Mixed Reality Closed Loop Communication Training

Empowering healthcare professionals to be patient safety advocates

The mixed reality closed loop communication training exercise is a mixed reality experience that trains healthcare professionals on how to properly communicate when administering medications to patients in the operating room


Adam Wendling, a faculty member and collaborator at UF Health wanted his anesthesia residents to properly communicate when administering medications. In his experience, closed loop communication was not frequently being used in the operating room.

I worked with UF Health to create a mixed reality experience designed specifically to educate anesthesia residents on the importance of closed loop communication during the administration of medications. 


  • Experience could last no longer than 30 minutes
  • Mixed reality humans (MRHs) need to be able to request for drugs to be administered and anesthesia residents need to be able to administer those drugs
  • MRHs need to influence the user’s closed loop communication behavior


Vicarious learning is a way to learn by observing and has been extensively studied in psychology. We hypothesized that users could potentially learn by observing mixed reality humans, and in a previous study, we found evidence to suggest that. Leveraging my previous experience on creating an experience to educate surgical technicians on how to handle conflict with authority figures, we knew that this new experience would be a vicarious learning experience. 

Since we knew that MRHs could influence user behavior, we wanted to understand how to most effectively influence behavior using vicarious learning. 

Sample Persona

Dr. Jones
  • Age: 30
  • Occupation: 3rd Year Anesthesia Resident

  • Wants to complete experience to fulfill didactic time requirement
  • Needs to complete experience before work 
  • Wants to strengthen skills as an anesthesiologist
  • Unsure of purpose of training exercise


Design Process

In the early stages of creating this experience, the focus was entirely on the content of the script for the MRHs. Since we were simulating actual stages of surgery, we could leverage standards of practice like the Surgical Safety Checklist to cover components users would expect during various stages of a surgery. Since one of our constraints was to create a 30 minute experience, we chose to focus only on two stages of the perioperative process in which medications are administered: Pre-Induction Briefing (before incision) and the Closing (after the incision has been closed).

Below are what are effectively table-reads of these stages. I worked with my colleagues at the Virtual Experiences Research Group to read through the script.

After getting an initial draft of the script, our next step was testing the script with an anesthesia provider. Adam Wendling’s wife, Linda, an anesthesiologist at UF Health, volunteered to play the role of an anesthesia resident. By having someone with similar expertise to an anesthesia resident, we were able to get a good idea of how well our script met the expectations of an anesthesiologist.

In order to understand how mixed reality humans could most effectively influence closed loop communication behavior, we developed three different experiences in which the MRH nurse and MRH surgeon modeled closed loop communication behavior. From our previous training experience, we knew that two of models would be an “Ideal” model in which the MRH nurse and MRH surgeon correctly used closed loop communication, and a “Bad” model in which the MRH nurse and MRH surgeon don't use closed loop communication at all. The “Ideal” model was based on recommendations from TeamSTEPPS from AHRQ on how to properly close the loop. The third model was a “Bad” model with correction. Originally, the “correction” moment was concerning the MRH nurse saying the wrong route of administration. Eventually, the “correction” moment evolved into more of a educational moment in which the MRH surgeon stresses the importance of closed loop communication.
Good Model (GM) Moment (v1)
Bad Model (BM) Moment
Bad Model with Correction (BMC) Moment (v1)
Surgeon: Okay, Nancy, could you give Mr. Smith 5000 units of Heparin SubQ right now?
Surgeon: Okay, Nancy, could you give Mr. Smith 5000 units of Heparin SubQ right now?
Surgeon: Okay, Nancy, could you give Mr. Smith 5000 units of Heparin SubQ right now?