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Context Three‐dimensional (3‐D) visualisation in anatomical education has been shown to be broadly beneficial for students. However, there is limited research on the relative efficacy of 3‐D modalities. This study compares knowledge performance, mental effort and instructional efficiency between autostereoscopic 3‐D visualisation (holograms), monoscopic 3‐D visualisation (3‐DPDFs) and a control (2‐D printed images). Methods A cardiac anatomy model was used to generate holograms, 3‐DPDFs and 2‐D printed images. Nursing student participants (n = 179) were randomised into three groups: holograms (n = 60), 3‐DPDFs (n = 60) and printed images (n = 59). Participants completed a pre‐test followed by a self‐study period using the anatomical visualisation. Afterwards, participants completed the NASA‐Task Load Index (NASA‐TLX) cognitive load instrument and a knowledge post‐test. Results Post‐test results showed participants studying with holograms (median = 80.0, interquartile range [IQR] = 66.7–86.7) performed significantly better regarding cardiac anatomy knowledge than participants using 3‐DPDF (median = 66.7, IQR = 53.3–80.0, p = 0.008) or printed images (median = 66.7, IQR = 53.3–80.0, p = 0.007). Mental effort scores, on a scale from 1 to 20, showed hologram (mean = 4.9, standard deviation [SD] = 3.56) and 3‐DPDF participants (mean = 4.9, SD = 3.79) reported significantly lower cognitive load than printed images (mean = 7.5, SD = 4.9, p < 0.005). Instructional efficiency (E) of holograms (E = 0.35) was significantly higher than printed images (E = −0.36, p < 0.001), although not significantly higher than 3‐DPDF (E = 0.03, p = 0.097). Conclusions Participants using holograms demonstrated significant knowledge improvement over printed images and monoscopic 3‐DPDF models, suggesting additional depth cues from holographic visualisation provide benefit in understanding spatial anatomy. Mental effort scores and instructional efficiency of holograms indicate holograms are a cognitively efficient instructional medium. These findings highlight the need for further study of novel 3‐D technologies and learning performance.

The adaptive instruction provided by Intelligent Tutoring Systems (ITSs) tailors direction, support, and feedback to enhance/maintain the learning needs (e.g., lack of knowledge or skill) of each individual. Today, ITSs are generally developed to support desktop training applications, with the most common domains involving cognitive problem solving tasks (e.g., mathematics and physics). In recent years, implementations of game-based tutors authored using the Generalized Intelligent Framework for Tutoring (GIFT), an open-source tutoring architecture, provided tailored training experiences for military tasks through desktop applications (e.g., games including Virtual Battlespace and Virtual Medic). However, these game-based desktop tutors have also been limited to adaptive instruction for cognitive tasks (e.g., problem solving and decision-making). The military requires adaptive instruction to extend beyond the desktop to be compatible with the physical nature of many tasks performed by soldiers, sailors, and airmen. This article examines how commercial sensor technologies might be adapted to work with GIFT and support tailored computer-guided instruction in the psychomotor domain for a military medical training task, specifically hemorrhage control. Toward this goal, we evaluated the usability and system features of commercial smart glasses and pressure-sensing technologies. Smart glasses were selected as the focus of this study over handheld mobile devices in order to promote a hands-free experience during the training of hemorrhage-control tasks on a mannequin. Pressure sensors were selected to provide direct measures of effectiveness during the application of tourniquets and pressure bandages. Each set of technologies (smart glasses and pressure sensors) was evaluated not with respect to each other, but with respect to their capabilities to support adaptive instruction in the wild at the learner’s point-of-need and criteria based on established usability heuristics. Instruction in the wild is training provided in an environment outside the classroom and areas where tracking and sensing infrastructure are available (e.g., deployed areas of operation). We examined a wide range of features and capabilities, and evaluated their compatibility with the hemorrhage-control task, to answer the following question: what system design features (e.g., usability and interaction) are needed to support adaptive instruction for this individual psychomotor task at the point-of-need in locations where no formal training infrastructure is available?

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