Could This Be Cancer? Self-Reflection of Emapthetic Responses Using an Immersive “through the Eyes of a Virtual Patient” Feedback System

Introduction: Providing effective patient care requires empathy; however, current methods for teaching and evaluating empathetic skills are limited. We have created a virtual patient (VP) to teach health professions students history-taking and examination skills (H&P). Previously, students have been shown to respond empathetically to VPs. Our purpose was to determine if an innovative feedback system permitting role reversal (RR) could influence self-assessment and improve empathy. Methods: Participants performed a breast H&P on a mixed reality human (MRH, a life-sized VP with a mannequin-based breast simulator). During the interaction, the VP challenges the student with a statement to prompt empathetic responses ("I'm scared. Could this be cancer?"). Interactions were recorded from the participant's and patient's perspective. Participants then underwent RR using a head-mounted display viewing their responses through the eyes of the VP (Figure 1). Another H&P with a different MRH was then performed. Participants completed questionnaires regarding the quality of their empathetic responses. Trained observers (TO) and breast cancer survivors (BCS) evaluated videotapes of the encounters. Results: Sixteen participants were enrolled (10 medical students, 4 residents, and 2 faculty). Participant comments regarding the MRH and RR were favorable. Most participants' rating of their empathy decreased after viewing their performance (After RR, Table 1). Upon their MRH2 interaction, self-evaluation of empathy significantly increased (Δ from After RR to MRH2=p<0.05, Student's t-test). Evaluations performed by TO and BCS failed to demonstrate a difference between interactions. Unexpectedly, during the MRH2 interaction, BCS viewed participants as more empathetic than TO (p=0.026, ANOVA). Conclusions: RR promotes self-reflection and encourages development of empathetic communication skills. However, the lack of improvement after the second interaction shows a need for objective feedback or the opportunity to observe expert clinicians. With further investigation, RR technology may facilitate self-directed learning through virtual scenarios. View Large Image Figure Viewer