The physician-to-population ratio is beginning to plateau, and is expected to decline right as the U.S. elderly (and more medically needy) population is on the rise. Thus, the physician workforce may not be able fulfill the U.S. population's demand. In fact, in 2020, the United States may face shortages of 45,400 primary care physicians and 46,100 medical specialists—a total of 91,500 too few doctors. Other projections estimate that the supply of US physicians may decrease even lower, with a shortfall as high as over 200,000 by 2020. Furthermore, the amount of quality time medical students have to learn procedures has drawn concern from researchers. ArchieMD has been developing a medical simulation augmented reality system to combine multimedia technologies with manikins to enable internal anatomy overlays on medical trainers. ArchieMD developed the technology based on a human manikin task trainer combined with 2D and 3D anatomic visual models presented on a screen. Using augmented reality tracking, ArchieMD's 3D imagery of the body's internal anatomy was superimposed over the view of the user, providing additional 3D didactic information while using a task trainer manikin. One of the key limitations of the approach is that it provides a 3rd person Point-of-View (POV) instead of a 1st person POV. While the 3rd person POV approach has utility for group activities and demonstration, it is of lesser value to the individual practicing the procedure. The use of a 1st person POV would enable seamless integration into medical training. This could be enabled through the use of augmented reality glasses or goggles. Recently, a number of exciting developments have occurred with respect to optical see-through augmented reality glasses and goggles. Phase I SBIR project, ArchieMD developed a 1st person POV MR trainer for Central venous catheter placement, which was evaluated at the University of Michigan for preliminary utility and feasibility in medical education. During Phase II we will continue the work by completing the following specific aims.  Specific Aim 1: Continue development of the 1st person POV Mixed Reality trainer to include: o Expanding procedures to incorporates a full range of important medical procedures including IV and arterial line placement, neuraxial techniques (spinals, epidurals), peripheral nerve blocks, paracentesis, thoracentesis and chest tube insertion. o Optimize 1st person POV MR trainer for improved performance and alignment.  Specific Aim 2: Conduct iterative usability testing with the expanded 1st person POV Mixed Reality trainer  Specific Aim 3: Conduct a randomized controlled trial to assess the ability of the 1st person POV Mixed Reality to improve procedural skills, as compared to traditional manikin trainers.

Public Health Narrative This proposed project could benefit public health by providing a novel method for efficiently and effectively training medical students key clinical skills, thus improving the knowledge and ability of our nation’s future physician workforce.