Explaining VR/AR Learning in Medical Education: A Comparative PLS-SEM Analysis of TAM, SDT, TTF, and Flow Theory

Authors

DOI:

https://doi.org/10.56294/mw2025799

Keywords:

Virtual reality, Augmented reality, Medical education, Student engagement, Learning outcomes

Abstract

Introduction: Virtual Reality (VR) and Augmented Reality (AR) are increasingly integrated into medical education, offering immersive and interactive environments for safe clinical training. Several theoretical frameworks—Technology Acceptance Model (TAM), Self-Determination Theory (SDT), Task-Technology Fit (TTF), and Flow Theory—can explain technology adoption and learning effectiveness. However, no comprehensive empirical comparison has been conducted within the context of VR/AR-based medical education.

Methods: A cross-sectional survey was conducted with 329 undergraduate medical and health sciences students who had prior experience using VR/AR for learning activities. Validated instruments representing each theoretical framework were employed. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to evaluate reliability, validity, and structural relationships, followed by a comparative assessment using R², Q², f², and path coefficients.

Results: Flow Theory demonstrated the strongest explanatory power (R² up to 0.72), with immersion and engagement as critical predictors of learning outcomes. SDT also showed high predictive strength (R² up to 0.63), emphasizing the role of intrinsic motivation. TTF was effective in predicting task-related learning effectiveness (R² = 0.67), whereas TAM provided only moderate explanatory power (R² ≈ 0.41–0.46).

Conclusions: Flow Theory and SDT offer the most comprehensive explanations of student engagement and learning outcomes in VR/AR medical education. TTF remains valuable for task-specific alignment, while TAM primarily captures initial usability perceptions. Overall, immersive and motivational factors are key drivers of effective VR/AR learning, providing guidance for both theoretical development and instructional design in medical training

References

1. Kassutto SM, Baston C, Clancy C. Virtual, Augmented, and Alternate Reality in Medical Education: Socially Distanced but Fully Immersed. ATS Scholar. 2021;2(4):651–64.

2. Samala AD, Rawas S, Rahmadika S, Criollo-C S, Fikri R, Sandra RP. Virtual reality in education: global trends, challenges, and impacts—game changer or passing trend? Discover Education [Internet]. 2025;4(1):229. Available from: https://doi.org/10.1007/s44217-025-00650-z

3. Yulastri A, Ganefri, Ferdian F, Elfizon, Fiandra YA, Farell G. University Students’ Intentions Toward Entrepreneurial Careers in the Hospitality and Tourism Sector: Empirical Insights From the Techno-Savvy Generation in Higher Education. Journal of Applied Engineering and Technological Science [Internet]. 2025;6(2):1121–34. Available from: http://dx.doi.org/10.37385/jaets.v6i2.6328

4. Tene T, Vique López DF, Valverde Aguirre PE, Orna Puente LM, Vacacela Gomez C. Virtual reality and augmented reality in medical education: an umbrella review. Frontiers in Digital Health. 2024;6:1365345.

5. Dewi IP, Mursyidaa L, Sriwahyuni T, Hidayat N, Soeharto S, Dhanil M, et al. The Use of Augmented Reality in Sensor and Actuator Device Learning: Is It Effective in Enhancing Students’ Conceptual Understanding? International Journal of Information and Education Technology [Internet]. 2025;15(4):858–66. Available from: http://dx.doi.org/10.18178/ijiet.2025.15.4.2292

6. Pantelidis P, Chorti A, Papagiouvanni I, Paparoidamis G, Drosos C, Panagiotakopoulos T, et al. Virtual and Augmented Reality in Medical Education. In: Medical and Surgical Education - Past, Present and Future. InTech; 2018.

7. Gerasimov OI. Bayesian Identifying One or Two Close Sources by Gaussian Estimates of Planar Location under Double Emission. Journal of Sensor Networks and Data Communications. 2025;5(1):01–21.

8. Fussell SG, Truong D. Accepting virtual reality for dynamic learning: an extension of the technology acceptance model. Interactive Learning Environments. 2023;31(9):5442–59.

9. Dewi IP, Ambiyar, Effendi H, Giatman M, Hanafi HF, Ali SK. The Impact of Virtual Reality on Programming Algorithm Courses on Student Learning Outcomes. International Journal of Learning, Teaching and Educational Research [Internet]. 2024;23(10):45–61. Available from: http://dx.doi.org/10.26803/ijlter.23.10.3

10. Prasetya F, Fajri BR, Wulansari RE, Primawati, Fortuna A. Virtual Reality Adventures as an Effort to Improve the Quality of Welding Technology Learning During a Pandemic. International journal of online and biomedical engineering [Internet]. 2023;19(2):4–22. Available from: http://dx.doi.org/10.3991/ijoe.v19i02.35447

11. Jang J, Ko Y, Shin WS, Han I. Augmented Reality and Virtual Reality for Learning: An Examination Using an Extended Technology Acceptance Model. IEEE Access. 2021;9:6798–809.

12. Grewe M, GIE L. Can virtual reality have a positive influence on student engagement? South African Journal of Higher Education. 2023;37(5).

13. Yulastri A, Ganefri, Fiandra YA, Ferdian F, Elfizon. A Systematic Review Looking at Digital Integration in Entrepreneurship Education in Higher Education. Salud, Ciencia y Tecnologia [Internet]. 2025;5. Available from: http://dx.doi.org/10.56294/saludcyt20251864

14. Azzam I, El Breidi K, Breidi F, Mousas C. Virtual Reality in Fluid Power Education: Impact on Students’ Perceived Learning Experience and Engagement. Education Sciences. 2024;14(7):764.

15. Ulfa S, Surahman E, Fatawi I, Tsukasa H. Task-Technology Fit Analysis: Measuring the Factors that influence Behavioural Intention to Use the Online Summary-with Automated Feedback in a MOOCs Platform. Electronic Journal of e-Learning. 2024;22(1):63–77.

16. Al-Rahmi AM, Shamsuddin A, Alismaiel OA. Task-Technology Fit Model: The Factors Affecting Students’ Academic Performance in Higher Education. Universal Journal of Educational Research. 2020;8(12):6831–43.

17. Hsiao KL, Lin KY. Understanding consumers’ purchase intention in virtual reality commerce environment. Journal of Consumer Behaviour. 2023;22(6):1428–42.

18. Kang S. The Effects of Metaverse Service Characteristics on Continuance Use Intention: A Task-Technology Fit Perspective. The Korean Society of Culture and Convergence. 2022;44(10):87–98.

19. Refdinal, Adri J, Prasetya F, Tasrif E, Anwar M. Effectiveness of Using Virtual Reality Media for Students’ Knowledge and Practice Skills in Practical Learning. International Journal on Informatics Visualization [Internet]. 2023;7(3):688–94. Available from: http://dx.doi.org/10.30630/joiv.7.3.2060

20. Wong EY cheung, Hui RT yin, Kong H. Perceived usefulness of, engagement with, and effectiveness of virtual reality environments in learning industrial operations: the moderating role of openness to experience. Virtual Reality. 2023;27(3):2149–65.

21. Bodzin A, Junior RA, Hammond T, Anastasio D. An Immersive Virtual Reality Game Designed to Promote Learning Engagement and Flow. Proceedings of 6th International Conference of the Immersive Learning Research Network, iLRN 2020. IEEE; 2020. p. 193–8.

22. Guerra-Tamez CR. The Impact of Immersion through Virtual Reality in the Learning Experiences of Art and Design Students: The Mediating Effect of the Flow Experience. Education Sciences. 2023;13(2):185.

23. Barrett AJ, Pack A, Quaid ED. Understanding learners’ acceptance of high-immersion virtual reality systems: Insights from confirmatory and exploratory PLS-SEM analyses. Computers and Education. 2021;169(104214):104214.

24. Dhanil M, Mufit F. How Virtual Reality Impacts Science Learning? A Meta-Analysis. International Journal of Interactive Mobile Technologies [Internet]. 2024;18(22):77–96. Available from: http://dx.doi.org/10.3991/ijim.v18i22.49989

25. Hu R, Hui Z, Li Y, Guan J. Research on Learning Concentration Recognition with Multi-Modal Features in Virtual Reality Environments. Sustainability (Switzerland). 2023;15(15):11606.

26. Lønne TF, Karlsen HR, Langvik E, Saksvik-Lehouillier I. The effect of immersion on sense of presence and affect when experiencing an educational scenario in virtual reality: A randomized controlled study. Heliyon. 2023;9(6):e17196.

27. AlAli R, Wardat Y. The Role of Virtual Reality (VR) as a Learning Tool in the Classroom. International Journal of Religion. 2024;5(10):2138–51.

28. Çeken B, Taşkın N. Examination of Multimedia Learning Principles in Augmented Reality and Virtual Reality Learning Environments. Journal of Computer Assisted Learning. 2025;41(1).

29. Hair JF, Hult GTM, Ringle CM, Sarstedt M, Thiele KO. Mirror, mirror on the wall: a comparative evaluation of composite-based structural equation modeling methods. Journal of the Academy of Marketing Science [Internet]. 2017;45(5):616–32. Available from: https://doi.org/10.1007/s11747-017-0517-x

30. Hair JF, Howard MC, Nitzl C. Assessing measurement model quality in PLS-SEM using confirmatory composite analysis. Journal of Business Research [Internet]. 2020;109:101–10. Available from: https://www.sciencedirect.com/science/article/pii/S0148296319307441

31. Hair JF, Risher JJ, Sarstedt M, Ringle CM. When to use and how to report the results of PLS-SEM. European Business Review. 2019;31(1):2–24.

32. Alavi M. Computer-mediated collaborative learning: An empirical evaluation. MIS quarterly. 1994;159–74.

33. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly: Management Information Systems. 1989;13(3):319–39.

34. Fredricks JA, Blumenfeld PC, Paris AH. School engagement: Potential of the concept, state of the evidence. Review of Educational Research. 2004;74(1):59–109.

35. Jennett C, Cox AL, Cairns P, Dhoparee S, Epps A, Tijs T, et al. Measuring and defining the experience of immersion in games. International Journal of Human Computer Studies [Internet]. 2008;66(9):641–61. Available from: http://dx.doi.org/10.1016/j.ijhcs.2008.04.004

36. Goodhue DL, Thompson RL. Task-technology fit and individual performance. MIS Quarterly: Management Information Systems [Internet]. 1995;19(2):213–33. Available from: http://dx.doi.org/10.2307/249689

37. Beck LA. Csikszentmihalyi, Mihaly. (1990). Flow: The Psychology of Optimal Experience . Journal of Leisure Research [Internet]. 1992;24(1):93–4. Available from: http://dx.doi.org/10.1080/00222216.1992.11969876

38. Fiandra YA, Yulastri A, Ganefri, Sakti RH. The Impact of Work Experience on Entrepreneurial Intention Among Vocational Education Students. Journal of Technical Education and Training. 2023;15(4):37–49.

39. Zhang D, Huang A, Lei Y, Liu H, Yang L, Wang C, et al. Nursing students’ experiences and perceptions regarding in-class flipped classroom: a mixed-methods study. BMC Medical Education. 2025;25(1):675.

40. Radianti J, Majchrzak TA, Fromm J, Wohlgenannt I. A systematic review of immersive virtual reality applications for higher education: Design elements, lessons learned, and research agenda. Computers and Education. 2020;147:103778.

41. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist. 2000;55(1):68–78.

42. Sailer M, Homner L. The gamification of learning: A meta-analysis. Educational psychology review [Internet]. 2020;32(1):77–112. Available from: http://dx.doi.org/

43. Meyer OA, Omdahl MK, Makransky G. Investigating the effect of pre-training when learning through immersive virtual reality and video: A media and methods experiment. Computers and Education. 2019;140:103603.

44. Barsom EZ, Graafland M, Schijven MP. Systematic review on the effectiveness of augmented reality applications in medical training. Surgical Endoscopy [Internet]. 2016;30(10):4174–83. Available from: http://dx.doi.org/10.1007/s00464-016-4800-6

45. Wulansari RE, Fortuna A, Marta R, Primawati P, Masek A, Kaya D, et al. Revolutionizing Learning: Unleashing the Power of Technology Gamification-Augmented Reality in Vocational Education. TEM Journal [Internet]. 2024;13(3):2384–97. Available from: http://dx.doi.org/10.18421/TEM133-65

46. Šumak B, Pušnik M, Heričko M, Šorgo A. Differences between prospective, existing, and former users of interactive whiteboards on external factors affecting their adoption, usage and abandonment. Computers in Human Behavior [Internet]. 2017;72:733–56. Available from: http://dx.doi.org/10.1016/j.chb.2016.09.006

47. King WR, He J. A meta-analysis of the Technology Acceptance Model A meta-analysis of the technology acceptance model. Journal of Information Management. 2018;43(September 2006):740–55.

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Published

2025-09-25

How to Cite

1.
Parma Dewi I, Aditya Fiandra Y, Fadillah R, Marta R, Rosalina L, Azima Noordin N, et al. Explaining VR/AR Learning in Medical Education: A Comparative PLS-SEM Analysis of TAM, SDT, TTF, and Flow Theory. Seminars in Medical Writing and Education [Internet]. 2025 Sep. 25 [cited 2025 Oct. 11];4:799. Available from: https://mw.ageditor.ar/index.php/mw/article/view/799