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The use of Mixed Reality in medical education: an evaluation of feasibility, usability and learning efficacy
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Date
2025
Authors
Connolly, Murray
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Background
Mixed reality technology offers potential educational advantages in the delivery of education to medical professionals. Head-mounted-displays with mixed reality capabilities, such as the Microsoft HoloLens 2 device studied in this thesis, can facilitate remote access to clinical events and supervision, and display holographic artefacts within a shared learning environment which can provide a means of sharing mental models. This may facilitate the vertical integration of basic and clinical curricular elements. However, the feasibility of employing this technology in medical education, its’ efficacy versus traditional teaching methods, and the perceptions of learners, educators, and patients of the technology require further evaluation. This thesis evaluates the technology in two different formats: bedside clinical tutorial with patients where the headset is utilised by the educator, and procedural skills tutorials, where the headset is worn by learners.
Aims
1. To evaluate the feasibility, usability and efficacy of using the Microsoft HoloLens 2 to deliver bedside tutorials on preoperative anaesthetic history and upper airway examination.
2. To examine the potential for the application of learning analytics to a combination of student-specific data and MR tutorial data for prediction of student’s performance in (i) proximate (end of tutorial assessment) and (ii) end-of-year summative assessment of related topics.
3. To evaluate the feasibility, usability and efficacy of using the Microsoft HoloLens 2 to deliver procedural tutorials on peripheral intravenous cannula insertion to medical students in a remote location.
4. To assess the student, tutor, facilitator, and patient perceptions of the tutorials.
Methods
Study 1: tutorials on preoperative anaesthetic history taking and upper airway examination were delivered by a tutor who wore the HoloLens device. Two-way audio-visual interaction was facilitated using the HoloLens 2 with groups of students who were located in a separate tutorial room. Holographic functions were employed by the tutor. The tutor, technical facilitator, patients, and students provided feedback, and three students participated in semi-structured feedback interviews. Students completed pre- and post-tutorial, and end-of-year examinations on the tutorial topics.
Correlations between potential predictor variables and performance in tutorial-based assessments and end-of-year examinations were described and three machine learning models were applied to the data to evaluate the feasibility of developing a model which could predict students’ performances at subsequent summative assessments.
Study 2: medical student volunteers were randomly allocated to an In-Person (IP) group and HoloLens (HL) group. Students in the IP group received a tutorial on intravenous cannulation in-person, the HL group received the tutorial remotely via the HoloLens. Both groups completed an initial metrics-based competency assessment, received a period of metrics-based feedback which informed a period of deliberate practice, followed by a second competency assessment. Students in the HL group provided quantitative and qualitative feedback, completed a System Usability Scale (SUS) questionnaire and three students completed interviews. One additional student completed a Think Aloud session.
Results
Study1: twelve patients and seventy-eight students participated across twelve tutorials. Analysis of quantitative and qualitative feedback revealed that technology and tutorial structure were viewed favourably by the tutor, facilitator and patients, and also highlighted several issues with the audio-visual quality, and concerns that the tutorial was not as beneficial as traditional in-person clinical tutorials. Significant improvement was observed between students’ pre- and post-tutorial MCQ scores (median 60% Vs 90%, p <0.001). Six direct-entry medicine and six graduate-entry medicine student predictor variables displayed significant positive correlations with students’ post-tutorial assessment scores. R-squared values for the machine learning models ranged from 0.04-0.35, which were deemed inadequate to provide reliable prediction of student performance based off the available dataset.
Study 2: sixteen students underwent block randomisation. One additional student completed the Think Aloud session. Baseline characteristics of the two groups were similar. Mean initial competency scores were similar for the HL and IP groups (18.56 and 18.63 respectively), both groups showed significant improvements in performance (to 26.69 and 27.94, respectively p < 0.001), and there was no significant difference between the groups’ post-feedback scores, (p = 0.11). Mean student SUS scores were 79.4 (Standard Deviation 13.1). Quantitative and qualitative feedback was generally positive, but identified several usability and technological limitations, including the development of headaches and visual fatigue.
Conclusion
This thesis demonstrates that it is possible to deliver educationally relevant tutorials, in two significantly different formats, from a remote location, using the Microsoft HoloLens 2 device. Overall, the technology and tutorial formats were agreeable to the students, tutors, and patients. However, this thesis also identifies several important issues which may be barriers to the widespread adoption of immersive technologies. Further investigation is required to evaluate the extent to which learning outcomes acquired through this training modality translate into improved clinical performance, and ultimately improved patient-centred outcomes.
Description
Keywords
Mixed Reality , Augmented Reality , Technology Enhanced Learning , Learning analytics , Immersive technology , Remote proctoring , HoloLens , Head-mounted-display
Citation
Connolly, M. 2025. The use of Mixed Reality in medical education: an evaluation of feasibility, usability and learning efficacy. MD Thesis, University College Cork.