# Applications of AI and VR in High-Risk Training Simulations: A Bibliometric Review
## 5 Conclusions  
The integration of artificial intelligence (AI) and virtual reality (VR) has revolutionized training protocols in critical sectors, according to the analysis of 700 scientific articles. The results show an exponential growth of 5.54% in publications between 2019 and 2024, reflecting the technological maturity achieved in fields such as emergency medicine (surgical simulations) and disaster management (training for CBRN incidents). This boom coincides with the adoption of immersive tools that allow high-risk scenarios to be simulated with anatomical accuracy or to replicate industrial emergencies, reducing operating costs and physical exposure. However, the reduction in thematic diversity from 2015 levels risks limiting responsiveness to new challenges and missing emerging opportunities in other less-explored fields.  
The co-authored analysis reveals a transdisciplinary collaboration, with notable contributions from the United States in medical simulations, China in industrial applications, and Germany in crisis response systems. The identified thematic clusters--nuclear aviation, disaster response, and emergency medicine--demonstrate how AI-based VR optimizes training through adaptive algorithms, while biometric records allow physiological responses to be evaluated in real time. Cases such as explosive deactivation simulators or virtual patients for surgeries illustrate this technological synergy.  
Despite the advances, this study identifies critical gaps: only 18% of research addresses ethical aspects of the use of biometric data, and there is a geographical disparity in access to these technologies, with scarce representation of developing countries. In addition, a trend towards excessive specialization is detected, where 73% of studies focus on sectoral applications without addressing unified theoretical frameworks. This underscores the need for standardized protocols for competency assessment and interoperable systems that integrate generative AI into simulations.  
To diversify the concentration of scientific contributions on the application of AI and VR in high-stakes simulation training, it is essential to implement accessible and context-specific solutions. Different strategies, such as low-cost virtual reality hardware and AI tools in the cloud, facilitate the access and expansion of these technologies without large investments. Likewise, AI-based educational platforms are key to democratizing knowledge and digital skills.  
As a future horizon, seven priority lines are proposed as follows: (i) the development of hybrid VR/AR environments with haptic feedback to improve realism; (ii) the implementation of explanatory AI models that justify real-time decisions; (iii) longitudinal studies on skill retention; (iv) regulatory frameworks for sensitive data management in training; (v) dynamic adaptation of virtual scenarios based on neurophysiological data obtained with AI and VR; (vi) investigate the ethical and psychological aspects of the use of AI and VR in high-risk training; and (vii) strategies for the democratization of AI and VR in high-stakes simulation training. The convergence between cognitive neurosciences and immersive systems emerges as a promising area for optimizing the learning curve in contexts of extreme pressure.  
Conceptualization, P.F.-A. and D.V.; methodology, P.F.-A., A.d.B. and G.L.; software, P.F.-A. and A.d.B.; validation, G.L. and D.V.; formal analysis, P.F.-A., A.d.B., G.L. and D.V.; investigation, P.F.-A., A.d.B. and D.V.; data curation, P.F.-A. and A.d.B.; writing--original draft preparation, P.F.-A. and A.d.B.; writing--review and editing, G.L. and D.V.; visualization, P.F.-A., A.d.B. and G.L.; supervision, D.V. All authors have read and agreed to the published version of the manuscript.  
This research received no external funding.  
Not applicable.  
The original contributions presented in this study are included in the article; further inquiries can be directed to the corresponding authors.  
The authors declare no conflicts of interest.