Our system is composed of a trainee-side wearable system, supporter-side desktop system, and network server (Figure 1). The trainee-side wearable system consists of Google Glass (GG), Bluetooth earphones, and a small mirror attached to the GG. GG has a front camera, Bluetooth audio, and a touchpad. The supporter-side desktop system consists of a desktop computer and headset, video conferencing application program to monitor the trainee, and image transmission program for sharing image files.
The trainee-side wearable system transmits real-time video and audio captured from the trainee's field of view through GG and receives audio and image transmitted from the supporter-side system. We used Google Glass Enterprise Edition 2 (Glass EE2; Android Oreo8.1). The supporter-side desktop system receives the trainee's video and enables voice communication. We also developed software that can transmit images and text required for training by accessing the web RTC server using Google Chrome.
Our system was installed in two simulation rooms: the emergency intensive care unit and emergency support unit (Figure 2). In the emergency intensive care unit, there were two trainees wearing a trainee-side wearable system and high-fidelity patient simulator. In the emergency support unit, there were two remote supporters sitting the supporter-side desktop system. The supporters can use two desktop application programs: Option1 – Image guide and Option2 – Monitoring system. The image guide delivers selected images to the corresponding trainees and transmits real-time video from the smart glasses to the supporter monitor.
High fidelity simulator
The METIman is a life-like human simulator that physically represents patients. With clinical features including breathing, pulse, heart and lung sounds, various scenarios of adults with heart disease can be simulated. Not only does the simulator show physical symptoms, but the monitor connected to the simulator displays associated signs (e.g., vital signs).
The framework of the 15-hour simulation program was developed based on a previous study  that included seven nursing skills and 4-5 incidents where students were required to perform nursing practice and make clinical decisions (Appendix 1). The smart glasses-based TBS consisted of three parts; 1)participants attended a lecture on EKG analysis, medication, and nursing care for patients with arrhythmia. 2)Two scenarios of arrhythmia (a-fib and PSVT) were introduced, and 3) a task was given to build a step-by-step algorithm. For each scenario, four students formed a group and two students took the role of remote supporters who were in charge of sharing information with bedside workers for optimal decision making. The control group attended traditional TBS, in which all students participated in the simulation as bedside trainees without smart glasses.
The study population included nursing students who attended a baccalaureate nursing program at a university located in J district, Korea. A total of 64 participants were recruited and allocated to either the experimental (n=32) or control (n=32) groups. Excluding incomplete surveys, data from 31 participants in the intervention group and 30 participants in the control group were used. The purpose of this study was explained to all study participants and written informed consent was obtained.
Developed by Ingrassia et al. , we revised the questionnaire according to the design and purpose of this study. The survey consisted of 54 questions spanning six categories: user input (12 items), system output (6 items), system usability (17 items), fidelity (8 items), immersivity (4 items), and likability (7 items). Using a 5-point Likert scale, the study participants provided ratings from 1 (strongly disagree) to 5 (strongly agree). There were four additional questions in which study participants rated their overall level of satisfaction from 1 (very dissatisfied) to 4 (very satisfied) regarding the smart glasses device, ease of use, system output, and smart glasses-based simulation.
Attitudes towards the interprofessional health care team
The Attitudes towards Interprofessional Health Care Teams scale was developed by Heinemann et al.  and modified by Curran et al. . This scale consists of 14 items that include the quality of care, time constraints, and teamwork of health professionals. This scale uses a 5-point Likert scale with values ranging from ‘strongly disagree’ (1) to ‘strongly agree’ ( 5).
Satisfaction with the education program was measured using the questionnaire used by Ji and Chung . The 5-point Likert scores were used, randing from “not at all satisfied” (1) to “very satisfied” (5). The higher the score, the higher the satisfaction with the education program.
An essay questionnaire was used that asked seven qualitative questions: 1) “How did you find the smart glasses-based emergency simulation in general?”; 2) “Was this program easy to use? What are the points that you thought needed further improvement?”; 3) “Were there any difficulties or constraints when operating the system?”; 4) “Do you think this smart glass-based simulation education would be useful for your future practice?”; 5) “Do you think the smart glass would be useful in the clinical environment?”; 6) “What are the components that require additional technical efforts for active application and continuous use of these smart glasses?”; and 7) “Please add any other comment on this program.”
Statistical analyses were performed using SPSS (version 25.0). For demographic data, the frequency, percentage, mean, and standard deviation were calculated. Independent t-tests and chi-squared tests were used to examine the homogeneity between the intervention and control groups. Independent t-tests were used to compared group differences, and statistical significance was set at p<.05.