Training built by those who've been there, for those who will be. Every training scenario is crafted by emergency medical professionals or combat medics - for emergency medical professionals and combat medics.
Battle-Tested by Those Who Serve: The Exonicus Simulator is a trusted training solution for the U.S. Department of Defense, NATO forces, and Ukrainian military personnel - deployed where training excellence matters most.
Real-World Impact at the Frontline: Our platform is actively training medics near the Ukrainian frontline, delivering life-saving skills where seconds count and precision saves lives.
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Immersive virtual reality (VR) is transforming trauma and emergency medical training, offering a scalable, cost-effective, and highly engaging alternative to traditional mannequin-based simulation. The Exonicus VR Trauma Simulator stands at the forefront of this innovation, with its effectiveness and usability validated in multiple peer-reviewed studies and extensive pilot testing.
1. Randomized Controlled Noninferiority Trial (2024, Military Medicine)
A single-center randomized controlled trial directly compared the Exonicus immersive VR Trauma Simulator to conventional mannequin-based simulation (MBS) for trauma resuscitation training. The results demonstrated that VR-based training was non-inferior to MBS for trauma resuscitation performance (mean Trauma Score: 163.2 for MBS vs. 163.1 for VR). Notably, VR-trained participants outperformed the MBS group when assessed in the VR environment, suggesting potential advantages in skill transfer and retention. The Exonicus platform also received high usability ratings (mean System Usability Scale 74.4) and minimal adverse effects (median Simulation Sickness score 3.7).
Lange M, Bērziņš A, Whitfill T, et al. Immersive Virtual Reality Versus Mannequin-Based Simulation Training for Trauma Resuscitation: A Randomized Controlled Noninferiority Trial. Military Medicine. 2025;190(5-6):e1216-e1223. doi:10.1093/milmed/usae510.
2. Feasibility and User Acceptance Study (2022, Frontiers in Virtual Reality)
This study evaluated the Ready Medic One VR trauma simulator, powered by Exonicus, in a real-world clinical setting. Participants across all emergency department roles reported high realism, strong support for VR integration into training, and a preference for VR over traditional methods - especially among younger, tech-savvy clinicians. The solution enabled hands-on, immersive trauma care practice without the need for costly equipment or dedicated faculty, paving the way for scalable, next-generation medical education.
Lombardo R, Walther N, Young S, et al. Ready Medic One: A Feasibility Study of a Semi-Autonomous Virtual Reality Trauma Simulator. Frontiers in Virtual Reality. 2022;2:719656. doi:10.3389/frvir.2021.719656.
3. Autonomous Trauma Training Platform Development (2020, Cureus)
Exonicus’ autonomous VR trauma training platform was developed in collaboration with military and emergency medicine experts. The system delivers dynamic, real-time feedback and grading, simulating high-stakes battlefield injuries. Its portability, realism, and scalability make it a game-changer for medical readiness, offering a template for future autonomous VR training solutions.
Couperus K, Young S, Walsh R, et al. Immersive Virtual Reality Medical Simulation: Autonomous Trauma Training Simulator. Cureus. 2020;12(5):e8062. doi: 10.7759/cureus.8062
4. NATO Science and Technology Organization study (2024)
A comprehensive NATO Science and Technology Organization study (STO-TR-MSG-HFM-220) analyzed extended reality technologies (which included the Exonicus Technology Stack) for military medical training, reviewing 52 evidence-based studies. The findings revealed: 96% of XR-based training delivered equal or superior outcomes compared to traditional methods.
Key NATO findings supporting XR technology:
-Enhanced safety through risk-free practice of high-stakes procedures
-Superior trainee engagement, retention, and performance under pressure
-Proven cost-effectiveness and scalability
-92% of military medical professionals endorse XR for advanced field hospitals and all NATO medical roles
Broader Evidence for Immersive Medical Training
Immersive technologies - including augmented reality (AR), virtual reality (VR), extended reality (XR), and mixed reality (MR) - are revolutionizing medical education by providing highly realistic, interactive, and scalable training environments, particularly for emergency medicine. These platforms enable learners to practice critical decision-making and procedural skills in lifelike scenarios, improving confidence, teamwork, and clinical performance while reducing errors and enhancing retention.
The effectiveness of these immersive approaches is supported by a growing body of high-impact research demonstrating significant advantages over traditional training methods:
Empower your learners with immersive technology - proven to elevate emergency medical training, boost clinical performance, and prepare future clinicians for the demands of real-world emergencies.
1. Immersive Medical Training: A Comprehensive Longitudinal Study of Extended Reality in Emergency Scenarios for Large Student Groups. Einloft J, Meyer HL, Bedenbender S, et al. BMC Medical Education. 2024;24(1):978. doi:10.1186/s12909-024-05957-3.
2. Knowledge Gain and the Impact of Stress in a Fully Immersive Virtual Reality-Based Medical Emergencies Training With Automated Feedback: Randomized Controlled Trial. Lindner M, Leutritz T, Backhaus J, König S, Mühling T. Journal of Medical Internet Research. 2025;27:e67412. doi:10.2196/67412.
3. Virtual Reality as an Engaging and Enjoyable Method for Delivering Emergency Clinical Simulation Training: A Prospective, Interventional Study of Medical Undergraduates. Walls R, Nageswaran P, Cowell A, et al. BMC Medicine. 2024;22(1):222. doi:10.1186/s12916-024-03433-9.
4. A Study on the Impact of Open Source Metaverse Immersive Teaching Method on Emergency Skills Training for Medical Undergraduate Students. Huang H, Yin J, Lv F, Lin Y, Zou J. BMC Medical Education. 2024;24(1):859. doi:10.1186/s12909-024-05862-9.
The organizations below represent the forefront of immersive technology adoption in medical education, with programs ranging from training dozens to thousands of healthcare professionals annually.
1. U.S. Department of Veterans Affairs (VA) - VA Immersive
Scale: Over 3,500 VR headsets deployed across 170+ VA medical centers and outpatient clinics in all 50 U.S. states, Puerto Rico, Guam, and American Samoa, serving over 9.1 million enrolled Veterans.
Project Overview: VA Immersive represents the nation's largest clinical implementation of immersive technology in healthcare. The program uses virtual reality to transform patient care, medical education, and staff training. VR applications include chronic pain management (showing 28% improvement in patient outcomes), physical rehabilitation, balance therapy for traumatic brain injury patients, and PTSD treatment. The VA has also developed custom VR content for training clinicians and staff across various medical scenarios, making standardized training accessible to healthcare workers at facilities of all resource levels.
How They're Using It: The VA employs VR headsets for both patient treatment and professional training. For patients, immersive environments help manage chronic pain, improve balance issues from brain injuries, and provide therapeutic interventions. For training purposes, the VA creates immersive educational platforms and simulation scenarios that allow medical professionals to practice clinical skills in safe, repeatable virtual environments.
Citation: VA Immersive. "VA Immersive | Defining a New Reality in Health Care." U.S. Department of Veterans Affairs, Office of Healthcare Innovation and Learning. https://www.innovation.va.gov/hil/views/immersive/immersive.html
2. Stanford Medicine - Neurosurgical Simulation Lab
Scale: Training residents, surgeons, and medical students at one of the nation's leading academic medical centers.
Project Overview: Stanford Medicine has implemented a sophisticated virtual reality system developed by Surgical Theater that combines imaging from MRIs, CT scans, and angiograms to create three-dimensional models of patient anatomy. The system serves three primary purposes: training residents in complex neurosurgical procedures, assisting surgeons in planning upcoming operations on actual patient anatomy, and educating patients about their conditions and surgical procedures. The VR system allows surgeons to practice operations beforehand using the specific patient's brain anatomy, identifying potential complications that wouldn't be visible on conventional 2D imaging.
How They're Using It: Residents and surgeons don VR headsets in the Neurosurgical Simulation Lab to navigate through patient-specific 3D brain models. Instructors can guide trainees through procedures like aneurysm repair and tumor removal while highlighting different anatomical structures. During actual surgeries, surgeons superimpose the 3D VR rendering onto real-time surgical microscope video feeds, providing enhanced visualization that traditional imaging cannot match.
Citation: Stanford Medicine. "Virtual reality system helps surgeons, reassures patients." Stanford Medical Giving News. https://med.stanford.edu/medicalgiving/news/virtual-reality-system-helps-surgeons-reassures-patients.html
3. Johns Hopkins University - Biomedical Engineering VR Training
Scale: Training fellows and medical students across multiple specialties at one of the world's premier medical institutions.
Project Overview: Johns Hopkins has developed VR simulation systems to provide risk-free environments for practicing high-stakes surgical procedures. The VR training platform allows trainees to practice rare surgical procedures that they may not encounter frequently during traditional apprenticeship training. The program is particularly focused on procedural skills where unlimited repetition in a low-risk environment can significantly boost trainee confidence and minimize surgical errors when they eventually treat real patients. Johns Hopkins School of Nursing has also implemented VR training at all educational levels, from doctoral to pre-licensure nursing programs.
How They're Using It: Students and fellows use VR headsets with handheld devices providing tactile feedback to perform virtual surgical simulations. The immersive environment replicates specific surgeries that physicians are about to perform, allowing unlimited practice without patient risk. The technology enables trainees to develop muscle memory and procedural confidence before ever entering an operating room with a real patient.
Citation: Johns Hopkins Biomedical Engineering. "VR Training." Johns Hopkins University. https://www.bme.jhu.edu/hello-world/vr-training/
4. Cleveland Clinic - Simulation and Advanced Skills Center
Scale: Multi-site training program across Cleveland Clinic's extensive healthcare system.
Project Overview: Cleveland Clinic launched its VR training program in 2022 to standardize medical education across all facilities. The program uses virtual reality to create consistent, high-fidelity clinical scenarios accessible to learners regardless of their physical location. The VR platform provides fully immersive 360-degree environments, such as complete operating room simulations, which feel more realistic to learners than traditional manikin-based training. The program is particularly effective for team training, decision-making scenarios, and communication exercises, though the institution notes that VR is best suited for specific specialized scenarios rather than all types of medical training.
How They're Using It: Learners at multiple Cleveland Clinic sites simultaneously participate in the same VR mock scenarios, such as code simulations, wearing VR headsets that immerse them in realistic clinical environments. The technology allows standardized training experiences across low-resource and well-equipped facilities alike, with learners reporting feeling more anonymous and less self-conscious than in traditional observed simulations.
Citation: Brown, N., Rinard, J., Feliciano, M., & Washock, M. (2023). "Pilot Project Reveals Opportunities and Challenges of Virtual Reality." Cleveland Clinic Consult QD. https://consultqd.clevelandclinic.org/pilot-project-reveals-opportunities-and-challenges-of-virtual-reality
5. Columbia University Medical Center - Clinical Innovation Lab VR Ultrasound Training
Scale: Training medical students, residents, and healthcare professionals at Columbia University Irving Medical Center with plans for wider dissemination.
Project Overview: Columbia's Clinical Innovation Lab has developed a groundbreaking VR ultrasound training system for teaching ultrasound-guided procedures, starting with central line placement. Created through collaboration between anesthesiologists, emergency medicine physicians, and computer scientists from Columbia's Computer Graphics and User Interfaces Lab, the system addresses the accessibility problem of expensive simulation centers. The VR training platform allows trainees to practice ultrasound-guided needle insertion with realistic hand-eye coordination challenges in an immersive virtual environment. The team is expanding the platform to other ultrasound-guided procedures, including nerve blocks for pain management.
How They're Using It: Trainees wear VR headsets and pick up physical ultrasound probes to practice scanning and inserting central lines into virtual patients. The system provides realistic ultrasound imagery and allows learners to develop the finesse and extraordinary hand-eye coordination required for these procedures. The virtual training can be deployed anywhere, making high-quality simulation accessible to healthcare workers who lack access to expensive physical simulation centers.
Citation: Columbia University Irving Medical Center. (2022). "Virtual Reality Training for Doctors Made Real by Columbia's Clinical Innovation Lab." Columbia University. https://www.cuimc.columbia.edu/news/virtual-reality-training-doctors-made-real-columbias-clinical-innovation-lab
6. USC Institute for Creative Technologies - Medical Virtual Reality Group
Scale: Research and development serving clinical populations with applications used nationally.
Project Overview: USC's Medical Virtual Reality group conducts cutting-edge research on designing, developing, and evaluating VR and AR systems for clinical assessment, treatment, and rehabilitation. Their work spans psychological, cognitive, and motor functioning in both healthy and clinical populations. Their most notable project, BRAVEMIND, is a VR exposure therapy system for treating PTSD in military veterans and active-duty service members. The system has demonstrated significant success in clinical trials, helping soldiers who suffer from combat-related PTSD by allowing them to safely confront and reprocess traumatic emotional memories, repairing damage to neural networks.
How They're Using It: The Medical VR group creates immersive simulations that recreate clinical scenarios and therapeutic environments. For BRAVEMIND, veterans wear VR headsets that immerse them in controlled combat-related environments, allowing clinicians to conduct exposure therapy in a safe, adjustable virtual setting. The research explores how interactive and immersive VR/AR simulations can address human healthcare needs beyond what's possible with traditional therapeutic tools.
Citation: USC Institute for Creative Technologies. "Medical Virtual Reality." University of Southern California. https://ict.usc.edu/research/labs-groups/medical-virtual-reality/
7. National Health Service (NHS) - UK National VR Training Initiative
Scale: Multi-million pound initiative training healthcare professionals across England, with one program training 17,000+ learners during COVID-19.
Project Overview: The NHS has implemented multiple VR training initiatives, including a £4.3 million government-funded program and partnerships with Oxford Medical Simulation. During the COVID-19 pandemic, over 50 NHS institutions with more than 17,000 learners signed up to use VR training platforms. Programs include immersive VR training for understanding patient conditions, fire safety training for 1.3 million NHS workers, mental health crisis simulation training, and mandatory training modules. The NHS East of England developed VR training that allows staff to experience life from a patient's perspective, improving empathy and care quality.
How They're Using It: NHS staff use VR headsets to practice clinical scenarios, from basic patient interactions to complex emergency responses. The VR simulations replicate NHS facilities and equipment, providing sustainable, realistic, and space-unlimited training environments. One notable application is the UK's first augmented reality mental health crisis training simulator for student nurses, teaching them to recognize when patients need additional support.
Citations:
8. Children's Hospital Los Angeles (CHLA) - Las Madrinas Simulation Center
Scale: Training pediatric healthcare professionals with partnerships expanding VR programs to 11 additional healthcare institutions.
Project Overview: CHLA has partnered with Meta (formerly Oculus) to develop and expand VR medical training programs focused on pediatric care. The hospital's Las Madrinas Simulation Center utilizes high-fidelity mannequins, virtual reality, and standardized patients to deliver immersive training experiences. CHLA developed VR simulations for rare pediatric emergency scenarios, allowing medical students and staff to practice responses to high-acuity events they might encounter only once or twice in their careers. The hospital has also pioneered the use of VR as a therapeutic tool for pediatric patients, reducing pain and anxiety during medical procedures.
How They're Using It: CHLA deployed Oculus Go headsets with custom VR simulations to healthcare providers across multiple institutions. Trainees practice responding to rare pediatric emergencies in fully immersive virtual environments. The hospital is one of the only institutions in the nation with a dedicated VR technologist position in its Interventional Radiology team, using virtual reality to transform minimally invasive procedures for both training clinicians and preparing patients.
Citations:
9. Mass General Brigham - AR/VR RAD Lab
Scale: Training nurses and clinicians across the Mass General Brigham healthcare system, which includes multiple hospitals in the Boston area.
Project Overview: Mass General Brigham has established an AR/VR Radiology Research and Development Lab exploring the integration of augmented and virtual reality tools in both training and clinical settings. The institution has developed a VR tool specifically for training clinicians on infection control concepts, teaching proper handling of portable medical equipment to prevent contamination. The immersive aspect of XR technologies enables experiential learning that traditional methods cannot replicate. The hospital system is also using augmented reality to train nurses and exploring AR applications for surgical planning and patient education.
How They're Using It: Clinicians use VR headsets to practice infection control protocols in realistic virtual hospital environments. The AR/VR tools provide hands-on training for scenarios where real-world practice would pose contamination risks. Augmented reality systems are being tested for overlaying patient imaging data during procedures and for training healthcare workers on complex equipment and protocols.
Citations:
10. UCLA Medical Simulation Center
Scale: Training medical students, residents, and healthcare professionals at UCLA Health.
Project Overview: UCLA's Simulation Center is exploring cutting-edge technologies including virtual reality, augmented reality, mixed reality, machine learning, and artificial intelligence to enhance medical training. The center utilizes virtual simulators as hardware and software tools that recreate a variety of clinical experiences for training both soft and hard skills. UCLA researchers are also conducting studies on VR training's effectiveness for mental health applications and clinical symptom management. The Extended Reality (XR) initiatives at UCLA span across the university's research applications, including architectural reconstructions of medical environments and immersive performance training.
How They're Using It: UCLA medical trainees use virtual simulators to practice clinical procedures and decision-making in realistic digital environments. The VR systems allow learners to experience various clinical scenarios without patient risk, developing both technical skills and clinical judgment. Research teams are actively studying how different VR training programs affect clinical outcomes and symptom management.
Citations:
11. University of Michigan - Medical and Surgical Extended Reality Initiative
Scale: Over 50 faculty, residents, and medical students participating across multiple Michigan Medicine departments.
Project Overview: University of Michigan launched the Medical and Surgical Extended Reality Initiative, utilizing augmented reality and mixed reality for medical education and clinical applications. A flagship project is Mi-VEST (Michigan Virtual Examination for Skills Training), an augmented reality tool that teaches learners how to perform diabetic foot examinations. The initiative has expanded to include mixed reality international grand rounds, allowing global participation in immersive surgical education experiences. The university's focus is bringing AR, VR, and MR technologies to support all 19 schools and colleges at the institution.
How They're Using It: Medical students use AR headsets to practice physical examination skills on virtual patients overlaid onto the real world. During mixed reality grand rounds, participants worldwide can visualize 3D anatomical structures and surgical procedures in real-time, asking questions and discussing cases in an immersive environment. The AR tools provide immediate feedback on examination techniques, accelerating skill development.
Citations:
12. Duke University - Surgical Education and Activities Lab (SEAL)
Scale: Training surgical residents and fellows at Duke University Medical Center.
Project Overview: Duke's SEAL is a comprehensive surgical simulation center that incorporates virtual reality alongside traditional simulators for training, patient safety education, and practicing new techniques. The facility offers VR surgical simulations and has developed immersive virtual reality programs for interventional radiology procedures that integrate visual, tactile, and biometric feedback. Duke's VR-HEAL (Virtual Reality for Health Education Advanced Learning) project creates realistic, interactive scenarios for medical students to practice procedures they'll perform in clinical settings.
How They're Using It: Surgical trainees use VR systems with haptic feedback to practice laparoscopic techniques, endovascular procedures, and other minimally invasive surgeries. The virtual reality simulations provide high-fidelity experiences that closely mimic real surgical procedures using 3D visuals, real-time responsiveness, and tactile feedback. The Clinical Skills and Simulation Center offers surgical VR simulations accessible to students across different training levels.
Citations:
Immersive virtual reality training has rapidly evolved from experimental technology to mission-critical infrastructure across multiple industries, with Fortune 500 companies and government organizations investing billions in VR-based workforce development. The business case for immersive training is now supported by compelling evidence demonstrating measurable improvements in learning outcomes, operational efficiency, and return on investment.
Walmart: Industry-Leading VR Training Infrastructure
Walmart operates one of the world's largest corporate VR training programs, deploying over 17,000 Oculus Go headsets across its 4,700+ U.S. stores to train more than 1 million associates annually.[1] The retail giant uses VR to prepare employees for high-pressure scenarios including active shooter safety training, complex equipment management, and customer service challenges. According to Walmart's senior director of digital operations, the VR program has transformed training scalability, enabling consistent, repeatable experiences across their massive workforce while significantly reducing the time and cost associated with traditional instructor-led training.[1][2]
PwC: Quantified Learning and Efficiency Gains
A comprehensive PwC study comparing VR training to classroom and e-learning methods revealed striking advantages across multiple dimensions:[3]
- 4x faster training completion: VR learners completed training in 30 minutes versus 2 hours for classroom participants
- 275% increase in confidence: Learners felt 275% more confident applying skills learned in VR compared to classroom training
- 3.75x more emotional connection: VR created significantly stronger emotional engagement with training content
- 4x more focus: VR learners were up to 4 times more focused than their e-learning peers
Critically, PwC's analysis demonstrated that VR training becomes more cost-effective than classroom instruction at scale, reaching cost parity at just 375 learners and delivering superior ROI for larger deployments.[3]
Additional Major Enterprise Implementations
- UPS: Deployed VR training to teach drivers how to identify road hazards from the perspective of a UPS delivery truck. The immersive training allows drivers to experience and respond to realistic road scenarios, improving their hazard recognition skills and safe driving techniques. UPS reports that the VR training has been instrumental in enhancing driver safety and reducing accidents.[4].[3][4]
- Bank of America: Implemented VR training for customer service representatives, allowing employees to practice handling difficult customer interactions in realistic branch environments. The bank's VR training program has generated excitement among employees while delivering powerful outcomes in skill development and employee engagement.5]
- Verizon: Deployed immersive VR training across its retail workforce, enabling employees to practice customer service scenarios, technical troubleshooting, and emergency response protocols in realistic virtual environments. The VR training platform has allowed Verizon to deliver consistent, scalable training experiences across thousands of retail locations.[6]
- Boeing: Implemented augmented reality (AR) technology in aircraft assembly operations, revolutionizing how technicians complete complex wiring tasks. Boeing's AR system provides workers with real-time visual guidance overlaid on their workspace, reducing training time and assembly errors. The immersive AR training and operational support has dramatically improved the efficiency and accuracy of intricate manufacturing processes. [7]
The convergence of improved learning outcomes, reduced training time, enhanced scalability, and decreasing hardware costs has created a compelling economic case for VR training adoption. Organizations report:[3][8]
- Elimination of travel costs and facility requirements for centralized training
- Ability to train distributed workforces consistently and simultaneously
- Reduction in equipment damage and resource consumption during training
- Decreased time-to-competency for new employees
- Improved retention and reduced need for retraining
The evidence is clear: immersive VR training has transcended the proof-of-concept phase and established itself as essential infrastructure for organizations committed to workforce excellence, operational readiness, and competitive advantage in an increasingly complex operational environment.
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References:
[1] Haynes, C. "How VR is Transforming the Way We Train Associates." Walmart Corporate. 2018. https://corporate.walmart.com/news/2018/09/20/how-vr-is-transforming-the-way-we-train-associates
[2] ArborXR. "ArborXR Helps Companies Manage Virtual Reality At Work." ArborXR Blog. https://arborxr.com/blog/arborxr-helps-companies-manage-virtual-reality-at-work
[3] PwC. "The Effectiveness of Virtual Reality Soft Skills Training in the Enterprise." 2020. https://www.pwc.com/us/en/tech-effect/emerging-tech/virtual-reality-study.html
[4] Novellino, T. "UPS Tests Virtual Reality to Teach Drivers Road Safety." Fortune. 2018. https://fortune.com/2018/04/11/virtual-reality-ups-trucks-safety/
[5] ArborXR. "Customer Story: Bank of America VR Training - Excited Employees, Powerful Outcomes." ArborXR Blog.
[6] STRIVR. "Verizon: Immersive Learning at Scale." STRIVR Customers. https://www.strivr.com/customers/verizon
[7] Innovate Energy Now. "Down to the Wire: How Boeing Uses AR in Assembly." https://innovateenergynow.com/resources/down-to-the-wire-how-boeing-uses-ar-in-assembly
[8] Accenture. "Extended Reality in the Enterprise: Seeing is Believing." 2019. https://www.accenture.com/us-en/insights/technology/extended-reality-enterprise