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A significant challenge novice physicians face is mastering ultrasound (US)-guided procedures, such as central venous catheter (CVC) placement, typically performed on critically ill patients and demanding precision and speed. Physicians must repeatedly switch focus between US screen and patient while simultaneously memorising multiple images, coordinating hand–eye movements, and interpreting two-dimensional (2D) images in a three-dimensional (3D) context. This challenges spatial orientation and imposes considerable cognitive load, affecting both learning and performance. As medical educators explore potential merits of using augmented reality (AR) via head-mounted displays to enhance immersive learning in clinical settings, we aimed to determine whether AR could enhance trainee skill acquisition by easing spatial orientation challenges and cognitive overload during this procedure. During 2021–2022, a cohort of final-year medical students (UGY) and postgraduate physicians (PGY) with prior instruction in US-guided CVC placement from three leading tertiary hospitals participated in in-depth investigations at Taiwan's prestigious i-Simulation Centres, aiming to discern potential benefits of AR use for US-guided CVC placement. Integrating the SIEMENS ACUSON P500 standard US device with the cutting-edge Foresee-X AR system, trainees could observe US imagery in the headset's upper half, and the simulator in the lower half, significantly reducing the need for visual shifting. For methodological consistency, all trainees used the standardised Blue Phantom® simulator. In this three-phase research, participants' foundational knowledge was first assessed. Then they were randomly (by coin-toss) assigned to use either standard US or AR-US. After CVC placement, the trainees assessed their experience using the NASA Task Load Index (NASA-TLX), and various performance parameters were evaluated. These included the time required for anatomical identification, puncture duration, total US operational time, and duration for procedures without US guidance. An additional assessment gauged participants' proficiency, measured by the level of assistance they required, ranging from hands-on guidance to complete autonomy. Data analysis from the 47 included participants yielded profound insights. The AR-US group consistently outperformed the standard US group in procedural efficiency, vital in practical medical scenarios. Key was the significant reduction in visual shifting from the US interface among AR users. The NASA-TLX data indicated that AR-US reduced the perceived cognitive workload across various dimensions, but not performance. This suggested that AR offers a streamlined and more cognitive-friendly learning environment. Notably, factors like seniority and gender did not significantly influence procedure times, while novice physicians using AR-US reported less cognitive stress and frustration. Interestingly, female trainees using AR-US identified anatomical landmarks faster than their male peers, while those using standard US felt a heightened sense of effort. In conclusion, leveraging AR technology in skill acquisition appeared to reduce cognitive burden and improve efficiency for trainees learning US-guided CVC placement procedures, as evidenced by faster completion of essential procedural steps, and smoother task performance. Our data suggested that integrating AR technology can lessen trainees' mental workload and decrease their dependence on instructional guidance. Our findings indicated that AR technology can significantly enhance medical education, especially in CVC placement training for UGY medical students and PGY physicians. Shu-Chen Liao: Conceptualisation; data collection; resources; project administration; writing the original draft; review and editing. Shih-Chieh Shao: Methodology; review and editing. Shi-Ying Gao: Formal analysis; review and editing. Edward Chia-Cheng Lai: Methodology; supervision and writing. None. The ethics committee approved the study (Institutional Review Board of Chang Gung Medical Foundation, IRB No.: 202002303B0). The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Liao et al. (Wed,) studied this question.