Virtual reality as a tool for research and training with healthcare professionals
By Emma Norris, on 1 August 2018
By Dr. Jo Hale (1), Dr. Xueni Pan (2) and Prof. Sylvie Delacroix (3)
(1) Centre for Behaviour Change, UCL, UK; (2) Goldsmiths, University of London, UK; (3) Birmingham Law School, University of Birmingham, UK
Virtual reality (VR) technology has advanced to the point where consumers and research participants can readily experience immersive, interactive scenes inside cheap and portable headsets. Since the 1990s, it has become an increasingly popular tool for research and training across many fields – military operations, engineering, medicine and social psychology are just some examples.
In healthcare, many VR applications focus on understanding patient behaviour and developing new treatment therapies. However, virtual scenarios can also be useful for examining and training behaviour among healthcare professionals, similar to the way doctors roleplay as part of their teaching. We demonstrated this in a proof-of-concept study which was discussed at the 3rd CBC Digital Health conference last year. Experienced GPs and trainees completed a virtual consultation with a computer-generated character who made unreasonable demands for antibiotics. Our initial results suggested this achieved the illusion of being in a real consultation room, and that professional experience may influence the decision to prescribe antibiotics or not.
Following on from that study, we have recently published new research focused on child safeguarding. While it is essential that GPs react appropriately to signs of child abuse, this is a difficult skill to impart, and it would be unethical to use child actors to roleplay relevant scenarios. Using VR allowed us to avoid these problems.
In our virtual scenario, a patient, Chris, enters the consultation room with his six year old son, Tom. Chris is there to discuss options for heart surgery. Throughout the consultation, there are signals of potential child abuse in Chris and Tom’s behaviour. Chris gestures aggressively, shouts at Tom and refuses to let him go to the toilet. When Chris leaves the room to take a phone call, Tom becomes visibly more relaxed, and the GP has a chance to talk to Tom alone. We varied the subtlety of Chris’s behaviour, programming it to be more obvious in one condition and more subtle in another, but kept Tom’s behaviour the same. At the end, each GP completed post-consultation notes. We were interested in the extent to which their notes would address the safeguarding concerns in the scenario, and this was rated by 10 professionals blinded to the experimental conditions.
Sixty-four GPs and trainee GPs took part in the study. As well as the subtlety of Chris’s behaviour, we looked at how professional experience, stress levels, and personality traits related to the quality of their notes. We found that the subtlety of Chris’s behaviour significantly affected how well participants picked up on the safeguarding concerns. This suggests that, in practice, doctors may respond to cues in an adult’s behaviour, even though child abuse guidance and training may recommend looking out for cues from the child. We also found that stress, neuroticism, agreeableness and extraversion were significantly correlated with alertness to safeguarding concerns, suggesting these personal factors may also influence a doctor’s ability to attend to safeguarding cues. However, in this study, years of professional experience did not have a significant effect.
Figure. The virtual parent (Chris, right) behaves aggressively towards his son (Tom, left).
When asked to feed back on their experience, doctors from both of our studies commented that the scenarios seemed realistic – “like I was part of the consultation rather than watching a simulation” – despite technical limitations, such as characters lacking facial expressions and not being able to examine the patient. Importantly, they also highlighted that the VR captured some pressures of a real consultation – for example, it “felt stressful” and “evoked a sense of discomfort”.So, can VR help us to better understand and change the behaviour of healthcare professionals? We have shown how virtual scenarios can help to understand what influences behaviours such as antibiotic prescribing and child safeguarding. When it comes to changing behaviour, there are reasons to think that VR may be a particularly potent type of intervention, as it can tap into the ‘raw’ emotional and intuitive reactions that often escape awareness. In this respect, further studies are needed to compare VR’s effectiveness to other types of training intervention, as well as a wider, ethical reflection on the potential for misusing this technology.
- Can a virtual reality scenario capture the diversity and complexity of interacting with real life patients?
- How desirable and feasible would it be to use VR scenarios in training healthcare professionals? Is there potential for misuse?
- We looked at antibiotic prescribing and child safeguarding among GPs. What other behaviours and healthcare professionals would you target?
Dr Jo Hale, UCL Centre for Behaviour Change
Jo Hale is a Senior Research Associate at the CBC, and is part of an interdisciplinary team working on urban change to improve environmental sustainability and population health (CUSSH). Her previous research used virtual reality to generate and model nonverbal behaviour in face-to-face conversations.
Dr Xueni Pan, Goldsmiths, University of London
Xueni Pan is a Lecturer in Virtual Reality at Goldsmiths, University of London. Working in VR for more than 10 years she developed a unique interdisciplinary research profile with publications in both VR technology and social neuroscience, including topic areas of social anxiety, nonverbal imitation, and moral decision-making.
Prof Sylvie Delacroix, University of Birmingham
Sylvie Delacroix is a Professor in Law and Ethics at the University of Birmingham. She focuses on the intersection between law and ethics, with a particular interest in Machine Ethics and Agency. Much of her current research calls for renewed attention to be paid to habits and their relationship to ethical agency, particularly within professional contexts.