A Pilot Study of the Impact of Virtually Embodying a Patient with a Terminal Illness

Abstract

Compassionate end-of-life care matters deeply for patients and their caregivers, but studies continue to demonstrate ways in which physicians fall short. Despite specific training during medical school, many patients report lack of empathy in their providers with respect to end-of-life conversations. This is likely because empathy is simply hard to teach. Numerous activities have been tried to combat the decline in empathy during medical training with little to moderate success. However, virtual reality, which allows users to viscerally experience anything from another person’s point of view, could be a game changer for building empathy within medicine. This type of perspective-taking has previously shown to improve understanding, reduce biases, facilitate empathy, and promote prosocial behaviors. In this pilot study, virtual reality was used to allow students to “become a patient” virtually embodying their daily activities, symptoms, and interactions with caregivers. Using the Embodied Labs modules, first-year medical students were able to experience first-hand having a terminal illness, being told no further treatments are available and witnessing loved ones’ reactions. Data generated through surveys and reflections indicated a high level of place illusion, plausibility, and embodiment of users. This high level of immersion generated an increase in comfortability with talking about end-of-life issues, produced a better understanding of what patients and their families experience, and promoted a change in the way students would approach clinical skills. Analysis of reflections indicated a high level of empathy for the patient and his family members. Overall, the activity was highly received by students as a valuable learning activity. As such, we propose that virtual reality could be a useful pedagogical tool to facilitate empathy and clinical skills within medical education.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Data Availability

All data generated or analyzed during this study are included in this published article.

References

  1. 1.

    Berger DM. Clinical empathy. Aronson; 1987.

  2. 2.

    Hojat M, Mangione S, Nasca TJ, Cohen MJM, Gonnella JS, Erdmann JB, et al. The Jefferson Scale of Physician Empathy: development and preliminary psychometric data. Educ Psychol Meas. 2001;61:349–65. https://doi.org/10.1177/00131640121971158.

    Article  Google Scholar 

  3. 3.

    Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: Definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–9. https://doi.org/10.1176/appi.ajp.159.9.1563.

    Article  Google Scholar 

  4. 4.

    Kerasidou A, Horn R. Making space for empathy: supporting doctors in the emotional labour of clinical care Ethics in Clinical Practice. BMC Med Ethics. 2016;17:8. https://doi.org/10.1186/s12910-016-0091-7.

    Article  Google Scholar 

  5. 5.

    Hojat M. Empathy in health professions education and patient care. Springer International Publishing; 2016. https://doi.org/10.1007/978-3-319-27625-0.

  6. 6.

    Neumann MA, Bensing JB, Mercer SC, Ernstmann NA, Ommen OA, Pfaff HA. H. Analyzing the “nature” and “specific effectiveness” of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient education and counseling analyzing the ‘nature’ and ‘specific effectiveness’ of clinical empathy: A theoretical overview and contribution towards a theory-based research agenda. Elsevier 2009;74:339–46. https://doi.org/10.1016/j.pec.2008.11.013.

  7. 7.

    Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013;88:1171–7. https://doi.org/10.1097/ACM.0b013e318299f3e3.

    Article  Google Scholar 

  8. 8.

    Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: a systematic review. BMC Med Educ. 2014;14:219. https://doi.org/10.1186/1472-6920-14-219.

    Article  Google Scholar 

  9. 9.

    Sugarman L. Experiential learning: Experience as the source of learning and development, David A. Kolb, Prentice-Hall International, Hemel Hempstead, Herts., 1984. No. of pages: xiii + 256. J Organ Behav 1987;8:359–60. https://doi.org/10.1002/job.4030080408.

  10. 10.

    Bunn W, Terpstra J. Cultivating empathy for the mentally ill using simulated auditory hallucinations. Acad Psychiatry. 2009;33:457–60. https://doi.org/10.1176/appi.ap.33.6.457.

    Article  Google Scholar 

  11. 11.

    Varkey P, Chutka DS, Lesnick TG. The aging game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc. 2006;7:224–9. https://doi.org/10.1016/j.jamda.2005.07.009.

    Article  Google Scholar 

  12. 12.

    Herrera F, Bailenson J, Weisz E, Ogle E, Zaki J. Building long-term empathy: a large-scale comparison of traditional and virtual reality perspective-taking. PLoS One. 2018;13:e0204494. https://doi.org/10.1371/journal.pone.0204494.

    Article  Google Scholar 

  13. 13.

    Slater M. Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments. Philos Trans R Soc B Biol Sci. 2009;364:3549–57. https://doi.org/10.1098/rstb.2009.0138.

    Article  Google Scholar 

  14. 14.

    Louie AK, Coverdale JH, Balon R, Beresin EV, Brenner AM, Guerrero APS, et al. Enhancing empathy: a role for virtual reality? Acad Psychiatry. 2018;42:747–52. https://doi.org/10.1007/s40596-018-0995-2.

    Article  Google Scholar 

  15. 15.

    Chris Milk: How virtual reality can create the ultimate empathy machine | TED Talk n.d. https://www.ted.com/talks/chris_milk_how_virtual_reality_can_create_the_ultimate_empathy_machine/discussion?la (accessed 31 Jan 2020).

  16. 16.

    Schutte NS, Stilinović EJ. Facilitating empathy through virtual reality. Motiv Emot. 2017;41:708–12. https://doi.org/10.1007/s11031-017-9641-7.

    Article  Google Scholar 

  17. 17.

    Kandaurova M, Lee SH (Mark). The effects of virtual reality (VR) on charitable giving: the role of empathy, guilt, responsibility, and social exclusion. J Bus Res 2019;100:571–80. https://doi.org/10.1016/j.jbusres.2018.

  18. 18.

    Russell V, Barry R, Murphy D. HAVE experience: an investigation into vr empathy for panic disorder. 2018 IEEE Games, Entertain. Media Conf. GEM 2018, Institute of Electrical and Electronics Engineers Inc.; 2018, p. 167–72. https://doi.org/10.1109/GEM.2018.8516461.

  19. 19.

    Dyer E, Swartzlander BJ, Gugliucci MR. Using virtual reality in medical education to teach empathy. J Med Libr Assoc. 2018;106:498–500. https://doi.org/10.5195/jmla.2018.518.

    Article  Google Scholar 

  20. 20.

    Gugliucci MR. Virtual reality medical education project enhances empathy. Innov Aging. 2019;3:S298. https://doi.org/10.1093/GERONI/IGZ038.1096.

    Article  Google Scholar 

  21. 21.

    Washington E, Shaw C. The effects of a VR intervention on career interest, empathy, communication skills, and learning with second-year medical students, Springer, Cham; 2019, p. 67–80. https://doi.org/10.1007/978-3-030-27986-8_7.

  22. 22.

    Rabow MW, McPhee SJ. Beyond breaking bad news: how to help patients who suffer. West J Med. 1999;171:260–3. https://doi.org/10.1136/sbmj.000365.

    Article  Google Scholar 

  23. 23.

    Weisse CS, Melekis K, Hutchins B. Providing end-of-life care: increased empathy and self-efficacy among student caregivers in residential homes for the dying. Am J Hosp Palliat Care. 2019;36:538–45. https://doi.org/10.1177/1049909118820844.

    Article  Google Scholar 

  24. 24.

    Embodied Labs n.d. https://embodiedlabs.com/ (accessed 24 Mar 2020).

  25. 25.

    Shin D. Empathy and embodied experience in virtual environment: To what extent can virtual reality stimulate empathy and embodied experience? Comput Human Behav. 2018;78:64–73. https://doi.org/10.1016/j.chb.2017.09.012.

    Article  Google Scholar 

  26. 26.

    Nicovich SG, Boller GW, Cornwell TB. Experienced presence within computer-mediated communications: initial explorations on the effects of gender with respect to empathy and immersion. J Comput Commun. 2006;10:00–00. https://doi.org/10.1111/j.1083-6101.2005.tb00243.x.

    Article  Google Scholar 

  27. 27.

    Halpern J. From detached concern to empathy : humanizing medical practice. Oxford University Press; 2001.

  28. 28.

    Reniers RLEP, Corcoran R, Drake R, Shryane NM, Völlm BA. The QCAE: A questionnaire of cognitive and affective empathy. J Pers Assess. 2011;93:84–95. https://doi.org/10.1080/00223891.2010.528484.

    Article  Google Scholar 

  29. 29.

    Bellet PS, Maloney MJ. The importance of empathy as an interviewing skill in medicine. JAMA J Am Med Assoc. 1991;266:1831–2. https://doi.org/10.1001/jama.1991.03470130111039.

    Article  Google Scholar 

  30. 30.

    Telle NT, Pfister HR. Positive empathy and prosocial behavior: a neglected link. Emot Rev. 2014;8:154–63. https://doi.org/10.1177/1754073915586817.

    Article  Google Scholar 

  31. 31.

    Barzansky B, Vesloski JJ, Miller R, Jonas HS. Education in end-of-life care during medical school and residency training. Acad Med. 1999;74:s102–4. https://doi.org/10.1097/00001888-199910000-00054.

    Article  Google Scholar 

  32. 32.

    Mermann AC, Gunn DB, Dickinson GE. Learning to care for the dying: a survey of medical schools and a model course. Acad Med. 1991;66:35–8. https://doi.org/10.1097/00001888-199101000-00010.

    Article  Google Scholar 

  33. 33.

    Linn LS, DiMatteo MR, Cope DW, Robbins A. Measuring physicians’ humanistic attitudes, values, and behaviors. Med Care. 1987;25:504–15. https://doi.org/10.1097/00005650-198706000-00005.

    Article  Google Scholar 

  34. 34.

    Ferreira-Valente A, Monteiro JS, Barbosa RM, Salgueira A, Costa P, Costa MJ. [1] Ferreira-Valente A, Monteiro JS, Barbosa RM, Salgueira A, Costa P, Costa MJ. Clarifying changes in student empathy throughout medical school: a scoping review. Adv Heal Sci Educ 2017;22:1293–313. https://doi.org/10.1007/s10459-016-9704-7.

  35. 35.

    Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84:1182–91. https://doi.org/10.1097/ACM.0b013e3181b17e55.

    Article  Google Scholar 

  36. 36.

    Preusche I, Lamm C. Reflections on empathy in medical education: what can we learn from social neurosciences? Adv Heal Sci Educ. 2016;21:235–49. https://doi.org/10.1007/s10459-015-9581-5.

    Article  Google Scholar 

  37. 37.

    Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS One. 2013;8:e61526. https://doi.org/10.1371/journal.pone.0061526.

    Article  Google Scholar 

  38. 38.

    Patel S, Pelletier-Bui A, Smith S, Roberts MB, Kilgannon H, Trzeciak S, et al. Curricula for empathy and compassion training in medical education: a systematic review. PLoS One. 2019;14:e0221412. https://doi.org/10.1371/journal.pone.0221412.

    Article  Google Scholar 

  39. 39.

    van Loon A, Bailenson J, Zaki J, Bostick J, Willer R. Virtual reality perspective-taking increases cognitive empathy for specific others. PLoS ONE. 2018;13:e0202442. https://doi.org/10.1371/journal.pone.0202442.

    Article  Google Scholar 

  40. 40.

    Blascovich J, Loomis J, Beall AC, Swinth KR, Hoyt CL, Bailenson JN. Immersive virtual environment technology: just another methodological tool for social psychology? Psychol Inq. 2002;13:146–9. https://doi.org/10.1207/S15327965PLI1302_03.

    Article  Google Scholar 

  41. 41.

    Bailenson JN, Yee N. A longitudinal study of task performance, head movements, subjective report, simulator sickness, and transformed social interaction in collaborative virtual environments. Presence Teleoperators Virtual Environ. 2006;15:699–716. https://doi.org/10.1162/pres.15.6.699.

    Article  Google Scholar 

  42. 42.

    Shriram K, Oh SY, Bailenson J. Virtual Reality and Prosocial Behavior. In: Burgoon JK, Magnenat-Thalmann N, Pantic M, Vinciarelli A, editors. Soc. Signal Process., Cambridge: Cambridge University Press; 2017, p. 304–16. https://doi.org/10.1017/9781316676202.022.

  43. 43.

    Psychiatry EW-HJ of C, 1980 undefined. The dutiful physician: the central role of empathy in psychoanalysis, psychotherapy, and medical practice. PsycnetApaOrg n.d.

  44. 44.

    Feighny KM, Monaco M, Arnold L. Empathy training to improve physician-patient communication skills. Acad Med. 1995;70:435–6. https://doi.org/10.1097/00001888-199505000-00031.

    Article  Google Scholar 

  45. 45.

    Real F, DeBlasio D, Ollberding N, Davis D, Cruse B, Mclinden D, et al. Resident perspectives on communication training that utilizes immersive virtual reality. Educ Heal. 2017;30:228. https://doi.org/10.4103/efh.EfH_9_17.

    Article  Google Scholar 

  46. 46.

    Fisher JA. Empathic actualities: toward a taxonomy of empathy in virtual reality. Lect. Notes Comput. Sci. (including Subser. Lect. Notes Artif. Intell. Lect. Notes Bioinformatics), vol. 10690 LNCS, Springer Verlag; 2017, p. 233–44. https://doi.org/10.1007/978-3-319-71027-3_19.

  47. 47.

    Shamasundar C. Understanding empathy and related phenomena. Am J Psychother. 1999;53:232–45. https://doi.org/10.1176/appi.psychotherapy.1999.53.2.232.

    Article  Google Scholar 

  48. 48.

    Hojat M, DeSantis J, Shannon SC, Speicher MR, Bragan L, Calabrese LH. Empathy as related to gender, age, race and ethnicity, academic background and career interest: a nationwide study of osteopathic medical students in the United States. Med Educ. 2020. https://doi.org/10.1111/medu.14138.

    Article  Google Scholar 

  49. 49.

    Grosseman S, Novack DH, Duke P, Mennin S, Rosenzweig S, Davis TJ, et al. Residents’ and standardized patients’ perspectives on empathy: Issues of agreement. Patient Educ Couns. 2014;96:22–8. https://doi.org/10.1016/j.pec.2014.04.007.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Carrie Elzie and Jacqueline Shaia. The first draft of the manuscript was written by Carrie Elzie, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Carrie A. Elzie.

Ethics declarations

Ethics Approval

This study was approved by the Human Research Ethics committee of Eastern Virginia Medical School (IRB # 19-10-WC-0246).

Competing Interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Elzie, C.A., Shaia, J. A Pilot Study of the Impact of Virtually Embodying a Patient with a Terminal Illness. Med.Sci.Educ. (2021). https://doi.org/10.1007/s40670-021-01243-9

Download citation

Keywords

  • Virtual reality
  • Empathy
  • Embodied learning