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

250 Participants Needed

Trial Summary

What is the purpose of this trial?

This is a quantifiable study evaluating the ability of a mixed reality (MR), immersive simulation experience to evoke empathy in anesthesiology trainees. Quantitative methodologies will be employed using standardized questionnaires including the The Jefferson Scale of Physician Empathy for Health Professions Students, (HP-version). Trainees will assess their preliminary, baseline empathy using the Jefferson Scale and after the simulation and debrief, will reassess empathy scores, once again using the Jefferson Scale. A satisfaction survey to assess simulated patient embodiment as a valuable exercise and contributor to empathy education curriculum.

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 data supports the effectiveness of the treatment Mixed Reality (MR) for learning empathy?

Research shows that virtual reality, a component of mixed reality, can help people experience situations from another person's perspective, which has been found to improve empathy and understanding in medical students and healthcare providers. ^{1 2 3 4 5}

Is mixed reality safe for use in educational settings to teach empathy?

The studies on mixed reality in educational settings, such as simulating patients for medical training, show that it is generally accepted and usable, with no reported safety concerns. Participants found the experiences believable and beneficial for learning, indicating that mixed reality is safe for these purposes. ^{2 6 7 8 9}

How does the Mixed Reality treatment for learning empathy differ from other treatments?

The Mixed Reality treatment for learning empathy is unique because it uses virtual reality to create immersive experiences where participants can 'walk in someone else's shoes' through body ownership illusions, enhancing empathy by allowing individuals to experience different perspectives firsthand. ^{10 11 12 13 14}

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

Group I: Mixed Reality Group Experimental Treatment 1 Intervention

Trainees will be wearing a headset displaying holograms of Intensive Care Unit (ICU) monitors with vital signs, including arterial line and central venous line waveforms, intravenous access lines, in addition to a cardiac defibrillator. Participants will conduct a self-assessment of empathy before the embodiment simulation and after the simulation debriefing.

Who Is Running the Clinical Trial?

Stanford University

Lead Sponsor

Trials

2,527

Recruited

17,430,000+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Virtual Reality as a Tool for Eliciting Empathetic Behaviour in Carers: An Integrative Review. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

A Pilot Study of the Impact of Virtually Embodying a Patient with a Terminal Illness. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Feasibility of a Cinematic-Virtual Reality Training Program for Health Professional Students: A Single-Arm Pre-Post Study. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Virtually Walking in a Patient's Shoes-the Path to Empathy? [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Immersive virtual reality simulated learning environment versus role-play for empathic clinical communication training. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Applying mixed reality to simulate vulnerable populations for practicing clinical communication skills. [2013]

7. United States pubmed.ncbi.nlm.nih.gov

Mixed reality humans: evaluating behavior, usability, and acceptability. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Innovative Use of Virtual Reality to Facilitate Empathy Toward Older Adults in Nursing Education. [2023]

9. United States 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. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Body swapping with a Black person boosts empathy: Using virtual reality to embody another. [2021]

11. Switzerland pubmed.ncbi.nlm.nih.gov

EEVEE: the Empathy-Enhancing Virtual Evolving Environment. [2020]

12. Switzerland 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. [2023]

13. Poland pubmed.ncbi.nlm.nih.gov

Increasing awareness and empathy among university students through immersive exercises - testing of the virtual reality application: A pilot study. [2023]

14. United States pubmed.ncbi.nlm.nih.gov

"Walking in Their Shoes": The effects of an immersive digital story intervention on empathy in nursing students. [2022]