AIRWAY-XR: Augmented Instruction to Refine Wayfinding and Yielding Skills in Emergency Medicine Residents for Intubation using Mixed Reality Technology

The goal of this study was to assess if mixed reality technology (MR) is a feasible training tool for educating new learners in endotracheal intubation. This is a feasibility trial to establish the feasibility of an MR airway education module compared to traditional airway teaching. The study participants were twenty-one postgraduate year one (PGY1) physicians accepted to an emergency medicine residency program located in a large, urban setting. The residency program is located in New York City, and has academic affiliations with two large, urban, academic emergency departments (ED) that each treat over seventy thousand patients per year. We enrolled 20 Emergency Medicine (EM) first-year residents into two research arms. Group A consisted of 10 first-year residents who utilized a novel MR education module containing self-guided training and real-time feedback via the Microsoft HoloLens 2. Group B consisted of 10 first year residents who trained on a phone-based module containing the same self-guided content and received real-time training via iPad, which is the traditional didactic format. Both groups had remote Senior EM Residents (PGY3) coaches who provided feedback and direction to the participants. Groups were subsequently assessed by Attending EM Physicians on a 10-point scale and given a post-survey to provide feedback on their experience. There was no difference in scores between the HoloLens 2 users and iPad users (HoloLens score [8.6] v. iPad score [8.5]; p = 0.56) or in completion time between the two groups (HoloLens = [3.4 +/- 0.9 min] v. iPad = [3.3 +/- 1.4 min]; p = 0.45). Out of the Group A participants, 70% rated their overall experience between good and excellent. We concluded that using the HoloLens 2 as a didactic model for intubation is feasible, with possible evidence for noninferiority to traditional didactic models if explored further in a larger standardized trial.