Delivering remote procedural training on peripheral intravenous cannulation to medical students using the Microsoft...

Head-Mounted-Displays which have mixed reality capabilities have a range of functions which may improve medical training and address certain challenges facing universities worldwide. Devices such as the Microsoft HoloLens 2 device can facilitate provision of procedural tutorials from remote locations, provide tutors with a first-person perspective of a student's field of view, and allow the insertion of holographic artefacts which can replicate in-person tutorials and facilitate vertical integration of curriculum elements. This study aimed to evaluate the feasibility, efficacy and usability of the Microsoft HoloLens 2 device in providing tutorials to medical students on peripheral intravenous cannulation from a remote location.

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 metric- 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 received a familiarisation session with the device, completed a Mental Rotations Test, provided feedback, completed a System Usability Scale (SUS) questionnaire and three students completed interviews. One additional student completed a Think Aloud session.

Seventeen student volunteers were recruited. 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, both groups showed significant improvements in performance, and there was no significant difference between the groups' post-feedback scores, (p= 0.11). Students SUS scores were mean 79.4 (Standard Deviation 13.1). Quantitative and qualitative feedback was relatively positive, but identified several usability and technological limitations, including the development of headaches and visual fatigue.

This study demonstrates that tutorials on intravenous cannulation which are delivered remotely using the HoloLens 2 device are feasible, show a similar improvement in student performance to in-person tutorials, and are relatively well received by students and tutors. The ability to deliver procedural tutorials to a remote location has the potential to be a significant asset to medical educators. However, it also highlights several usability issues, including the development of "cybersickness" symptoms which may be limiting factors in its widespread adoption by educational institutions, and warrants further investigation.