Murphy Kevin J, O'Brien Niall, Connolly Murray, Iohom Gabriella, Gibson James, Shorten George
The following authors are at Cork University Hospital: is a Fellow in Regional Anaesthesia; is a Consultant Anaesthesiologist. The following authors are at University College Cork: is a Biotechnician; is a Medical Student. is a Consultant Anaesthesiologist at Cork University Hospital and a Senior Lecturer in University College Cork. is a Consultant Anaesthesiologist at Cork University Hospital and Professor Emeritus at University College Cork and Insight Research Centre for Data Analytics.
J Educ Perioper Med. 2025 Jun 6;27(2):E745. doi: 10.46374/VolXXVII_Issue2_Murphy. eCollection 2025 Apr-Jun.
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.
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.
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).
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.
在医学教育中，纵向整合（VI）指的是临床科学与基础科学之间的整合。混合现实（MR）指的是一种呈现的体验，学习者可以同时感知虚拟和“真实”元素。微软HoloLens2是一款新型头戴设备，它能够呈现混合现实环境，并便于向一个或多个远程环境进行实时双向广播。我们在此展示一项混合方法研究，该研究扩展了我们之前的工作，即检验混合现实在医学生临床教育中的可行性、可用性和有效性，特别是在临床背景下教授疼痛传导通路。
由一位教师（K.J.M.）使用HoloLens2进行了一系列关于疼痛传导通路及其与术后疼痛管理相关性的7个交互式床边教程。每个教程都包括在术后期间与一名患者以及一组位于医院综合体内远程讲堂的5名医学生进行互动。该教程使用了虚拟教具的插入，包括经常叠加在患者身上或位于患者旁边的疼痛传导通路的示意性示例。通过使用经过修改的技术增强学习材料评估：学习者认知（ETELM-LP）工具来收集学生反馈。
这是一项前瞻性观察研究，采用了定性和定量方法。7名患者和35名学生参与了7个独立的教程。医学生的系统可用性量表平均得分为72.5（四分位间距为62.5 - 80.0），临床医生的平均得分为70.5，表明可用性良好。使用7点李克特量表的修改后的ETELM问卷显示，混合现实有助于实现教程的学习目标（中位数 = 6，范围为5 - 7），并且优于计算机投影幻灯片支持的讲座。与现场患者接触相比，学生们对混合现实教程的价值存在分歧（中位数 = 4,范围为3 - 5）。患者一直对与临床医生的沟通给予高度评价（中位数 = 7，范围为6 - 7），并且比起小组床边教学更喜欢混合现实教程（中位数 = 7，范围为6 - 7）。
我们在本机构内证明，使用微软HoloLens2和混合现实进行疼痛传导通路的床边临床教学是可行且有效的，并且可以加强医学本科课程中基础和临床材料的纵向整合。本研究涉及教师、协调员和课程专家的协作应用开发模式，为未来医疗保健教育技术树立了先例。计划在这种背景下对该设备的可用性进行进一步评估，未来的研究可能会评估我们的研究结果对医学教育其他要素的可推广性。
