The success of an educational VR project heavily relies on assembling a carefully selected, multidisciplinary consortium. Securing expertise in medical didactics, computer science, and design is crucial to developing a comprehensive and impactful learning environment. When forming such a consortium, it is important to choose members with proven expertise in these domains, a strong record of collaborative work, and a shared commitment to educational innovation. Additionally, expertise in AI can substantially enhance the capabilities and outcomes of VR development. It is also important to define how medical specialists will be involved in the development and evaluation process. By ensuring these competencies are well represented, the project establishes a robust foundation for success.

Budget constraints may necessitate adjustments in project setup, such as reducing staffing levels. This can be addressed by focusing on specific goals and scaling back staffing in disciplines with lower workloads. To compensate, leveraging tools, libraries, and off-the-shelf solutions—such as standard user interface (UI) elements, 3D asset libraries, and VR world builders—can streamline development processes. While it is often inadvisable to entirely forgo a discipline, maintaining at least one senior team member to oversee and guide the effective use of these tools helps ensure quality and consistency.

Furthermore, the rapid evolution of generative AI offers new opportunities for innovative workflows in VR development. This advancement has the potential to substantially transform existing processes. Team members should stay actively informed about advancements in AI to identify and effectively integrate these developments into the project.

The inherent size and interdisciplinarity of a consortium developing VR simulations for medical education require both a project manager and a project coordinator. The project coordinator fulfills a support role, primarily focusing on administrative tasks such as scheduling, reporting, and coordinating communication among team members. The project coordinator ensures that day-to-day activities align with the project’s objectives. By contrast, the project manager holds a leadership role, overseeing the entire project life cycle, including planning, resource allocation, risk management, and strategic decision-making. While the project manager adopts a high-level perspective and makes key decisions, the project coordinator focuses on operational aspects to ensure smooth execution.

Additionally, responsibilities within the teams at each location should be coordinated, ideally through team leaders who work closely on the respective topics.

From our experience, clearly defining responsibilities is especially important in interdisciplinary teams. Splitting the coordination role into technical and didactical (ie, nontechnical) components ensures that all needs and project goals are addressed. These coordinators must maintain constant communication and collaboratively address challenges, escalating issues to the project manager when necessary.

The technical coordinator is responsible for ensuring the technical implementation of the VR project, including the integration of hardware, software, and additional modules such as an authoring tool. This role involves monitoring the build process; diagnosing and resolving technical issues; managing updates and merge requests (ie, developers’ proposals to integrate source code changes); and maintaining performance and compatibility standards for the VR simulations.

The didactical coordinator ensures that the educational content and learning objectives are correctly integrated into the VR simulations. Collaborating closely with educators and medical experts, they align the simulations with current medical curricula, such as the NKLM 2.0 [17], and broader educational frameworks such as competency-based medical education. This role ensures that the simulations are pedagogically sound and meet the intended educational outcomes.

To streamline administrative tasks, an overall coordinator position can be beneficial. In our project, administrative responsibilities were also managed by the didactical coordinator.

Coordinating the technical aspects and workflows of such a multidisciplinary project across multiple sites (in our case, UMTL, CVMLS, FHMS, HBKsaar) is complex. In the medical tr.AI.ning project, the role of a central technical coordinator, as described above, was not planned in the granted project outline. Instead, each site operated under the leadership of a team leader who managed an interdisciplinary team and closely collaborated with the other sites. However, the absence of a central technical coordinator hindered cross-site collaboration and reduced overall project efficiency. It is recommended to establish a central technical coordinator to ensure efficient collaboration between sites and to guarantee the quality of the technical implementation, thereby achieving project goals more effectively. Table 1 suggests the distribution of roles and responsibilities as a RACI (responsible, accountable, consulted, and informed) matrix.

All consortium members should have the opportunity to propose ideas for a suitable project name. After gathering suggestions, potential candidates can be discussed within the team, culminating in a final vote and confirmation by the project manager. In our case, the name needed to represent both medical education and the integration of AI technology. As a result, we chose medical tr.AI.ning, emphasizing the acronym “AI” to highlight its dual focus and delivering a memorable, descriptive name.

Project goals and milestones must be clearly defined to ensure structured progress. Goals must align with the intended educational outcomes, such as improving procedural skills or enhancing clinical decision-making. Based on our experience, this step should precede detailed scenario design to ensure alignment between educational objectives and technical implementation.

Milestones should track key phases, including content development, technical implementation, user testing, and iterative evaluation cycles. Each milestone should be specific, measurable, achievable, relevant, and time-bound (SMART), including tasks such as completing scenario designs, integrating feedback from medical experts, and conducting beta testing. Regular reviews are essential to adjust for technical challenges or evolving educational requirements.

In the medical tr.AI.ning project, we identified 4 milestones (Textbox 1).

The project timeline should follow a phased approach with clear, realistic deadlines. This typically begins with the discovery phase, which includes goal setting, stakeholder alignment, and requirements gathering. Next, the design phase should focus on content creation, scenario mapping, and visual asset development, followed by the development phase, which covers programming, VR integration, and interactivity design. The testing phase involves feedback from medical experts and beta testing [18].

Finally, the deployment phase ensures that the scenarios are refined and ready for educational use. Periodic reviews should be scheduled to assess progress and make adjustments as needed. After the VR scenarios are integrated into the curriculum, feedback from students should be collected to optimize both usability and content.

Budgeting and resource allocation should be based on well-defined objectives, with careful attention to relevant cost categories. Key cost components include personnel expenses for medical (didactical) experts, designers, and developers, which often constitute the largest share. Other substantial costs include licenses for software tools and assets (eg, VR development platforms, 3D modeling software, communication, and data storage tools). Hardware costs for head-mounted displays (HMDs), powerful computers, and necessary accessories (eg, cables, tripods, hygiene equipment) also represent a substantial portion of the budget.

Additionally, providing technical support to manage ongoing maintenance and supervise related courses is essential. In the medical tr.AI.ning project, this was done by research assistants. For dissemination, costs related to presenting the project at national and international conferences, publishing in open-access venues, and ensuring public accessibility (eg, through a dedicated website) should be included in the calculations.

Cross-departmental collaboration plays a critical role in ensuring that financial resources are appropriately aligned with project milestones. Regular reviews should be scheduled to adjust for evolving needs and unforeseen expenses, ensuring that the project remains on budget and achieves its objectives.

Securing financial support is essential to account for the interdisciplinary nature of the consortium and the associated costs. Researchers should actively explore grant opportunities and funding programs focused on technology in education, health care innovation, and digital transformation. Priority should be given to funding calls that emphasize interdisciplinary research; medical training innovations; and VR, augmented reality, or extended reality technology. Funding sources can include national and international project calls, European Union programs such as Horizon Europe, or regional grants targeting medical technology. Partnerships with private-sector companies specializing in educational medical hardware or software should also be considered to supplement public funding and potentially facilitate subsequent commercialization.

Additionally, it is crucial to designate a team member or external consultant to take responsibility for securing funding for follow-up projects early in the development cycle. This ensures continuity of the research and development pipeline, allowing the consortium to build on its initial achievements and scale the project’s impact. Early identification of future funding opportunities and alignment with upcoming calls or partnerships can help avoid interruptions in development and support the long-term sustainability of the initiative.

The medical tr.AI.ning project was funded through the program “Artificial Intelligence in Higher Education” by the German Federal Ministry of Education and Research for a 3-year period (grant 16DHBKI077). The project was successfully submitted in the subcategory “national cooperative research project.”

To ensure sustainability, the educational context of a VR-based medical education project should be closely aligned with current competency-based learning objective guidelines, such as those outlined in the German National Competency-Based Learning Objectives Catalogue for Medicine (NKLM 2.0 [17]). This alignment helps ensure that the VR simulations directly address the core competencies and skills expected of medical graduates and educators. Furthermore, alignment with established national and international medical education frameworks helps keep the content relevant, which ultimately fosters not only institutional support but also adoption by other medical schools.

In the medical tr.AI.ning project, we initially focused on dermatological education and defined the corresponding learning objectives based on the NKLM 2.0 before the development of the actual application. A strong overall focus was placed on the competency “clinical reasoning,” which refers to the process by which medical professionals gather and analyze patient information, generate differential diagnoses, and make informed decisions about patient management [21].

The requirements arising from the course design for the VR simulation must be discussed with the technical team members to assess their feasibility and, if necessary, revise the concept. This includes, for example, requirements for the environment, objects, and examination tools, as well as the behavior of virtual patients and the necessary interactions within the simulation.

The course structure for VR-based courses in medical education should be designed to target specific, predefined learning objectives and requirements. A modular design approach divides the course into distinct sections, each focused on specific competencies, such as clinical procedures or clinical reasoning, allowing for independent updates to individual modules. A blended learning strategy combines immersive VR simulations with traditional lectures, workshops, or online materials, providing a comprehensive learning experience that supports both practical application and the necessary theoretical knowledge. As part of this strategy, theoretical input should precede the VR simulation to ensure that students have sufficient knowledge to complete the respective tasks in VR. Additionally, offering a VR tutorial session is advisable to help students become familiar with the navigation and controls.

Courses can either be self-paced, allowing students to learn at their own pace and offering flexibility for their schedules, or instructor-led, ensuring structured guidance and personalized feedback from experts. Scenario-based learning within VR allows students to engage in real-world medical situations, promoting critical thinking and decision-making under realistic conditions.

Finally, integrating assessment and feedback mechanisms, such as formative and summative evaluations, ensures continuous tracking of student progress, alignment with competency-based educational goals, and the individual feedback students need to continuously improve their performance.

In the medical tr.AI.ning project, we started the course day by providing instructions and theoretical background knowledge on the strategy of a dermatological whole-body examination by a qualified dermatologist to ensure that students had sufficient theoretical knowledge to benefit adequately from practicing the procedure. After that, an interactive VR tutorial had to be completed, in which all necessary interactions could be practiced. Following the actual simulation, the results were discussed with the dermatologist, feedback was given, and questions could be asked. Figure 2 illustrates the overall structure and sequence of activities in the VR dermatology course (also see [14]).

Several factors influence the decision regarding the most appropriate VR hardware. Performance requirements are crucial, as the hardware must support high-quality graphics and real-time interactions to create immersive and realistic medical scenarios.

Ease of use and comfort are also important, particularly for longer training sessions, so lightweight headsets with ergonomic designs are preferred.

Cost and scalability are major considerations, as the hardware must be affordable for institutions and scalable to accommodate multiple users simultaneously. Durability and ease of maintenance should be factored in, as the hardware will likely undergo frequent use, necessitating reliable performance and straightforward repair or replacement options. Mobility is another key consideration, that is, whether the VR setup will be room-based or portable, wire-free or PC-tethered, depending on the logistical possibilities and learning objectives. To meet hygiene standards, disinfection equipment should be used to clean the hardware between users, and single-use hygiene masks should be placed inside the HMD.

As graphic resolution plays a substantial role, not only in the context of cybersickness [22] but also in the accurate representation of medical conditions, the “Valve Index” by Valve was chosen for the medical tr.AI.ning project at both locations in 2022. The special Knuckles Controllers of the Valve Index were favored because of their finger-tracking capabilities, which allow the hands to be used as naturally as possible in medical scenarios. Although the VR hardware market is rapidly evolving, future compatibility and dissemination strategy should be considered when choosing the appropriate hardware. For example, in our case, relying on Steam’s Valve Index VR Kit made transfer to other faculties challenging because of Steam’s credit card–only acquisition policy.

Ensuring appropriate infrastructure is crucial for the success of the project. The physical infrastructure should include dedicated rooms equipped with adequate space, power, and ventilation to accommodate VR hardware, such as HMDs, sensors, and powerful computers. These spaces need to be arranged to facilitate ease of movement and interaction (Figure 3).

On the technical side, IT support is essential to ensure that the VR hardware and software receive regular updates and troubleshooting when necessary. Network infrastructure is equally important, as VR simulations often require stable, high-bandwidth internet connections, particularly if cloud-based processing or collaborative simulations are involved. Additionally, the infrastructure should meet data management requirements, particularly if student performance data and feedback are being collected for evaluation or research purposes. This requires secure storage solutions that comply with data privacy standards, especially when handling sensitive information.

Finally, the infrastructure should be scalable to accommodate the growth of the project, whether through expansion to additional courses or by upgrading equipment as technology advances.

Overall, interdisciplinary communication is a critical challenge that must be addressed effectively [24]. In addition to the typical difficulties faced by growing teams, there are further obstacles related to differing vocabularies and the potential for unrealistic expectations regarding the capabilities of other teams. Regular meetings are essential to quickly identify, uncover, and resolve misunderstandings. Additionally, visual representations of current development stages can help nontechnical team members stay aligned and informed.

While this aspect may initially seem trivial, it is often overlooked in practice. Project tasks should be defined in great detail and assigned to specific individuals, making it clear who is responsible for each task. This reduces confusion and ensures that no critical aspect of the project is overlooked. It also facilitates better progress tracking, enabling project managers to identify potential delays or issues early on. Moreover, assigning tasks based on individuals’ skills or expertise ensures that the right people handle the right responsibilities, thereby improving the overall quality of the project. This structured approach promotes better collaboration, as each team member understands their role and contribution to the project’s success.

Clear deadlines are essential for any project, as they provide structure, focus, and a sense of urgency, helping to keep the project on track. By setting deadlines, teams can prioritize tasks, allocate resources efficiently, and ensure steady progress toward milestones. In particular, for complex interdisciplinary projects, deadlines help synchronize the efforts of all disciplines, minimize bottlenecks, and ensure the timely delivery of the project.

In case of delays or when deadlines cannot be met, transparency with all cooperation partners is essential. Open communication helps to identify the underlying challenges and collaboratively develop solutions. One effective approach can be to reassign tasks to other team members or partners who are better positioned to complete them within the required time frame. This ensures that the project remains on schedule while maintaining quality.

Implementing VR-based courses in medical education requires meticulous planning to effectively address practical aspects. Supervision during the course, such as by student assistants, must be well coordinated, with clearly assigned roles for overseeing student interactions within the VR environment and addressing potential technical issues. Access to dedicated rooms and facilities equipped with VR hardware, including HMDs and computers, is essential, and scheduling these resources must be streamlined to avoid bottlenecks. Regular hardware and software maintenance, including timely updates and technical support, is critical to ensuring smooth operation during sessions.

Both staff and students should receive an introduction to the course design, including training on VR tools and how the simulations align with learning objectives. To enhance the scientific value of the project and promote continuous improvement, we recommend that the project be scientifically monitored through evaluation methods. This involves data collection, such as automatic logging of performance data, user feedback, and assessment of learning outcomes. Where appropriate and with prior consent, additional measures such as external assessments or video recordings can also be used. Finally, depending on the hardware used, it must be ensured that all wireless components are fully charged before sessions to allow uninterrupted use.

Depending on the course format and its learning objectives, it may be advisable to provide alternative learning options for students experiencing cybersickness, allowing everyone to achieve creditable learning outcomes regardless of constraints. This comprehensive organization ensures the smooth integration of VR simulations into the medical education curriculum while fostering effective operation and alignment with institutional settings.

A VR tutorial should guide users in learning to interact with the software. The structure of the tutorial should ensure that students learn basic interactions at the beginning, such as teleporting and basic object interactions, before introducing more specific functionalities, such as using tools like the digital dermatoscope in the medical tr.AI.ning application.

Interactions should be demonstrated step-by-step, allowing students to follow along and understand the controls. Later, students should be asked to apply their knowledge without specific instructions. For example, navigation should be among the first skills introduced: students should learn how to move around the virtual environment early in the tutorial. Subsequent tasks should require them to navigate without further guidance, reinforcing their understanding of movement controls through active use. This progression from guided learning to independent application ensures that, by the end of the tutorial, students have a solid grasp of the necessary VR controls and can confidently apply them during the actual simulation scenarios. In the medical tr.AI.ning tutorial, students start in a doctor’s office and are familiarized with the environment. Gestures and functions to be learned are introduced within a medical context so that the subsequent transition to the actual medical examination simulation feels logical and intuitive.

Establishing a clear assessment strategy is crucial to evaluating the effectiveness and acceptance of VR-based courses in medical education. This strategy should incorporate both formative and summative evaluations to measure acceptance among educators and students, as well as specific learning outcomes. In the initial stages, conducting extensive feasibility evaluations is particularly important. These evaluations should address key aspects such as usability, immersion, presence, cybersickness, and subjective learning outcomes. The findings from these studies provide valuable insights into the UX and educational impact, allowing for the refinement of subsequent prototypes. The respective evaluations of the medical tr.AI.ning project, based on the first courses conducted, have been published and are accessible for reference [14,25], providing detailed insights into the feasibility and effectiveness of the approach. In summary, both studies demonstrate technical feasibility and positive learner reception. Students reported high usability and immersion, alongside significantly increased self-assessed competence following VR training. The VR implementations were positively evaluated for their educational value while also drawing attention to resource and cost considerations relevant to broader curricular adoption.

By integrating these assessment practices, the project can ensure that the VR simulations align with educational goals, meet user expectations, and continuously improve based on empirical feedback.

To ensure a consistent and unified visual identity for external correspondence, a logo should be developed to represent the project. The creation of a logo requires careful consideration and respect for the values of the individual working groups within the consortium. An iterative design process, with multiple review cycles, ensures that team members feel a sense of pride and unity in the final result. The logo should strike a balance between abstraction and inclusivity to fairly represent the diverse ideas and values contributed by all project partners. In addition, a project website should be developed to support the project’s public presence and facilitate contact with potential cooperation partners. Furthermore, representation at relevant conferences ensures visibility, provides opportunities for hands-on experiences with the developed simulations, and opens possibilities for future scientific collaborations.

The logo for the medical tr.AI.ning project was developed by designers within our consortium. It integrates multiple concepts into a cohesive design. The outer shape resembles a stylized brain, symbolizing the role of AI in the project. The sharp angles create the impression of a 3D ribbon, reflecting the VR application’s immersive and realistic content. Additionally, the line’s end points suggest the head and tail of a coiled snake, evoking the image of the Aesculapian staff, a symbol widely associated with medicine. This thoughtful integration of concepts underscores the project’s interdisciplinary nature and its connection to medical education. Emphasizing the use of AI, the letters “AI” were highlighted in the project name. The green color of the logo was adopted as the official project color to create a unified visual identity. In addition to the logo and colors, it is important that the interaction design and interface of both the authoring tool and the VR environment be developed in a consistent style. This approach reinforces the perception of unity, allowing teachers and students to intuitively recognize all elements as part of a single, integrated system.

To further enhance visibility and outreach, a dedicated project website was developed [26]. The website features a video-based project overview, illustrative images, and continuously updated content, such as details on congress participation, publications, and reports from project meetings. The website reflects the essential stylistic elements of the authoring tool and VR environment interface to ensure a clear association with the project.

To convey professionalism and quality at conferences, the designers created branded materials, including business cards, leaflets, and a booth adorned with posters. These were complemented by a hands-on setup of the VR simulation, allowing attendees to directly experience the application. During public testing rounds, close attention was paid to immediate user feedback. Such settings often bring together experts in medical education and VR technology, providing valuable recommendations and opening opportunities for potential collaborations.

The project was showcased through lectures, exhibition stands, and workshops at various national and international congresses. Notable events included “Würtual Reality” in Würzburg, “Shift Medical” in Heidelberg, the German-speaking countries (Germany, Austria, and Switzerland; DACH region) “Annual Conference of the Association for Medical Education” (GMA) in Osnabrück, and the “International Association for Health Professions Education Conference” in Basel, Switzerland.

To support sustainability and foster collaborations, consortium members should actively participate in specialized working groups. In our case, we prioritized networking through the VR Working Group of the GMA, taking on both active participation and leadership roles. This working group facilitates regular exchanges of knowledge and resources, providing updates on relevant congresses, publications, and other critical developments related to VR in medical education. The medical tr.AI.ning project was presented within this context, significantly enhancing its visibility and recognition among professional circles across the DACH region. This exposure sparked interest from several universities in adopting the project following the completion of software development. Furthermore, it paved the way for potential collaborations exploring the integration of VR technology in medical education.

To ensure the value and usability of the developed project outcomes beyond the project’s life cycle, it is crucial to establish a distribution solution early in the process. A significant challenge in this endeavor is ensuring the transferability of the interface to various hardware systems. For example, in our case, the currently utilized finger-tracking functionality of Valve’s Knuckles Controllers enables interaction with objects using natural grasping movements. However, this feature is not supported by most other current controller variants, necessitating the development of a fully button-based alternative to maintain compatibility across different systems.

Additionally, legal and formal considerations must be addressed to provide clear guarantees for all stakeholders, including both developers and end users. This involves reviewing each asset used in the project to identify potential licensing conflicts. Where such issues arise, suitable alternatives should be identified and implemented to ensure the legality and accessibility of the final product.

Providing a dedicated authoring tool, medical asset library, and open-source solutions can enable developers and medical educators to build upon the work of the VR project.

To provide value to the scientific community and other developers, it is essential to disseminate collected data and research findings through online articles and open-access publications. In our project, several open-access articles have been published, contributing valuable insights into the integration of VR in medical education. These publications address various aspects of the project, including its overall objectives [8], students’ perceptions and desires regarding the integration of VR into medical curricula [27], a scoping review of the current state of VR integration in medical education [1], and specific findings from implementing a VR simulation for skin cancer screening in the dermatology curriculum at both clinical sites involved in the project [14,25]. Collectively, these works offer a comprehensive perspective on the project’s potential and the evolving role of VR in advancing medical training, serving as a resource for future research and development in this field.