Our Work / Research & Evidence

VR training for nurse leaders at Mayo Clinic

About the papers

Mayo Clinic researchers published two peer-reviewed papers about the same VR diversity, equity and inclusion (DEI) training programme, built for Mayo Clinic nurse and social worker leaders:

Both papers describe the VR module as built in partnership with Equal Reality. JONA states: "The VR developers were contracted external to the organization through the company Equal Reality, which specializes in DEI VR training." Social Science & Medicine states: "a virtual reality module was created in partnership with Equal Reality (equalreality.com)." Neither paper lists a PTR or Equal Reality author; both describe it as the external VR development partner.

A person wearing a Meta Quest VR headset, smiling and holding out a cup while another person looks on
A greyscale render from the VR module: two nurse avatars at a table in a breakroom scenario, with a third avatar standing in the background.

What was built and delivered

Study design flow: design, sample, measure, result Four connected stages showing how the two Mayo Clinic VR studies were run, from designing the scenarios through to the reported results. DESIGN 4 scenarios, 2 settings Co-designed with nursing staff with lived experience of bias, built with Equal Reality. Breakroom and patient-room settings. SAMPLE 1,149 leaders Nurse and social worker leaders, 3 campuses, 4 US regions. 841 completed a baseline survey for the RCT. MEASURE Survey + RCT Post-class education survey (JONA). Quasi-experimental controlled trial (Social Science & Medicine). RESULT 91.9% + p < .001 met learning objectives; empathy and upstander gains held 6 to 8 months.
How the two studies ran, from scenario design through to the reported results.

Scenarios were co-designed with nursing staff who had lived experience of workplace racism and microaggressions, many of whom identify as Black, Indigenous or people of colour, working with Equal Reality's developers.

Four VR situations were built around two settings, a staff breakroom and a patient room, each pairing an embodiment component (the participant experiences bias as a Black nurse avatar) with a rehearsal component (the participant practises responding as themselves). Delivery was synchronous and virtual: 100 VR headsets were distributed, and 28 two-hour class sessions ran over 4 months, combining VR immersion with small-group debriefing led by trained facilitators.

A staff breakroom scene from the VR module.
A staff breakroom scene from the VR module, one of the two settings the four scenarios were built around.
A patient room scene from the VR module.
A patient room scene from the VR module, the other of the two settings the four scenarios were built around.

What the JONA paper reports

Of 1,131 leaders who attended, 593 (52.4%) completed the post-class education survey.

91.9%

of the 593 survey respondents agreed or strongly agreed they achieved the learning objectives.

90.3%

of the same 593 respondents agreed the debrief was effective.

61.1%

rated the overall activity "very good" or "excellent" on a 5-point scale, the more mixed result; authors suggest technical issues, discomfort with the content, or the class's mandatory nature as possible reasons.

A separate, randomised program evaluation found that most respondents (86.2%) felt the VR simulation was valuable to their professional growth and 89.2% would repeat it, but fewer felt the simulation represented real people (66.3%) or that the avatar felt like them (55.8%).

What the Social Science & Medicine paper reports

This paper analyses a quasi-experimental trial of the same programme: 841 of the 1,149 eligible leaders completed a baseline survey and were assigned to intervention or a waitlist control group (665 randomly, 176 assigned to the intervention automatically because of scheduling). A third empathy measure, empathic awareness, did not change significantly at any point in the study.

p = .002

the intervention group's increase in empathic feeling and expression, immediately after the VR session, relative to a waitlist control group.

p < .001

the intervention group's increase in upstander-behaviour predictors (Theory of Planned Behavior), relative to controls, immediately after the session.

6 to 8 mo.

later, the same measures (except empathic awareness) remained significantly higher than each participant's own baseline; there was no longer a control group at this point for comparison.

The intervention group also showed significant gains, relative to controls, in empathic perspective-taking (p = .01) and in willingness to respond, rather than do nothing, to a hypothetical scenario of a coworker facing racial bias (p = .008). The authors describe the 6 to 8 month durability as one of the study's most notable findings, since attitude-change effects from similar interventions often fade over time.

Limitations the authors note

Read with caution

Both papers flag real constraints. The Social Science & Medicine authors note that 176 of 841 baseline participants were not randomised, that there was no control group at the 6 to 8 month mark, and that the sample was drawn from a single health system and was mostly white (about 94-95%) and female (about 89-90%), reflecting who held these leadership roles at Mayo Clinic at the time. Measures were self-reported scales and a hypothetical written vignette, not observed workplace behaviour. The JONA authors add that delivery varied by site (some used a flatscreen instead of a headset), that the fully virtual, COVID-era format limited in-person technical support, and that scope was limited to racial DEI because that was what its funding targeted.

Both papers study the same 1,149-leader cohort and the same four-scenario VR module: JONA focuses on the programme's rollout and participant-reported evaluation, while Social Science & Medicine reports the controlled-trial analysis of its effect on empathy and upstander-behaviour intentions.

Published paper

Promoting Nursing Diversity, Equity, and Inclusion Through Virtual Reality Learning

Nelson et al. (ten Mayo Clinic authors)

The Journal of Nursing Administration (JONA), Vol. 54, No. 11, pp 638-644, November 2024

Funded internally by Mayo Clinic. DOI: 10.1097/NNA.0000000000001503

Download the paper (PDF)

Read the paper (PDF)

Published paper

A virtual reality intervention to increase interracial empathy and upstander behaviors in nursing leaders

Phelan et al. (thirteen Mayo Clinic authors)

Social Science & Medicine, Vol. 366, 117648, 2025 (received June 2024, published online December 2024)

Quasi-experimental controlled trial. DOI: 10.1016/j.socscimed.2024.117648

Download the paper (PDF)

Read the paper (PDF)

1,149

nurse and social worker leaders trained, across 3 major campuses and 4 regions of Mayo Clinic's network (Southwest, Midwest, Southeast United States).