Beyond the Surface: Mixed Reality in Procedural Skill Development in Physician Assistant Education.

Abstract: While the application of virtual reality (VR) and mixed reality (MR) technologies to enhance learning motivation in science education remains a hot topic that garners significant interest from scholars, there is a paucity of studies addressing whether and how VR or MR may be more effective in motivating students’ learning intention. Accordingly, the current study investigates the distinctive effects of VR and MR on students’ learning intention through the theoretical lenses of plausibility illusion and enjoyment. Employing a within-subject design experiment ( N = 71), the current research explores whether and how the learning experience of the solar system, either via VR or MR headsets, may impact students’ intention to learn using VR or MR. We posited that the sense of plausibility illusion and enjoyment will serially mediate the impact of XR modality (VR vs. MR) on students’ learning intention. Results from a two-condition within-subjects mediation analysis confirmed the significant mediating effects of plausibility illusion and enjoyment on the relationship between XR modality and learning intention. By exploring the differences in the structural affordances of VR and MR technologies, this study provides insights into understanding the distinctive roles of VR and MR technologies on students’ learning intentions.

Digital hydraulics is a discrete technology that integrates advanced dynamic system controls, digital electronics, and machine learning to enhance fluid power systems’ performance, overall efficiency, and controllability. A mechanically actuated inline three-piston variable displacement digital pump was previously proposed and designed. The inline three-piston pump incorporates complex mechanical and hydraulic subsystems and highly coupled mechanisms. The complexity of the utilized subsystems poses challenges when assessing the viability of the conceptual design. Therefore, this work focuses on designing, developing, and implementing a collaborative virtual platform involving a digitized module showcasing the internal mechanical structure of the digital pump utilizing mixed reality (MR) technology. MR technology is acknowledged as the forthcoming evolution of the human–machine interface in the real–virtual environment utilizing computers and wearables. This technology permits running simulations that examine the complexity of highly coupled systems, like the digital pump, where understanding the physical phenomenon is far too intricate. The developed MR platform permits multiple users to collaborate in a synchronized immersive MR environment to study and analyze the applicability of the pump’s design and the adequacy of the operated mechanisms. The collaborative MR platform was designed and developed on the Unity game engine, employing Microsoft Azure and Photon Unity Networking to set up the synchronized MR environment. The platform involves a fully interactive virtual module on the digital pump design, developed in multiple stages using Microsoft’s Mixed Reality Tool Kit (MRTK) for Unity and deployed in the synchronized MR environment through a HoloLens 2 MR headset. A research study involving 71 participants was carried out at Purdue University. The study’s objective was to explore the impact of the collaborative MR environment on understanding the complexity and operation of the digital pump. It also sought to assess the effectiveness of MR in facilitating collaboration among fluid power stakeholders in a synchronized digital reality setting to study, diagnose, and control their complex systems. Surveys were designed and completed by all 71 participants after experiencing the MR platform. The results indicate that approximately 75% of the participants expressed positive attitudes toward their overall MR platform experience, with particular appreciation for its immersive nature and the synchronized collaborative environment it provided. More than 70% of the participants agreed that the pump’s collaborative MR platform was essential for studying and understanding the complexity and intricacy of the digital pump’s mechanical structure. Overall, the results demonstrate that the MR platform effectively facilitates the visualization of the complex pump’s internal structure, inspection of the assembly of each of the involved subsystems, and testing the applicability of the complicated mechanisms.

Fluid power systems can be expensive and difficult to access, making it challenging to provide hands-on training. This work discusses the incorporation of Mixed Reality (MR) technology in Fluid Power applications for providing a virtual training environment that simulates the behavior of fluid power systems, allowing users to receive immediate feedback on the system’s performance. Mixed reality is a digitized-based technology that integrates a virtual environment with our real world by utilizing real-world sensor data and computer models. This technology allows running simulations that examine the complexity of highly-coupled systems, producing new digital environments where physical and digital elements can interact in real-time. With all these features, MR technology can be a practical training tool for running virtual simulations that mimic real-life industry settings. It can extend the user with a virtual training environment, thus preparing the next generation of fluid power engineers and specialists. Throughout this work, we present the development and capabilities of a digitized virtual copy of a hydraulic excavator’s arm in an MR environment as a proof of concept. The MR arm module is developed and deployed using Microsoft’s Mixed Reality Tool Kit (MRTK) for Unity through HoloLens 2 MR headset. The MR development involves generating virtual copies of the mechanical and hydraulic subsystems, conducting the virtual assembly, and creating a user interface in the MR environment to visualize and interact with the model. The developed MR module enables visualizing the excavator’s internal structure, conducting the virtual assembly, and running virtual simulations, all of which assist in training future fluid power operators. It is an effective training tool that helps train junior engineers/technicians, cutting down on cost and time.

INTRODUCTION Health and wellness promotion and disease prevention are goals that are often included in expert committee recommendations for the improvement of health care delivery and health professional education.1 The challenge for physician assistant (PA) education has been to incorporate these goals into an already intense curriculum with students who are frequently overwhelmed by the volume and scope of program requirements. The purpose of this study was to examine the effects of an experiential wellness project on the perceived wellness of first-year PA students utilizing self-selected, common lifestyle interventions. The competencies for the PA profession developed jointly by the National Commission on Certification of Physician Assistants (NCCPA), the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), the Physician Assistant Education Association (PAEA, formerly APAP), and the American Academy of Physician Assistants (AAPA) include specific objectives promoting wellness and patient education to maintain health and prevent disease.1 Healthy People 2010 advocates the inclusion of competencies in health promotion and disease prevention in health professional training school curricula.2 The General Professional Education of the Physician Report identifies the importance of lifestyle in determining health and wellness and recommends that medical school curricula emphasize health promotion and disease prevention as well as the development of values that engender concern for individuals and society.3 PA education has incorporated these goals. A survey of 108 PA programs by Perkin et al found that more than 90% of responding programs includJohn Laird, ND, is assistant professor; Susan Hawkins, MSEd, PA-C, is assistant professor and interim program director; Mark Hertweck, MA, PA-C, is assistant professor; and Brenda Swanson-Biearman, MPH, RN, is assistant professor in the Chatham College PA Program, Pittsburgh, Pennsylvania.

Neurodiversity, encompassing conditions such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and dyslexia, represents a significant and often under-recognized segment of the population, including within science, technology, engineering, mathematics, and medicine fields like medicine. Neurodiverse individuals possess unique skills, including enhanced creativity, analytical thinking, and meticulous attention to detail, which are valuable in health care professions. However, failure to recognize and support these individuals can result in missed opportunities, social isolation, and mental health challenges. Despite a growing emphasis on diversity, equity, inclusion, and belonging in higher education, neurodiversity is frequently overlooked, particularly in physician assistant (PA) education. This article examines the unique challenges faced by neurodiverse PA student learners and the existing literature gap regarding neurodiversity in PA education. It underscores the need for greater awareness, reduced stigma, and improved support systems. Recommendations include integrating neurodiversity into the PA curriculum, providing faculty training on inclusive teaching practices, and establishing tailored accommodations to foster a sense of belonging. PA programs can foster a more equitable health care system by creating inclusive learning environments that acknowledge and cater to the unique needs of neurodiverse student learners, thereby enhancing student-faculty interactions and promoting academic success. The aim of this article was to facilitate the reimagining of PA education to champion cognitive diversity. By promoting a more inclusive learning environment, PA programs can cultivate future clinicians who are better equipped to serve diverse patient populations.

The literature of a profession reflects its vitality, activity, and intellectual temperature. A thorough review of literature can reveal areas of growth and improvement as well as serve as a means to share relevant research accomplishments. As the physician assistant (PA) education profession continues to thrive and expand, it is important for the literature that reflects the profession to also develop and expand its audience. A retrospective, systematic analysis of published research articles in the Journal of Physician Assistant Education (JPAE) and its predecessor publication, Perspective on Physician Assistant Education, from 2001-2011 (N = 145) was conducted. Articles were organized by study topic, cohort of interest, and methodology and further analyzed to determine respective response rates and frequency of topics. Nearly one-fourth of all articles considered were dedicated to studying various PA curricula. Methodological approaches used in these studies tended toward Internet-based surveys, but telephone-based surveys retained the highest response rate (97%). Among study subjects (cohorts) examined, the most frequently studied cohort consisted of PA students, who displayed high response rates (74.4%). The total number of articles published in JPAE increased annually; study methodology reflects a predominance of survey research approaches. Analysis from this review of 10 years of JPAE content suggests that studies using effective methodology to gain high response rates, those that have more sophisticated designs and use appropriate statistical measures, and those that aim to reach a more diverse pool of cohorts may be future goals.

Introduction: The development of physician assistant (PA) education programs grew out of a need to improve access to healthcare services in the United States. That need has resulted in a blossoming of PA education programs. Today there is a wide assortment of PA programs to choose from, but there has been little comparison of these programs from a financial standpoint. We undertook a descriptive study of PA programs by examining some of the opportunity cost variables that might be critically viewed by an applicant. Method: We obtained information available to the public in 2000 in 126 PA education tracks spread over 124 PA programs. This data was gathered from catalogs, Web sites, and/or by contacting the program. In public institutions, the in-state tuition cost was selected over the out-of-state cost. Total tuition cost was computed by dividing the first year's tuition by 12, then multiplying this amount by the duration of the PA program (in months). This and other data were entered into a spreadsheet and analyzed for differences in year 2000 dollars. Results: The total tuition cost of PA education ranges from $4,370 to $69,258. The average cost of a public- funded PA education was $14,366; a private education was $38,846. The tuition for a master's program track was, on average, $32,531 versus $22,685 for a bachelor's or certificate track. Private institutions averaged 44 (range 12-100) students per entering class while public institutions averaged 35 (range 10-80). The length of a PA program, on average, was 25-26 months, but ranged from 12-36 months. Privately funded programs tended to be longer in duration. Conclusion: There is almost a 16-fold difference from the low end to the high end of PA tuition costs. On average, the tuition burden for a public-funded PA education is approximately one- third of private education tuition. These differences are striking and raise the question of what a PA student gains from programs with high-tuition costs that cannot be achieved at a less expensive institution. The debt imposed on students by higher tuition PA programs may lead graduates away from lower-paying primary care roles to higher-paying nonprimary care positions in order to pay for their education.

Mixed Reality (MR) headsets offer the promise of greatly enhancing the ways that archaeologists collect and interact with their data during fieldwork. Archaeology is inherently spatial, visual, and grounded in the 3D reality of the world, which makes immersive MR headsets a natural fit for our discipline. However, none of the existing MR headsets are suitable for continuous practical use during archaeological fieldwork. Therefore, we here undertake the important creative exercise of laying out a design for an ideal MR headset for archaeologists of the future. We base this design upon our own practical experiments with existing technology during our field excavation. First, we provide our motivation for pursuing this project, to enhance how archaeologists interact with their 3D data. We then present both a vision of how MR headsets could be used to support fieldwork, and we document the limitations of the current MR headsets that work against achieving this vision. Next, we present specific details for several different requirements for an ideal headset that could overcome these limitations. Our goal is to encourage other archaeologists to engage in experimentation with MR headsets during their own fieldwork in order to better understand the future possibilities. We also hope to encourage technologists and archaeologists to collaborate towards building new MR headsets that can achieve at least some aspects of our ideal design.

Ensuring integrity of a pipeline network is an essential activity for a pipeline operator. Pipeline integrity management programs are designed to identify and mitigate potential risks to pipeline to maintain safe and reliable operation of pipelines. To support decision making about integrity management, interpretation of data is necessary and better insights of data can be achieved by visualization of data. Visualization enables users to identify patterns, trends, and relationships quickly and easily in the data that might not be immediately apparent through textual or numerical data alone. Data visualization through Augmented Reality (AR) is an emerging trend that allows users to view and interact with data in a more immersive and interactive way. Going a step ahead, Mixed Reality (MR) combines Augmented Reality (AR), Virtual Reality (VR), and other forms of digital content to produce a seamless environment in which digital objects are placed in real-world settings, allowing users to interact with them in real-time. MR technology provides pipeline inspectors with a more immersive and detailed view of the pipeline, allowing them to identify potential issues such as gouges, corrosion, and dents etc. This can help to improve the accuracy of inspections and reduce the risk of human error. The paper discusses about the potential uses of Mixed Reality (MR) technology in pipeline industry including several case studies. First case includes study on an offshore pipeline dent, wherein the repair decisions were supported by the virtual model of the dent profile. In another case, MR technology was used by the experts sitting at office to see and identify causes of failure through the MR headset. The technology has also been used to see drone footage of pipeline Right of Use (RoU) for assessing coating refurbishment works. Fourth case study includes visualization of digital elevation model for the sites identifies for washouts based on Artificial Neural Network. Last case includes visualization of seabed profile using a multibeam side scan sonar. The technology requires specialized hardware, software, and algorithms. Several algorithms were created to digest various survey and open-source data such as Inline inspection, drone imagery, 3D photogrammetry, sonar surveys and satellite data. Several datasets and assets were modelled to create a digital 3D library. The library thus forms a Metaverse where users can import data models and evaluate the asset using mixed reality device in a collaborative environment. MR technology has enhanced intuitive view of the pipeline, allowing the pipeline operators to identify and repair issues more quickly and efficiently, thereby, reducing downtime and minimizing disruption to pipeline operations. In summary, the use of mixed reality for visualizing integrity of pipelines has several potential applications which is going to increase manifolds in the coming future as it offers new paradigm for communication and better collaboration by replacing flat displays and keyboards with 3D, virtual and interactive environment which is a major shift in user engagement.

INTRODUCTION Building foresight about the future is a critical component of planning for growth in any profession. As an essential arm of the profession, physician assistant (PA) education programs prepare competent and qualified practitioners to meet the evolving needs of the US health care system and to an increasing extent, global health care needs. Therefore it is incumbent upon PA educators and their representative organizations to monitor emerging trends, forces, and other factors in the education, health care industry, and clinical medicine arenas that that could potentially affect future health care and the PA profession. The short lag time between the beginning of a student’s education and clinical practice, combined with the speed and amount of change occurring in the many areas that affect health care, challenge faculty to stay ahead of the curve to ensure the relevance of the curriculum. Because it is nearly impossible to predict the future of health care, the key to operating successful programs will be the ability of PA education leadership, equipped with vision and flexibility, to efficiently and rapidly implement the changes required to respond to the needs of students and society. This paper will explore the impact of emerging trends and forces that may affect PA education. Rather than attempt to predict specific outcomes, we present potential opportunities and challenges for PA programs and faculty. The intent is to sensitize PA educators to impending issues and forces and to reinforce our belief that as educators we have an obligation to continually monitor the global and national health care environments in order to prepare practitioners for the future and not just the present.

This study aims to explore the transformative impact of Mixed Reality (MR) technologies in the U.S. retail sector. It focuses on analyzing how MR reshapes shopping experiences, enhances customer engagement, and influences the economic landscape of retail. The methodology encompasses a comprehensive literature review, utilizing academic journals, conference proceedings, and industry reports. The search strategy involved keyword searches and manual screening, with inclusion and exclusion criteria set to filter relevant literature. The selection criteria prioritized recent studies to capture the latest trends in MR technology. The key findings reveal that MR technologies have evolved significantly, offering immersive and interactive shopping experiences that revolutionize customer engagement and satisfaction. The economic implications of MR in retail are profound, indicating substantial market growth and financial opportunities for retailers. However, the adoption of MR also presents challenges, including the need for integration into existing retail models and the development of user-friendly interfaces. The study also highlights the importance of regulatory frameworks and standardization in the successful implementation of MR technologies in retail. In conclusion, MR technologies hold great potential for the retail sector, offering innovative ways to engage customers and enhance their shopping experiences. However, realizing these opportunities requires overcoming various challenges, including adapting financial strategies and addressing infrastructure needs. As MR continues to evolve, it is poised to play a pivotal role in shaping the future of the retail sector. The study underscores the need for ongoing research to fully understand and leverage the potential of MR in retail.

IntroductionTelehealth is crucial to the provision of high-quality treatment of critically unwell patients in rural areas. Our aim was to explore the benefits and limitations of a mixed reality (MR) headset for clinician-to-clinician telehealth in a simulated rural context, in which the advising clinician directly views the treating clinician's point-of-view and uses holographic annotations to provide visual guidance in three-dimensional space.MethodsTwenty-five clinicians trialled a MR headset—the Microsoft HoloLens 2—and evaluated it against a trolley-based videoconferencing device used in current practice. Each participant trialled the devices while role-playing one of two perspectives: the Rural Clinician accessing support or the Advising Clinician providing support.ResultsAdvising Clinicians had higher ratings of usability and self-efficacy, and lower ratings of mental workload, when providing support via the MR headset compared to the videoconferencing trolley (ps < 0.035). However, Rural Clinicians rated the MR headset lower on usability compared to the videoconferencing trolley (p = 0.020), and rated their self-efficacy and mental workload equally when using both devices (ps > 0.253). Participants generally preferred to use the MR headset over the videoconferencing trolley. On average, scenarios took 1 minute longer to complete when using the MR headset (p < 0.001).DiscussionWearable MR technology has the potential to improve the quality of support provided to rural clinicians; however, it may be more beneficial for those dialling in to the device (advising clinicians) rather than those wearing the device (rural clinicians). Factors that may limit its safety and efficiency are discussed.

The purpose of the study was to describe inclusion of didactic and clinical instruction in oral health in physician assistant (PA) education programs in 2014. A previous study in 2008 found that PA education program directors generally understood the importance of teaching about the linkage of oral health with systemic health; yet, few programs had actually integrated oral health instruction into the PA curriculum. This study was undertaken to ascertain the number of PA programs teaching oral health topics and to evaluate the content of instruction and implementation strategies. The study used a Web-based survey using a skip logic design that branched respondents based on inclusion or the absence of an oral health curriculum in the PA education program. The questions included predefined response options with the opportunity for narrative responses and comments. Analysis of survey data was completed using SPSS (IBM) and SAS (SAS Institute, Inc) and consisted mainly of frequencies and cross tabulations. There was greater inclusion of oral health curriculum in 2014 than in 2008 with most PA programs now providing didactic and clinical training in oral health. Stakeholders' efforts to engage PA program faculty with integration of oral health subject matter into core curriculum have resulted in wider availability of training for PA students in oral health promotion and prevention services. Efforts to equip PA faculty to teach oral health topics and clinical skills should continue as past efforts have resulted in wider integration of oral health subject matter into core PA curriculum.

Background: One-step cranioplasty combined with tumor removal is a recognized approach in neuro-oncology for patients with neoplastic skull invasion. The use of advanced technologies, including Mixed Reality (MR), has introduced new possibilities in surgical workflows. MR technology may provide additional benefits in preoperative planning, patient engagement, and intraoperative guidance. Can the proposed treatment algorithm, which includes Mixed Reality (MR) for preoperative planning and intraoperative navigation, demonstrate tangible utility and improve outcomes in the surgical management of skull-invasive tumors? Methods: A retrospective study was conducted on 14 patients treated at Cannizzaro Hospital, Catania, Italy, for skull-invasive tumors. The treatment algorithm incorporated tumor removal and one-step cranioplasty using custom-made titanium alloy meshes. Standard intraoperative navigation was compared with MR-based navigation. MR headsets and the Virtual Surgery Intelligence (VSI) platform were employed for preoperative planning, surgical guidance, and patient/family communication. Tumor types included nine meningiomas and five other tumor variants. Results: The integration of MR proved beneficial for preoperative planning, facilitating enhanced visualization of patient anatomy and aiding communication with patients and families. MR-assisted intraoperative navigation offered improved anatomical familiarity but demonstrated slightly lower accuracy compared with standard navigation. Postoperative outcomes were satisfactory across the cohort, with no significant complications reported. Conclusions: The study highlights the potential utility of the proposed treatment algorithm including MR technology in the surgical management of skull-invasive tumors. While MR provides enhanced visualization and preoperative engagement, standard navigation remains more precise during surgery. Nevertheless, MR serves as a valuable complementary tool, and its role in neuro-oncological workflows is expected to grow with technological advancements.

Purpose: Physician assistant (PA) educators must prepare their students to effectively manage psychosocial issues. Designing a curriculum that attends to these issues presents challenges to PA faculty since study of PA involvement in patients’ psychosocial issues has been sparse. This study examines the frequency of psychosocial issues seen in primary care PA practice and the degree and manner in which PAs respond to the psychosocial issues seen. Methods: A randomly selected national sample of primary care PAs logged information about psychosocial issues encountered in their first eight patient visits on appointed dates. Information logged included psychosocial issues encountered, the PA’s level of response to each issue encountered, and referrals made to specialists. PA respondents returned study materials anonymously. Results: Study response rate was 12% (162 respondents from 1,328 randomly selected PAs). Of the 1,270 primary care visits recorded, 67.8% included at least one psychosocial issue. Behavioral health was the category of psychosocial issues most frequently logged (58%), and five issues together accounted for 41.3% of all identified issues (coping with own illness, anxiety/nerves/tension, depression, pain, and worry about health). PAs provided help in response to 93.2% of psychosocial issues identified and referred nearly a quarter of patients who presented with psychosocial issues to specialists for evaluation or treatment. Conclusions: A variety of psychosocial issues are frequently seen in primary care PA practice. Consequently, PA curricula must prepare students to recognize and respond to a wide range of psychosocial issues. Further study is warranted to confirm and build on the results of this study.