The term “virtual reality” has been used to describe a wide range of realism in a simulated experience. In medical trainings having interactions with patients, the realism varies from programs that display virtual patients on a computer screen to immersive experiences wearing a VR headset where you feel as if you are in the room with the patient. Interactions with virtual patients vary from “talking” with them using a keyboard and selecting from a list of potential statements to actually conversing with virtual patients saying anything. Skills learned and practiced in more realistic VR may translate into clinical practice more effectively.

Virtual patients having natural language understanding via voice recognition software have been developed and used in medical training, including counseling and other clinical skills. These “intelligent” virtual patients have the ability to talk, respond to what users say, and express nonverbal behavior making VR trainings in communication skills more realistic. Virtual humans in these products deliver responses that are selected using complex algorithms to fit conversational input from users. Users experience realistic (but virtual) reactions to what they say and can try out various ways of communicating something or practice new patient-relationship skills. A number of organizations have already developed immersive VR products that achieve this level of realism in the virtual patients. For example:

  • USC’s Institute for Creative Technologies has developed a number of VR products for training purposes, many for the military. They developed immersive and experiential virtual trainings for junior military leaders in counseling and interpersonal communication skills. The training includes role-play practice with a virtual human and tracking and assessment. Similar functionality could be used in medical communications trainings.
  • UNC’s Center for Innovation in Pharmacy Simulation is developing a 3D virtual clinical training with realistic human models for training pharmacy students. In addition to having conversations with virtual patients and simulated medical records, students will experience the patient at different life stages. The virtual model is aged so that students can practice making clinical decisions over the course of a patient’s life.

In order to save time for those who wish to build VR educational experiences, products are being developed that provide the basic programming needed to develop virtual human models. USC Institute for Creative Technologies has developed tools for rapid development of “completely embodied” virtual humans having conversational abilities. The models can be integrated with other software and are working on something similar for rapid development of interactive virtual humans in mobile devices.

With the tools that help create interactive virtual humans, use of realistic VR in medical training will probably increase. However, the process of creating highly realistic VR training still uses a lot of resources. Whether a high level of realism is required for effectiveness in VR training is not clear. To learn clinical choice-making, enough realism is needed to suspend disbelief and support the deliberate practice. Future research could compare VR trainings at different levels of fidelity with reality to determine how much cognitive realism is needed to support training in non-procedural skills.

The advantages of VR, together with research demonstrating its effectiveness as a training tool, make it likely that use of VR will continue to grow in medical education. Health Impact Studio is currently developing a number of VR-based educational games that covers a wide range of subjects. Comparative research and usability feedback will help determine the best level of realism for each type of training.

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