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Alliance 2020 Award Winner: Pioneering the Use of Mixed Reality in CPD

By Lily Zurkovsky, PhD and Jonathan B. Scoble

Mixed reality offers a new direction for CME/CPD practitioners to connect learners to information in a non-didactic, hands-on manner. This innovative technology integrates key features of virtual and augmented realities to immerse users in three-dimensional (3D) content where they can interact with holographic images situated in the real world. When using mixed-reality devices, images do not obscure the user’s view, supporting shared experiences and discussions amongst groups of learners and/or teachers and experts.

Our group, Forefront Collaborative, worked with clinical experts and technology partners to develop a mixed-reality program on educational gaps in migraine. It was selected as the inaugural recipient of ACEHP’s Pioneer Award for Breaking New Ground (in/with) Your CPD Program at the 2020 Annual Conference in San Francisco this past January.

Patients living with a migraine disorder experience life-altering burdens extending far beyond pain, with varied symptoms ranging from sensory sensitivities to vomiting. Their lives are disrupted at their work, school, and they often become socially isolated. Additionally, the headache, clinical care landscape is shifting due to scientific advances and therapies that target neurologic mechanisms of the disease. Preventive treatment has traditionally been limited to therapies initially developed for non-headache diseases. The challenge for HCPs — and a contributing factor to the educational gaps — is the varied neurologic approaches through which therapies target migraine. Mixed reality presents itself as the optimal means to address this need given the complexity of neurologic phenomena, the varied nature of therapies and benefit of interpersonal interaction to the education.

In our first foray into mixed reality, we selected the Microsoft HoloLens, a mixed-reality headset whose first users included NASA and the United States military. With our partners and collaborators, we developed 3D representations of neurons, receptors, and other relevant features to explore the pathophysiology of migraine and the mechanisms of action (MOAs) of five different classes of therapies. The biological features were developed at three levels of magnification: whole brain, cellular and receptor. Using the Unity platform, the 3D representations and animations were transformed into an interactive, mixed-reality experience. Additionally, for a large-room audience, the experience within the headset can be projected onto a large screen using a spectator view capability.

The pictures below depict the “mixed” component of mixed reality. Through either the headset or spectator view, the technologic experience is superimposed in real-world space.


In July 2019, we incorporated the migraine mixed-reality experience into two satellite symposia that were conducted in conjunction with national conferences. These served as the basis for the Pioneer Award submission. Faculty narrated the educational talking points and applied the information to clinical practice gaps. Activities were supported by educational grants from Lilly.

The Hololens was extremely effective in helping me visualize the mechanism of action, which will help me retain the information longer — Learner

The live activities were designed primarily for headache specialists and primary care physicians. The education successfully reached the target audience and has the potential to benefit the care of at least 1,366 patients with migraine. Below are outcomes from the HoloLens portion of the activities:

  • Ninety-five percent of respondents reported that the HoloLens presentation met the associated learning objective, resulting in 90% of all respondents feeling more confident in developing treatment plans in migraine.
  • Eighty-five percent of respondents specifically reported that the HoloLens feature enhanced their learning experience.
  • Ninety-three percent and 94% of respondents reported that the technical/scientific level of the HoloLens presentation and feature, respectively, was “appropriate.”
  • Ninety-four percent of respondents reported that the HoloLens activity was applicable to improving their clinical practice.
  • Sixty-five percent of respondents reported they would make changes in their practice as a result of the HoloLens activity.

Overall, the HoloLens activity was a success, and it is only the beginning of our journey to explore how to use mixed reality in CPD. As of this publication, four more live activities have been implemented across the three mixed-reality experiences developed. The various paths, by which mixed reality can serve as a springboard for education, such as creating spaces for interpersonal exchange, will continue to be examined and refined. In the educational field, the mixed-reality medium represents an appreciable shift for content delivery. Along with developing the material, we also partner with our faculty to develop the presentation format. Moving forward with the development and implementation of mixed reality within accredited medical education curricula, our group is eager to evolve, putting immersive technologies such as Microsoft HoloLens in the hands of learners to develop more opportunities for active learning and faculty-learner exchange.

In conclusion, merging the best ideas in CPD with new advances in technology will ensure the most effective education to clinical learners. We believe that mixed reality devices are an integral frontier in medical education, creating a unique opportunity for experiential learning while conveying intricate biological and medical concepts.