Development and enrichment of the undergraduate simulation experience is needed due to its utility in developing the aspiring clinician and their ability to assess and manage acutely unwell patients. However, with its heavy resource demand, and the desire for technologically enhanced learning by ‘Generation Z’, novel simulation modalities must now be considered [1]. Mixed reality (MR) technology provides a platform to deliver such simulation training; however, it is yet to be studied in this context. To evaluate this, we conducted an observational cohort study to assess if MR simulation improves students’ perceived ability to assess and manage acutely unwell patients.

We recruited 32 undergraduate medical students and asked them to rate their ability to assess and manage acutely unwell patients out of 10, before delivering a 2-hour MR simulation teaching session using the Microsoft HoloLens head-mounted device and HoloScenario software produced by GigXR [2]. They were then asked again to rate their assessment and management ability alongside their experience of the MR system and its usability. Data were analysed using paired t-tests to assess for significant improvement.

Analysis of the MR teaching session showed a statistically significant improvement of student scores in their perceived ability in assessment (p = .00) and management (p = .00) of the acutely unwell patient. In self-rated ability to assess the unwell patient, mean scores improved by 1.09 on the 10-point scale (95% CI [0.67, 1.52]) with 89% of students feeling more confident in assessment. In self-rated ability to manage the unwell patient, mean scores improved by 1.63 (95% CI [1.15, 2.10]) with 84% of students feeling more confident in management. Sixty-nine per cent of the students did not find the MR system easy to use, with 75% of students having technical issues and 38% experiencing side effects. Eighty-eight per cent of students believed the teaching experience to be beneficial to their learning.

MR shows promise in its ability to deliver simulation training and improve students’ perceived ability to assess and manage acutely unwell patients. Advances in software availability and simulation exercises are required for complete integration into undergraduate medical curricula. Further research is required to assess if MR simulation objectively improves student performance in this area.

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.