Study Design
Full prospective ethical approval and study registration were obtained for this randomized crossover trial, and all participants provided written informed consent. The study was conducted and reported according to the Consolidated Standards of Reporting Trials (Resident-grade physicians working in acute medical and surgical specialties were prospectively identified and invited to participate through the medical education department of a single UK tertiary Academic Health Sciences Centre. The study was conducted from September to November 2021. Participants received a standardized MR platform headset and operational tutorial and completed a qualitative questionnaire to determine their clinical experience and exposure to the technology prior to commencing the study. The facilitated tutorial provided a practical introduction to the fundamentals of use, how to make and receive calls, and how to use clinical data assets. A competency test permitted progress to the trial phase, ensuring standardized basic technical competency and mitigating device-related first-use learning effects.Participants completed 2 simulated clinical resuscitation scenarios and were randomized via block randomization to standard care (SC) or MR-supported care (MR-SC) groups for their first scenario prior to crossover and analysis by care group to account for learning and carryover effects. Clinical scenarios were based on standardized clinical moulages undertaken for advanced life support qualifications and those undertaken by physicians in training as part of their core curriculum. SC was delivered by participants with access to didactic instruction, standard written clinical support tools, and telephonic support. Resources inclusive of radiology, blood results, patient notes, and clinical guidelines were available through standard ward-base computer systems. Access to senior support was provided through telephones and a bleep or on-call system standard to practice within the host institution. The MR-SC scenario made these resources available through the MR device. Participants were able to access patient data, visualize clinical guidance, and access interactive 3D content, including patient-specific visualization and guidance to aid with clinical procedures, in addition to bidirectional audiovideo calls to senior support (