Virtual reality (VR) has been used widely and successfully to train medical professionals in clinical skills. Advantages of VR over learning “on the job” in a clinic include the opportunity for repeated practice without risk to the patient and the exposure of each medical student to the variety of cases needed for a complete education. The majority of VR trainings developed so far teach procedural skills, such as surgery. However, VR is increasingly being used for training in non-procedural skills, such as communication and counseling skills, as well as other provider-patient relationship-building. For example:
Counseling skills can be challenging for a new health care provider to learn and require practice to develop. Using a VR experience, 13 primary care physicians and residents were trained to use a counseling technique called motivational interviewing (MI) to help patients quit smoking. The training took place within the simulated environment of Second Life. It consisted of lectures followed by practice with standardized patients (played by live, trained humans) or observing other providers practice with standardized patients. Providers received feedback on their performance via chat. The training produced significant improvement in nearly all MI competencies.
- Learning to ask patients about sensitive subjects, such as substance abuse, is a skill that new medical providers need to develop. A virtual reality simulation training in how to ask patients about their alcohol use and provide brief interventions was tested with 102 healthcare professional students. Students, represented as avatars, engaged in realistic conversational exchanges with simulated patients expressing complex social cues in an interactive environment. The simulation combined video, voice recognition, and non-branching logic. Students could choose from a list of 707 questions or statements to communicate with the virtual patient. An algorithm was used to select from 1207 possible responses and respond appropriately to each question or statement. With repeated practice (at least 10 sessions), the experimental group had significantly better scores than a control group with no training.
- It can be challenging for providers to avoid taking an overly authoritarian stance when patients request something that the provider does not recommend. Using VR role-play, providers were trained in shared decision-making with patients while avoiding prescribing unnecessary antibiotics. Providers (n=35) viewed a brief movie on their goals for the practice session and then completed a 15-minute simulated conversation with a virtual patient. Providers’ self-ratings following the training showed small, immediate gains in their attitudes about shared decision-making.
It is worth noting that, although the educational interventions in the above studies have all been called VR, they vary in the format used and the extent of realism. Next week, we’ll talk more about the level of realism in VR that is used to teach communication skills in medicine.