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.

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.