Immersive virtual characters for educating medical communication skills
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Immersive Virtual Characters for Educating Medical Communication Skills. T. Bernard, C. Oxendine, D. S. Lind, P. Wagner Dept of Surgical Oncology (Medical College of Georgia) K. Johnsen, A. Raij, R. Dickerson, R. Wells, B. Lok Dept of Comp and Info Science and Eng (College of Eng)

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Immersive virtual characters for educating medical communication skills

Immersive Virtual Characters for Educating Medical Communication Skills

T. Bernard, C. Oxendine, D. S. Lind, P. Wagner

Dept of Surgical Oncology (Medical College of Georgia)

K. Johnsen, A. Raij, R. Dickerson, R. Wells, B. Lok

Dept of Comp and Info Science and Eng (College of Eng)

M. Cohen, A. Stevens

Dept of Surgery (College of Med)

J. Cendan, M. Duerson, R. Pauly

Dept of Community Health and Family Med (College of Med) R. Ferdig

College of Education


Previous work technology for medical communication skills
Previous Work: Technology for Medical Communication Skills Communication Skills

  • Traditional approaches [Bearman 2003]

    • Narrative

    • Problem Solving

  • Human Patient Simulator [Meurs 1997]

    • Mechanical simulation

    • Motors and actuators for I/O

  • JUST VR [Ponder 2002]

    • Immersive approach (Stereo Projection)

    • Trains students to react to emergency situations

    • Uses human instructor to control system

  • Virtual Standardized Patient [Hubal 2000]

    • Commercial Desktop application by RTI

    • Speech Recognition

    • Natural Language Engine


Project description
Project Description Communication Skills

  • Simulate a standardized patient encounter

  • Allow repeated interaction with an Immersive, interactive virtual patient in a constrained scenario

  • Virtual patient, DIANA

  • Virtual instructor, VIC

  • To address issues with SPs

    • Experience diversity

    • Quality Control

    • Feedback

  • Communication skills

  • No physical diagnosis

  • Interpersonal Simulator


  • Play Video Communication Skills

  • Things to look for: interaction modalities


System
System Communication Skills

  • Low Cost

    • < $8,000(USD)

  • COTSComponents

  • Potential:

    • Every Hospital


Natural interaction input
Natural Interaction Input Communication Skills

  • No Keyboard, No Mouse

  • Speech Recognition

    • Dragon Naturally Speaking 8 Pro

    • Accuracy 90+% with 10 minutes training

    • 70% match to database

  • Track Communication Cues

    • Non-Verbal

      • Track head gaze

      • Track left hand

      • Track body lean

    • Verbal

      • Inflection

      • Jargon

  • Gesture Recognition

    • Pointing, handshake


Natural interaction output
Natural Interaction Output Communication Skills

  • DIANA and VIC look at user

  • Life-size characters

  • Animation

    • Hand gestures

    • Head movement

  • Perspective-Correct Rendering

  • Why this works

    • Does not rely on complete sentences

    • Constrained scenario

    • Students trained on specific questions


Eight studies
Eight Studies Communication Skills

  • 2004

    • April: Project initiated

    • August: Prototype (n=7) UF

    • October: Experts (n=3) UF

    • December: Pilot Test (n=10) UF

  • 2005

    • June: Two Institutions (n=16) UF/MCG

    • July: VP vs SP (n=16, n=8) UF/MCG

    • October: Cultural Bias (n=16) MCG

    • October: Class Integration (n=33) UF

  • n = 101

  • Testing Centers

    • Harrell Center at UF

    • Medical College of Georgia

    • Diana was in Exam Room #3 (video)


Eight studies1
Eight Studies Communication Skills


Vp sp
VP Communication Skills≈? SP

  • How is experiencing an interpersonal scenario with a virtual person similar to – and different from – experiencing an interpersonal scenario with a real person?

  • Clearly different

    • But… in what important ways?

  • Patient-doctor interview provides a constrained scenario

  • The study asks:

    • Are post-encounter impressions similar?

    • Are empathy and other emotions and attitudes similarly expressed?

    • Which social constructs are followed?

  • These questions must be explored to:

    • Determine the extent to which interpersonal scenarios can be simulated with virtual humans

    • Identify how component technologies need to improve to enable effective interpersonal virtual human systems


Overall performance
Overall Performance Communication Skills

  • Similar Experiences

    • Same % of participants asked key questions

    • Out of 12: 6.3 ± 1.7, 5.5 ± 2.1 (α = 0.37)

    • Same % of participants passed the scenario

    • SP = 50%, VP = 36%

  • But…

    • Some critical items were not asked at the same frequency

    • Sexual activity (SP = 0.88, VP = 0.44)

    • Nausea (SP=0.88, VP=0.25)

    • Related to virtual patient expressiveness


Behavioral measures
Behavioral Measures Communication Skills

  • Empathy

    • Empathetic moment – “I’m scared, can you help me?”

    • Expressed the same % and same # of times (SP = 2.2, VP = 1.3)

  • But…

    • Appears less genuine (very robotic)

    • Conversation flow is “rapid-fire”

      • Confirmatory phrases statistically different (SP = 20, VP = 3.5)


Lessons learned
Lessons Learned Communication Skills

  • Overall experiences similar

    • Questions asked

    • Global measures

  • Education goals met

    • Students rated educational merits similarly

    • Students rated difficulty similarly

  • Global measures of realism do not work

    • Battery of specific measures more accurate

  • Practice tool in addition to SPs

  • Diana rated a 6.36(.85) on a 1 to 10 scale (Average is a 7.47 for real SP’s)

  • VR works out of the lab


Papers
Papers Communication Skills

  • Computer Science

    • Raij,et al., “Interpersonal Scenarios: Virtual≈Real?”, IEEE Virtual Reality 2006

    • Johnsen, et al., “Evolving an Immersive Medical Communication Skills Trainer”, Journal on Presence: Teleoperators and Virtual Environments

    • Dickerson, et al., “Virtual Patients: Assessment of Synthesized Versus Recorded Speech”, Medicine Meets Virtual Reality 14

    • Johnsen, et al., “Experiences in Using Immersive Virtual Characters to Educate Medical Communication Skills”, IEEE Virtual Reality 2005

    • Dickerson, et. al., “Evaluating a Script-Based Approach to Simulating Patient-Doctor Interaction”, SCS 2005 Int’l Conf on HCI Adv for Modeling and Sim

  • Medicine

    • Stevens, et al., “The Use of Virtual Patients to Teach Medical Students History Taking and Communication Skills“, American Journal of Surgery

    • Lind and Lok, “The Role of Virtual Patients in Medical Education: Teaching Tool Versus Technological Trend”, FOCUS on Surgical Education

    • Stevens, et al., “Implementing a Virtual Patient into the Medical School Curriculum at the University of Florida”, Southern Group on Education Affairs 2006 (pres.)

    • Cohen, et al., “Do Health Professions Students Respond Empathetically to a Virtual Patient?”, Southern Group on Education Affairs 2006 (pres.)

    • Bernard, et al. “A Multiinstitutional Pilot Study to Evaluate the Use of Virtual Patients to Teach Health Professions Students History-Taking and Communication Skills”, Society of Medical Simulation 2006

    • Stevens, et al., “The Use of Virtual Patients to Teach Medical Communication Skills”, Assoc of Surg Educ 2005, Southern Group on Educational Affairs 2005 (pres.)


Current work
Current Work Communication Skills

  • Incorporation into the classroom

  • UF Essentials of Patient Care

    • n=34 students this year

    • n=135 next year

  • MCG Patient Communication

    • n=200 each year

  • Study

    • Real Speech vs. Synethsized Speech

    • Immersive vs. Non-immersive





Patient diversity
Patient Diversity for Geriatric Patients

  • Measures

    • Eye gaze

    • Body Lean

    • Vocal Inflection

    • Time

    • Interruptions

  • Do students treat different virtual patients similarly?


Communication skills
Communication Skills for Geriatric Patients

  • Fundamental to clinical practice.

    Patient & physician satisfaction.

    Patient understanding & adherence.

    Healthcare outcomes.

    Malpractice litigation.

  • Learned skill & experiential learning alone is insufficient.


Virtual objective structured exam vosce
Virtual Objective Structured Exam for Geriatric Patients(VOSCE)

NBME


Curriculum integration

UF for Geriatric Patients

1st year Medical Students

n = 135

MCG

1st year Medical Students

n = 200

EPC courses

(Semester 1)

ECM courses

(Semester 1)

Virtual Patient Experience

(Early 1st semester)

EPC courses

(Semesters 2-4)

ECM courses

(Semesters 2-4)

Curriculum integration


Virtual patient teams

Virtual Patient Teams for Geriatric Patients

T. Bernard, C. Oxendine, D. S. Lind, P. Wagner

Dept of Surgical Oncology (Medical College of Georgia)

K. Johnsen, A. Raij, R. Dickerson, R. Wells, B. Lok

Dept of Comp and Info Science and Eng (College of Eng)

M. Cohen, A. Stevens

Dept of Surgery (College of Med)

J. Cendan, M. Duerson, R. Pauly

Dept of Community Health and Family Med (College of Med) R. Ferdig

College of Education


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