Avatar-Mediated Training in the Delivery of Bad News in a Virtual World

Abstract

Delivering bad news to patients is an essential communication skill for physicians. Educators commonly use standardized patient (SP) encounters to train physicians in the delivery of bad news. It is expensive to use actors, for logistical reasons such as travel and scheduling, and there are limits to the characters and conditions an actor can portray in teaching encounters. Thus we studied the feasibility of creating SP avatars in a virtual world for the task of training medical trainees to deliver bad news. The SP avatars are easily customized for different scenarios and amenable to distance learning. We recruited 10 medical trainees to interact with a standardized female avatar in a three-dimensional simulated clinic, where the trainee was to inform the avatar of her newly diagnosed breast cancer. The trainee evaluated his or her self-efficacy in delivering bad news via an affective competency score (ACS) before and after the encounter. Two palliative care specialists evaluated each trainee's performance using the Bad News Assessment Schedule and the performance ACS. The self-efficacy ACS scores of the trainees improved overall: before, 20 ± 4, versus after, 24 ± 3, p = 0.001 (maximum score = 30). All participants considered the experience positive and commended the novel approach, although noting that the avatars were not able to portray body language cues. Participants viewed the avatar-mediated training as an excellent approach for learning how to deliver bad news but believed it could not substitute for real patient interactions. However, participant self-efficacy improved, which suggests that avatar-mediated training in a virtual world is a viable educational approach for skill training in delivering bad news.