## 5 Future Directions
#### Towards Implementation: A Proposed Protocol for AR Integration in Medical Education  
Based on a university-wide survey involving both medical students and teaching faculty, there is a growing interest in using innovative technologies to enhance cardiovascular education. Augmented reality (AR), particularly when used with devices like the Microsoft HoloLens, has emerged as a promising tool to support the teaching of complex anatomical and pathophysiological content. This project aims to develop a modular, small-groupAR-based teaching course that incorporates patient-specific heart models to supplement and enrich traditional cardiovascular instruction. Phase 1: Conceptualization and Didactic Integration  
The initial phase involves aligning the course with the existing curriculum and defining clear educational objectives. The focus will be on improving the understanding of cardiac anatomy and topography, especially congenital heart defects, electrical conduction disorders, coronary anatomy, and valvular interventions. The course is designed to allow students to engage with clinical cases comprehensively, from initial symptoms and diagnostics to therapeutic decision making and follow-up care. The course will be structured in multiple sessions, beginning with an introductory unit on AR technology and device handling. This will be followed by thematic modules covering key content areas: normal heart anatomy, congenital defects, arrhythmias, interventional procedures, and a final case-based session that allows students to manage a complete patient case using AR heart models. This culminating session will guide participants through every step of clinical reasoning, using a fully interactive, patient-specific 3D heart model. Didactically, the course is planned as a blended learning format. Self-paced digital learning materials will prepare students for in-person sessions, which will be conducted in small groups of four to six participants in AR multiplayer sessions with one instructor. This format promotes active learning, hands-on engagement, and direct feedback from instructors. Phase 2: Technical and Logistical Preparation  
Simultaneously, the technical infrastructure must be established. Representative patient cases will be selected, and imaging data (CT, MRI, or ultrasound) will be processed to create detailed 3D heart models. Using segmentation software, such as 3D Slicer 5.8.1 or comparable alternatives, DICOM datasets will be transformed into high-quality digital reconstructions suitable for AR use. To enable immersive interaction, these models will be optimized for AR devices. The implementation will utilize platforms such as Unity or other suitable development environments to ensure stable and high-performance visualization. Interactivity features like rotation, transparency layers, annotations, and animations (e.g., cardiac conduction pathways) will enhance educational value. The physical setup will require dedicated lab space with reliable Wi-Fi, power sources, and open movement zones. Devices like the HoloLens will be equipped with user-friendly interfaces, enabling intuitive navigation of the 3D heart models. Multi-user synchronization features will also be explored, allowing all participants to interact with the same virtual model in real time. Faculty training for future course tutors will be established. Phase 3: Pilot Implementation and Evaluation  
The initial pilot phase will involve a selected group of clinical-year students, for example, those in their final years or in the practical year (PJ). The aim is to test the feasibility of the course format, collect feedback, and identify areas for improvement both technically and pedagogically. Evaluation will be conducted using a combination of quantitative surveys and qualitative interviews with both students and instructors. Pre- and post-testing will assess learning outcomes, such as improvement in anatomical comprehension or clinical reasoning related to the cases discussed.