Australasian Journal of Educational Technology, 2017, 33(6). 69 Improving paramedic distance education through mobile mixed reality simulation James Birt Bond University Emma Moore and Michael Cowling Central Queensland University There is growing evidence that the use of simulation in teaching is a key means of improving learning, skills, and outcomes, particularly for practical skills. In the health sciences, the use of high-fidelity task trainers has been shown to be ideal for reducing cognitive load and leading to enhanced learning outcomes. However, how do we make these task trainers available to students studying at a distance? To answer this question, this paper presents results from the implementation and sustained testing of a mobile mixed reality intervention in an Australian distance paramedic science classroom. The context of this mobile mixed reality simulation study, provided through a user-supplied mobile phone incorporating 3D printing, virtual reality, and augmented reality, is skills acquisition in airways management, focusing on direct laryngoscopy with foreign body removal. The intervention aims to assist distance education learners in practising skills prior to attending mandatory residential schools, building a baseline equality between those students who study face to face and those at a distance. Outcomes from the study showed statistically significant improvements in the use of the simulation across several key performance indicators in the distance learners, but also demonstrated problems to overcome in the pedagogical method. Introduction As educators, we are increasingly surrounded by a new breed of individual who tackles problems in new and different ways through technology (Clark & Mayer, 2016; Corrin, Bennett, & Lockyer, 2013). In fact, Jones, Ramanau, Cross, and Healing (2010) point out that these students expect to be engaged by their environment through simulation, with participatory, interactive, sensory-rich, experimental activities (either physical or virtual), and opportunities for input. They are more oriented to visual media than previous generations and they prefer to learn visually, by doing, rather than by telling or reading. In health education, simulation can assist with student skills (Cook et al., 2013), especially in task training (Wickens, Hutchins, Carolan, & Cumming, 2013). Given that paramedic science is seeing a shift away from face-to- face lectures towards blended learning and distance education (Williams et al., 2011), this presents an opportunity to explore methods to provide simulation task training to distance education students. Literature review Simulation use in health disciplines and paramedic science In health education, there is growing evidence that simulation improves learners’ safety (Abraham, Wade, O’Connell, Desharmaus, & Jacoby, 2011), competence, and skills (Cook et al., 2013), especially when compared to traditional didactic methods and or no simulation training (Cook et al., 2012). Of significant importance to the health profession is airways management (Baker, Weller, Greenland, Riley, & Merry, 2011), where inadequate skill and poor judgment can lead to patient complications and death (Cook, Woodall, & Frerk, 2011). Airways management simulation education and hands-on training builds essential skills (Baker et al., 2011; Kennedy, Cannon, Warner, & Cook, 2014) and changes attitudes and behaviour for all health professionals. This is especially true for trainee paramedics studying high-priority invasive skills such as direct laryngoscopy with foreign body removal in pre-emergency care (Butchart, Tjen, Garg, & Young, 2011), where students require confidence and experience to execute skills correctly (Youngquist et al., 2008). Task trainers are an ideal setting for novice paramedics to train these important hands-on airways skills as they isolate specific tasks to enhance procedural or surgical techniques using three-dimensional (3D) parts