Mixed reality and 3D user interface technologies have increased the immersion, presence, and physicality of user interactions. These technologies can also increase the physicality of embodied conversational agents (ECAs) by making the ECAs occupy and interact with the physical space. We propose that increasing the physicality of an ECA can increase the ECA's social presence, that is, the feeling that the ECA is a real person. In this paper, we examine existing research and formalize the idea of ECA physicality. We also explored the relationship between physicality and social presence by conducting two user studies ( n = 18 and n = 29). Both user studies took place in a medical team training context and involved virtual human ECAs as fellow team members. The first study's results suggested that increasing physicality increased social presence and elicited more realistic behavior. The second study's results suggested that individual dimensions of physicality affect social presence to different extents.

This paper presents our experiences in evolving the Virtual Objective Structured Clinical Exam (VOSCE) system. This system allows medical students to experience the interaction between a patient and a medical doctor using natural methods of interaction with a high level of immersion. These features enable the system to provide training on medical communication skills. We discuss the experiences of a group of medical and physician assistant students that pilot tested the system. Further, we examine the impact of evolving the system based on their feedback. The VOSCE system's performance in subsequent studies has indicated that end-user feedback improvements have significantly impacted overall performance and efficacy.

Immersive virtual environments (VEs) provide participants with computer-generated environments filled with virtual objects to assist in learning, training, and practicing dangerous and/or expensive tasks. But does having every object being virtual inhibit the interactivity and level of immersion? If participants spend most of their time and cognitive load on learning and adapting to interacting with virtual objects, does this reduce the effectiveness of the VE? We conducted a study that investigated how handling real objects and self-avatar visual fidelity affects performance and sense of presence on a spatial cognitive manual task. We compared participants' performance of a block arrangement task in both a real-space environment and several virtual and hybrid environments. The results showed that manipulating real objects in a VE brings task performance closer to that of real space, compared to manipulating virtual objects. There was no signifi-cant difference in reported sense of presence, regardless of the self-avatar's visual fidelity or the presence of real objects.