Medical procedures are an essential part of healthcare delivery, and the acquisition of procedural skills is a critical component of medical education. Unfortunately, procedural skill is not evenly distributed among medical providers. Skills may vary within departments or institutions, and across geographic regions, depending on the provider's training and ongoing experience. We present a mixed reality real-time communication system to increase access to procedural skill training and to improve remote emergency assistance. Our system allows a remote expert to guide a local operator through a medical procedure. RGBD cameras capture a volumetric view of the local scene including the patient, the operator, and the medical equipment. The volumetric capture is augmented onto the remote expert's view to allow the expert to spatially guide the local operator using visual and verbal instructions. We evaluated our mixed reality communication system in a study in which experts teach the ultrasound-guided placement of a central venous catheter (CVC) to students in a simulation setting. The study compares state-of-the-art video communication against our system. The results indicate that our system enhances and offers new possibilities for visual communication compared to video teleconference-based training.