A Feasibility Trial of HoloLens 2™; Using Mixed Reality Headsets to Deliver Remote Bedside Teaching During COVID-19

Background: COVID-19 has had a catastrophic impact measured in human lives. Medical education has also been impacted: appropriately stringent infection control policies have precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not transitioned so well. The aim of this study was to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching to trainee doctors during the COVID-19 pandemic. Methods: Two MR sessions were led by senior specialty registrars (the clinical trainers) wearing the HoloLens™ headset. The trainers selected patients admitted with pathology requiring their specialist input; thus, the educational sessions were opportunistic. The headset allowed bi-directional video and audio communication between the trainer and trainee doctors during the consultation. Trainee doctor conceptions of bedside teaching, impact of COVID-19 on bedside teaching and technical success of the session was evaluated using pre- and post-round questionnaires using 1 (‘strongly disagree’ or ‘never’) to 7 (‘strongly agree’ or ‘always’) Likert scales and white space questions. Feedback on acceptability of the round was collected verbally from patients after each encounter. Data related to clinician exposure to at risk patients and use of PPE were also collected. Results: Pre-questionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (7, IQR 6-7). It was also apparent that bedside teaching had become a rarity during COVID-19 (2, IQR 2-4). Session 1 feedback (n=6) was adversely affected by a loose microphone connection. With the issue rectified for session 2 (n=4), most respondents strongly agreed that they felt like they were physically present for the session (7, IQR 6.75-7). Mixed-reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use. Conclusions: This study is proof of principle that HoloLens™ can be used effectively to deliver high-quality clinical bedside teaching. This novel format confers significant advantages in terms of: minimising exposure of trainees to COVID-19; saving PPE; enabling larger attendance; and convenient accessible real-time clinical training.