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There is growing evidence that the use of simulation in teaching is a key means of improving learning, skills, and outcomes, particularly for practical skills. In the health sciences, the use of high-fidelity task trainers has been shown to be ideal for reducing cognitive load and leading to enhanced learning outcomes. However, how do we make these task trainers available to students studying at a distance? To answer this question, this paper presents results from the implementation and sustained testing of a mobile mixed reality intervention in an Australian distance paramedic science classroom. The context of this mobile mixed reality simulation study, provided through a user-supplied mobile phone incorporating 3D printing, virtual reality, and augmented reality, is skills acquisition in airways management, focusing on direct laryngoscopy with foreign body removal. The intervention aims to assist distance education learners in practising skills prior to attending mandatory residential schools, building a baseline equality between those students who study face to face and those at a distance. Outcomes from the study showed statistically significant improvements in the use of the simulation across several key performance indicators in the distance learners, but also demonstrated problems to overcome in the pedagogical method.

New accessible learning methods delivered through mobile mixed reality are becoming possible in education, shifting pedagogy from the use of two dimensional images and videos to facilitating learning via interactive mobile environments. This is especially important in medical and health education, where the required knowledge acquisition is typically much more experiential, self-directed, and hands-on than in many other disciplines. Presented are insights obtained from the implementation and testing of two mobile mixed reality interventions across two Australian higher education classrooms in medicine and health sciences, concentrating on student perceptions of mobile mixed reality for learning physiology and anatomy in a face-to-face medical and health science classroom and skills acquisition in airways management focusing on direct laryngoscopy with foreign body removal in a distance paramedic science classroom. This is unique because most studies focus on a single discipline, focusing on either skills or the learner experience and a single delivery modality rather than linking cross-discipline knowledge acquisition and the development of a student's tangible skills across multimodal classrooms. Outcomes are presented from post-intervention student interviews and discipline academic observation, which highlight improvements in learner motivation and skills, but also demonstrated pedagogical challenges to overcome with mobile mixed reality learning.

Abstract:In health sciences education, there is growing evidence that simulation improves learners' safety, competence, and skills, especially when compared to traditional didactic methods or no simulation training. However, this approach to simulation becomes difficult when students are studying at a distance, leading to the need to develop simulations that suit this pedagogical problem and the logistics of this intervention method. This paper describes the use of a design-based research (DBR) methodology, combined with a new model for putting 'pedagogy before technology' when approaching these types of education problems, to develop a mixed reality education solution. This combined model is used to analyse a classroom learning problem in paramedic health sciences with respect to student evidence, assisting the educational designer to identify a solution, and subsequently develop a technology-based mixed reality simulation via a mobile phone application and three-dimensional (3D) printed tools to provide an analogue approximation for an on-campus simulation experience. The developed intervention was tested with students and refined through a repeat of the process, showing that a DBR process, supported by a model that puts 'pedagogy before technology', can produce over several iterations a much-improved simulation that results in a simulation that satisfies student pedagogical needs.

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