Aiello, StephenCochrane, ThomasAguayo, Claudio2026-06-102026-06-102026-06-09Journal of University Teaching and Learning Practice, ISSN: 1449-9789 (Print); 1449-9789 (Online), Open Access Publishing Association. doi: 10.53761/ma83x4981449-97891449-9789http://hdl.handle.net/10292/21364<jats:p>This paper critically evaluates the third prototype design iteration of an immersive reality (XR) enhanced simulation project in healthcare higher education. Drawing from design principles developed since the project’s inception in 2016, the research addresses a gap in current literature: whilst XR has demonstrated positive impacts on clinical skill development, examples of longitudinal studies and engagement with learning theory to inform the design of these environments remain limited. The MESH360 project applies design-based research (DBR) to explore the impact of XR-enhanced simulation for training novice and professional paramedics, triangulating participant feedback, observation, and biometric data. The resulting XR design principles provide a framework for transferable learning designs in high-risk, practice-based environments.</jats:p>Copyright © by the authors, in its year of first publication. This publication is an open access publication under the Creative Commons Attribution CC BY-ND 4.0 license.https://creativecommons.org/licenses/by-nd/4.0/1301 Education Systems1302 Curriculum and Pedagogy3901 Curriculum and pedagogy3903 Education systemsbiometricsDesign-based researchhealthcare educationclinical simulationXRJournal ArticleOpenAccess10.53761/ma83x498