Background: The current state-of-the-art in medical simulation is mannequin-based and utilizes highly specialized and costly personnel, equipment, and centers. We have created a new mixed reality (MR) platform, HoloSIM, which consists of laptop-based instructor software and Microsoft Hololens headset-based student software. The Microsoft Hololens allows spatially stable, interactable, and animated holograms to be inserted into a user’s workspace (MR). Though infrequent, anaphylaxis is a high-risk crisis that requires rapid decisive action, which presents a challenge for trainees.

Hypothesis: HoloSIM simulation will be non-inferior in knowledge acquisition and application of decision-making concepts in anaphylaxis management compared to high-fidelity mannequin-based simulation.

Methods: This study is a REB-approved prospective randomized control trial where 40 junior medical students were randomized to either a Hololens-based or a mannequin-based simulation regarding anaphylaxis management. Both groups completed a pre-test and practiced anaphylaxis management using their assigned modality. We invited the participants to return one week later to complete a post-test and knowledge application test on a new mannequin-based crisis assessment scenario.

Results: For the knowledge application test, the HoloSIM group had an average score of 25.7+/-5.5, and the mannequin group had an average score of 26.7+/-6.1 (P=0.59). We were unable to demonstrate non-inferiority. Conversely, there were no statistically significant differences either. The system usability score (SUS) for the HoloSIM platform was 59.9, which is considered below average (SUS Average = 68) and in the ‘marginally acceptable’ category. Despite the usability scores, when asked if ‘this type of simulation was beneficial to my learning’ and if they ‘would participate in this type of simulation session in the future’, 89% and 95% of participants in the HoloSIM group agreed or strongly agreed with the statements.

Conclusion: MR is still a new innovation in medical education. This study is among the first to create MR critical care simulations using comprehensive learning theories. Given the HoloSIM platform is still a prototype platform, the low SUS could have interfered with the desired learning outcomes. However, given the medical students’ enthusiasm, we believe these issues can be improved with further development and studies.