In the past few years, advances have been made on how mixed reality humans (MRHs) can be used for interpersonal communication skills training for medical teams; however, little research has looked at how MRHs can influence communication skills during training. One way to influence communication skills is to leverage MRHs as models of communication behavior. We created a mixed reality medical team training exercise designed to impact communication behaviors that are critical for patient safety. We recruited anesthesia residents to go through an operating room training exercise with MRHs to assess and influence residents' closed loop communication behaviors during medication administration. We manipulated the behavior of the MRHs to determine if the MRHs could influence the residents' closed loop communication behavior. Our results showed that residents' closed loop communications behaviors were influenced by MRHs. Additionally, we found there was a statistically significant difference between groups based on which MRH behavior residents observed. Because the MRHs significantly impacted how residents communicated in simulation, this work expands the boundaries for how VR can be used and demonstrates that MRHs could be used as tools to address complex communication dynamics in a team setting.

In a group setting, it is possible for attributes of one group member to indirectly affect how other group members are perceived. In this paper, we explore whether one group member's agency (e.g. if they are real or virtual) can indirectly affect behavior with other group members. We also consider whether variations in the agency of a group member directly affects behavior with that group member. To do so, we examined gaze behavior during a team training exercise, in which sixty-nine nurses worked with a surgeon and an anesthesiologist to prepare a simulated patient for surgery. The agency of the surgeon and the anesthesiologist were varied between conditions. Nurses' gaze behavior was coded using videos of their interactions. Agency was observed to directly affect behavior, such that participants spent more time gazing at virtual teammates than human teammates. However, participants continued to obey polite gaze norms with virtual teammates. In contrast, agency was not observed to indirectly affect gaze behavior. The presence of a second human did not affect participants' gaze behavior with virtual teammates.

In this paper we present a study exploring whether the physical presence of another human changes how people perceive and behave with virtual teammates. We conducted a study (n = 69) in which nurses worked with a simulated health care team to prepare a patient for surgery. The agency of participants' teammates was varied between conditions; participants either worked with a virtual surgeon and a virtual anesthesiologist, a human confederate playing a surgeon and a virtual anesthesiologist, or a virtual surgeon and a human confederate playing an anesthesiologist. While participants perceived the human confederates to have more social presence (p <; 0.01), participants did not preferentially agree with their human team members. We also observed an interaction effect between agency and behavioral realism. Participants experienced less social presence from the virtual anesthesiologist, whose behavior was less in line with participants' expectations, when a human surgeon was present.

We introduce a taxonomy for mixed simulation focusing on mixed simulators with physical exteriors augmented with virtual underlays for practicing medical procedures such as central venous access (CVA). We used CT and MRI imaging and 3D printing to develop anatomically authentic mixed simulators, i.e., exact physical and/or virtual replicas of their human models. Embedded 6 DOF magnetic sensors monitor tracked instruments during simulated procedures, facilitating after action review or self-debriefing. We implemented automated scoring algorithms that include tracking and grading of near misses. After 28 anesthesia residents trained with the CVA simulator, incidence of pneumothorax and arterial puncture in the simulated environment dropped from 11 % to 7% and 13% to 7%, respectively.

The concepts of immersion and presence focus on the environment in a virtual environment. We instead focus on embodied conversational agents (ECAs). ECAs occupy the virtual environment as interactive partners. We propose that the ECA analogues of immersion and presence are physicality and social presence. We performed a study to determine the effect of an ECA's physicality on social presence and eliciting realistic behavior from the user. The results showed that increasing physicality can elicit realistic behavior and increase social presence but there was also an interaction effect with plausibility.

We integrated two simulators, a Virtual Patient (VP) system and a physical Human Patient Simulator (HPS) to create a mixed reality conscious sedation training environment. The VP system simulates clinical environments where learners conduct patient interviews. The HPS is a mannequin that models and simulates a wide array of clinical signs. The VP+HPS combination provides new capabilities specially suited for conscious sedation training. Future work will evaluate the efficacy of this MR simulation.

This paper proposes collocated After Action Review (AAR) of training experiences. Through Mixed Reality (MR), collocated AAR allows users to review past training experiences in situ with the user’s current, real-world experience. MR enables a user-controlled egocentric viewpoint, a visual overlay of virtual information, and playback of recorded training experiences collocated with the user’s current experience. Collocated AAR presents novel challenges for MR, such as collocating time, interactions, and visualizations of previous and current experiences. We created a collocated AAR system for anesthesia education, the Augmented Anesthesia Machine Visualization and Interactive Debriefing system (AAMVID). The system was evaluated in two studies by students (n=19) and educators (n=3). The results demonstrate how collocated AAR systems such as AAMVID can: (1) effectively direct student attention and interaction during AAR and (2) provide novel visualizations of aggregate student performance and insight into student understanding for educators.

Mixed reality's (MR) ability to merge real and virtual spaces is applied to merging different knowledge types, such as abstract and concrete knowledge. To evaluate whether the merging of knowledge types can benefit learning, MR was applied to an interesting problem in anesthesia machine education. The virtual anesthesia machine (VAM) is an interactive, abstract 2D transparent reality simulation of the internal components and invisible gas flows of an anesthesia machine. It is widely used in anesthesia education. However when presented with an anesthesia machine, some students have difficulty transferring abstract VAM knowledge to the concrete real device. This paper presents the augmented anesthesia machine (AAM). The AAM applies a magic-lens approach to combine the VAM simulation and a real anesthesia machine. The AAM allows students to interact with the real anesthesia machine while visualizing how these interactions affect the internal components and invisible gas flows in the real world context. To evaluate the AAM's learning benefits, a user study was conducted. Twenty participants were divided into either the VAM (abstract only) or AAM (concrete+abstract) conditions. The results of the study show that MR can help users bridge their abstract and concrete knowledge, thereby improving their knowledge transfer into real world domains.