Empathy, the ability to sense, understand, and share the feelings of another, is a cornerstone of compassionate, patient-centered care. In the clinical context, empathy involves both cognitive and affective processes - intellectually grasping the patient’s situation, resonating with their emotions, and communicating that understanding back to the patient [1]. Empathic care has been associated with numerous benefits, including improved patient satisfaction, treatment adherence, clinical outcomes, and lower provider burnout [2-5].

However, research has consistently documented a troubling decline in empathy as students progress through medical training [6,7]. The demands and stressors of medical education, including time pressure, fatigue, and exposure to suffering, can erode students’ empathic capacities [8]. The biomedical focus of curricula and the technological intensity of modern healthcare may also divert attention away from humanistic aspects of care [9]. Counteracting this empathy decline has thus become a key priority for medical educators and institutions.

While many educational strategies have been used to teach empathy, from literature and narrative medicine to patient perspective-taking exercises, the continuing empathy deficit suggests a need for more immersive, experiential approaches [10,11]. Just as flight simulators revolutionized pilot training by providing realistic, embodied practice, virtual reality (VR) technology may hold untapped potential as a tool for empathy education [12].

Virtual reality (VR) refers to interactive, computer-generated environments that dynamically respond to a user’s movements, creating a powerful sense of presence or the feeling of “being there” within the simulated world [13]. What sets VR apart from other forms of multimedia are three defining features. First, immersion, wherein sensory input from the virtual environment replaces real-world stimuli, transporting users to an entirely different setting. Second, interaction, which allows users to engage with and manipulate virtual objects through naturalistic movements, thereby enhancing engagement and realism. Third, imagination, as VR environments are not limited by the physical constraints of the real world, enabling users to experience scenarios that would otherwise be impossible or impractical in real life [14].

In medical and health professions education, VR has been increasingly adopted for clinical skills training, such as practicing surgical techniques, conducting physical exams, or responding to emergency scenarios [15,16]. By providing standardized, low-stakes practice opportunities, VR can supplement traditional training and accelerate skill development. Learners can receive automated feedback, track their progress, and learn at their own pace [17]. VR also overcomes logistical barriers of physical simulation, such as the cost of equipment and facilities [18].

Beyond procedural training, however, VR affords unique potential for what Dyer and colleagues term “socioemotional education” - cultivating empathy, compassion, and interpersonal skills [19]. The immersive quality of VR lends itself to perspective-taking; learners can virtually step into the shoes of patients to viscerally experience their thoughts, feelings, and challenges [20]. For instance, a medical student could see through the eyes of an elderly patient struggling to navigate the hospital, or a nursing trainee could embody a patient receiving a frightening diagnosis. Such virtual experiences may evoke a level of emotional engagement and personal insight difficult to achieve through passive learning methods [21].

A growing number of qualitative studies have begun to explore learner and educator experiences with VR empathy interventions across healthcare disciplines. For example, Kyaw et al. interviewed medical and nursing students who role-played as patients with Alzheimer’s disease in a VR simulation, eliciting themes of heightened empathy and appreciation for the patient’s perspective [22]. Lin et al. analyzed reflective essays from dental students who experienced the journey of a pediatric patient with cleft lip/palate, revealing increased understanding of psychosocial impacts and motivation to provide patient-centered care [23]. Ma et al. conducted focus groups with mental health providers who used VR to simulate auditory hallucinations in schizophrenia, uncovering insights into VR’s capacity to reduce stigma and sharpen empathic listening skills [24].

Despite the burgeoning interest in VR empathy training, the field remains nascent. Most studies to date have been small-scale pilots or single-site initiatives. The comparative effectiveness of VR versus other empathy education approaches is unclear. Technical and logistical barriers to implementing VR at scale, as well as potential unintended consequences such as distress or reinforcement of stereotypes, remain underexplored. A systematic synthesis of the complex, context-dependent experiences and perspectives of VR users is needed to guide thoughtful instructional design and deployment.

This systematic review aims to comprehensively synthesize qualitative evidence on the use of virtual reality (VR) for empathy training in healthcare education. The overarching objective is to understand the feasibility, acceptability, and perceived impact of VR empathy interventions from the first-hand perspectives of learners, educators, and VR developers. Specifically, the review seeks to explore how VR empathy interventions are designed and implemented in healthcare education settings, including their key learning objectives, instructional strategies, and technological features. It will examine how healthcare students and professionals subjectively experience and engage with VR empathy simulations, as well as the factors that promote or hinder immersion and perspective-taking. The review also aims to identify the perceived impacts of these interventions on empathy, attitudes, knowledge, and behaviors, and how they compare to traditional educational approaches. Furthermore, it will investigate the facilitators and barriers to integrating VR empathy training into healthcare curricula from both learner and educator perspectives. Finally, the review will synthesize stakeholder-identified implementation considerations, best practices, and research priorities for advancing the use of VR in empathy training.

By synthesizing granular insights into participant experiences across diverse educational contexts, this review aims to provide an in-depth understanding of how VR empathy interventions work, for whom, and under what circumstances. The findings can inform evidence-based instructional design, professional development for educators, and institutional support for VR initiatives. Uncovering current gaps and challenges can also guide a strategic research agenda to maximize the impact of this emerging educational technology.