Transforming competency development through digital innovation and graduated learning models: the future of dysphagia and tracheostomy tube management training

Purpose of review This narrative review explores evidence- and simulation-based teaching strategies for tracheostomy management (TTM) and dysphagia in adult patients, focusing on immersive technologies and instructional approaches within speech and language education. Recent findings Increasing clinical complexity and multimorbidity demand advanced competencies, yet many high-risk skills cannot be practiced safely in real-world settings. Simulation-based learning environments, including extended reality (XR) technologies such as virtual reality (VR), augmented reality (AR), and mixed reality (MR), provide safe, repeatable, and scalable opportunities for clinical reasoning, psychomotor skill development, and interprofessional communication. Evidence shows that VR-based TTM training improves knowledge acquisition, skill retention, and confidence. Competency-oriented instructional frameworks, including 4C/ID and ADDIE, with structured feedback and debriefing, support staged skill development. However, standardization of clinical workflows, guidelines, and outcome measures remains limited, particularly in speech and language therapy-specific scenarios. Summary XR-based teaching enhances clinical, communication, and interdisciplinary skills in TTM. To fully realize its potential, standardized clinical guidelines, workflows, and evidence-based teaching standards are needed. Integrating VR within structured instructional models ensures pedagogical rigor and safe transfer of learning to clinical practice.