Can Virtual Reality Technology be Used for Empathy Education in Medical Students: A Randomized Case-control Study (Preprint)

Abstract

BACKGROUND Empathy is an important factor in the doctor-patient relationship, but mental illness is more difficult to understand than other diseases. While traditional medical empathy education, such as workshops, role-playing, and patient shadowing, has been effective, it is also time-consuming, and the outcome may be inconsistent due to different training processes. Virtual reality (VR) has been identified as a promising tool in empathy education for schizophrenia. However, what kind of thoughts and attitudes could be changed through VR and whether empathy education through VR could be widely applied to other mental diseases have not been fully addressed by previous studies. OBJECTIVE This study aimed to investigate the ability of empathy enhancement, the feasibility of depression education, and the changes in thoughts and attitudes in medical students through a single VR experience. METHODS We recruited medical students and randomly assigned them to two groups based on their completed Interpersonal Response Index (IRI) scores. Two sets of VR systems were provided; the intervention group experienced the daily life of the depressed medical student, while the control group experienced the general medical student scenario. The improvement of empathy was assessed using the Jefferson Scale of Empathy-Health Professional Students (JSE-HPS), and the change of attitude was assessed through the Implicit Association Test (IAT). In addition, other questionnaires were used to evaluate the user experience of this VR system, and correlation analysis was conducted to examine the association between the use of VR and changes in the JSE and IAT scores. RESULTS A total of 59 medical students were enrolled in this study. The intervention group showed a significant increase in the perspective-taking (PT) (pre: mean 5.817, SD 0.536; post: mean 5.947, SD 0.620; P=.03) and compassionate care (CC) (pre: mean 5.546, SD 0.581; post: mean 5.721, SD 0.629; P=.01) domains of the JSE score and a significant decrease in the empathy (SP) domain (pre: mean 3.583, SD 1.253; post: mean 2.967, SD 1.252; P=.002). The Pearson correlation analysis found a significant positive correlation between the JSE score with immersion aspect (r=0.308, P=.049) and presence aspect (r=0.415, P=.01), and we also found a significant negative correlation between the IAT score and presence aspect (r=-0.333, P=.036). CONCLUSIONS To the best of our knowledge, this study is the first randomized case-control study to investigate the effect of two different versions of VR on empathy development toward depression for medical students. Although the single VR experience was unable to induce a great improvement in empathy or attitude, the VR system could help medical students enhance their understanding of depressive disorders more efficiently in future studies, with the extension of VR to a long-term course, in combination with traditional intervention after the VR experience, and application to other mental illnesses. CLINICALTRIAL The purpose of our study was to examine the change in empathy and attitude in medical students, which meets one of the conditions that does not require registration. This randomized controlled trial was not registered, but its protocol was approved by the Institutional Review Board of Chang Gung Memorial Hospital (202001315B0D001).