New Technology Teaches Healthcare Professionals to Deliver Messages Patients Don't Want to Hear

What is your technology used for?

For practicing challenging communication in healthcare, where the doctor or healthcare professional has to manage strong emotions, whether their own or those of the patient or the patient's family member. Through our technology, which utilizes a virtual patient that we program, healthcare professionals can practice difficult conversations anytime and anywhere, and be better prepared for the real ones. Generally, standardized patients, who are well-prepared actors playing the role of a patient receiving a serious diagnosis, are most commonly used. We replace them with virtual patients.

How long did it take to develop the technology until it was implemented in practice?

The first scenario took three quarters of a year to develop, and we encountered many dead ends. Our goal is for the creation of additional situations and scenarios to require less and less effort in the future. For instance, to be able to cover situations specific to particular healthcare specializations.

How many people and with what professional focus were involved?

The core team consists of communication experts in healthcare, usually doctors and nurses, along with a screenwriter and a director. Then we record the movements and voice of the future virtual patient with an actor or actress, much like in movies. The final development is handled by technical professionals: an animator, a developer, an artificial intelligence expert, a sound engineer, and others. Approximately 15 people participated in the development, although not all of them were full-time. However, the development does not end here; we continuously modify the application based on feedback from healthcare professionals who go through our virtual reality.

How do you create scenarios for communication practice?

First, we need to agree on a topic or situation. This is not easy, since we have identified almost a hundred potential situations. Then we work with experts to determine the evidence-based approach to healthcare, what the correct protocol is, and how to pedagogically best convey it to the course participants.

What are you currently training the most?

Generally, working with emotions, using parts of the NURSE communication protocol (Naming, Understanding, Respecting, Supporting, and Exploring), because this protocol is widely applicable in most cases where the patient or their family member is experiencing strong emotions. This is important for us at the beginning because it is something that can be used by a wide range of healthcare professionals and allows us to assess how hospital management feels about training their staff in challenging communication. See the picture.

Fig. Workshop at České Budějovice Hospital. Photo: ComGuide

How has the refinement of your application progressed since its first practical use at Jihlava Hospital last November?

There's a short story I’d like to share: During our first virtual reality (VR) workshop for six healthcare professionals, we discovered that when everyone talks to their virtual patient, they can hear each other. We suspected this might be an issue but weren't sure how significant it would be. And it was a big problem. So, we bought noise-cancelling headphones, added more background sounds to the application, and tested the entire setup at a workshop with friendly healthcare professionals. We solved the issue in about a week.

We are continuously improving our technology, especially the artificial intelligence that listens to the healthcare professional and decides what the virtual patient will say. We are also developing additional scenarios and situations. Currently, our primary focus is improving our workshops for customers, mainly hospitals. We are finding out what they need to ensure the application has the greatest value for them and to make sure their healthcare professionals attend the course.

Have you encountered any problems in hospitals?

Yes. For instance, we found out that we need to reassure healthcare professionals in advance that they will have their own safe space, that no one will judge them, and that they will be speaking only to their virtual patient. That there is nothing to be afraid of and that virtual reality isn't anything technically challenging, they just need to put on glasses and talk to the patient.

What do you see as the main benefit of collaborating with foreign universities?

Information. Through the VR-talks project, we lead a consortium of foreign universities, and just showing them our application and getting their feedback is very valuable for us. Regarding healthcare communication training, these foreign universities are several years ahead of our partners in the Czech Republic. For instance, during medical studies at Leiden University, students have several mandatory courses on communication, unlike Czech faculties where it's still in its early stages.

We ask foreign universities if what we are creating is practical for them. This information is crucial for our future expansion into Europe and North America. Through our partnerships, we are also able to determine whether there are any significant differences in recommended practices between countries in the transatlantic world.

And are there?

They are minimal, which is good for us. We would like to create standardized patients based on evidence-based data. It appears we can take into account that both patients and procedures are quite similar across Europe and North America.

Do you plan to use the application in nursing schools?

Yes, it is important for us to influence the entire system of teaching challenging communication, or rather the future system, because currently, for example, in the Czech Republic, it is all just developing. To be able to teach healthcare professionals, we need to collaborate with both secondary and higher education institutions, as well as hospitals for lifelong learning. Our aim is for healthcare professionals to encounter the virtual patient from the beginning of their study and throughout their practice.

Audio: Jan Hrdlička summarizes what doctors and nurses should take away from the workshop.

Video: Demonstration of how the described technology works.

Eva Presová

editorial staff MeDitorial