To explore residents' learning experiences, perceived mechanisms of competence development, and implementation barriers of an augmented reality/virtual reality (AR/VR) scenario-based simulation teaching model in Focused Assessment with Sonography for Trauma (FAST) training, and to provide evidence for curriculum design and quality improvement in residency training.

A descriptive qualitative design was adopted. Fifteen ultrasound medicine residents who had participated in an AR/VR scenario-based simulation program at the Fourth Affiliated Hospital of Zhejiang University School of Medicine from December 2025 to January 2026 were recruited for semi-structured interviews. Data were coded and analyzed using Colaizzi's seven-step method, from which themes and categories were derived.

Four themes were identified: (1) Psychological safety enhanced classroom engagement: the virtual environment reduced residents' anxiety, encouraged active questioning and disclosure of uncertainty, and strengthened their sense of responsibility for independent problem-solving; (2) Immersive experience facilitated integration and understanding of knowledge and skills: a stronger sense of immersion promoted contextual understanding, linking scanning planes, sonographic interpretation, and clinical decision-making, while partially compensating for limited case exposure during rotations; (3) AR-enabled feedback promoted standardized scanning and confidence, although transfer to clinical practice still required bridging; (4) Key conditions and optimization priorities for implementation: functional fidelity of scenarios needs enhancement, alongside addressing cybersickness/discomfort, time costs, faculty adaptation, and standardized assessment, as well as the demand for automated evaluation and feedback.

The AR/VR scenario-based simulation model for FAST training can promote active participation in a low-risk environment and improve scanning standardization through immersive tasks and AR-enabled feedback. Sustainable implementation requires attention to functional alignment of scenarios, technological feasibility, faculty development, and the establishment of standardized assessment systems.