An Evaluation of the Microsoft HoloLens2 in the Clinical Teaching of Pain Pathways for Undergraduate Medical Students.

Background: In medical education, vertical integration (VI) refers to integration between the clinical and basic sciences. Mixed reality (MR) refers to a rendered experience in which virtual and "real" elements are perceived simultaneously by a learner. The Microsoft HoloLens2 is a novel headset that allows the rendering of an MR environment and facilitates a live 2-way broadcast to (a) remote environment(s). We present here a mixed-methods study that extends previous work of ours examining the feasibility, usability, and efficacy of MR in the clinical education of medical students, specifically teaching pain pathways in a clinical context. Methods: A series of 7 interactive bedside tutorials on pain pathways and their relevance to postoperative pain management was delivered by a single teacher (K.J.M.) using the HoloLens2. Each tutorial included interaction with a patient during the postoperative period and a group of 5 medical students who were situated in a remote lecture theater within the hospital complex. The tutorial used insertion of virtual artifacts, including diagrammatic examples of pain pathways often superimposed on or positioned adjacent to the patient. Student feedback was elicited using a modified Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions (ETELM-LP) tool. Results: This was a prospective, observational study that used both qualitative and quantitative methods. Seven patients and 35 students participated across 7 separate tutorials. The mean System Usability Scale score for medical students was 72.5 (interquartile range 62.5-80.0) and for the clinician was 70.5, indicating favorable usability. The modified ETELM Questionnaire using a 7-point Likert scale demonstrated MR contributed to achieving the learning objectives of the tutorial (median = 6, range 5-7), and was superior to a lecture supported by computer- projected slides. There was disagreement among students regarding the value of the MR tutorial in comparison with a live patient encounter (median = 4, range 3-5). Patients consistently rated communication with the clinician highly (median = 7, range 6-7) and favored the MR tutorial over small group bedside teaching (median = 7, range 6-7). Conclusions: We demonstrated within our institution that bedside clinical teaching of pain pathways using the Microsoft HoloLens2 and MR is both feasible and effective, and could enhance vertical integration of basic and clinical material within a medical undergraduate curriculum. This study's collaborative application development model, involving tutors, facilitators, and curriculum experts, sets a precedent for future educational technology in health care. Further evaluation of the usability of the device in this context is planned, and future research may evaluate the generalizability of our findings to other elements of medical education.