Learning Empathy Through Virtual Reality: A Mixed Methods Study

Abstract

Longitudinal empathy measurement amongst rising physicians suggests a decline that begins when medical students transition from their pre-clinical to clinical years and residency training. Current empathy interventions such as mindfulness and neurobiology of empathy workshops have shown mixed results, are difficult to scale and are time consuming. Virtual reality is an emerging technology being used increasingly in the non-medical educational field. It has recently been used for empathy training in the medical education setting. Therefore, our aim was to investigate the effectiveness of virtual reality in empathy training using a mixed methods study design. For the quantitative component, we ran a randomized controlled trial with 17 students randomized to the VR-based curriculum intervention group and 17 students to the education as usual control group. Associative analysis between learner background and baseline empathy scores showed a statistically significant interaction between empathy and speaking more than two languages, being part of a minority group and studying humanities as an undergrad (p=0.01). Additionally, the intervention group’s baseline empathy increased significantly by 5.1 points, while the control by 1.5 points (p=0.01). For the qualitative component, we explored two questions: the effectiveness of VR in empathy training through qualitative analysis and the utility of VR in medical education. In the qualitative program evaluation, we found that VR trigger affective emotional responses (Level 1 Kirkpatrick) from learners that are identical to patients’ reaction. We also found generated empathic concern towards patients and their caregivers (Level 2) along with examples of behavioral intentions expressed by students (Level 3). In terms of barriers to empathy we found that 1) self and 2) Macrosystem, both acted as barriers to empathic concern. For self-barriers, 1) Time, 2) Attention and 3) Fear were key players. For the macrosystem, 1) Moral injury, 2) Educational policies, 3) Management policies and 4) Organizational culture were macrosystem barriers. In relation to the question around utility of VR in medical education, we found that its utility was in 1) Creating a psychologically safe environment for learning, 2) Promoting humanism in healthcare, 3) Bridging experiential, immersive and situated learning for constructivism, 4) Enhancing emotional intelligence and 5) Facilitating personalized learning. Subsequently, we hypothesize a theoretical model describing how VR triggers empathy towards patients.