusing on
learning outcomes, intervention characteristics, and assessment measures associ-
ated with I-VR use has been sparse. To explore this, the current systematic review
examined experimental studies published since 2013, where quantitative learning
outcomes using HMD based I-VR were compared with less immersive pedagogi-
cal methods such as desktop computers and slideshows. A literature search yielded
29 publications that were deemed suitable for inclusion. Included papers were
quality assessed using the Medical Education Research Study Quality Instrument
(MERSQI). Most studies found a significant advantage of utilising I-VR in educa-
tion, whilst a smaller number found no significant differences in attainment level
regardless of whether I-VR or non-immersive methods were utilised. Only two stud-
ies found clear detrimental effects of using I-VR. However, most studies used short
interventions, did not examine information retention, and were focused mainly on
the teaching of scientific topics such as biology or physics. In addition, the MERSQI

* D. Hamilton
david.hamilton@uws.ac.uk
J. McKechnie
jim.mckechnie@uws.ac.uk
E. Edgerton
edward.edgerton@uws.ac.uk
C. Wilson
claire.wilson@uws.ac.uk
1
Division of Psychology, School of Education & Social Sciences, University of the West
of Scotland, Paisley, UK

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 J. Comput. Educ.

showed that the methods used to evaluate learning outcomes are often inadequate
and this may affect the interpretation of I-VR’s utility. The review highlights that a
rigorous methodological approach through the identification of appropriate assess-
ment measures, intervention characteristics, and learning outcomes is essential to
understanding the potential of I-VR as a pedagogical method.

Keywords  Virtual reality · Head mounted displays · Education · Learning ·

Simulations

Introduction

The increasing financial feasibility of virtual reality (VR) has allowed for educational
institutions to incorporate the technology into their teaching. According to research,
96% of universities and 79% of colleges in the UK are now utilising augmented or
virtual reality in some capacity (UKAuthority 2019). In addition, the rising power
of personal computers and associated hardware has led to a revolution in graphical
fidelity, with ever more complex and realistic simulations and virtual worlds (Slater
2018). As Dickey (2005) alludes to, this has both challenged and expanded the very
conceptual definition of what is defined as a learning environment. Where once this
would have been restricted to classroom teaching or field trips, VR’s innate ability to
give users a sense of presence and immersion has opened new possibilities in educa-
tion if implemented appropriately (Häfner et al. 2018).
The use of technology-aided education as a pedagogical method is not a modern
phenomenon, and investigations into its utility have been studied for almost half a cen-
tury. As far back as the 1970s, Ellinger and Frankland (1976) found that the use of
early computers to teach economic principles produced comparative learning outcomes
with traditional didactic methods such as lectures. However, as Jensen and Konradsen
(2018) allude to, it was with the release of the Oculus Rift in 2013 that VR became
synonymous with head-mounted-display (HMD) based VR. This had several ramifica-
tions. First, HMDs became economically feasible for consumers and educational insti-
tutions to acquire en masse, due to a significant drop in price (Hodgson et al. 2015).
As Olmos et al. (2018) remarks, the economic viability of VR has tackled one of the
main entry barriers to adopting the technology. And secondly, academic research into
the potential benefits of I-VR in education starts to expand, as well as its applied use
in pedagogical settings (Hodgson et al. 2019). One of VR’s most important contribu-
tions to education is that it has allowed students to repeatedly practice complex and
demanding tasks in a safe environment. This is particularly true of procedural tasks
such as surgical operations or dental procedures that cannot be carried out for real until
a certain level of competency has been achieved (Alaraj et al. 2011; Larsen et al. 2012).
Additionally, VR has allowed for students to gain cognitive skills by way of experi-
ential learning, such as exposing them to environments that would be too logistically
problematic to visit in reality (Çalişkan 2011). For instance, by using a HMD, Bailen-
son et al. (2018) were able to expose students to an underwater environment to facilitate
learning about climate change. VR has made an important contribution to education in

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J. Comput. Educ.

that it has allowed for students to directly experience environments or situations that are
difficult to replicate by using traditional teaching methods such as lectures, slideshows,
or 2D videos.
A concise definition of VR’s key characteristics is challenging due to the ever-
changing nature of the technology. However, Sherman and Craig (2003) proposed
that there are a number of constituent elements that must underpin the VR experience,
ultimately leading to the life-like perception of the virtual environment. These include
the necessity for VR to be immersive, in that the participant’s own cognitive faculties
produce a sense of being present and involved in the virtual space, often with reduced
awareness of what is happening in the real-world around them. Additionally, the virtual
space should offer a degree of interactivity, in that the user can manipulate the environ-
ment and test variables. This can include interacting with objects, virtual avatars, or
even collaborating with other real-life users within the computer-generated space.

Definition of key terms

Due to the multidisciplinary nature of VR research and its pedagogical applications, it

is important to define key terms used. VR can broadly be broken down into two main
categories: desktop VR (D-VR), and immersive-VR (I-VR). D-VR is typically classi-
fied as non-immersive, in that a headset is not used, and the participant will be control-
ling and manipulating the virtual environment on a computer screen with traditional
keyboard and mouse hardware (Lee et al. 2010). On the other hand, I-VR is typically
multi-modal in nature by providing a sense of immersion in the environment through
360° visuals by aid of a HMD, auditory stimulation through the use of earphones, and
increasingly the proprioception of limbs by way of controllers and tracking (Freina and
Ott 2015; Howard-Jones et al. 2015; Murcia-López and Steed 2016). Although there
are a range of HMDs on the market, from high-end hardware like the HTC Vive, to via-
ble low-cost options like the Google Cardboard, they all utilise the same core principals
of operation (Brown and Green 2016). Typically, a HMD will feature a set of embed-
ded liquid crystal displays (LCD) which will present each eye an image from a slightly
different angle. This mimics natural optic function by allowing the wearer to view a ste-
reoscopic image complete with depth perception and a wide field of view. Mobile VR
headsets can achieve the same effect using a single display by dividing the screen down
the middle and presenting each half to the corresponding eye. Therefore, the current
review defines a HMD as a device worn over the head, which provides a stereoscopic
computer-generated or 360° video image to the user. This includes tethered (connected
to a computer), stand-alone (no computer needed), or mobile VR headsets (mobile/cell
phone connected to a HMD).

Previous literature and reviews

There have been a number of systematic reviews that have previously explored the
relationship between VR and pedagogical attainment. Lee (1999) reviewed 19 stud-
ies from as far back as 1976 and found that 66% of students in simulation groups
outperformed those in their respective control groups. However, this review did not

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 J. Comput. Educ.

focus exclusively on an educational level or age range, so featured both young kin-
dergarten children, as well as higher education students. As a result, the generalis-
ability of VR’s effectiveness as a pedagogical method is difficult to ascertain, with
significant differences in age, task difficulty, and applications. Furthermore, all the
studies are dated in terms of the technology utilised and feature early D-VR pro-
grammes and rudimental computer simulations. This early technology may be prim-
itive when compared with the high-fidelity graphics and immersive components of
contemporary technology. Nevertheless, these early studies do help exemplify that
the use of technology in education is not a new concept, and computer-based simu-
lations have long been employed as a way of facilitating learning.
A more recent analysis was undertaken by Merchant et al. (2014), and looked at
three specific sub-categories of VR: games, simulations, and virtual worlds. Games
give the actor autonomy and freedom to move around the virtual world, testing
hypotheses, achieving goals, and eliciting motivation and learning through immer-
sion (Gee 2004). Simulations attempt to recreate a real-world environment that can
help facilitate learning by allowing for the testing of variables and resulting out-
comes. Finally, virtual worlds can provide an immersive or non-immersive sense
of presence in a three-dimensional (3D) world, and the ability to manipulate, inter-
act, or construct objects. Furthermore, virtual worlds can give the opportunity for
multiple users to interact with one another within the digital environment (Dickey
2005). The meta-analysis showed that although game-based VR produced the high-
est learning outcomes, simulations and virtual worlds were also effective at increas-
ing educational attainment. Once again, the limitation of this review is that it did not
restrict its analysis to exclusively one domain of education. Although higher educa-
tion made up the greatest number of studies, research from elementary and middle
school were also included in the analysis.
One of the most recent systematic reviews to look exclusively at I-VR through
the utilisation of HMDs was carried out by Jensen and Konradsen (2018). In their
comprehensive search of existing literature published between 2013 and 2017, the
review identified 21 quantitative and qualitative papers that focused on both learn-
ing outcomes in I-VR, and subjective attitudes and experiences on the part of the
user. The review found limited effectiveness of HMD in the acquisition of cognitive,
psychomotor, and affective skills when compared with less immersive technologies.
However, Jensen and Konradsen (2018) did highlight the relatively low quality of
studies included as a concern, and this may impede the ability to draw firm conclu-
sions about the educational utility of I-VR.

Rationale for review

There are several fundamental reasons that necessitate an updated assessment of the
topic area, such as the increase in relevant published literature, as well as the nar-
row scope of previous reviews. The last major review looking at I-VR and HMDs
as an educational tool was carried out by Jensen and Konradsen (2018), with the
most recent studies featured in that paper being published in 2016. Since then, there
has been a significant increase in relevant published literature, with > 70% of the

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J. Comput. Educ.

papers included in the current review being published since 2017, and therefore not
included in the previous systematic review. Additionally, unlike previous reviews,
the current examination of I-VR’s pedagogical utility focuses exclusively on studies
where I-VR is directly compared to a less immersive method of learning. As a result,
the current paper is able to highlight not only whether I-VR is an effective medium,
but also whether it is more effective when compared to alternative methods. Addi-
tionally, no other systematic review looking at I-VR and HMDs has had a particular
focus on the experimental design, assessment measures, and intervention character-
istics of the included studies. The review also addresses the underlying methodology
of the included studies, to offer an understanding of how I-VR is being employed in
experimental literature. Based upon the findings of previous studies as well as areas
yet to be sufficiently explored, this paper has a number of core research questions:

• To assess the subject area, discipline, and learning domain that I-VR has been
employed in.
• Understand where I-VR confers an educational benefit in terms of quantitative
learning outcomes over non-immersive and traditional teaching methods.
• To examine the experimental design of studies, focusing on how learning out-
comes are assessed, and how the I-VR intervention is delivered.
• To inform future experimental and applied practice in the field of pedagogical
I-VR application.

Methodology

Search strategy

The current systematic review included peer-reviewed journal articles and confer-
ence proceedings that passed all the inclusion criteria detailed. An initial scoping
review identified seven databases that could be utilised in a comprehensive litera-
ture review, as well as associated keywords and search terms. These included Web
of Science (Core Collection), Science Direct, Sage, IEEE Xplore, EBSCO, Taylor
& Francis, and Google Scholar. These databases encompass a mixture of general,
social science, and technological literature.
Each of the seven databases was searched using a series of keywords based on the
following Boolean logic string:
("Virtual Reality" OR "Virtual-Reality" OR “Immersive Virtual Reality” OR
“Head Mounted Display” OR “Immersive Simulation”) AND (Education OR
Training OR Learning OR Teaching)
Due to the scope and parameters of the research objectives, only peer-reviewed lit-
erature published between January 2013 and December 2018 was included in the
final review. Early access articles due to be published in 2019 were also included
if these were found using the database searches. Date criteria was based upon an
initial scoping review that found a substantial growth in relevant I-VR literature
from 2013 onwards. A major contributing factor was the release of the Oculus Rift

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 J. Comput. Educ.

Development Kit 1 (DK-1) in early 2013, which is regarded as one of the first eco-
nomically viable and high quality HMDs that could be used both within educational
institutions, and at home (Lyne 2013).
The literature search across the databases yielded more than 12,000 references
from a variety of sources. After the removal of duplicate records, 9,359 unique refer-
ences were included for the title and abstract screening stage of the review.

Selection and screening

The open and general nature of the search string used led to a large number of refer-
ences being returned for screening. As Jensen and Konradsen (2018) already alluded
to in the last major review, VR research transcends various academic disciplines.
The result is a lack of a clear taxonomy of definitions and terms. This means a wide
net must be cast to ensure comprehensive capture of relevant material. This review
defined I-VR as either a completely computer-generated environment, or the view-
ing of captured 360° video through the use of a HMD. Studies that utilised sur-
gical or dental simulators and trainers such as the da Vinci Surgical System, were
excluded as these represent a separate domain of both technological and pedagogi-
cal application. For example, surgical simulation based VR typically combines com-
puter-generated visuals with simulated surgical tools, haptic feedback, and robotic
components (Li et al. 2017). This type of technology would therefore not be appli-
cable for general pedagogical application. Additionally, references were excluded if
they: (1) focused on using I-VR as a rehabilitation or therapeutic tool; (2) were not
in English; or (3) where the full-text was not available.
After title and abstract screening was performed, 197 references remained to be
included in the full-text review. Each reference had to pass an inclusion flowchart
based on each of the following criteria:

1. The population being sampled was from a high school, further or higher education
establishment, or was an adult education student.
2. Population sampled did not have a developmental or neurological condition, nor
could VR be used as a rehabilitation tool.
3. Paper described an experimental or quasi-experimental trial with at least one
control group.
4. At least one group had to have undergone an educational HMD I-VR experience,
and was compared with another group who underwent a non-immersive or tradi-
tional pedagogical method of education (e.g. Desktop VR, PowerPoint, traditional
lecture).
5. A quantitative and objective learning outcome such as tests scores, completion
time, or knowledge retention was used to assess effectiveness.

After full-text screening, 29 references passed all stages and were included in the
systematic review. See Fig. 1 for a summary of the selection process by stage.
Inter-rater reliability checks were conducted at the title and abstract screen-
ing stage to assess the agreement of included studies. There were four individual

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J. Comput. Educ.

evaluators that assessed the suitability of each reference based upon the inclusion
criteria, which yielded an average agreement of 96%. Where any disagreement
existed, the paper was discussed among all assessors until a unanimous decision
was reached as to its suitability.

Quality assessment tool

To assess the quality of the studies, the Medical Education Research Study Qual-
ity Instrument (MERSQI) was used (Reed et  al. 2007). Although this tool was
primarily designed to examine the quality of studies in the field of medical edu-
cation, it is in practice subject neutral. As the MERSQI assesses not only the
quality of experimental design and outcomes measures, but also the assessment
instrumentation used, it was viewed as a suitable and comprehensive tool for
quality appraisal. In addition, the same instrument was used in a previously peer-
reviewed systematic review examining VR, by Jensen and Konradsen (2018).
The MERSQI tool covers six quality assessment domains. These include: study
design, sampling, type of data, validity of evaluation instrument, data analysis,
and outcomes. Each domain is scored out of three, with a maximum overall score
of 18. Unlike Jensen and Konradsen (2018), the current review gave full points in
the study design category for experimental trials with participant randomisation,
as well as appropriate pre-intervention measures. This decision was made as true
randomised control trials featuring random sampling is unrealistic in I-VR peda-
gogical research, as the participant sample can only be drawn from an educational
establishment.

Papers identiied Papers remaining

Papers remaing after
through initial after duplicate records
title and abstract
database search: N = were removed: N =
screening: N = 197
12,055 9,362

Total number of
papers remaining
after full-text
screening: N = 29

Fig. 1  Stage-by-stage selection process

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 J. Comput. Educ.

Results

Quality of studies

The first domain examined for quality was the study design of the papers. There
were 20 studies (69%) that featured an experimental design with stated random
allocation of participants between control and experimental group. The review
featured nine studies (31%) that were quasi-experimental in nature, meaning there
was non-random allocation of participants into experimental groups.
Only one of the studies featured participants being studied at more than one
institution, with most of the studies included (N = 28) only sampling from a sin-
gle establishment. All studies produced response rates of over 75%, which means
they were given the highest score in that domain.
In terms of the type of data presented, all included studies featured an objective
measure of learning outcomes such as test scores or completion times. No studies
used self-assessment on the part of the participant to gauge learning outcomes.
The most pronounced weakness of the studies included in the review was
the validity of the evaluation instrument used to assess learning outcomes. This
domain pertained to the physical assessment instrumentation such as the quiz,
test, or questionnaire that was given to the participant. Only six of the included
studies (21%) reported the internal structure sufficiently through dimensional-
ity, measurement invariance, or reliability using the criteria set down by Rios
and Wells (2014). In addition, only 10 studies (34%) stated how the content was
validated, with the majority (N = 19) not reporting this information. Only three
studies (Kozhevnikov et al. 2013; Makransky et al. 2017; Molina-Carmona et al.
2018) appropriately outlined both the internal structure and validity of evaluation
content. The majority of studies (N = 16) did not report either item.
Of the 29 studies in the current review, 26 scored full marks on the data analy-
sis domain with both an appropriate and sufficiently complex analysis and report-
ing of the findings. Three studies scored lower than this due to reporting descrip-
tive statistics only (Angulo and de Velasco 2013; Babu et al. 2018; Ray and Deb
2016).
Overall, the average quality score of a study in this systematic review was 12.7
with a range of 10.5–14.5 (SD = 1.0). This was 1.8 points higher than the review
carried out by Jensen and Konradsen (2018), which could in part be due to differ-
ences in study design criteria which was previously outlined. A full summary of
the MERSQI scores for each study can be found in Table 2 in the Appendix.

Subject areas and learning domains

Table  1 provides a summary of all 29 articles that were included in the review.
Studies were first categorised by the population that was sampled. Most I-VR
studies took place in a higher education establishment (college or university)
using undergraduate or postgraduate students (N = 25). A smaller number of

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 Table 1  Details of included studies including domain, variables, and summary of main findings
Study (year) Learning domain HMD(s) used Comparison variable(s) Findings

Harrington et al. (2018) Cognitive Samsung Gear VR 2D video No difference in information retention between both
mediums
J. Comput. Educ.

Yoganathan et al. (2018) Procedural Unspecified 2D video I-VR produced higher scores in knot tying skills. No
Face-to-face training difference in completion time
Makransky et al. (2017) Cognitive Samsung Gear VR Desktop VR Knowledge test score worse when using I-VR. No
difference in transfer score
Greenwald et al. (2018) Cognitive HTC Vive 2D system Study found no difference in test scores or number
of moves between both mediums. One session was
slower in I-VR compared to 2D
Lamb et al. (2018) Cognitive HTC Vive Lecture I-VR produced a better test score than a traditional
Serious game lecture. No difference between I-VR and educa-
Hands-on activity tional game or hands-on activity
Webster (2016) Cognitive Sony HMZ Lecture I-VR produced significantly higher test scores than
a lecture
Smith et al. (2018) Cognitive and procedural Oculus Rift Desktop VR No difference in test score or completion time
Written instructions between I-VR and other methods
Ostrander et al. (2018) Cognitive HTC Vive Instructor lesson In 6 out of 7 lessons, I-VR was no more effective
than a lesson delivered by an instructor
Angulo and de Velasco (2013) Cognitive Other 3D physical model Higher appraisal of architectural spaces designed
with I-VR than physical model
Stepan et al. (2017) Cognitive Oculus Rift Online textbook No difference in test score at pre-test, post-test, or
8-week follow-up
Sankaranarayanan et al. (2018) Cognitive and procedural Oculus Rift No I-VR (written material only) Using I-VR produced higher learning gains in
procedural activity and transfer test. There was no
difference in MCQ test scores
Fogarty et al. (2017) Cognitive Oculus Rift No I-VR (lectures only) At pre-intervention the participants performed sig-
nificantly poorer than the control group. At post-
intervention, this difference disappeared showing
improvement in cognitive knowledge

13


Table 1  (continued)
Study (year) Learning domain HMD(s) used Comparison variable(s) Findings

13
Rupp et al. (2019) Cognitive Google Cardboard 2D video (on phone screen) Significantly better learning outcomes were
Oculus CV1 demonstrated on test scores when I-VR was used
Oculus DK2 compared to non-immersive condition
Bharathi and Tucker (2015) Procedural Oculus Rift Desktop VR Functional analysis task was carried out signifi-
cantly faster in I-VR condition compared to D-VR
Johnston et al. (2018) Cognitive Oculus Rift No I-VR (lectures only) Those participants who underwent the I-VR experi-
ence performed better on final exam question than
those who did not use I-VR
Allcoat and von Mühlenen (2018) Cognitive HTC Vive Textbook Those who used I-VR performed better on a test
2D Video than 2D control group. The I-VR group performed
better on remembering questions than those in the
textbook group, but no difference in understand-
ing questions
Kozhevnikov et al. (2013) Cognitive nVisor SX60 Desktop VR Performance in understanding relative motion con-
cepts were significantly higher when participants
used I-VR compared to D-VR
Parong and Mayer (2018) Cognitive HTC Vive Slideshow I-VR was demonstrated to cause significantly poorer
results on a cell biology test than those who
learned using a traditional PowerPoint
Olmos-Raya et al. (2018) Cognitive Samsung Gear VR Desktop VR Those participants who learned about geography
using I-VR demonstrated significantly higher
learning gains and medium term retention than
those who used D-VR
Akbulut et al. (2018) Cognitive Mobile VR Lecturers and lab sessions Test scores were significantly higher in those who
used the I-VR platform compared to those who
learned through lectures and lab sessions alone
Ray and Deb (2016) Cognitive Google Cardboard Slideshow Over the course of 16 sessions, those who learned
Lectures computer science through I-VR tended to score
higher on test scores than those who did not
J. Comput. Educ.
 Table 1  (continued)
Study (year) Learning domain HMD(s) used Comparison variable(s) Findings

Moro et al. (2017) Cognitive Oculus Rift Desktop VR I-VR and D-VR were shown to be equally effective
modes of learning on an anatomy skill test
J. Comput. Educ.

Maresky et al. (2019) Cognitive Oculus Rift Independent study Those who used I-VR to learn about cardiac
anatomy scored significantly higher on post-test
than a control group who used independent study
Madden et al. (2018) Cognitive Oculus Rift Desktop VR I-VR was no more effective than D-VR or a tradi-
Ball-and-stick method tional model demonstration when learning about
astronomy
Liou and Chang (2018) Cognitive HTC Vive Traditional didactic teaching I-VR was shown to produce significantly higher
levels of learning in anatomy and chemistry tests
than those who did not use the technology
Molina-Carmona et al. (2018) Cognitive Mobile VR Desktop VR I-VR was shown to improve the spatial ability of
those participants who used it, compared to those
that used D-VR
Babu et al. (2018) Cognitive HTC Vive Desktop VR (tablet based) Although I-VR and D-VR produced similar post-test
scores, I-VR was shown to improve retention of
knowledge learned
Alhalabi (2016) Cognitive Oculus Rift Traditional methods I-VR was shown to produce significantly higher
attainment in engineering content than traditional
educational methods. Furthermore, HMD based
I-VR produced better results than a CAVE based
system
Gutiérrez-Maldonado et al. (2015) Affective and cognitive Oculus Rift DK1 Stereoscopic desktop VR Both immersive and non-immersive mediums
produced similar results in psychiatric interview
training

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 J. Comput. Educ.

studies used high school pupils (N = 2), or adult education students (N = 2) such
as those in vocational or work-based programmes.
Each of the included studies were then examined for the topic and subject area
they pertained to. This was based upon the nature of the VR experience, partici-
pant pool, and intervention. In total, six main subject areas were identified. This
included: medicine (N = 4), science (biology, chemistry, and physics) (N = 13),
social science (human geography) (N = 1), computer science (N = 2), engineering
and architecture (N = 7), and safety education (N = 1). One of the included studies
(Molina-Carmona et  al. 2018) did not neatly fit into one of the pre-defined cat-
egories as it utilised I-VR to teach abstract spatial concept abilities to multimedia
engineering students. It was therefore categorised as ‘other’. Figure 2 shows the
percentage of papers included by subject area.
In addition to the subject area, the learning outcomes were also categorised into
three specific domains based upon the findings of previous systematic reviews, as
well as the taxonomy of learning developed by Bloom et al. (1956). The first was
cognitive which related to studies that intended to teach specific declarative infor-
mation or knowledge. The second was procedural which intends to teach the user
how to perform a specific task or learn psychomotor skills that pertain to a cer-
tain activity. Finally, the third learning outcome was affective skills which can be
defined as a growth in areas relating to emotion and attitude. Most of the included
studies (N = 24) concentrated on the cognitive domain, with two studies focus-
ing on purely procedural and psychomotor skills. The remaining studies were a
blend of two domains with Sankaranarayanan et al. (2018) and Smith et al. (2018)
examining both cognitive and procedural skills, and Gutiérrez-Maldonado et  al.
(2015) utilising both cognitive knowledge and affective awareness in psychiatric
diagnosis training. Figure 3 shows the percentage of studies included by learning
domain.

Studies by subject area

Science
45%

Other
3%
Safety Educaon
Engineering and
3%
Architecture
Social Science
24%
4%
Computer Science Medicine
7% 14%

Fig. 2  Percentage of papers per subject area

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J. Comput. Educ.

Studies by learning domain

Procedural
7%
Mixed (Procedural
Cognive & Cognive)
83% 7%

Mixed (Affecve &

Cognive)
3%

Fig. 3  Percentage of papers per learning domain

Experimental design

Outcome measures

A thorough understanding of the role of I-VR as a pedagogical practice can only

be fully appreciated when consideration is given to the assessment instrumenta-
tion and outcome measures used to assess its utility. As previously mentioned,
when analysing the quality of the included studies, it was the evaluation instru-
mentation itself that was shown to have the most pronounced weakness.
To assess the evaluation instruments being employed, the measures were bro-
ken down into two broad domains: outcome measures, and assessment instru-
mentation. Outcome measures can broadly be defined as how learning outcomes
were quantified (e.g. by comparing test scores). Assessment instrumentation
pertains to the evaluative instrument itself that is used to measure the learning
outcomes (e.g. multiple-choice questionnaire, exam style questions). Twenty-
seven of the included studies (93%) used test scores to assess learning outcomes,
with the majority using this as their sole method. There were four studies that
used completion time as a metric of learning outcome, although only one study
(Bharathi and Tucker 2015) used this method exclusively. There was one study
(Sankaranarayanan et  al. 2018) that used the correct order of operation in a
procedural task as one of its main outcome measures. There were three papers
that utilised other outcome measures that could not be easily categorised. For
instance Greenwald et al. (2018) used counting the number of moves needed to
complete a task, Webster (2016) used the performance on a virtual jigsaw puz-
zle, and Angulo and de Velasco (2013) used a mixture of scores and evaluations
of an architectural space.

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Assessment instrumentation

In terms of the direct assessment instrumentation used to examine outcome meas-

ures, there was a heavy reliance on the multiple-choice questionnaire (MCQ).
There were eighteen (62%) studies that utilised this method of assessment, with the
majority of those using it as their sole evaluation instrument. Only five studies used
extended answer questions (long or short form) to probe for a deeper understanding
of the educational content, which was usually done in combination MCQs. The stud-
ies that included the teaching of procedural skills used marking criteria and check-
lists to assess whether the correct order was being followed. For instance Yogana-
than et al. (2018) had an expert assessor use marking criteria to assess the knot tying
skills of students. Similarly, Smith et al. (2018) had evaluators observe students with
a decontamination checklist which evaluated performance based upon certain key
tasks that were performed.
There were a smaller number of studies that used more novel instrumentation and
methods for evaluation, such as the utilisation of labelling and identifying parts of a
3D model (e.g. Babu et al. 2018; Moro et al. 2017; Stepan et al. 2017). Fogarty et al.
(2017) probed spatial and conceptual understanding in their assessment instrument
by having participants draw shapes based on their understanding of structural engi-
neering principles. Additionally, Alhalabi (2016) used quizzes on both mathematical
knowledge, and the appropriate understanding of graphics and charts as an assess-
ment measure for engineering students.
There were three studies (Liou and Chang 2018; Madden et  al. 2018; Ray and
Deb 2016) where the nature of the assessment instrumentation could not be defini-
tively ascertained from the description.
The majority of studies (62%) utilised the pretest–posttest design by comparing
the test scores pre-intervention with those after the I-VR experience. The remainder
of the studies tended to assess post-intervention scores only, usually by comparing
the difference in learning outcome between I-VR and one or more control group.
Less conventional means of post-intervention comparison was sometimes utilised,
such as Johnston et al. (2018) comparing the average score on a specific exam ques-
tion that pertained to an I-VR experience that some student did or did not undertake.
There were four studies that examined the short to medium term retention rate of
information and learning through follow-up assessment. This ranged from as soon as
1 day after the initial I-VR experience (Babu et al. 2018), through to 6 months post-
intervention (Smith et al. 2018). Olmos-Raya et al. (2018) and Stepan et al. (2017)
had follow-up assessments at 1-week and 8-weeks, respectively.

Intervention characteristics

In addition to having appropriate assessment measures, it is also important to exam-

ine the nature of the I-VR intervention itself. The most popular HMDs used were
the Oculus (N = 13) and HTC Vive (N = 7). There were seven studies that used a
form of mobile VR headset such as the Google Cardboard or Samsung Gear VR.
In one study (Yoganathan et  al. 2018) the exact HMD system used could not be

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J. Comput. Educ.

definitively ascertained. Figure  4 provides a breakdown of the HMDs used in the

included studies.
Most studies (72%) featured only a single intervention with the I-VR experience,
meaning that the student was exposed to the technology just once. There were a few
exceptions to this, with Ostrander et al. (2018) having seven individual I-VR experi-
ences in their manufacturing lesson, as well as Ray and Deb (2016) utilising smart-
phone based I-VR over the course of 16 sessions. Other studies allowed a greater
degree of freedom in the number of interventions or times that a student could use
I-VR. This was usually a result of time being dedicated to the technology through
scheduled classes or lab times (e.g. Akbulut et  al. 2018; Alhalabi 2016; Molina-
Carmona et al. 2018). Despite this, the I-VR intervention was usually a single and
isolated one.
As well as most of the studies featuring a single intervention, the exposure dura-
tion was also typically short, ranging from 6 to 30 mins. Generally, the exception to
this was when the I-VR exposure lasted as long as it took the participant to complete
a specific task, assessment, or procedure within the immersive environment (e.g.
Babu et al. 2018; Bharathi and Tucker 2015; Greenwald et al. 2018; Sankaranaray-
anan et al. 2018). Molina-Carmona et al. (2018) supplemented the limited interven-
tion duration by allowing participants to take the HMD away with them, so they
could access the educational content for 2 weeks outside the classroom. However,
just as with the number of interventions, exposure duration tended to be short, last-
ing on average 13 mins for those I-VR experiences that had a set time limit.
Most of the studies (62%) utilised I-VR as the sole method of learning, and did
not combine the technology with additional pedagogical practices or materials to
encourage learning. Only a limited number of studies (38%) supplemented the I-VR
lesson by providing additional aids that were designed to complement the educa-
tional experience. For example, Smith et al. (2018) and Stepan et al. (2017) both had
participants use web-based modules and textbooks in addition to the I-VR experi-
ence before testing them on learning outcomes. A number of the included studies

HMDs used
45%
40%
35%
Percentage of studies

30%
25%
20%
15%
10%
5%
0%
Oculus HMD HTC Vive Google Samsung Other Sony HMZ- NVIS nVisor Other Not
Cardboard Gear-VR Mobile-VR T1 SX60 Specified

HMD type

Fig. 4  HMDs used in studies

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 J. Comput. Educ.

also utilised lecture based instruction or scheduled class time to operate in tandem
with the I-VR environments (e.g. Akbulut et al. 2018; Fogarty et al. 2017; Johnston
et al. 2018; Ray and Deb 2016; Sankaranarayanan et al. 2018).

Theoretical frameworks

A fundamental component of any educational tool or activity is to ground its use

in learning theory or educational paradigms. Learning theories can broadly be bro-
ken down and defined by proposals regarding how student imbibe, process, and
retain the information that they have learned (Pritchard 2017; Schunk 2011). When
applied to educational I-VR, these theories should provide a pedagogical frame-
work and foundation as how best to design interventions. Papers were examined
for explicit statements regarding the theoretical basis for the study. Those papers
that only mentioned theoretical approaches as part of the introduction or literature
review were not deemed to have explicitly stated them. The majority of studies
(N = 24) made no mention of a theoretical approach underpinning the intervention.
There were two studies that applied a generative learning framework (Makransky
et  al. 2017; Parong and Mayer 2018). This can be defined as an approach where
the learner will actively integrate new knowledge with information that is already
stored in the brain (Osborne and Wittrock 1985). Webster (2016) employed Mayer’s
(2009, 2014) Cognitive Theory of Multimedia Learning (CTML). CTML proposes a
dual channel approach where visual and auditory information is actively processed,
organised, and then stored in the brain. This is contingent on neither channel (visual
or auditory) becoming overloaded with information. Smith et  al. (2018) used the
NLN Jeffries Simulation Theory as their theoretical basis. This theory, most com-
monly employed in nursing education, is where students learn information as part
of a simulated experience (Jeffries et al. 2015). For the teaching of vocational skills,
Babu et al. (2018) stated that their approach aligned with situated learning. Situated
learning employs a constructivist approach in that students learns professional skills
by actively participating in the experience (Huang et al. 2010).

Learning outcomes

For I-VR to gain wide-spread acceptance as a reliable pedagogical method, it must

be shown to confer a tangible benefit in terms of learning outcomes over less immer-
sive or traditional teaching methods.

Cognitive studies

There were twenty-four included studies that fell into the cognitive domain and
aimed to teach specific declarative information or knowledge through the I-VR
environment. The current review found that most studies demonstrated benefits in
terms of learning outcomes when using I-VR compared to less immersive methods
of learning. A smaller number of studies found no significant advantage regardless

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of the pedagogical method being utilised. The results of these cognitive studies have
been broken down by subject area.

Science based cognitive studies

The review found that cognitive learning activities requiring a high degree of visual-
isation and experiential understanding may be best facilitated using immersive tech-
nologies. For instance, both Liou and Chang (2018) and Maresky et al. (2019) found
that anatomical learning facilitated by complex 3D visualisations of the human body
were more conducive to learning in I-VR compared to traditional learning or inde-
pendent study. Similarly Lamb et al. (2018) used a virtual environment that allowed
for the manipulation and movement of strands of DNA, which produced better learn-
ing outcomes in content tests than a lecture or a serious educational game. Greater
attention and engagement with the I-VR environment as measured with infrared
spectroscopy was one of the possible explanations given for the effectiveness of the
technology. In a study by Johnston et al. (2018), participants volunteered to take part
in a cell biology experience either because they were engaged with the subject mat-
ter itself, or wanted supplementary instruction. Johnston et al. (2018) compared the
exam scores of those students who volunteered to take part with those who did not.
The study found that participants who underwent the I-VR experience scored 5%
higher on the related exam question compared to the rest of the assessment. Those
who did not undergo the cell biology I-VR experienced scored on average 35%
worse on the same question.
The increase in graphical fidelity afforded by I-VR has allowed not only for the
creation of complex computer-generated environments, but also the viewing of
high resolution 360° video. In one such study, Rupp et al. (2019) had participants
watch a six minute 360° video about the International Space Station with either a
HMD which created a sense of immersion and presence, or on a mobile screen. The
research found that those participants in the HMD condition scored significantly
higher in a learning outcome test (MCQ) than those who watched the video in the
non-immersive condition.
Although I-VR has been shown to confer a benefit in science education, there
is evidence to suggest that not all learning objectives can be learned equally well.
For instance, in task devised by Allcoat and von Mühlenen (2018), the researchers
found that I-VR conferred a benefit over video or textbook learning when questions
required remembering, but not ones pertaining to understanding of the material. The
authors suggest that unfamiliarity and the novelty of the I-VR environments could
have contributed to the lack of an obvious benefit in the latter domain. Another study
that examined specific question types to understand I-VR’s effectiveness was under-
taken by Kozhevnikov et  al. (2013). In this study, participants learned more con-
ceptual and abstract relative motion concepts using either I-VR or D-VR. The study
demonstrated that those in the I-VR condition performed significantly better in the
two-dimensional problems than their D-VR counterparts, although there was no sig-
nificant difference between groups in problems featuring only one spatial dimension.
There were several studies in the domain of science that showed no obvious ben-
efits to using I-VR over traditional pedagogical methods. Two studies (Greenwald

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 J. Comput. Educ.

et al. 2018; Moro et al. 2017) compared science learning in I-VR with desktop based
VR and 2D videos. Results showed no clear benefit of I-VR based instruction when
comparing the difference and significance of learning outcomes between mediums.
Similarly, Stepan et  al. (2017) found that I-VR was no more effective than online
textbooks for the teaching of neuroanatomy. Interestingly, the same study found
no difference in information retention rates when the participants were reassessed
8-weeks later. Madden et al. (2018) used I-VR, D-VR, and the traditional ball and
stick method to teach astronomy principles pertaining to phases of the moon. The
study found that I-VR and D-VR produced comparable test score results, with no
significant differences in attainment. However, the authors commented on the
encouraging finding that despite being a novel technology to most participants, I-VR
still facilitated comparable learning outcomes to more traditional methods.
Despite the majority of studies demonstrating that I-VR learning is more effective
or at least on par with traditional pedagogical methods, some studies have shown a
detrimental effect of I-VR. Makransky et al. (2017) used a combination of assess-
ment and EEG to find that an I-VR lab simulation produced significantly poorer test
scores than a non-immersive alternative. Similarly, during another science experi-
ment, Parong and Mayer (2018) found that students who used I-VR during a biology
lesson scored significantly poorer than those who learned using a PowerPoint. Both
of these studies cited Mayer’s (2009, 2014) Cognitive Theory of Multimedia Learn-
ing as a possible explanation for the poorer performance for I-VR. The research-
ers postulate that the high-fidelity graphics and animations could have significantly
increased cognitive load, which would have detracted from the learning task at
hand. It was therefore proposed that a less immersive, yet well designed PowerPoint
presentation would facilitate better learning outcomes than a graphically rich I-VR
experience.

Engineering and architectural based cognitive studies

I-VR was effective in engineering and architectural education as a tool to visualise

key concepts within the discipline. For example, Fogarty et al. (2017) allowed stu-
dents to volunteer for an I-VR experience who struggled with the comprehension of
spatial arrangements in structural engineering. Before the intervention, those stu-
dents who volunteered to take part scored significantly poorer than their non-inter-
vention counterparts. At post-test, not only did those who underwent the I-VR expe-
rience score significantly higher than they did at pre-test, but they also eliminated
the significant difference with the non-intervention group. This would suggest that
I-VR could serve an important function in supplementing or assisting learning in
those students who are struggling to grasp complex problems relating to their disci-
pline. Interestingly, Angulo and de Velasco (2013) used many of these same spatial
and visualisation principles in a more applied setting. Their study split students into
groups who were tasked with designing an architectural space (a health clinic wait-
ing room), either with the assistance of an I-VR design tool (experimental group) or
a physical model (control group). The study found the space that gained the most
positive affect was designed by the I-VR group.

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J. Comput. Educ.

Webster (2016) created a graphically rich immersive environment which com-

bined active and passive media with elements of gamification and interactivity to
teach corrosion concepts to US army personnel. The study found that although both
the I-VR environment and a traditional lecture were effective pedagogical methods
for teaching these principles, it was the I-VR condition that produced the highest
gain in knowledge acquisition.
There was also some evidence to suggest that I-VR interventions could assist
in short-term retention of information in engineering related activities. Babu et al.
(2018) found that although participants performed similarly in a mechanical label-
ling task using either I-VR or a tablet computer immediately post-intervention, the
I-VR group had better retention of knowledge when the test was re-administered
1 day later. Furthermore, those participants in the I-VR group were also less likely
to wrongly recall information compared to the non-immersive group on the retention
test.
Interestingly, Ostrander et al. (2018) examined cognitive learning outcomes over
seven separate manufacturing tasks utilising I-VR in one group, and a traditional
class-based environment in the other. The study found that in six out of seven tasks,
I-VR was no more effective than a traditional class where students could interact
with the instructor or the physical models that they were accustomed to.

Medical based cognitive studies

Although papers featuring surgical simulators did not form part of this review, there
were several applications of I-VR in the field of general medical education. Har-
rington et al. (2018) had medical students watch a ten-minute 360° video with slides
containing surgical information superimposed over it. This was viewed either on a
large television screen, or through a Gear VR headset. The study found no signifi-
cant differences in knowledge retention scores between those who viewed the infor-
mation through a HMD, or a traditional television screen. Despite not showing a
distinct advantage in cognitive learning outcomes, the authors did suggest that the
360° surgical experience may facilitate a better understanding of how teamwork and
interaction takes place within an operating theatre. This type of learning may be
more difficult to measure using assessment instrumentation such as the MCQ, but
nevertheless it could be that the experiential nature of I-VR may facilitate an under-
standing of interactions and communications. Smith et al. (2018) used either I-VR
or D-VR on a computer to teach students about decontamination protocols. The
research found that I-VR was no more effective than D-VR in a MCQ immediately
post-intervention, or at 6-weeks follow-up.

Computer science based cognitive studies

Two studies demonstrated a significant advantage in using I-VR to teach computer

science information. For instance, Akbulut et  al. (2018) found that students who
underwent an I-VR experience that focused on software engineering principles
scored 12% higher than students who did not undergo I-VR learning. Interestingly,
in a study by Ray and Deb (2016) that ran over 16 sessions on microcontrollers in

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computing, the I-VR group performance lagged behind that of the control group who
used slideshows for the first four sessions. It was only on session number five that
the I-VR group outperformed the control group, and this performance enhancement
remained relatively stable in the majority of the remaining 11 sessions. In effect, it
took the I-VR group some time to catch up with the control group, but once they
did, they tended to outperform them in the remaining lessons. The authors propose
that this may have been due to the novelty of the I-VR equipment which participants
took time to become comfortable and competent with.

Other cognitive studies

I-VR was also used by Molina-Carmona et al. (2018) as a means of spatial ability
acquisition and visualisation. The study showed that learning outcomes as assessed
by a spatial visualisation test were higher among those who undertook the task in an
immersive, compared to a non-immersive environment. There was only one study
in the field of social science that used I-VR to teach cognitive information. Olmos-
Raya et al. (2018) used either I-VR or a tablet-based system to teach high school stu-
dents about human geography. The research found that I-VR produced higher learn-
ing gains on a MCQ than the tablet-based system. Further, those who used I-VR
performed better than the non-immersive group on a knowledge retention quiz when
administered 1-week later.

Procedural studies

Three of the four studies that attempted to utilise I-VR as a means of teaching proce-
dural skills showed a distinct advantage over less immersive methods. Bharathi and
Tucker (2015) found that engineering students were faster in assembling a house-
hold appliance in a virtual functional analysis activity in I-VR compared to D-VR.
Yoganathan et  al. (2018) also found that medical students were more accurate in
knot tying practice when using I-VR as a training tool as opposed to a control group
who used a standard video. Medical and surgical residents were also studied by
Sankaranarayanan et al. (2018) who used I-VR as a teaching tool for emergency fire
response in an operating theatre environment. This study found that 70% of those
who utilised the I-VR training were able to perform the correct procedure in the
correct order. This was 50% higher than the control group who were exposed to a
presentation and reading material only and did not experience I-VR.
One of the studies found no significant advantage to using I-VR as a learning
tool. Smith et  al. (2018) split nursing students into an I-VR group, a D-VR group
(desktop PC based), or a written instruction group to learn about appropriate proto-
cols for decontamination. The study found that there was no significant difference in
performance between the groups as measured by a decontamination checklist, or the
time taken to complete the task. Furthermore, reassessment 6 months later showed
that I-VR conferred no advantage in procedural knowledge retention (accuracy and
speed) compared to less immersive methods.

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J. Comput. Educ.

Affective studies

Only one of the studies attempted to use I-VR as a pedagogical tool to teach applied
behavioural and affective skills. Gutiérrez-Maldonado et al. (2015) used I-VR in the
field of diagnostic psychiatry in an attempt to improve interview skills when assess-
ing patients for an eating disorder. Participants were exposed to a series of virtual
patient avatars in either the I-VR condition, or a D-VR condition using stereoscopic
glasses. Analysis showed that both conditions were equally as effective, and no sig-
nificant differences were shown in the acquisition of skills between the two groups.
Nevertheless, this was a novel study as it traversed the boundaries between tradi-
tional cognitive skill acquisition and applied behavioural and affective change.

Discussion and implications

The purpose of this review was to investigate I-VR’s effectiveness as a pedagogical

method in education, as well as examining the experimental design and character-
istics of the included studies. In particular, the review found that the utilisation of
I-VR is typically restricted to a small number of subject areas such as science and
engineering. Furthermore, a heavy reliance has been placed on the MCQ and test
score measures to assess learning outcomes. In addition, I-VR interventions were
typically short and isolated, and were not complemented with additional or supple-
mentary learning material. Despite this, most studies did find a significant advantage
of using I-VR over less immersive methods of learning. This was the case particu-
larly when the subject area was highly abstract or conceptual, or focused on proce-
dural skills or tasks.

Is the utilisation of I‑VR within education restrictive?

The findings of the review suggest a relatively homogenous application of I-VR in

terms of both the subject areas represented, as well as the learning domain being
taught. Almost 70% of the studies were from the field of science or engineering,
with other subjects being marginally represented. It is worth noting, however, that
although medical disciplines made up a small proportion of the studies included
(14%), this was because most medical applications of I-VR feature surgical simula-
tors and therefore were not part of the current review’s inclusion criteria. Most stud-
ies utilised I-VR as a way of teaching cognitive skills, with only a handful examin-
ing the procedural or affective applications.
The findings of the review raise several issues when trying to assess the general
effectiveness of I-VR in education. Similar to the findings of others (e.g. Jensen and
Konradsen 2018; Radianti et  al. 2020), the arts, humanities, and social sciences
were underrepresented in in the current review. This makes generalisable conclu-
sions as to the cognitive benefit of the technology in these subjects challenging. One
major reason for this under representation may be the lack of I-VR learning con-
tent, experiences, and teaching tools. Jensen and Konradsen (2018) highlighted that

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 J. Comput. Educ.

instructors are restricted to the material published and produced by VR designers,

and this may not necessarily meet the individual needs of the teacher, or the learning
outcome trying to be achieved. The skillset needed to produce and create wholly vir-
tual environments that can be rendered and displayed in a HMD is still demanding,
despite the release of affordable VR creation suites. Therefore, the bespoke I-VR
experiences required to teach social science lessons (or indeed any subject) is com-
pletely dependent on an appropriate I-VR tool already existing or having the techni-
cal proficiency to create one. A potential solution to the lack of bespoke material
could be the examination of the pedagogical effectiveness of HMD 360° video in the
classroom, as opposed to computer-generated environments. This content is com-
paratively easier to create using appropriate video equipment and can be tailored
to the individual needs of the instructor or student group. Widespread research that
examines the potential of I-VR in a multitude of diverse disciplines and learning
domains will continue to be constrained by the availability of the requisite material.
That is until such a time where bespoke and individually tailored I-VR experiences
become more accessible.

Implications of outcome measures and assessment instrumentation

One of the most striking characteristics of the assessment instrumentation used in

the studies was the reliance on the MCQ to assess learning outcomes. Although
there have been many debates on the respective advantages and disadvantages of
utilising the MCQ, it has generally been considered that it is most appropriate for
testing large amounts of surface knowledge over the course of an entire module or
syllabus (Excell 2000). As O’Dwyer (2012) points out, the assessment instrumenta-
tion encourages comprehensive learning of the entirety of the taught material, as
opposed to just specific components. However, since most of the studies featured
single interventions of between 6 and 30 mins, doubts are cast on whether MCQs
are the most appropriate way to assess learning. Since the MCQ was most com-
monly administered immediately after the I-VR experience, much of the information
may still be stored in short-term memory, and this may not give an accurate reflec-
tion of more comprehensive learning or long-term retention.
A second disadvantage associated with the heavy reliance on the MCQ is the
limited breadth of knowledge that can be assessed. In Jensen and Konradsen’s
(2018) systematic review, the researchers found that none of the cognitive studies
went beyond teaching lower level cognitive skills as defined by Bloom’s taxonomy
(Bloom et  al. 1956). Similar results were found in the current review, with most
studies requiring only a knowledge of previously learned material to successfully
achieve the desired learning goal. Previous research on pedagogical assessment
material (e.g. Ozuru et al. 2013) has suggested that the MCQ cannot assess higher
levels of cognitive understanding or conceptual knowledge. Therefore, it may not
only be the nature of the I-VR experience itself that restricts the learning of higher
level cognitive skills, but also the restrictive nature of the assessment instrumenta-
tion that may impede an appropriate demonstration of learning outcomes. The uti-
lisation of short or long form answers could be able to provide a more appropriate

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measure of the depth of learning achieved, giving the student an opportunity to dem-
onstrate their conceptual knowledge of a given subject. Furthermore, I-VR research
could benefit by expanding the very definition of what constitutes a learning out-
come. This could be achieved by not relying exclusively on test score comparisons,
but rather examine how I-VR could be used to foster deeper conceptual understand-
ing through experiential learning and subsequent classroom discussions with peers
or instructors.

Implication of intervention characteristics for learning outcomes

The current review examined how I-VR is being utilised in experimental and applied
settings, and the implications this has for assessing its pedagogical suitability. In
most studies, the participant took part in a single I-VR experience that was also
short in duration. This presents several key challenges. Most importantly, the nov-
elty of the I-VR technology itself may have impeded the learning experience of the
user, especially if they had never used the technology before or were unfamiliar with
it. This seemed to be demonstrated by Ray and Deb (2016) who found that in the
initial sessions of I-VR learning, performance was on average poorer than those who
underwent traditional teaching methods. It was only after the participants began to
become familiar with the technology (on session number five) that learning sur-
passed the control group. Similarly, studies that allowed for extended exposure to
I-VR (e.g. Akbulut et al. 2018; Alhalabi 2016; Molina-Carmona et al. 2018), either
through free navigation, repeated sessions, or scheduled class time, tended to show
an advantage of using I-VR over non-immersive or traditional methods. It is there-
fore important to address the potentially negative influence that I-VR’s novelty as a
learning tool may have, especially when outcomes are directly compared to another
medium or method. Scepticism for media comparison studies was highlighted in the
1980s by Clark (1983), and then later re-addressed by Parong and Mayer (2018). As
Parong and Mayer (2018) put it, the side-by-side comparison of two learning meth-
ods is an “apples-to-oranges type of comparison” (p. 788). This “apples-to-oranges”
comparison is made starker when considering that I-VR is an unfamiliar technology
to most in an educational capacity, and its pedagogical outcomes are being directly
compared with familiar methods such as textbooks or lectures. It is important to
consider that the novelty of HMDs and I-VR may hinder learning outcomes and
classroom application, and it is therefore prudent to ensure that the degree of famili-
arity with I-VR technology is factored into any direct comparison with other meth-
ods. In practice, this could mean that participants require extended familiarisation
trials or free navigation before the start of experimental studies as a means of miti-
gating against potential problems caused by technological novelty.
In addition to the short intervention and exposure time, most studies did not com-
plement I-VR with an additional method of teaching or self-learning. The limited
number of studies that did tended to utilise web-based textbooks or modules, as well
as lectures and scheduled class time. Encouragingly, those studies that combined or
supplemented traditional class-based learning with I-VR (e.g. Akbulut et al. 2018;
Fogarty et al. 2017; Johnston et al. 2018; Sankaranarayanan et al. 2018; Yoganathan

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 J. Comput. Educ.

et al. 2018) tended to show a learning advantage. This suggests that I-VR may be
best employed as form of blended or multi-modal learning to supplement and com-
plement class-based instruction (Garrison and Kanuka 2004). An area for investiga-
tion would be to examine I-VR’s application longitudinally in a natural classroom
environment. The current review contained only a limited number of studies that
employed this approach, however, by implementing and studying how I-VR can be
adopted and integrated into a module or syllabus, a clearer picture of its capabilities
can emerge.
Learning theories ultimately provide a theoretical framework and foundation as
how best to design educational interventions (Pritchard 2017; Schunk 2011). How-
ever, the review found that few papers explicitly state that any predetermined learn-
ing theory was used to advise the characteristics or methods of the study. Similar
findings were reported in a systematic review by Radianti et  al. (2020) examining
I-VR use in higher education exclusively. Radianti et al.’s (2020) review found that
in around 70% of the 38 studies included, no learning theory was mentioned as
forming the foundation of the VR activity. Several studies have shown that educators
regard clear pre-defined intervention characteristics and objectives as essential com-
ponents of I-VR teaching (Fransson et al. 2020; Lee and Shea 2020). It is therefore
essential that future experimental and applied research is based on a sound theo-
retical basis that can advise how the technology can be appropriately utilised and
assessed.

Learning outcomes in I‑VR

The current review examined learning outcomes across three domains: cognitive,
procedural, and affective. By far the most popular domain was the teaching of cogni-
tive skills and knowledge which made up 83% of the studies in the current review.
Around half of those demonstrated a positive effect on learning when using I-VR
over less immersive pedagogical methods. Most of the remaining studies showed
no significant effect either way, with only a small number of papers exhibiting det-
rimental results. Researchers have suggested that the increased levels of immersive
content that stimulate multisensory engagement can ultimately lead to more effective
learning outcomes (Webster 2016). When this is implemented in cognitive learn-
ing activities that require a high degree of spatial understanding and visualisation
(e.g. Maresky et al. 2019), I-VR can allow the user to gain insights that are difficult
to reproduce in reality. This review has already identified scientific subjects such
as biology and physics as promising avenues for educational I-VR implementation.
However, other scientific disciplines that require abstract or conceptual understand-
ing (e.g. chemistry, mathematics) could also benefit from the visualisation afforded
by I-VR.
Studies that utilised I-VR for the teaching of procedural skills and knowledge
produced encouraging results, with three of the four studies finding a significantly
positive increase in learning (Bharathi and Tucker 2015; Sankaranarayanan et  al.
2018; Yoganathan et al. 2018). Interestingly, two of the studies featured a transfer
component by having the user first practice the procedure in I-VR, and then use this

13
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form of experiential learning to complete a task in the real world. Yoganathan et al.
(2018) had students practice how to tie a surgical knot in I-VR and then complete
this task for real in-front of an expert. Sankaranarayanan et al. (2018) had medical
students learn how to deal with an operating theatre fire by first practicing the proce-
dure in I-VR, and then applying this knowledge to a mock emergency in a real oper-
ating room. Both studies found a positive effect of using I-VR as the training method
by demonstrating improved results when performed in a real environment. These are
encouraging findings for I-VR’s effectiveness in psychomotor and procedural educa-
tion, as there has been a degree of scepticism over whether I-VR simply produces a
“getting good at the game” effect. For instance, Jensen and Konradsen (2018) point
out that the honing of procedural skills within I-VR may simply lead to the partici-
pant becoming proficient when performing the task virtually, and this may not nec-
essarily transfer to the real world. The current review has identified that the two pro-
cedural studies that implemented a transfer task did indeed demonstrate a significant
benefit to using I-VR as an initial education method. This demonstrates that virtual
training can be a successful precursor to implementation in the real world. This sug-
gests that I-VR could be useful in educating students in dangerous vocational sub-
jects such as electrical engineering without risk to themselves or others. However,
this view is based on a small number of studies, and it is therefore important that
future procedural tasks utilise a transfer activity to understand the potential scope
and parameters surrounding I-VR training and real-world application.
Only one of the studies had a firm focus on the training of affective skills, namely
by using I-VR as a way of teaching diagnostic interview techniques in a psychiat-
ric setting (Gutiérrez-Maldonado et  al. 2015). Although this study found no clear
advantage to using I-VR, other research out with the domain of education has dem-
onstrated promising results in utilising the technology for affective and behavioural
change. This included applying the technology successfully in areas such as expo-
sure therapy, anxiety disorder treatment, and empathy elicitation (Botella et  al.
2017; Maples-Keller et al. 2017a, b; Schutte and Stilinović 2017). As a result of the
strong non-educational body of literature suggesting I-VR can facilitate affective and
behavioural change, future research should examine how this can be applied in an
educational context, and then transferred to real-world scenarios. For instance, in
their psychiatric interview experience, Gutiérrez-Maldonado et al. (2015) had users
interact solely with virtual avatars, and did not have the participants demonstrate
their learning with a real actor or patient. Therefore, just like with procedural skill
acquisition, affective I-VR experiences should seek to understand how virtual learn-
ing can then be applied to real situations.

Implications and future practice

The current review has been able to identify a body of experimental and applied
research that show the potential benefits of using I-VR in education. It has already
been noted that I-VR has traditionally been used to teach low level or fundamental
skills and knowledge, and has not necessarily been used to facilitate what Bloom
et al. (1956) would consider higher level learning. This would include analysing and

13
 J. Comput. Educ.

evaluating experience. By expanding the definition of learning outcomes to encom-

pass potential benefits such as an increased depth of understanding or the ability to
identify complex themes, pedagogical practice can take advantage of the inherent
strength of the medium. These should be comprehensively analysed to investigate
learning outcomes that go beyond simple test scores.
The review has also been able to identify areas for improvement in future stud-
ies, which would address confounding variables and expand the scope of research.
Firstly, as Allcoat and von Mühlenen (2018) suggest, the novelty of I-VR could
hamper learning outcomes due to unfamiliarity with the technology. Therefore, it
is important to factor in an extended familiarisation or free navigation period that
would help alleviate this concern. Additionally, follow-up qualitative analysis such
as interviews or focus groups could help explore the phenomenology or direct expe-
rience of using I-VR, and highlight concerns relating to unfamiliarity or technologi-
cal anxiety. The biggest concern relating to the assessment instrumentation was the
over reliance on the MCQ (62% of studies used it as the sold method of assessment).
Although this method is deemed appropriate for assessing large amounts of surface
knowledge, it may not reveal more nuanced forms of learning that extend beyond
mere recall of information. Therefore, long form essay questions, oral examinations,
or group discussions could be used to facilitate students’ ability to present their in-
depth understanding and applied knowledge. Future research must base the nature of
these interventions on a sound theoretical framework. This would assist in identify-
ing specific learning objectives and methods of assessments. An explicit theoretical
approach was commonly lacking in the included studies.
I-VR has already been demonstrated to be an effective tool in non-pedagogical
behaviour change, such as treating phobias, mental health conditions, or as a tool
for rehabilitation (Botella et al. 2017; Maples-Keller et al. 2018; Ravi et al. 2017).
Research should therefore concentrate on I-VR’s potential as an acquisition tool for
affective skills. There is already a strong body of evidence suggesting I-VR experi-
ences can elicit high levels of empathetic response and perspective taking, and this
should be explored within an educational context (Herrera et al. 2018; Shin 2018).
For example, Dyer et al. (2018) used I-VR to allow health care students to take the
perspective of an older patient with age-related medical conditions, which led to
increased empathy. Future studies should investigate whether this perspective tak-
ing ability can lead to higher domains of learning, such as evaluating one’s actions,
applying problem solving skills, or creating new solutions as a direct result of the
insights they received from I-VR. This will require researchers and instructors to
carefully consider their tools for evaluation and assessment, perhaps incorporating
mixed-methods to give a more holistic overview of learning achieved.

Conclusions

The current review found that I-VR conferred a learning benefit in around half of
cognitive studies, especially where highly complex or conceptual problems required
spatial understanding and visualisation. Although many studies found no significant
benefit of using I-VR over less immersive technology, only a small number resulted

13
J. Comput. Educ.

in detrimental effects on learning outcomes. However, the homogenous nature of

assessment instrumentation, such as an over reliance on the MCQ may have stifled
the ability for participants to demonstrate learning outcomes beyond low level cog-
nitive knowledge. Short exposure times and isolated interventions could also pose a
problem as the novel nature of the technology could negatively impact the amount
of learning able to be imbibed. Encouragingly, most procedural tasks did show a
benefit to utilising I-VR, and furthermore, there was evidence that virtual skill
acquisition could be transferred successfully to real world problems and scenarios.
The ability to repeatedly practice a procedure in a safe environment whilst expend-
ing little resources could be one of the most advantageous and intrinsic benefits of
I-VR technology. Although affective behavioural change has been widely studied in
non-educational applications of I-VR, the domain was underrepresented in the cur-
rent review, and is an important area for future investigation.
Over the coming years, technological advancement, an increase in creative con-
tent, and the possibilities for instructors to create bespoke I-VR experiences will
all contribute to I-VR’s potential as a teaching tool. It is essential therefore that the
implementation of such technology is based on sound theoretical and experimental
evidence in order to ensure that the I-VR is utilised correctly, and to its full potential.

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ses/by/4.0/.

Appendix

See Table 2.

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 J. Comput. Educ.

Table 2  MERSQI quality appraisal scores for included studies

Study (year) Design Sampling Type of data Validity of Data analysis Outcomes Total
instrument

Harrington et al. 3 2 3 1 3 1.5 13.5

(2018)
Yoganathan et al. 3 2.5 3 1 3 1.5 14
(2018)
Makransky et al. 3 2 3 2 3 1.5 14.5
(2017)
Greenwald et al. 2 2 3 0 3 1.5 11.5
(2018)
Lamb et al. (2018) 3 2 3 0 3 1.5 12.5
Webster (2016) 2 2 3 1 3 1.5 12.5
Smith et al. (2018) 2 2 3 1 3 1.5 12.5
Ostrander et al. (2018) 3 2 3 0 3 1.5 12.5
Angulo and de 2 2 3 0 2 1.5 10.5
Velasco (2013)
Stepan et al. (2017) 3 2 3 1 3 1.5 13.5
Sankaranarayanan 2 2 3 1 3 1.5 12.5
et al. (2018)
Fogarty et al. (2017) 2 2 3 1 3 1.5 12.5
Rupp et al. (2019) 3 2 3 0 3 1.5 12.5
Bharathi and Tucker 3 2 3 0 3 1.5 12.5
(2015)
Johnston et al. (2018) 2 2 3 0 3 1.5 11.5
Allcoat and von Müh- 3 2 3 1 3 1.5 13.5
lenen (2018)
Kozhevnikov et al. 3 2 3 2 3 1.5 14.5
(2013)
Parong and Mayer 3 2 3 1 3 1.5 13.5
(2018)
Olmos-Raya et al. 3 2 3 0 3 1.5 12.5
(2018)
Akbulut et al. (2018) 2 2 3 0 3 1.5 11.5
Ray and Deb (2016) 3 2 3 0 2 1.5 11.5
Moro et al. (2017) 3 2 3 1 3 1.5 13.5
Maresky et al. (2019) 3 2 3 0 3 1.5 12.5
Madden et al. (2018) 3 2 3 0 3 1.5 12.5
Liou and Chang 3 2 3 0 3 1.5 12.5
(2018)
Molina-Carmona et al. 3 2 3 2 3 1.5 14.5
(2018)
Babu et al. (2018) 3 2 3 0 2 1.5 11.5
Alhalabi (2016) 2 2 3 0 3 1.5 11.5
Gutiérrez-Maldonado 3 2 3 0 3 1.5 12.5
et al. (2015)
Average 2.7 2.0 3.0 0.6 2.9 1.5 12.7

13
J. Comput. Educ.

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and institutional affiliations.

D. Hamilton  is a PhD student in psychology at the University of the West of Scotland. His current
research focuses on the application of immersive virtual-reality technology as a pedagogical method in
higher education.

J. McKechnie  is a Professor of Psychology at the University of the West of Scotland. His research
focuses on national and international aspects of child workers and early experiences of the workplace. As
a founder member of the Child Employment Research Group, his work has included government funded
projects into the nature and extent and policy and practice relating to child employment

E. Edgerton  is a Reader in Psychology at the University of the West of Scotland. He is an experienced

researcher in environmental psychology and has played a leading role in a wide range of environment-
behaviour projects including: environmental design within a psychiatric hospital, the role of the learning
environment in the educational process and dementia friendly design in care homes. He was a Board
member of the International Association of People-environment Studies (IAPS) from 2005 to 2014 and
was President from 2012 until 2014

C. Wilson  is a Lecturer in Psychology at the University of the West of Scotland. Her research interests
lie predominantly within the field of social and educational psychology. Claire is interested in applying
psychological theories most commonly applied in social psychology to educational problems. She has
examined attitudinal and social cognitive predictors of behaviour, automaticity of behaviour, behaviour
change interventions and has used cognitive tests to assess psychological constructs across a range of
contexts including teachers’ inclusive behaviours for children with disabilities, bullying in schools and
parent–child interactions

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