Background: Mixed Reality (MR) environments rely on multimodal feedback to enrich sensory integration and realism, which enhances User Experience (UX). Prior studies have shown the benefits of haptic feedback in audio–visual MR medical training environments, but researchers have not fully examined how audio cues influence Haptic–Visual (HV) training environments. Methods: We built a high-fidelity MR medical training environment that synchronized visual, haptic, and audio of the human pulse. We conducted a between-subjects study with thirty novice participants who performed pulse palpation tasks in HV and Haptic–Audio–Visual (HAV) modalities. We employ a multidimensional UX evaluation by measuring task performance, presence, usability, and task workload to assess the impact of adding audio feedback in MR pulse palpation training environments. Results: Participants in the HAV modality performed tasks more accurately and reported stronger presence and higher usability. They did not report any significant increase in workload compared to the HV modality. Conclusions: Audio feedback improved perceptual coherence and enhanced UX in pulse palpation tasks. Our findings highlight the training value of integrating multimodal feedback in MR pulse palpation training systems and provide practical guidelines for designing more immersive and effective MR environments.

Background: Perioperative anxiety affects most children undergoing surgery and predicts emergence delirium, postoperative pain, and behavioral change. The validated modified Yale Preoperative Anxiety Scale (mYPAS) is scored at only a few discrete timepoints, leaving physiologic status between assessments unmeasured. Aims: We tested whether continuous wearable heart rate correlates with the mYPAS where scored, and whether heart‐rate elevations of undetermined cause occur during intervals without concurrent mYPAS observation. Methods: Children aged 4–17 undergoing elective surgery wore a wrist biosensor (Empatica EmbracePlus) from holding through induction; the mYPAS was scored at consent, parental separation, and induction. We assessed heart rate–mYPAS concordance and the proportion of heart‐rate elevations falling outside ±5 min of any mYPAS timepoint, stratified by premedication. Results: Of 32 consented children, 15 were analyzable (median age 10 years, nine male, eight premedicated). Induction‐window heart rate correlated with induction anxiety (Spearman ρ = 0.55, 95% CI 0.01–0.84, p = 0.034) and rose into induction in 13 of 15 children (median + 10 beats/min, p = 0.022). Of 90 heart‐rate elevations among 14 children with reliable timing, 71% fell outside the assessment windows (95% CI 58%–80%); 12 of 14 (86%) had ≥ 1 event outside all assessment windows. This pattern persisted regardless of premedication. Heart rate tracked children's state self‐report ( ρ = 0.62, ages ≥ 9) but not trait anxiety; informants agreed modestly. Conclusions: In this small feasibility cohort, wrist‐derived induction‐window heart rate was associated with concurrent mYPAS scores. The majority of heart‐rate elevations of undetermined cause occurred outside scheduled mYPAS assessment windows. These exploratory findings require confirmation in a larger study incorporating raw physiologic signals, motion measurement, and continuous or event‐linked behavioral assessment, which would establish whether continuous physiologic monitoring can complement intermittent behavioral assessment by identifying physiologic events occurring between scheduled anxiety assessments.