Using Mixed Reality Simulation to Improve Junior Medical Trainees' Preparedness to Manage High-Acuity Trauma.

High-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This quality education report sought to investigate whether a simulation course operated via mixed reality (MR) headset devices (Microsoft HoloLens) could enhance the clinical knowledge recall and preparedness to practice of junior trainees with no prior experience managing trauma.The Plan-Do-Study-Act quality improvement method was used to refine six emergency trauma vignettes compatible with an MR teaching platform. Each vignette was curated by a multidisciplinary team of orthopaedic surgeons, clinical fellows and experts in simulation-based medical education. As a baseline assessment, a 2-hour emergency trauma course was delivered using traditional didactic methods to a cohort of pre-registration medical students with no clinical exposure to high-acuity trauma (n=16). Next, we delivered the MR simulation to an equivalent cohort (n=32). Clinical knowledge scores derived from written test papers were recorded for each group during and 2 weeks after each course. Each attendee's end-of-rotation clinical supervisor appraisal grade was recorded, as determined by a consultant surgeon who supervised participants during a 2-week placement on a major trauma ward. Balancing measures included participant feedback and validated cognitive load questionnaires (National Aeronautics and Space Administration-Task Load Index).Overall, attendees of the MR simulation course achieved and sustained higher clinical knowledge scores and were more likely to receive a positive consultant supervisor appraisal. This project serves as a proof of concept that MR wearable technologies can be used to improve clinical knowledge recall and enhance the preparedness to practice of novice learners with otherwise limited clinical exposure to high-acuity trauma.

Effect of Mixed Reality on Delivery of Emergency Medical Care in a Simulated Environment: A Pilot Randomized Crossover Trial.

Importance: Mixed-reality (MR) technology has the potential to enhance care delivery, but there remains a paucity of evidence for its efficacy and feasibility. Objective: To assess the efficacy and feasibility of MR technology to enhance emergency care delivery in a simulated environment. Design, Setting, and Participants: This pilot randomized crossover trial was conducted from September to November 2021 at a single center in a high-fidelity simulated environment with participants block randomized to standard care (SC) or MR-supported care (MR-SC) groups. Participants were 22 resident-grade physicians working in acute medical and surgical specialties prospectively recruited from a single UK Academic Health Sciences Centre. Data were analyzed from September to December 2022. Intervention: Participants resuscitated a simulated patient who was acutely unwell, including undertaking invasive procedures. Participants completed 2 scenarios and were randomly assigned to SC or MR-SC for the first scenario prior to crossover. The HoloLens 2 MR device provided interactive holographic content and bidirectional audiovisual communication with senior physicians in the MR-SC group. Main Outcomes and Measures: The primary outcome was error rate assessed via the Imperial College Error Capture (ICECAP) multidimensional error-capture tool. Secondary outcomes included teamwork (Observational Teamwork Assessment for Surgery [OTAS]; range, 0-6 and Teamwork Skills Assessment for Ward Care [T-SAW-C]; range, 1-5), scenario completion, stress and cognitive load (NASA Task Load Index [NASA-TLX; range 0-100]), and MR device user acceptability. Results: A total of 22 physicians (15 males [68.2%]; median [range] age, 28 [25-34] years) were recruited. MR technology significantly reduced the mean (SD) number of errors per scenario compared with SC (5.16 [3.34] vs 8.30 [3.09] errors; P = .003), with substantial reductions in procedural (0.79 [0.75] vs 1.52 [1.20] errors; P = .02), technical (1.95 [1.40] vs 3.65 [2.03] errors; P = .01), and safety (0.37 [0.96] vs 0.96 [0.85] errors; P = .04) domains. MR resulted in significantly greater scenario completion rates vs SC (22 scenarios [100%] vs 14 scenarios [63.6%]; P = .003). It also led to significant improvements in the overall quality of teamwork and interactions vs SC as measured by mean (SD) OTAS (25.41 [6.30] vs 16.33 [5.49]; P < .001) and T-SAW-C (27.35 [6.89] vs 18.37 [6.09]; P < .001) scores. As reported via mean (range) NASA-TLX score, there were significant reductions for MR-SC vs SC in participant temporal demands (38 [20-50] vs 46 [30-70]; P = .03) and significant improvements in self-reported task performance (50 [30-60] vs 39 [10-70]; P = .01). Overall, 19 participants (86.4%) reported that they were more confident in making clinical decisions and undertaking clinical procedures with MR support. Conclusions and Relevance: This study found that the use of MR technology reduced error, improved teamwork, and enhanced practitioner confidence when used to support the delivery of simulated emergency medical care. Trial Registration: ClinicalTrials.gov Identifier: NCT05870137.

Self-assessment of surgical ward crisis management using video replay augmented with stress biofeedback.

BACKGROUND: We aimed to explore the feasibility and attitudes towards using video replay augmented with real time stress quantification for the self-assessment of clinical skills during simulated surgical ward crisis management. METHODS: Twenty two clinicians participated in 3 different simulated ward based scenarios of deteriorating post-operative patients. Continuous ECG recordings were made for all participants to monitor stress levels using heart rate variability (HRV) indices. Video recordings of simulated scenarios augmented with real time stress biofeedback were replayed to participants. They were then asked to self-assess their performance using an objective assessment tool. Participants attitudes were explored using a post study questionnaire. RESULTS: Using HRV stress indices, we demonstrated higher stress levels in novice participants. Self-assessment scores were significantly higher in more experienced participants. Overall, participants felt that video replay and augmented stress biofeedback were useful in self-assessment. CONCLUSION: Self-assessment using an objective self-assessment tool alongside video replay augmented with stress biofeedback is feasible in a simulated setting and well liked by participants.