In this era of evidence-based practice, scholarly work such as peer-reviewed scientific publications play a vital role in policy and decision-making at…
A guest post from Daniel Palazuelos, M.D., MPH, global health implementer-educator at Harvard Medical School, the Brigham and Women’s Hospital (BWH), and Partners In Health (PIH), Sean M. Noble, Ph.D. student at North Carolina State University (NCSU), and English Sall, Ph.D., postdoctoral researcher at the Carolina Health Informatics Program at UNC Chapel Hill.
Doctors who care are better doctors. But how do you get doctors to care? Taking a step back, what makes someone an empathetic person? Some of this is developmental, genetic, and determined by life experiences that cannot be easily undone or replicated. It’s unclear exactly how empathy can be changed, but some early research suggests that perspective taking is a powerful precursor to cognitive empathy, which can compensate for a lack of emotional empathy due to differences in race, ethnicity, religion, or physiology. This is what makes the “clinical rotations” on the wards so transformative; when young students see doctoring in action, listen to and touch patients for the first time, they cease being novices and begin seeing themselves as physicians. Not everything they learn is perfect: they may pick up the corner-cutting habits of their residents to manage the time crunch they face, and they may adopt the curt ways an attending speaks to patients who won’t tell their medical history in concise bullet points. In short, they become a doctor, with all the good and sometimes some of the bad.
However, new technologies have emerged which may be able to mitigate the influence of some of those unintended lessons. Virtual reality (VR) is a technology which creates virtual environments where users experience a sense of physical presence. In other words, VR is able make users feel like they’re really “there.” While experiences within VR can never perfectly replicate real life, they may be pedagogically effective in influencing attitudes. One genre of these experiences are 360-videos such as Clouds Over Sidra, which walks the user through the life of a 12-year-old Syrian refugee living in the Za’atari Refugee Camp in Jordan. Clouds Over Sidra leverages the immersive properties of VR to induce empathy by more easily understanding the perspective of another individual. Studies on 360-videos have already demonstrated that the greater presence and engagement afforded by HMD VR are related to greater empathy.
Harvard medical school delivers a mandatory course for all first-year students that teaches four topics that are considered indispensable for the responsible practice of medicine: social medicine, ethics, health policy and epidemiology. Called the “Essentials of the Profession” course, students engage with materials largely through small group sessions facilitated by Harvard faculty. In the 2019 and 2020 classes, students were able to volunteer to participate in a VR video booth where they could watch a library of impactful 360 video shorts. When we asked students for anonymous feedback, we were pleased to learn that they were unanimous in their enjoyment of the experience and enthusiasm for seeing more in future classes. For example, one student told us that, “It helped me realize how critical it is to ‘immerse’ in the field and experience realities in different settings rather than simply read about them. Of course, VR immersions are not the same as immersions in the field, but I found this to be a significant improvement over simply reading about cases.” While these opinions did not surprise us, more empirical research will be necessary to determine whether this technology will be equally affecting in all students, including those who don’t volunteer enthusiastically to participate.
Care will also need to be taken to produce materials that don’t induce unintended consequences, such as disability simulation programs. Experiences meant to simulate the experiences of individuals sometimes lack an authenticity that only disabled people with extensive lived experience are uniquely positioned to understand. This may lead to the adoption of superficial attitudes towards the struggles faced by disabled people. Avoiding complications when utilizing VR experiences will therefore require opening the conversation on content development to include patients, caregivers, community leaders and activists. It will require putting into action what we are trying to teach our students in the first place: compassion, humility, and the ability to simply and deeply listen.
Nevertheless, immersive virtual experiences may be a powerful new tool for training doctors to become more empathetic and understanding. By enhancing empathy training in doctors, we believe VR can be leveraged to contribute to global goals such as the United Nation’s Sustainable Development Goals, particularly the fulfillment of goal three, “good health and well-being.” Used correctly, VR can be a tool to transport fledgling physicians from the ivy-covered walls of Harvard to the reality of health in Malawi.