Mixed Reality for Learning Empathy

(Empathy Trial)

Overseen By Thomas Caruso, MD, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Stanford University

Disqualifiers: Severe motion sickness, Seizures, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a mixed reality (MR) experience can enhance empathy in anesthesiology trainees. Participants will use a headset to interact with virtual hospital monitors and equipment, such as heart rate monitors and defibrillators. The researchers will measure changes in empathy before and after the simulation. Ideal participants are trainees or staff at specific Stanford healthcare facilities who do not experience severe motion sickness or have a history of seizures. As an unphased trial, this study provides a unique opportunity to contribute to innovative educational methods in healthcare.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this mixed reality experience is safe for trainees?

Research has shown that immersive virtual reality (VR) experiences, such as the mixed reality used in this trial, are generally easy for people to handle. For instance, one study found that VR can boost brain function and increase empathy without causing significant side effects. Another study discovered that using VR to teach empathy in medical training improved empathy scores, with no major negative effects reported. These findings suggest that mixed reality experiences, like the one in this trial, are safe and well-received by participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using Mixed Reality (MR) to teach empathy because it offers a unique, immersive experience that traditional methods can't match. Unlike standard training, which might include role-playing or lectures, MR places trainees in a virtual Intensive Care Unit (ICU) environment where they can interact with holograms displaying vital signs and medical equipment. This hands-on, visual approach could help participants understand and feel the emotional complexities of patient care more deeply. By simulating real-life situations, MR has the potential to enhance empathy in healthcare professionals, leading to better patient outcomes.

What evidence suggests that this mixed reality experience is effective for learning empathy?

Research has shown that virtual reality (VR) can be a powerful tool for helping healthcare students become more empathetic. One study found that VR experiences help students understand what patients go through and feel more compassion for them. Another study discovered that VR training can improve how students communicate with empathy, especially in medical settings. In this trial, participants in the Mixed Reality Group will use mixed reality (MR), similar to VR, to help anesthesiology trainees develop empathy. By simulating real-life medical situations, MR could help trainees better understand and connect with patients' emotions. ^{2 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for anesthesiology trainees who are interested in using immersive mixed reality (MR) simulations to potentially enhance their empathy towards patients with learning difficulties. There's no specific exclusion criteria provided, so it seems open to all trainees willing to participate.

Inclusion Criteria

I work or volunteer at Lucile Packard Children's Hospital Stanford / Stanford Health Care and am over 18.

Exclusion Criteria

History of severe motion sickness

I am currently experiencing nausea.

I am uncomfortable wearing a ~7 pound vest.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

Simulation and Assessment

Participants undergo a mixed reality simulation to evoke empathy and complete pre- and post-simulation empathy assessments using the Jefferson Scale.

1 day

1 visit (in-person)

Follow-up

Participants complete satisfaction and usability surveys immediately after the simulation.

immediately after simulation

What Are the Treatments Tested in This Trial?

Interventions

• Mixed Reality (MR)

Trial Overview

The study tests whether a mixed reality simulation can increase empathy in anesthesiology students. Empathy levels are measured before and after the simulation using the Jefferson Scale of Physician Empathy. The experience includes a debriefing session and participants will also complete a satisfaction survey.

How Is the Trial Designed?

Group I: Mixed Reality Group Experimental Treatment 1 Intervention

In the MR group, the simulation instructor will explain the scope of the simulation embodiment experience and equip a weighted vest on the participant as they are asked to lay on a hospital patient gurney, seated upright. The participant, who is wearing a weighted vest to simulate an anterior mediastinal mass, will be asked to be seated upright and will view various holograms including vitals monitors, hear hospital related sounds via the headset, and also see additional holographic assets including intravenous polls and a defibrillator as well as experience heat (simulating a fever) from heat lamps. The simulation instructor will play the role of a physician who is using good communication skills based on the Calgary-Cambridge Guide to review a scripted consent for a high risk biopsy under sedation that may require life saving interventions such as extracorporeal membranous oxygenation (ECMO).

Group II: Control Active Control 1 Intervention

In the control group, there will be no headset, no heat lamps, and no weighted vest and the participant will rely on their imagination to embody the teenager while lying in the simulation room bed while being consented for the same procedure as the MR group.

Who Is Running the Clinical Trial?

Stanford University

Lead Sponsor

Trials

2,527

Recruited

17,430,000+

Published Research Related to This Trial

Empathy plays a crucial role in promoting prosocial behavior and understanding others' pain, and virtual reality (VR) can enhance this by creating a body ownership illusion that allows users to experience life from another person's perspective.

The paper proposes a framework for designing VR-based empathic training, categorizing various empathy-related practices and identifying strategies to effectively use VR technology to develop specific empathic skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality. Bertrand, P., Guegan, J., Robieux, L., et al.[2023]

A pilot study involving 20 university students from 3 countries found that immersive virtual reality (VR) exercises effectively increased awareness and empathy towards marginalized groups, such as pregnant women and people with disabilities.

The VR technology created a strong sense of presence, allowing students to experience diverse perspectives, which suggests that incorporating VR into training programs could promote behavior change and reduce prejudice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing awareness and empathy among university students through immersive exercises - testing of the virtual reality application: A pilot study. Raposo, R., Vairinhos, M., Laska-Leśniewicz, A., et al.[2023]

Participants who engaged in embodied perspective-taking using virtual reality showed significantly higher empathy scores compared to a control group, indicating that this method can enhance understanding of others' experiences.

However, neither the embodied nor the mental perspective-taking interventions had a significant impact on reducing explicit or implicit race bias, suggesting that while empathy may improve, it does not necessarily translate to changes in bias.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Body swapping with a Black person boosts empathy: Using virtual reality to embody another. Thériault, R., Olson, JA., Krol, SA., et al.[2021]

The Empathy-Enhancing Virtual Evolving Environment (EEVEE) platform allows researchers to study empathy by using avatars that express emotions, while measuring physiological responses from participants, making it a powerful tool for understanding social interactions.

Initial validation shows that healthy adults can accurately identify varying levels of negative emotions, such as pain, from avatars, indicating that this platform can effectively assess empathy even in individuals with neurological or psychiatric disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

EEVEE: the Empathy-Enhancing Virtual Evolving Environment. Jackson, PL., Michon, PE., Geslin, E., et al.[2020]

Using virtual humans to simulate pediatric patients allows health sciences students to practice and gain confidence in conducting developmental exams, addressing the lack of exposure to vulnerable populations.

In a study with 22 participants, students accepted the virtual child as realistic and preferred a natural interaction interface, although the type of interface did not change how realistically they treated the virtual child.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applying mixed reality to simulate vulnerable populations for practicing clinical communication skills. Chuah, JH., Lok, B., Black, E.[2013]

A pilot study using virtual reality (VR) allowed first-year medical students to experience the perspective of patients with terminal illnesses, leading to increased comfort in discussing end-of-life issues and a deeper understanding of patient experiences.

The immersive VR experience significantly enhanced students' empathy towards patients and their families, suggesting that VR could be an effective tool for improving empathy and clinical skills in medical education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Pilot Study of the Impact of Virtually Embodying a Patient with a Terminal Illness. Elzie, CA., Shaia, J.[2022]

The cine-VR diabetes training program was feasible and well-received by health professional students, with all 92 participants completing the training without any reported technological difficulties or adverse events.

Post-training assessments showed significant improvements in cultural self-efficacy, diabetes attitudes, and empathy, indicating that this innovative training method could enhance the understanding and care of patients with diabetes among future healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of a Cinematic-Virtual Reality Training Program for Health Professional Students: A Single-Arm Pre-Post Study. McCalla, MM., Jones, D., Grice, R., et al.[2023]

A pilot study involving 121 nursing students demonstrated that a virtual reality (VR) experience significantly improved empathy towards older adults.

This research highlights the potential of VR as an innovative educational tool to combat age bias and enhance understanding of older adults in healthcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Innovative Use of Virtual Reality to Facilitate Empathy Toward Older Adults in Nursing Education. Quay, C., Ramakrishnan, A.[2023]

A novel immersive digital story intervention significantly increased empathy among 238 second-year nursing students immediately after the intervention, with a notable difference in empathy scores between the intervention group and the control group (p = .012).

However, this increase in empathy was not sustained at follow-up, indicating the need for further development of the intervention to maintain long-term improvements in empathy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Walking in Their Shoes": The effects of an immersive digital story intervention on empathy in nursing students. Yu, J., Parsons, GS., Lancastle, D., et al.[2022]

The AREduX program uses augmented reality to simulate the physical and cognitive challenges faced by people living with dementia, aiming to enhance empathy among healthcare providers and caregivers.

This innovative training approach is designed to improve patient care and satisfaction by fostering empathetic responses, addressing a significant gap in existing empathy training programs for healthcare professionals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Augmented Reality Education Experience (AREduX): An Augmented Reality Experience and Experiential Education Medium to Teach Empathy to Healthcare Providers and Caregivers of Persons Living With Dementia. Hollaender, G., Peisachovich, E., Kapralos, B., et al.[2023]

A review of seven studies involving 485 carers indicates that Virtual Reality (VR) can effectively elicit empathetic behavior in healthcare providers, supporting its use in training and development.

Despite the positive findings, all studies had a moderate to high risk of bias, highlighting the need for future research with larger, well-designed randomized controlled trials to identify the most effective VR experiences for fostering empathy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual Reality as a Tool for Eliciting Empathetic Behaviour in Carers: An Integrative Review. Brydon, M., Kimber, J., Sponagle, M., et al.[2021]

Medical students interacted with Mixed Reality Humans (MRHs) as social actors, using touch to comfort them similarly to real patients, indicating that MRHs can effectively simulate interpersonal scenarios in medical training.

In a study with 11 medical students, MRHs were found to be as effective as human patients for practicing clinical skills, with high acceptability ratings, especially as the visual realism of the MRH improved, highlighting the importance of realism in training simulations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mixed reality humans: evaluating behavior, usability, and acceptability. Kotranza, A., Lok, B., Deladisma, A., et al.[2019]

Medical students are losing empathy during their training, which is crucial for effective patient-physician relationships.

Using immersive virtual reality experiences can help students better understand patients' perspectives, potentially reversing the decline in empathy and enhancing clinical practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtually Walking in a Patient's Shoes-the Path to Empathy? Elzie, CA., Shaia, J.[2021]

Trainees using immersive virtual reality (VR) for clinical communication training showed a significant improvement in communication confidence (11%) compared to those using role-play (4.3%), indicating that VR may enhance learning outcomes in a safe environment.

Participants trained in VR demonstrated a 5% better ability to select empathic statements than those in role-play, suggesting that VR can effectively improve the recall of empathic communication skills in clinical scenarios.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immersive virtual reality simulated learning environment versus role-play for empathic clinical communication training. Sapkaroski, D., Mundy, M., Dimmock, MR.[2022]

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