Using Virtual Reality To Teach Medical Student Empathetic Communication Skills Interview with:
Frederick W. Kron, MD

President and Founder of Medical Cyberworlds, Inc
Department of Family Medicine,Ann Arbor, MI and
Michael D. Fetters, M.D., M.P.H., M.A.
Professor of Family Medicine
University of Michigan What is the background for this technology and study?

Dr. Kron: Communication is the most important component of the doctor-patient relationship. I know that through research, but also through personal experience. As a cancer survivor, I’ve seen first-hand the difference that outstanding communication skill can make to a vulnerable patient.

At the beginning of the project, we asked medical educators about the challenges they had in assessing and training communication competency. They told us that technical skills are easy to teach and assess, but communication skills are mainly behavioral skills that involve verbal and nonverbal behaviors, facial expressions, and many other cues that pass between patient and provider. That’s hard to teach and assess. Activities like role play with standardized patients (SPs) have been widely used, but it’s impossible for SPs to accurately portray these behaviors, or for faculty to fully assess the nuanced behaviors of both learner and patient. Supporting this idea is a lack of evidence proving that SP encounters translate in behavioral changes or transfer into clinical settings.

Developments in virtual reality provided us with a great opportunity for assessing and teaching of communication behaviors. Working with a national group of experts, we created computer-based Virtual Humans that interact with learners using the full range of behaviors you’d expect from two people talking together. They are so behaviorally realistic and compelling, that they trigger emotional responses in learners, and make learners want to learn so they can do their best.

Dr. Fetters: Our team has particular interest in doctor-patient communication in the context of cancer. There are many critical aspects of cancer communication: breaking the bad news to the patient, negotiating sometimes conflicting family opinions about treatment, and communication among team members about the patient’s care, just to name a few. We’ve begun building out those scenarios in the technological platform we developed, Mpathic-VR. What are the main findings?

Dr. Fetters: Our research is called MPathic-VR, an acronym from the NIH grants funding the project, “Modeling Professional Attitudes and Teaching Humanistic Communication in Virtual Reality.” After successfully developing and testing a prototype, we sought to develop rigorous evidence that MPathic-VR was effective through a randomized controlled trial, and used a mixed methods approach to fully understand leaners’ attitudes towards, and experiences with the system. We tested for quantitative, objective measures of communication skills improvement and training transfer to a new setting, and we also collected qualitative data –student descriptions about the nature of their experiences interacting with the system, and their reflections about what it was like to interact with virtual human.

Dr. Kron: Testing the system in three medical schools led to three major findings.

  • First, students learned to communicate better as they repeatedly went through each module.
  • Second, the students assigned to the MPathic-VR virtual human arm performed better than students assigned to a control when they encountered a realistic scenario presented up to 2 weeks after their training. This is important, since the goal of any training is to see if learners retain it and can use it later, in new settings. We showed that this happened for Mpathic-VR-trained students, but not for students in the control group.
  • Third, from the mixed methods analysis, we learned that learners preferred the MPathic-VR virtual human experience.

    This was due to its interactivity, the chance for repetitive practice in emotionally charged situations, and the ability for students to see and practice facial expressions and nonverbal behaviors. What should readers take away from your report?

Dr. Fetters: This research demonstrates convincingly, for the first time, that medical learners can be taught complex communication skills using virtual human computer simulations, and that those skills can transfer into higher-reality clinical scenarios.

Dr. Kron: The Mpathic-VR computer simulation gives medical learners an opportunity to practice communication skills in a safe setting. Any doctor can tell you that reading a book or article only goes so far for teaching clinical skills. Virtual Human computer simulation effectively bridges a gap between book learning and interacting with actual patients.

Dr. Fetters: Our research demonstrates that Virtual Human training is feasible and effective. It sends a message to educators that behavioral skills can be taught using virtual human technology. Given the central role of communication in the doctor-patient relationship, virtual reality opens an entirely new venue for better education of learning verbal and non-verbal, really, the entire gamut of communication skills. What recommendations do you have for future research as a result of this study?

Dr. Fetters: This research opens up a host of new opportunities in communication training. Apart from the specific situation of cancer communication, areas for further research abound.

Dr. Kron: Whether the challenge is patient engagement, medication compliance, substance abuse, depression, PTSD, or shared decision-making, good communication is the cardinal skill that leads to correct diagnoses, drives high-quality health outcomes, and enhances patient experience.

Dr. Fetters: Our hope is that we will be able to address these potential applications, to help as many doctors and patients as possible to improve care through empathic and effective communication. Is there anything else you would like to add?

Dr. Fetters: We would like to acknowledge the support we received from the National Institutes of Health, both the National Cancer Institute (NCI), and National Center for Advancing Translational Sciences (NCATS) who funded this research. In addition, this research could not have been possible with collaboration and cooperation of many people, both research and development team members, the medical school leadership who facilitated the study, and especially the medical students who participated in the study.

Also, we think this research is a real game-changer. I look forward to being part of this next wave in advancement of medical education and beyond. The fun has just begun!


Dr. Kron serves as president and Michael Fetters has stock options in Medical Cyberworlds, Inc., the entity receiving the grant funds for this project. The University of Michigan Conflict of Interest Office considered potential for conflict of interest, and concluded that no formal management plan was required.


Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial
Patient Education and Counseling 100(4) · October 2016
DOI: 10.1016/j.pec.2016.10.024

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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