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Oral Themed Presentation
Oral Themed
Loren Sacks, MD
Clinical Assistant Professor
Stanford University Department of Pediatrics, Division of Pediatric Cardiology
Lauren Schneider, PsyD
Clinical Assistant Professor
Stanford University Department of Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry and Child Development
Marcos Mills, MD
Fellow
Stanford University Department of Pediatrics, Division of Pediatric Cardiology
Josh Oates, N/A
Director, Business Development
STRIVR Labs Incorporated
Tessie October, N/A
Assistant Professor
George Washington University Division of Pediatric Critical Care Medicine
Lillian Su, MD
Clinical Assistant Professor
Stanford University Department of Pediatrics, Division of Pediatric Cardiology
Anne Dubin, MD
Professor
Stanford University Department of Pediatrics, Division of Pediatric Cardiology
Background: : The compassionate delivery of devastating diagnoses, and the ability to guide families through discussions of withdrawal of technological support, requires high quality communication skills. Despite the importance of such abilities, pediatric practitioners rarely receive formal communication training. When practitioners do receive training, most commonly actors serve as standardized patients allowing for practice and real time feedback. However, the resource-intensive nature of a program of this type limits its application. Typically, the coordination of space and of time dedicated by actors and faculty results in one experience per student over the course of a medical training program. Virtual Reality (VR) has the potential to provide a novel and more readily accessible training system. VR allows for the creation of realistic, emotionally charged environments that can engage learners repeatedly, amplifying their exposure to communication skills training. Moreover, VR simulations are readily scaleable and, once validated, can be used to broadly disseminate communication skills techniques.
Research Question: : This pilot study seeks to evaluate the self-reported efficacy of a virtual reality conversation simulator in improving the communication skills of pediatric care providers.
Methodology: : An interactive VR training environment was designed, simulating discussions between ICU practitioners and the mother of a patient found to have suffered a significant intracranial hemorrhage following heart surgery. Incorporated into the simulation were prompts suggesting evidence-based communication techniques. 18 pediatric trainees preparing for Pediatric Cardiology fellowship, and 3 Pediatric Cardiology faculty members were enrolled. Learners engaged a VR “mother” in a difficult conversation, delivering news of this devastating diagnosis and allowing the “mother” to respond with voice and body-posture changes. Learners then reviewed their interactions using audio playback and by observing a VR avatar that mimicked their own body posture, gaze, and hand motions. Learners were surveyed before and after this experience, using Likert scales. Statistical analysis was completed using the Wilcoxon Signed-Rank Test.
Results: : 12/21 (57%) participants had previously undergone formal communication skills training, while 11/21 (52%) had previously led actual conversations recommending withdrawal of support for a patient. Despite this prior exposure, there was significant increase in self-reported preparedness for leading difficult conversations after the VR session (p=0.0004). Learners consistently rated the VR program as realistic and 20/21 agreed that VR is “a great practice tool for having difficult conversations”. Finally, despite describing a sense of discomfort similar to that experienced in actual difficult conversation, 19/21 learners (90.5%) stated they would be eager to repeat this VR training.
Discussion/Conclusions: : This novel VR training program has the potential to significantly improve learners’ comfort and skill when discussing terminal diagnoses and/or the a withdrawal of technological support. The current training paradigm is limited by cost and logistics, whereas VR can be rapidly and repeatedly deployed to meet this training need. Trainees were eager to engage in training and reported significant improvement in readiness for these demanding interactions. This pilot work emphasizes the potential of this program, and that further studies to validate its impact are needed.