Abstract
Mixed Reality (MR) merges the physical and digital worlds to create immersive environments that significantly enhance user engagement, learning, and procedural training across various fields. This study focuses on the application of MR in medical training, specifically in orthopedic surgeries like reverse total shoulder surgery, to investigate the interplay between perception and cognition and their impact on surgical decision-making and outcomes. Using MR simulator in conjunction with Unity 3D and Microsoft HoloLens 2, ten surgical residents participated in simulations that replicated reverse total shoulder surgical environments. The study evaluated how MR affects cognitive load using the modified NASA Task Load Index and assessed perceptual and cognitive skills through structured feedback. Results indicated a strong positive correlation between enhanced perceptual skills and cognitive function, crucial for surgical proficiency. Furthermore, MR environments were found to effectively manage cognitive load, thereby supporting the potential of MR technology in improving surgical training outcomes. The findings suggest that MR not only reduces cognitive load but also enhances perceptual and cognitive skills, which are essential for complex surgical procedures. Future research directions include developing training programs that target perceptual skills enhancement and optimizing MR viewpoints to maximize educational outcomes in medical training environments.