Background
COVID-19 has had a catastrophic impact measured in human lives. Medical education has also been impacted: appropriately stringent infection control policies have precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not. This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching.

Methods
Two MR sessions were led by senior doctors wearing the HoloLens™ headset. The trainers selected patients requiring their specialist input. The headset allowed bi-directional audio-visual communication between the trainer and trainee doctors.
Trainee doctor conceptions of bedside teaching, impact of COVID-19 on bedside teaching and the MR sessions were evaluated using pre- and post-round questionnaires, using Likert scales. Data related to clinician exposure to at risk patients and use of PPE were collected.

Results
Pre-questionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (7, IQR 6-7). Post-session questionnaires showed that overall users subjectively agreed the MR session was helpful to their learning (6, IQR 5.25 – 7) and that it was worthwhile (6, IQR 5.25 – 7). Mixed-reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use.

Conclusions
This study is proof of principle that HoloLens™ can be used effectively to deliver clinical bedside teaching This novel format confers significant advantages in terms of: minimising exposure of trainees to COVID-19; saving PPE; enabling larger attendance; and convenient accessible real-time clinical training.