A Mixed-Methods Approach to Extended Reality in Medical Education: Evaluation of VR-Applications and Identifying User-Centered Needs for Auscultation Training

Auscultation is a fundamental diagnostic skill that remains insufficiently addressed in traditional medical education. Extended Reality (XR) offers considerable potential to bridge this gap through immersive and interactive learning environments. However, current Virtual Reality (VR) applications do not yet fully leverage this potential, as they exhibit limitations in didactic structure and feedback mechanisms. This mixed-methods study builds upon quantitatively identified weaknesses by conducting a qualitative needs analysis to determine the specific requirements of medical students for didactically grounded, user-centered, and ergonomically optimized XR learning systems, thereby deriving evidence-based design implications. The overall study design follows the Double Diamond design process (Discover, Define, Develop, Deliver), with the derived design implications validated through a two-tiered process involving both medical students and experienced medical professionals. In the quantitative preliminary study, three VR applications were evaluated across the dimensions of Presence, Perceived Learning, Satisfaction, and Technical Implementation. Building on these findings, qualitative interviews with medical students were conducted to further investigate the underlying causes of the identified shortcomings and to provide deeper insights into user needs. Results: The quantitative analysis showed that the highest-rated application – which performed significantly better in all evaluation dimensions (presence, satisfaction, technical implementation) – nevertheless had considerable shortcomings in terms of perceived learning effectiveness. Based on this quantitative study, which revealed consistent deficits in interactivity, didactic structure, feedback, and gamification across all VR apps examined, the central research question focuses on what user-centered requirements medical students formulate for XR-supported auscultation training systems and how these can be reconciled with the empirically identified weaknesses of existing VR applications. The qualitative requirements analysis identified three key factors for perceived learning success: (1) a guided curriculum with clear learning objectives and levels, (2) multimodal, adaptive feedback (acoustic + visual), and (3) clinical contextualization (e.g., realistic patient positions, vital signs, case examples). Conclusion: The results provide a detailed requirements profile for didactic, user-centered, and ergonomically based XR learning applications. The deduced design implications can serve as a guideline for the development of tools that effectively complement traditional medical education and sustainably improve diagnostic competence, particularly through the implementation of a guided curriculum, multimodal feedback, and contextualization through clinical cases.