Using Virtual Patients to Teach Empathy

Foster, Adriana; Chaudhary, Neelam; Kim, Thomas; Waller, Jennifer L.; Wong, Joyce; Borish, Michael; Cordar, Andrew; Lok, Benjamin; Buckley, Peter F.

doi:10.1097/sih.0000000000000142

Cited by 77 publications

(26 citation statements)

References 15 publications

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“… 23 28 29 35 37 39 41 49 52 Thirteen defined inclusion criteria only 30–33 36 38 40 42 43 45–47 50 and in three studies inclusion/exclusion criteria were either not given or not clear. 34 48 51 …”

Section: Resultsmentioning

confidence: 99%

“…Five studies did not explicitly state duration. 34 36 38 46 48 Training packages in six studies were considered to be ‘short duration’, lasting 3 hours or less 32 37 39 42 47 49 ; 10 were considered ‘medium duration’, lasting between 4 and 12 hours 23 28–30 35 39 43 44 50 51 ; and 5 were considered ‘long duration’, lasting more than 12 hours. 31 33 41 45 52 Timespan of the interventions ranged from 1 to 120 days, with a mean length of 38.5 days (SD 40.2).…”

Section: Resultsmentioning

confidence: 99%

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Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials

et al. 2020

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ObjectiveTo estimate the effect of empathy interventions in health education and training from randomised controlled trials (RCTs).MethodsMEDLINE, PsycINFO, EMBASE, CINAHL and Cochrane databases were searched from inception to June 2019 for RCTs investigating the effect of empathy-enhancing interventions in medical and healthcare students and professionals. Studies measuring any aspect of ‘clinical empathy’ as a primary or secondary outcome were included. Two reviewers extracted data and assessed the risk of bias of eligible studies using the Cochrane Risk of Bias Tool. Random effects meta-analyses of the impact of empathy training on participants’ empathy levels were performed.ResultsTwenty-six trials were included, with 22 providing adequate data for meta-analysis. An overall moderate effect on participant empathy postintervention (standardised mean difference 0.52, 95% CI 0.36 to 0.67) was found. Heterogeneity across trial results was substantial (I2=63%). Data on sustainability of effect was provided by 11 trials and found a moderate effect size for improved empathy up until 12 weeks (0.69, 95% CI 0.23 to 1.15), and a small but statistically significant effect size for sustainability at 12 weeks and beyond (standardised mean difference 0.34, 95% CI 0.11 to 0.57). In total, 15 studies were considered to be either unclear or high risk of bias. The quality of evidence of included studies was low.ConclusionFindings suggest that empathy-enhancing interventions can be effective at cultivating and sustaining empathy with intervention specifics contributing to effectiveness. This review focuses on an important, growing area of medical education and provides guidance to those looking to develop effective interventions to enhance empathy in the healthcare setting. Further high-quality trials are needed that include patient-led outcome assessments and further evaluate the long-term sustainability of empathy training.Protocol registration numberPROSPERO (CRD42019126843).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials

et al. 2020

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“…A need for more guidance within virtual patient simulations may appear in studies with different instructional methods where narrative virtual patient design was better than more autonomous problem-oriented designs [ 97 ]. Feedback given by humans in a virtual patient system was better than an animated backstory in increasing empathy [ 98 ], but no feedback had no more positive result on the outcomes than learning from a virtual patient scenario [ 99 ]. This reminds us that presenting realistic patient scenarios with a great degree of freedom may not be an excuse for neglecting guidance in relation to learning objectives [ 100 ].…”

Section: Discussionmentioning

confidence: 99%

Blended Learning Compared to Traditional Learning in Medical Education: Systematic Review and Meta-Analysis

Vallée¹,

Blacher²,

Cariou³

et al. 2020

J Med Internet Res

327

230

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Background Blended learning, which combines face-to-face learning and e-learning, has grown rapidly to be commonly used in education. Nevertheless, the effectiveness of this learning approach has not been completely quantitatively synthesized and evaluated using knowledge outcomes in health education. Objective The aim of this study was to assess the effectiveness of blended learning compared to that of traditional learning in health education. Methods We performed a systematic review of blended learning in health education in MEDLINE from January 1990 to July 2019. We independently selected studies, extracted data, assessed risk of bias, and compared overall blended learning versus traditional learning, offline blended learning versus traditional learning, online blended learning versus traditional learning, digital blended learning versus traditional learning, computer-aided instruction blended learning versus traditional learning, and virtual patient blended learning versus traditional learning. All pooled analyses were based on random-effect models, and the I2 statistic was used to quantify heterogeneity across studies. Results A total of 56 studies (N=9943 participants) assessing several types of learning support in blended learning met our inclusion criteria; 3 studies investigated offline support, 7 studies investigated digital support, 34 studies investigated online support, 8 studies investigated computer-assisted instruction support, and 5 studies used virtual patient support for blended learning. The pooled analysis comparing all blended learning to traditional learning showed significantly better knowledge outcomes for blended learning (standardized mean difference 1.07, 95% CI 0.85 to 1.28, I2=94.3%). Similar results were observed for online (standardized mean difference 0.73, 95% CI 0.60 to 0.86, I2=94.9%), computer-assisted instruction (standardized mean difference 1.13, 95% CI 0.47 to 1.79, I2=78.0%), and virtual patient (standardized mean difference 0.62, 95% CI 0.18 to 1.06, I2=78.4%) learning support, but results for offline learning support (standardized mean difference 0.08, 95% CI –0.63 to 0.79, I2=87.9%) and digital learning support (standardized mean difference 0.04, 95% CI –0.45 to 0.52, I2=93.4%) were not significant. Conclusions From this review, blended learning demonstrated consistently better effects on knowledge outcomes when compared with traditional learning in health education. Further studies are needed to confirm these results and to explore the utility of different design variants of blended learning.

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“…Integrating explicit knowledge with the information coded in emotional cues to enhance understanding and care for suicidal individuals in training curricula and continuing education programs may facilitate assessment, intervention and ultimately reduce the risk of suicide. Training interventions for clinicians may focus on emotional self-awareness, such as mindfulness training for mental health professionals and trainees ( 71 ); relational therapy interventions that focus on the therapeutic alliance and managing counter-transference responses ( 72 , 73 ) as well as novel training methods designed for improving empathic communication with psychiatric patients ( 74 ). In addition, existing training programs for suicide prevention ( 75 ) would benefit from including a component targeting emotional responses to suicidal individuals.…”

Section: Discussionmentioning

confidence: 99%

Emotional Responses to Suicidal Patients: Factor Structure, Construct, and Predictive Validity of the Therapist Response Questionnaire-Suicide Form

et al. 2018

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BackgroundMental health professionals have a pivotal role in suicide prevention. However, they also often have intense emotional responses, or countertransference, during encounters with suicidal patients. Previous studies of the Therapist Response Questionnaire-Suicide Form (TRQ-SF), a brief novel measure aimed at probing a distinct set of suicide-related emotional responses to patients found it to be predictive of near-term suicidal behavior among high suicide-risk inpatients. The purpose of this study was to validate the TRQ-SF in a general outpatient clinic setting.MethodsAdult psychiatric outpatients (N = 346) and their treating mental health professionals (N = 48) completed self-report assessments following their first clinic meeting. Clinician measures included the TRQ-SF, general emotional states and traits, therapeutic alliance, and assessment of patient suicide risk. Patient suicidal outcomes and symptom severity were assessed at intake and one-month follow-up. Following confirmatory factor analysis of the TRQ-SF, factor scores were examined for relationships with clinician and patient measures and suicidal outcomes.ResultsFactor analysis of the TRQ-SF confirmed three dimensions: (1) affiliation, (2) distress, and (3) hope. The three factors also loaded onto a single general factor of negative emotional response toward the patient that demonstrated good internal reliability. The TRQ-SF scores were associated with measures of clinician state anger and anxiety and therapeutic alliance, independently of clinician personality traits after controlling for the state- and patient-specific measures. The total score and three subscales were associated in both concurrent and predictive ways with patient suicidal outcomes, depression severity, and clinicians’ judgment of patient suicide risk, but not with global symptom severity, thus indicating specifically suicide-related responses.ConclusionThe TRQ-SF is a brief and reliable measure with a 3-factor structure. It demonstrates construct validity for assessing distinct suicide-related countertransference to psychiatric outpatients. Mental health professionals’ emotional responses to their patients are concurrently indicative and prospectively predictive of suicidal thoughts and behaviors. Thus, the TRQ-SF is a useful tool for the study of countertransference in the treatment of suicidal patients and may help clinicians make diagnostic and therapeutic use of their own responses to improve assessment and intervention for individual suicidal patients.

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Using Virtual Patients to Teach Empathy

Abstract: 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.

Cited by 77 publications

References 15 publications

Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials

Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials

Blended Learning Compared to Traditional Learning in Medical Education: Systematic Review and Meta-Analysis

Emotional Responses to Suicidal Patients: Factor Structure, Construct, and Predictive Validity of the Therapist Response Questionnaire-Suicide Form

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