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Usability Evaluation of Augmented Reality: A Neuro-Information-Systems Study
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Non-technical skill performance during remote, international, augmented-reality neonatal resuscitation protocol

Marcos Rojas1,2, Romy Yun3, Asheen Rama3

  • 1Stanford School of Medicine, Stanford University, California, United States. marcosrp@stanford.edu.

BMC Medical Education
|February 4, 2026
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Summary

Remote augmented reality (AR) simulations effectively assessed non-technical skills (NTS) in neonatal resuscitation training for international residents. This technology offers a scalable solution for NTS education, overcoming resource limitations in global health settings.

Keywords:
Augmented realityMedical educationNeonatal resuscitationNon-technical skillsSimulation

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Area of Science:

  • Medical Simulation
  • Global Health Education
  • Augmented Reality in Medicine

Background:

  • Neonatal resuscitation training necessitates proficiency in both technical and non-technical skills (NTS).
  • The Neonatal Resuscitation Program (NRP) curriculum integrates leadership, teamwork, and situational awareness.
  • Simulation-based education is crucial for NTS but faces accessibility challenges in low-resource regions; augmented reality (AR) presents a scalable, remote alternative.

Purpose of the Study:

  • To evaluate the feasibility of remote AR medical simulation for assessing NTS during neonatal resuscitation.
  • To determine the efficacy of AR in delivering NTS training across international medical institutions.

Main Methods:

  • A prospective, single-arm feasibility study was conducted with pediatric and anesthesiology residents in Santiago, Chile, remotely guided by instructors in California.
  • Neonatal resuscitation scenarios were delivered via an AR medical simulator.
  • Non-technical skills performance was assessed using the Anesthetists' Non-Technical Skills (ANTS) tool and Behaviorally Anchored Rating Scale (BARS), alongside system usability (SUS) and ergonomics evaluations.

Main Results:

  • Participants achieved adequate NTS performance, with ANTS scores ranging from 2.5-2.9 and BARS scores from 5.2-5.4 (on scales of 1-4 and 1-9, respectively).
  • Performance metrics were comparable to traditional, in-person simulation-based training.
  • The AR system demonstrated high usability and minimal ergonomic burden.

Conclusions:

  • Remote, international AR neonatal resuscitation simulations are feasible for assessing measurable NTS performance.
  • This approach validates AR as a viable tool for global NTS medical education, addressing logistical barriers.