Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
Chang Gung University College of Medicine, Taoyuan, Taiwan.
BMC Med Educ. 2024 Sep 27;24(1):1058. doi: 10.1186/s12909-024-05998-8.
Augmented reality (AR) technology involving head-mounted displays (HMD) represents a significant innovation in medical education, particularly for training in guided invasive procedures. Novice physicians often face challenges in simultaneously identifying anatomical landmarks and performing procedures when learning point-of-care ultrasound (POCUS). Our primary objective was to determine the effectiveness of AR in enhancing physician training for ultrasound-guided interventions using AR visual overlays. The secondary objective was to compare cognitive load between traditional ultrasound training settings and AR-assisted training settings.
This randomized crossover study, conducted from 2021 to 2022, compared performance and cognitive load of trainees attempting accurate central venous catheter (CVC) placement using an AR-HMD to display ultrasound images (AR-US), compared with standard ultrasound without visual overlay (S-US). We enrolled 47 trainees, including 22 final-year undergraduate medical students and 25 postgraduate physicians (years 1-4) from three hospitals in Taiwan. All participants had basic training in US-guided CVC placement but lacked AR-US experience. Performance and cognitive load were assessed using time measurements and NASA Task Load Index (NASA-TLX), covering the dimensions of Mental-, Physical- and Temporal Demand, and Performance, Effort and Frustration.
We found AR technology reduced the time required for critical steps in CVC placement, while minimizing users' neck strain. Female and junior trainees using AR-US identified anatomy and localized veins faster than those using S-US. Using AR-US, female trainees significantly outperformed males in anatomical identification [mean difference (MD): -10.79 s (95% CI: -2.37 to -19.21)]. The NASA-TLX cognitive load assessment showed mental workload trending lower in all dimensions except performance while using AR-US, compared to S-US. Similarly, junior trainees' effort- and frustration scores were lower [MD: -2.73 (95% CI: -5.04 to -0.41) and -2.41 (95% CI: -4.51 to -0.31), respectively], as were female trainees' effort scores [MD: -3.07 (95% CI: -6.10 to -0.03)] when using AR-US, compared to S-US, whereby these differences were statistically significant.
AR technology helped improve trainee performance and reduced cognitive load during ultrasound-guided CVC placement. These findings support the application of AR technology to enhance physician training in ultrasound-guided interventional procedures, suggesting that AR-HMDs could be a valuable tool in medical education.
The trial was registered with Clinicaltrials.gov on 20/09/2023 as a clinical trial, under the identifier NCT06055400.
增强现实（AR）技术涉及头戴式显示器（HMD），是医学教育的重大创新，尤其适用于引导性介入手术的培训。新手医师在学习即时护理超声（POCUS）时，往往难以同时识别解剖标志和进行操作。我们的主要目的是确定使用 AR 视觉叠加进行超声引导介入的 AR 在增强医师培训方面的有效性。次要目标是比较传统超声培训环境与 AR 辅助培训环境的认知负荷。
本研究于 2021 年至 2022 年进行，是一项随机交叉研究，将 47 名受训者（包括来自台湾三家医院的 22 名医学本科最后一年学生和 25 名住院医师（1-4 年））分为两组，一组使用 AR-HMD 显示超声图像（AR-US）进行操作，另一组使用标准超声（S-US）。评估标准为使用 AR-HMD 进行中央静脉导管（CVC）置管时受训者的操作表现和认知负荷。我们评估了时间测量和 NASA 任务负荷指数（NASA-TLX），涵盖了心理、生理和时间需求以及绩效、努力和挫折等维度。
我们发现 AR 技术减少了 CVC 置管关键步骤所需的时间，同时最大程度地减少了受训者的颈部劳损。使用 AR-US 的女性和初级受训者比使用 S-US 的更快识别解剖结构并定位静脉。使用 AR-US，女性受训者在解剖识别方面的表现明显优于男性受训者[平均差异（MD）：-10.79 秒（95%置信区间：-2.37 至 -19.21）]。使用 AR-US 时，NASA-TLX 认知负荷评估显示，除了绩效外，在所有维度上的心理工作量都呈下降趋势，而使用 S-US 时则不然。类似地，初级受训者的努力和挫折得分更低[MD：-2.73（95%置信区间：-5.04 至 -0.41）和-2.41（95%置信区间：-4.51 至 -0.31）]，而女性受训者的努力得分更低[MD：-3.07（95%置信区间：-6.10 至 -0.03）]，使用 AR-US 时，这些差异具有统计学意义。
AR 技术有助于提高超声引导 CVC 置管过程中的受训者表现并降低认知负荷。这些发现支持将 AR 技术应用于增强超声引导介入手术的医师培训，表明 AR-HMD 可能是医学教育中的一种有价值的工具。
该试验于 2023 年 9 月 20 日在 Clinicaltrials.gov 上注册为一项临床试验，标识符为 NCT06055400。
