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The COVID-19 pandemic has disrupted traditional clinical teaching, depriving medical students of valuable clinical engagement with patients who required an aerosol-generating procedure (AGP) in the emergency department (ED). Because of the infection control restrictions, medical students are not allowed to enter resuscitation room where AGPs takes place, even in the aftermath of the pandemic.
The Microsoft HoloLens 2 is an augmented reality (AR) head-mounted device (HMD) which enables a single clinical teacher to facilitate real-time distant immersive learning by medical students on critically ill ED patients while insulating them from infection risks. Our team has successfully developed an AR HMD prototype based on HoloLens for clinical teaching and conducted 10 pilot teaching sessions. Overall, the audio-visual quality of the video-laryngoscope image captured by the HoloLens were rated satisfactorily by the students. Cybersickness symptoms such as dizziness, nausea, and eye strain were infrequent among the viewers.
The investigators conduct a pilot randomised controlled trial (RCT) which aims to evaluate the feasibility of conducting a full-scale RCT. The investigators collect data of the impact of AR learning and bedside learning on student knowledge gain, cognitive load, motivation and adverse effects. The investigators invite 33 Year 5 or 6 medical students to participate in this study during the Emergency Medicine Specialty Clerkship rotation at the Accident and Emergency Department (A&E) of Queen Mary Hospital (QMH). Consented medical students are randomly assigned in clusters based on their existing student group assignment (around 10 students per each small group) in a 1:1 to two arms: AR clinical learning arm and the control arm (bedside clinical learning).
Randomisation is performed by a research assistant not directly involved in the study using sequentially numbered opaque, sealed envelopes. Given the first-person perspective through the HoloLens, it is not possible to blind the medical students.
To standardise the teaching content of all study sessions, all such sessions are delivered by the principal investigator (PI) of this study during the study period and the pre-reading materials are the same for both groups. The PI will demonstrate endotracheal intubation using video laryngoscope and other AGPs on a manikin in the resuscitation room.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Augmented reality (AR) clinical learning arm | Experimental | In the AR clinical learning arm, students will have one 3-hour session of AR clinical learning of emergency airway management. The PI will put on a HoloLens device and demonstrate endotracheal intubation using video laryngoscope (C-MAC®) and other AGPs, such as bag-valve-mask ventilation on a manikin in the resuscitation room. The students will be situated in another room and have a first-person view captured by the HoloLens during the demonstration. |
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| Control clinical learning arm | Active Comparator | In the control arm, students will have one 3-hour regular session of bedside learning of emergency airway management. The PI will demonstrate endotracheal intubation using video laryngoscope (C-MAC®) and other AGPs, such as bag-valve-mask ventilation on a manikin in the resuscitation room in front of the students there. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Augmented reality clinical learning | Other | Clinical learning of emergency airway management including endotracheal intubation using video laryngoscope and other AGPs, such as bag-valve-mask ventilation, using augmented reality immersive learning technology. |
| Measure | Description | Time Frame |
|---|---|---|
| Knowledge gain (in full-scale RCT) | Knowledge gain measured with pre- and post-AR/control session knowledge tests, which consist of 20 multiple choice questions on emergency airway management | Immediately after the AR/control learning session |
| Measure | Description | Time Frame |
|---|---|---|
| Student domain interest | Student interest in emergency airway management assessed with 3 questions (e.g. "I know a lot about emergency airway management.") with responses captured using 100 mm visual analogue scales. To each of these questions, the answer ranges from 0 to 100 on a VAS where 0 is complete disagreement and 100 is perfect agreement with the statement. | Immediately after the AR/control learning session |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Rex Pui Kin Lam, MBBS, FHKCEM | Rex Pui Kin Lam | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Accident and Emergency Department, Queen Mary Hospital | Hong Kong | Hong Kong |
Data could be shared with other researchers upon reasonable requests and after additional approval by the institutional review board.
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| ID | Term |
|---|---|
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Control arm regular clinical learning | Other | Regular bedside learning of emergency airway management including endotracheal intubation using video laryngoscope and other AGPs, such as bag-valve-mask ventilation, |
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| Student opinion on the learning method | Student opinion on the learning method assessed with 5 questions (e.g. "The learning method is highly effective for me to learn about emergency airway management.") with responses captured using 100 mm visual analogue scales. To each of these questions, the answer ranges from 0 to 100 on a VAS where 0 is complete disagreement and 100 is perfect agreement with the statement. | Immediately after the AR/control learning session |
| Student perceived motivation | Student perceived motivation assessed with 4 questions (e.g. "The quality of the clinical session helped to hold my attention.") with responses captured using 100 mm visual analogue scales. To each of these questions, the answer ranges from 0 to 100 on a VAS where 0 is complete disagreement and 100 is perfect agreement with the statement. | Immediately after the AR/control learning session |
| Self-efficacy | Student self-efficacy assessed with 5 questions (e.g."I am confident that I will be able to master the skills taught in this clinical session.") with responses captured using 100 mm visual analogue scales. To each of these questions, the answer ranges from 0 to 100 on a VAS where 0 is complete disagreement and 100 is perfect agreement with the statement. | Immediately after the AR/control learning session |
| Student cognitive load | Student cognitive load assessed with 7 questions (e.g. "For this clinical session, many things needed to be kept in mind simultaneously.") with responses captured using 100 mm visual analogue scales. To each of these questions, the answer ranges from 0 to 100 on a VAS where 0 is complete disagreement and 100 is perfect agreement with the statement. | Immediately after the AR/control learning session |
| Adverse health effects | Adverse health effects during the learning session such as symptoms of cybersickness assessed including dizziness and nausea using 7-point Likert scale, with higher numerical scores indicating more severe symptoms. | Immediately after the AR/control learning session |