A Pilot Study of the Impact of Virtually Embodying a Patient with a Terminal Illness

Assessing virtual patients for empathy training in healthcare: A scoping review

OBJECTIVE

A growing body of virtual patients (VPs) generated by computers has been incorporated into medical education that includes empathy training. We sought to uncover the validity and effectiveness of VPs in empathy training.

METHOD

The authors carried out a comprehensive search of all articles published between 1991 and 2023 in the seven databases of literature in the areas of health science and education. In total, 2170 abstracts were reviewed, and ultimately, the final corpus consisted of 44 articles.

RESULTS

Guided by the Computer-as-social-actor framework, this study identified four types of primary social cues presented in current literature to arouse trainees' social responses. Overall, the social cues used across the included studies were similar. However, the efficacy and effectiveness of VPs varied, and we identified four factors that may influence these outcomes. First, technology matters. VPs for VR systems were found to be effective in clinical empathy training, but limited empirical evidence supported web-or-mobile-based VPs. Second, improvement was only observed in the cognitive empathy dimension. Third, studies that have longer interaction duration (over 30 minutes). Last, using self-report measurements were more likely to observe significant improvements. Qualitative findings revealed that VPs for VR systems can create an immersive experience that allows users to understand the needs of patients and put themselves in patients' shoes, while web-or-mobile-based VPs are more convenient for trainees.

PRACTICAL IMPLICATIONS

This review displays evidence supporting the efficacy and effectiveness of VPs in future medical empathy training. Mechanisms and future research agendas were discussed.

CONCLUSION

VPs are promising tools for future empathy training.

Teaching empathy and compassion to healthcare providers in palliative care: a scoping review

Empathy and compassion are core competencies that healthcare providers (HCPs) require when caring for patients and families with life-threatening illnesses like cancer. These constructs are often challenging to define and generalise and are often used interchangeably. Medical education has evolved from the traditional curriculum-based approach to a more eclectic competency-based approach. The purpose of this review is to explore the current evidence on teaching compassionate care for palliative care issues in cancer settings in lower-middle-income countries. A preliminary search of the Scopus database from 2,000 until now identified 1,502 records, of which 54 peer-reviewed articles were included in this review. Training in compassion and empathy was delivered in three formats: online, face-to-face and blended learning or hybrid. The training modalities were didactic, experiential and reflective, with many educational interventions using a multimodal approach. The educational interventions reported a positive outcome and improvement in empathetic and compassionate behaviours. However, they were limited due to inadequately defined constructs, use of self-reported outcome measures and difficulty in ascertaining if these skills were retained long-term and were translated into the clinical settings. Given that compassion and empathy are multidimensional constructs, it is imperative that educational interventions be multimodal and learner-centred, focusing on developing the knowledge, attitudes, skills and behaviours of the HCP in providing compassionate care while aiming for conceptual clarity regarding definition and more robust validated outcome measures.

Tolerance for Ambiguity: Correlations With Medical and Physical Therapy Student Traits and Experiences Within the Learning Environment

PURPOSE

Health care professions trainees and clinicians who perceive ambiguous situations as sources of threat (low tolerance for ambiguity [TFA]) experience greater risk for mental health disorders and professional burnout. Physical therapists likely encounter substantial ambiguity because of the biopsychosocial nature of their main therapeutic strategies. The purpose of this study was to identify student traits and experiences within the learning environment that differentiate students with high and low TFA for medicine and physical therapy (PT), and to identify areas of interprofessional overlap and distinction.

METHOD

Graduation Questionnaire survey data from graduating PT (n = 2,727) and medical students (n = 33,159) from the 2019-2020 and 2020-2021 academic years were sorted according to student TFA score, and respondents in the highest and lowest TFA quartiles were retained for analysis. Difference-in-differences analysis was used to reduce the number of potential explanatory factors to a parimonious subset that was put into linear regression models. Inferential statistics were applied to all significant factors identified from the linear regression models.

RESULTS

For both professions, higher TFA was generally associated with more positive ratings of the learning environment (student-faculty interactions, faculty professionalism, satisfaction with career choice), lower experiences of exhaustion and disengagement (the 2 axes of academic burnout), and higher scores for the empathy domain of perspective taking. Uniquely for medical students, low TFA was associated with lower empathy scores and a lower degree of interest in working with underserved individuals.

CONCLUSIONS

Findings suggest that for both professions, high TFA corresponded with better ratings of the educational experience and with traits that are advantageous for patient-centered practice and occupational resilience. Interventions to cultivate TFA among health care trainees may be an important way to meet the growing demand for humanistic health care professionals who are prepared to meet society's complex needs.

Increased medical student understanding of dementia through virtual embodiment

Given the growing prevalence of Alzheimer's disease (AD), we assessed the impact of virtually embodying someone with progressive AD. This pilot explored students' understanding of individuals' needs with dementia, as well as, the efficacy of virtual reality (VR) as a curricular tool. Second-year medical students (n = 150) completed a pre-survey, Embodied Labs, Inc. Beatriz Lab VR module, and a post-survey. Most students knew someone with dementia (72%), were a family member of someone with dementia (52%) or had worked with a patient (61%) with dementia. Using paired survey questions, students reported significant increases in understanding how their lives would be affected by dementia (71% vs. 94%) and the needs of a person with dementia (64% vs. 95%) after VR. They reported increased understanding of being a caregiver of someone with dementia (24% vs. 81%) and the impact it can have on the entire family (64% vs. 97%). Overall students agreed this simulation made them think about their approach to clinical skills (94%) and should be utilized more in the curriculum (76%). This pilot study indicated that this VR experience can be used to advance understanding of a person's experiences with dementia and that integrating VR into the medical curricula should be considered.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice

Virtual simulation (VS) as an emerging interactive pedagogical strategy has been paid more and more attentions in the undergraduate medical education. Because of the fast development of modern computer simulation technologies, more and more advanced and emerging VS-based instructional practices are constantly increasing to promote medical education in diverse forms. In order to describe an overview of the current trends in VS-based medical teaching and learning, this scoping review presented a worldwide analysis of 92 recently published articles of VS in the undergraduate medical teaching and learning. The results indicated that 98% of included articles were from Europe, North America, and Asia, suggesting a possible inequity in digital medical education. Half (52%) studies reported the immersive virtual reality (VR) application. Evidence for educational effectiveness of VS in medical students' knowledge or skills was sufficient as per Kirkpatrick's model of outcome evaluation. Recently, VS has been widely integrated in surgical procedural training, emergency and pediatric emergency medicine training, teaching of basic medical sciences, medical radiation and imaging, puncture or catheterization training, interprofessional medical education, and other case-based learning experiences. Some challenges, such as accessibility of VS instructional resources, lack of infrastructure, "decoupling" users from reality, as well as how to increase students' motivation and engagement, should be addressed.