{"id":"https://openalex.org/W7213437332","doi":"https://doi.org/10.64898/2026.09.15.26363133","title":"Delayed Retention of Technical Surgical Skills Following Virtual, Augmented, and Mixed-Reality Simulation: A Systematic Review and Meta-analysis","display_name":"Delayed Retention of Technical Surgical Skills Following Virtual, Augmented, and Mixed-Reality Simulation: A Systematic Review and Meta-analysis","publication_year":2026,"publication_date":"2026-09-16","ids":{"openalex":"https://openalex.org/W7213437332","doi":"https://doi.org/10.64898/2026.09.15.26363133"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.15.26363133","doi":"https://doi.org/10.64898/2026.09.15.26363133","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.15.26363133","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/16/2026.09.15.26363133.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/16/2026.09.15.26363133.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5116071460","display_name":"Faraz Shamim","orcid":"https://orcid.org/0009-0007-2674-4269","observed_orcids":["https://orcid.org/0009-0007-2674-4269"]},"institutions":[{"id":"https://openalex.org/I4210154879","display_name":"KIST Medical College","ror":"https://ror.org/04zz3m093","country_code":"NP","type":"education","lineage":["https://openalex.org/I4210154879"]}],"countries":["NP"],"is_corresponding":true,"raw_author_name":"Faraz Shamim","raw_affiliation_strings":["KIST Medical College and Teaching Hospital"],"raw_orcid":"https://orcid.org/0009-0007-2674-4269","affiliations":[{"raw_affiliation_string":"KIST Medical College and Teaching Hospital","institution_ids":["https://openalex.org/I4210154879"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5151894042","display_name":"Raziya Akhtar Hussain","orcid":"https://orcid.org/0009-0000-5540-4684","observed_orcids":["https://orcid.org/0009-0000-5540-4684"]},"institutions":[{"id":"https://openalex.org/I4210154879","display_name":"KIST Medical College","ror":"https://ror.org/04zz3m093","country_code":"NP","type":"education","lineage":["https://openalex.org/I4210154879"]}],"countries":["NP"],"is_corresponding":false,"raw_author_name":"Raziya Akhtar Hussain","raw_affiliation_strings":["KIST Medical College and Teaching Hospital"],"raw_orcid":"https://orcid.org/0009-0000-5540-4684","affiliations":[{"raw_affiliation_string":"KIST Medical College and Teaching Hospital","institution_ids":["https://openalex.org/I4210154879"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5116071460"],"corresponding_institution_ids":["https://openalex.org/I4210154879"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10916","display_name":"Surgical Simulation and Training","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10916","display_name":"Surgical Simulation and Training","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11238","display_name":"Simulation-Based Education in Healthcare","score":0.0005000000237487257,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/extended-reality","display_name":"extended reality","score":0.5099999904632568},{"id":"https://openalex.org/keywords/virtual-reality","display_name":"virtual reality","score":0.7990000247955322},{"id":"https://openalex.org/keywords/augmented-reality","display_name":"augmented reality","score":0.9959999918937683},{"id":"https://openalex.org/keywords/mixed-reality","display_name":"mixed reality","score":0.9919999837875366},{"id":"https://openalex.org/keywords/surgical-skills-training","display_name":"surgical skills training","score":0.7080000042915344},{"id":"https://openalex.org/keywords/skill-retention","display_name":"skill retention","score":0.8999999761581421},{"id":"https://openalex.org/keywords/reacquisition","display_name":"reacquisition","score":0.8019999861717224},{"id":"https://openalex.org/keywords/surgical-simulation","display_name":"surgical simulation","score":0.48500001430511475},{"id":"https://openalex.org/keywords/transfer-of-learning","display_name":"transfer of learning","score":0.5320000052452087}],"concepts":[{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.7071999907493591},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6805999875068665},{"id":"https://openalex.org/C168563851","wikidata":"https://www.wikidata.org/wiki/Q1436668","display_name":"Randomized controlled trial","level":2,"score":0.5001999735832214},{"id":"https://openalex.org/C2776916960","wikidata":"https://www.wikidata.org/wiki/Q637156","display_name":"Warrant","level":2,"score":0.42410001158714294},{"id":"https://openalex.org/C203092338","wikidata":"https://www.wikidata.org/wiki/Q1340863","display_name":"Clinical endpoint","level":3,"score":0.4043999910354614},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.37389999628067017},{"id":"https://openalex.org/C95190672","wikidata":"https://www.wikidata.org/wiki/Q815382","display_name":"Meta-analysis","level":2,"score":0.3619999885559082},{"id":"https://openalex.org/C168743327","wikidata":"https://www.wikidata.org/wiki/Q1826427","display_name":"Random effects model","level":3,"score":0.3440000116825104},{"id":"https://openalex.org/C7493553","wikidata":"https://www.wikidata.org/wiki/Q1520777","display_name":"Certainty","level":2,"score":0.3174999952316284},{"id":"https://openalex.org/C2778067643","wikidata":"https://www.wikidata.org/wiki/Q166507","display_name":"Interval (graph theory)","level":2,"score":0.31459999084472656},{"id":"https://openalex.org/C148220186","wikidata":"https://www.wikidata.org/wiki/Q7111912","display_name":"Outcome (game theory)","level":2,"score":0.30469998717308044},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.3012999892234802},{"id":"https://openalex.org/C41426520","wikidata":"https://www.wikidata.org/wiki/Q1192065","display_name":"Point estimation","level":2,"score":0.3003999888896942},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.2856999933719635},{"id":"https://openalex.org/C19648533","wikidata":"https://www.wikidata.org/wiki/Q691640","display_name":"Evidence-based medicine","level":3,"score":0.27950000762939453},{"id":"https://openalex.org/C82789193","wikidata":"https://www.wikidata.org/wiki/Q2142611","display_name":"Relative risk","level":3,"score":0.27619999647140503},{"id":"https://openalex.org/C28804328","wikidata":"https://www.wikidata.org/wiki/Q7623693","display_name":"Strictly standardized mean difference","level":3,"score":0.2711000144481659},{"id":"https://openalex.org/C105054674","wikidata":"https://www.wikidata.org/wiki/Q3707381","display_name":"Mean difference","level":3,"score":0.26759999990463257},{"id":"https://openalex.org/C2778111679","wikidata":"https://www.wikidata.org/wiki/Q5155639","display_name":"Comparative effectiveness research","level":3,"score":0.2646999955177307},{"id":"https://openalex.org/C2779318504","wikidata":"https://www.wikidata.org/wiki/Q1438035","display_name":"Research design","level":2,"score":0.2563000023365021},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.250900000333786}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.15.26363133","doi":"https://doi.org/10.64898/2026.09.15.26363133","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.15.26363133","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/16/2026.09.15.26363133.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.15.26363133","doi":"https://doi.org/10.64898/2026.09.15.26363133","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.15.26363133","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/16/2026.09.15.26363133.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"score":0.8048999905586243,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"},{"score":0.5385000109672546,"display_name":"Quality education","id":"https://metadata.un.org/sdg/4"}],"study_designs":[{"display_name":"Systematic Review","id":"https://openalex.org/study-designs/systematic-review"},{"display_name":"Meta-Analysis","id":"https://openalex.org/study-designs/meta-analysis"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7213437332.pdf","grobid_xml":"https://content.openalex.org/works/W7213437332.grobid-xml"},"referenced_works_count":44,"referenced_works":["https://openalex.org/W1251689921","https://openalex.org/W1524922436","https://openalex.org/W1968302100","https://openalex.org/W1968433787","https://openalex.org/W1969241382","https://openalex.org/W1980975738","https://openalex.org/W1984332107","https://openalex.org/W1991476457","https://openalex.org/W1993630761","https://openalex.org/W2004374507","https://openalex.org/W2018700848","https://openalex.org/W2027421362","https://openalex.org/W2049923124","https://openalex.org/W2075057776","https://openalex.org/W2077216925","https://openalex.org/W2077522719","https://openalex.org/W2104675861","https://openalex.org/W2113536117","https://openalex.org/W2142649304","https://openalex.org/W2161448088","https://openalex.org/W2162740361","https://openalex.org/W2199614199","https://openalex.org/W2252417439","https://openalex.org/W2324130177","https://openalex.org/W2342513260","https://openalex.org/W2689842576","https://openalex.org/W2746695018","https://openalex.org/W2753529102","https://openalex.org/W2765146640","https://openalex.org/W2787251070","https://openalex.org/W2973213097","https://openalex.org/W2999614510","https://openalex.org/W3004632017","https://openalex.org/W3005128048","https://openalex.org/W3082211171","https://openalex.org/W3088691906","https://openalex.org/W3091091286","https://openalex.org/W3118615836","https://openalex.org/W3153493693","https://openalex.org/W3209491030","https://openalex.org/W4324018360","https://openalex.org/W4387354460","https://openalex.org/W4391036170","https://openalex.org/W4400907721"],"related_works":["https://openalex.org/W7213909241","https://openalex.org/W7214445825","https://openalex.org/W2113536117","https://openalex.org/W4386192576","https://openalex.org/W2342513260","https://openalex.org/W7204063165","https://openalex.org/W7169786180","https://openalex.org/W7172380042","https://openalex.org/W2018700848","https://openalex.org/W4407808440"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Extended-reality":[2],"simulation":[3,221],"is":[4],"widely":[5],"used":[6,70],"for":[7,76,197],"technical":[8,77,217],"surgical":[9,66],"training,":[10,78],"yet":[11],"immediate":[12],"gains":[13],"do":[14],"not":[15,232],"establish":[16],"that":[17],"skills":[18],"persist":[19],"once":[20],"practice":[21],"stops.":[22],"Objective":[23],"To":[24],"characterize":[25],"delayed":[26,45],"technical-skill":[27],"outcomes":[28],"after":[29,219],"virtual,":[30,71],"augmented,":[31,72],"or":[32,68,73,213,236],"mixed-reality":[33],"training":[34],"and":[35,53,79,94,244,249],"estimate":[36,182,254],"the":[37,41,171,180,184,198,228],"comparative":[38,229],"effect":[39,155,185],"at":[40,83],"first":[42],"eligible":[43],"uncontaminated":[44],"assessment.":[46],"Methods":[47],"PubMed/MEDLINE,":[48],"Europe":[49],"PMC,":[50],"CENTRAL,":[51],"ERIC,":[52],"ClinicalTrials.gov":[54],"were":[55,107,126,142,151,222],"searched":[56],"from":[57,92,139,251],"inception":[58],"through":[59],"May":[60],"5,":[61],"2026.":[62],"Eligible":[63],"studies":[64,133,145],"enrolled":[65],"learners":[67],"practitioners,":[69],"mixed":[74],"reality":[75],"measured":[80],"objective":[81],"performance":[82],"least":[84],"seven":[85],"days":[86,212],"later.":[87],"Pure":[88],"retention":[89,238],"was":[90,102,156,175,201],"distinguished":[91],"maintenance":[93],"reacquisition.":[95],"One":[96],"endpoint":[97],"per":[98],"independent":[99],"study":[100,206],"family":[101],"selected.":[103],"Standardized":[104],"mean":[105],"differences":[106],"expressed":[108],"as":[109],"Hedges\u2019":[110],"g,":[111],"oriented":[112],"so":[113],"positive":[114],"values":[115],"favored":[116],"extended":[117],"reality.":[118],"Paule-Mandel":[119],"random":[120],"effects":[121],"with":[122],"Hartung-Knapp":[123],"confidence":[124],"intervals":[125],"primary.":[127],"Results":[128],"Thirty-four":[129],"reports":[130],"representing":[131],"33":[132],"(1,186":[134],"participants;":[135],"21":[136],"randomized":[137],"trials)":[138],"12":[140],"countries":[141],"included.":[143],"Six":[144],"(162":[146],"participants":[147],"in":[148,224],"selected":[149],"arms)":[150],"pooled.":[152],"The":[153],"summary":[154],"g":[157,187],"=":[158,166,169,188],"1.39":[159],"(95%":[160,190],"CI":[161,191],"-0.94":[162],"to":[163,177,186,193],"3.72;":[164],"I\u00b2":[165],"88.0%;":[167],"\u03c4\u00b2":[168],"4.53);":[170],"95%":[172],"prediction":[173],"interval":[174,209],"-5.04":[176],"7.81.":[178],"Excluding":[179],"figure-derived":[181,253],"reduced":[183],"0.61":[189],"-0.76":[192],"1.99).":[194],"GRADE":[195],"certainty":[196],"primary":[199],"outcome":[200],"very":[202],"low.":[203],"No":[204],"pooled":[205],"assessed":[207],"an":[208],"of":[210],"90":[211],"longer.":[214],"Conclusions":[215],"Delayed":[216],"advantages":[218],"extended-reality":[220],"observed":[223],"some":[225],"settings,":[226],"but":[227],"evidence":[230],"does":[231],"define":[233],"a":[234],"precise":[235],"generalizable":[237],"effect.":[239],"Substantial":[240],"heterogeneity,":[241],"sparse":[242],"transfer":[243],"longer-term":[245],"evidence,":[246],"comparator":[247],"differences,":[248],"influence":[250],"one":[252],"warrant":[255],"cautious":[256],"interpretation.":[257]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-09-17T00:00:00"}