Using Virtual Patients to Teach Empathy: A Randomized Controlled Study to Enhance Medical Students' Empathic Communication.

INTRODUCTION: Physician empathy is a complex phenomenon known to improve illness outcomes; however, few tools are available for deliberate practice of empathy. We used a virtual patient (VP) to teach empathic communication to first-year medical students. We then evaluated students' verbal empathy in a standardized patient (SP) interaction. METHODS: Seventy medical students, randomly assigned to 3 separate study groups, interacted with (1) a control VP portraying depression, (2) a VP with a backstory simulating patient shadowing, or (3) a VP able to give immediate feedback about empathic communication (empathy-feedback VP). Subsequently, the students interviewed an SP portraying a scenario that included opportunities to express empathy. All SP interviews were recorded and transcribed. The study outcomes were (1) the students' verbal response to the empathic opportunities presented by the SP, as coded by reliable assessors using the Empathic Communication Coding System, and (2) the students' responses as coded by the SPs, using a communication checklist. RESULTS: There were no significant differences in student demographics between groups. The students who interacted with the empathy-feedback VP showed higher empathy in the SP interview than did the students in the backstory VP and the control VP groups [mean (SD) empathy scores coded on a 0-6 scale were 2.91 (0.16) vs. 2.20 (0.22) and 2.27 (0.21), respectively). The difference in scores was significant only for the empathy-feedback VP versus the backstory VP group (P = 0.027). The SPs rated the empathy-feedback and the backstory VP groups significantly higher than the control VP group on offering empathic statements (P < 0.0001), appearing warm and caring (P = 0.015), and forming rapport (P = 0.004). CONCLUSIONS: Feedback on empathy in a VP interaction increased students' empathy in encounters with SPs, as rated by trained assessors, whereas a simulation of patient shadowing did not. Both VP interventions increased students' empathy as rated by SPs, compared with the control VP group.

Do Variations in Agency Indirectly Affect Behavior with Others? An Analysis of Gaze Behavior.

In a group setting, it is possible for attributes of one group member to indirectly affect how other group members are perceived. In this paper, we explore whether one group member's agency (e.g. if they are real or virtual) can indirectly affect behavior with other group members. We also consider whether variations in the agency of a group member directly affects behavior with that group member. To do so, we examined gaze behavior during a team training exercise, in which sixty-nine nurses worked with a surgeon and an anesthesiologist to prepare a simulated patient for surgery. The agency of the surgeon and the anesthesiologist were varied between conditions. Nurses' gaze behavior was coded using videos of their interactions. Agency was observed to directly affect behavior, such that participants spent more time gazing at virtual teammates than human teammates. However, participants continued to obey polite gaze norms with virtual teammates. In contrast, agency was not observed to indirectly affect gaze behavior. The presence of a second human did not affect participants' gaze behavior with virtual teammates.

Teaming Up with Virtual Humans: How Other People Change Our Perceptions of and Behavior with Virtual Teammates.

In this paper we present a study exploring whether the physical presence of another human changes how people perceive and behave with virtual teammates. We conducted a study (n = 69) in which nurses worked with a simulated health care team to prepare a patient for surgery. The agency of participants' teammates was varied between conditions; participants either worked with a virtual surgeon and a virtual anesthesiologist, a human confederate playing a surgeon and a virtual anesthesiologist, or a virtual surgeon and a human confederate playing an anesthesiologist. While participants perceived the human confederates to have more social presence (p <; 0.01), participants did not preferentially agree with their human team members. We also observed an interaction effect between agency and behavioral realism. Participants experienced less social presence from the virtual anesthesiologist, whose behavior was less in line with participants' expectations, when a human surgeon was present.