Interactive module’s effectiveness on empathy and attitudes of healthcare students

Methods

The institutional review board at Rocky Vista University approved an exempt protocol with IRB ID: 2022-136. DO and PA students engaged in an interactive virtual reality module as part of their curriculum. This project provided informed consent at the beginning of the pre-survey and post-survey that students elected to complete. Responses were de-identified and gathered through electronic data aggregation. ST and JW collected the consents and responses for further evaluation and analysis by JW.

This module was introduced during the diabetes section of the Osteopathic Medicine (OM) 1006 Endocrinology/Reproductive Course for the DO students and Physician Assistant Studies (PAS) 5233 Professional Seminar III for PA students. Students were informed of the option to participate in research by engaging in the virtual video simulation experience, which included a pre-survey and post-survey from February 1, 2023 to February 22, 2023, a 21-day period as outlined in Figure 1. The demographic information obtained was gender, race/ethnicity, highest level of education completed, close friend or family member with diabetes, if they were a healthcare provider or student, year in school, campus of study, as well as their specialty of interest.

Figure 1:

The figure displays the mean scores on the Jefferson empathy scale before after completion of the virtual interactive modules. Scores range from 1 (strongly disagree) to 7 (strongly agree). The error bars represent the standard deviation of each result. Analysis shows there was a significant increase in scores after the completion of the modules, which indicates a positive impact on empathy modules for health professional students.

This module was funded by Medicare/Medicaid via the Medicaid Equity Simulation Project and created by Ohio University’s Game Research and Interactive Design Lab [16]. The module encompasses 12 subsections and possesses 360-degree view capabilities. The virtually simulated patient is a 72-year-old female living in the Appalachians named Lula Mae Tate. She has been living with Type 2 diabetes mellitus for the past 22 years and is the primary support for her immediate family. The Lula Mae module was produced by EB and gave permission for use for educational purposes. Before and after interacting with the module, the students were asked to complete a survey (Appendices 1 and 2).

Three scales were utilized for analyzing their data. The first was the Diabetes Attitude Scale, which gauged four subscales utilizing a five-point Likert-type scale with 1=strongly disagree and 5=strongly agree [17]. The subscales included the need for special training, seriousness of type 2 diabetes, psychosocial impact of diabetes, and patient autonomy. The second scale utilized was the Jefferson Empathy Scale, which utilized a 20-item seven-point Likert-type scale with 1=strongly disagree and 7=strongly agree [18]. The last scale utilized was Assessing Student Competence and Knowledge of Social Determinants of Health (ASCK-SDH), which was a four-point Likert-type scale consisting of eight items with 1=strongly disagree and 4=strongly agree. This scale is a relatively new validated instrument for measuring student competency and knowledge of SDH [19]. Paired t tests were utilized to analyze the data with mean (M) and standard error of the mean (SEM) accounting for variability.

Results

The sample size for DO and PA students was 379 and 34 students, respectively. One hundred fifty-one DO students (40 % response rate) and 7 PA students (21 % response rate) completed both surveys. The low response rate among the PA students explains why they were not included in the data analysis.

Based on the paired responses from DO students, there was evidence of an enhanced understanding of the nuances of diabetes management. For Diabetes Attitudes, M and SEM were calculated for the four subscales: the need for special training, seriousness of type 2 diabetes, psychosocial impact of diabetes, and patient autonomy. Students concurred for the need for special training (M=4.58; SEM=0.03), seriousness of type 2 diabetes (M=4.29; SEM=0.04), psychosocial impact of diabetes (M=4.36; SEM=0.03), and patient autonomy (M=4.23; SEM=0.04). After module completion, these four subscales showed significant increases. Postsurvey, need for special training increased (M=4.71; SEM=0.04; t[151]=−4.389, p<0.001), seriousness of type 2 diabetes increased (M=4.49; SEM=0.04; t[151]=−5.843, p<0.0001), psychosocial impact of diabetes increased (M=4.65; SEM=0.04; t[151]=−8.946, p<0.0001), and patient autonomy increased (M=4.33; SEM=0.04; t[151]=−3.199, p<0.0002) (Table 1).

For the Jefferson Empathy Scale, students had a M=4.10 with a SEM=0.02 on their premodule surveys, which increased to a M=4.14 with a SEM=0.02 postmodule completion (t[151]=−2.355, p<0.05) (Figure 2).

Figure 2:

The figure represents ASCK-SDH scores before and after completion of the virtual interactive module. The error bars represent the standard deviation of each result. Scores were assessed through presurveys and postsurveys. Analysis shows a significant increase in the awareness of SDH for health professional students.

Finally, the ASCK-SDH scale showed a positive trend with a significant difference from presurvey to postsurvey with a p value<0.001 (t[151]=−3.68). Students had a M=25.98 and SEM=0.3 on the presurvey scale, while postsurvey scores showed a M=27.08 with a SEM=0.2 (Figure 3).

Figure 3:

The figure provides a reference of the study design of the prelearning and postlearning activity surveys for the DO and PA students.

Regarding the PA students, there were only seven paired responses between the presurvey and postsurvey. Due to the low response rate, statistical evidence on the impact of the module for the PA students was not seen.

Discussion

The integration of the Lula Mae virtual reality module has the potential of enhancing DO students’ cultural competency and attitudes toward diabetes management. By providing a realistic and immersive learning experience, the module is seen to promote a deep understanding of cultural, social, and societal factors impacting diabetes care. Students exposed to these multifaceted types of patient encounters through virtual reality have the ability to develop patient-centered approaches, tailor treatment plans, and utilize effective communication strategies through early exposure with virtual reality.

Additionally, the module may help students in recognizing their own biases as well as challenging stereotypes, thereby improving their ability to provide equitable care. Our study shows that virtual reality can be an effective teaching tool on enhancing empathy. However, whether it can completely replace traditional standardized patient encounters remains to be seen. Alternatively, it can be utilized as an adjunct tool with other curricula in healthcare education settings. As with all novel technologies, ease of implementation and use may hinder virtual reality modules’ initial impact.

It is unfortunate that the PA data was not large enough to reinforce our findings from the DO data. A subsequent study featuring students from this career path would greatly bolster support for its potential use in subsequent curricula. Biases considered during our study were optimism and pessimism toward diabetes management as well as contextual bias. Again, these modules were embedded in both the PA and DO curricula leading to possible skewing to factors including time-constraint pressures and grading anxiety. Further research is also needed to explore the long-term impact of the module on healthcare outcomes and to determine its effectiveness in other healthcare education settings.

This study assessed DO student empathy and improvement in diabetes attitudes. Empathy statistically significantly increased from presurvey (M=4.10) to postsurvey (M=4.14). While this may seem modest, it improved on an already-high empathy score, which could have experienced the ceiling effect and demonstrated no improvement or a decline. In paired data, diabetes attitudes showed a stronger agreement for specialty training for nonhealthcare providers caring for individuals with type 2 diabetes as well as an increase in seriousness of type 2 diabetes. The virtual module increased agreement in the psychosocial impact of diabetes as well as an agreement in the need to support, patient autonomy. By providing a realistic and immersive learning experience, the module is seen to promote a progressive awareness of the myriads of factors impacting diabetes management. Students exposed to these multifaceted patient encounters through virtual reality can develop patient-centered approaches, tailored treatment plans, and utilize effective communication strategies through early exposure with virtual reality.

Additionally, the module may help students in recognizing their own biases as well as challenging stereotypes, thereby improving their ability to provide equitable care. Our study shows that virtual reality can be an effective teaching tool for enhancing empathy. Its strength may be an adjunct tool with other curricula in healthcare education settings. As with all novel technologies, ease of implementation and use may hinder virtual reality modules’ initial impact.

Given that the intersection of SDH and chronic disease necessitates expertise beyond individual professions, this immersive learning experience has the potential to foster engaging interprofessional education. Consequently, incorporating this learning experience across various healthcare disciplines could significantly enhance educational opportunities and outcomes.

Conclusions

This study focused on discovering innovative methods to enhance health professionals’ approaches to diverse patient care. The results showed that implementing interactive virtual reality modules significantly improved DO students’ empathy and attitudes toward individuals with chronic conditions and their SDH. These findings suggest that such modules could benefit the education of osteopathic medical students and other health professionals. Perhaps including more than one such module throughout the course of the program may boost empathy. Longitudinal follow-up may assist in understanding if this module is useful in maintaining empathy gains.