Table 6 Distribution of technical, didactical and organisational requirements reported by reviews. Linked to RQ4.

 Respective hardware

69

All included reviews

 Sensory feedback (especially haptic)

5

[29, 38, 46, 105, 108]

 Appropriate amount of realism (e.g., precise contextual factors (sizes, sounds, functionalities of instruments in OR)

4

[11, 29, 37, 38]

 Facilitating installation and operation (shared VR training facilities, availability on mobile devices, shared single specific platform for assessment to avoid continuous training of developers and learners)

4

[36, 48, 61, 105]

 Accurate tissue interaction (difficult with current technology)

3

[37, 38, 40]

 IT skills / assistance

2

[92, 105]

 Gamification

1

[84]

 Converting real patient data

1

[29]

DIDACTICAL REQUIREMENTS

 Structured curricula (incl. skill-based instruction, clear learning objectives as part of larger curricular goals, gap analysis [which skills are not adequately addressed] before early integration)

15

[3, 29, 35, 41, 42, 84, 96,97,98, 100, 103, 106, 110, 111, 113]

 Mastery learning

4

[77, 102, 103, 113]

 Deliberate practice / Self-regulated learning / Possibility to make mistakes

3

[77, 103, 113]

 Mandatory involvement

2

[41, 96]

 Educational training

2

[92, 105]

 Progressive learning curriculum and variation of complexity

2

[84, 113]

 Feedback by instructor

2

[37, 98]

 Evaluation feedback by virtual trainer (tutor mode), automatically generated evaluation feedback

2

[29, 108]

 Focus on clinical care incl. crisis management, teamwork, communication + problem-based learning

2

[89, 103]

 Accompany cognitive material (video/reading…)

2

[35, 98]

 High risk & low volume scenarios

1

[113]

 Automated evaluation process

1

[59]

 Reliable and validated assessment tools

1

[110]

ORGANISATIONAL REQUIREMENTS

 Validation programs (usability, transfer, construct, concurrent, performance metrics)

5

[3, 29, 35, 105, 108]

 Cost-effectiveness

3

[30, 36, 46]

 Adequate time for training to avoid cognitive overload

2

[64, 110]

 VR as supplemental resource

2

[47, 100]

 User-centred design

1

[105]

 Comprehensive manual

1

[105]

 Interdisciplinary team for development

1

[105]