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Background

Virtual reality technology describes the use of headsets displaying a particular environment to simulate a user’s physical existence in a virtual or imaginary setting. Avatars (virtual characters with whom the user interacts) can be programmed to express emotions, for example, by blushing or crying. Headsets are sometimes combined with other sensory inputs, such as haptic feedback, smells, and changing temperatures. These high-fidelity avatars provide the user a greater sense of reality and Hornyofficebabes.com facilitate meaningful interaction (2).

The field of virtual reality first came to light decades ago; however, recent advances in technology have made it the exciting and emerging field it is today. Its applications are vast, ranging from military training to gaming. In medicine, the technology has been trialed for uses such as cognitive rehabilitation post-stroke (3), improving reaction times in children with cerebral palsy (4) and in aiding the diagnosis of psychiatric conditions (5).

This paper sets out the viewpoint that virtual reality technology could be a new focus of direction in the development of training tools for medical education. Responses of the avatar were pre-programmed, with a researcher selecting the most appropriate quote depending on what the participant said. The dilemma of tenacious calls for antibiotics by patients is a common yet difficult scenario due to the great threat posed by growing antimicrobial resistance worldwide. In essence, the doctor’s main goal was to try to resist calls for unnecessary antibiotics. Participants were required to interact with two avatars: an elderly woman, the patient, and her daughter, who was requesting antibiotics for her mother’s likely viral infection. We concentrate on its use in improving the communication skills of clinicians and medical students. We refer extensively to Pan et al.’s study, ”The Responses of Medical General Practitioners to Unreasonable Patient Demand for Antibiotics-A Study of Medical Ethics Using Immersive Virtual Reality,” which explores the extent to which portable immersive virtual reality technology can help us gain an accurate understanding of the factors that influence a doctor’s response to an ethical dilemma. The videos were available after completing the session for reflection and to establish learning points. Pan et al. carried out a ”proof of concept” research project, whereby twelve general practitioners (GPs) and nine GP trainees took part in a videoed 15-min virtual reality scenario. The doctor undergoing the scenario was easily able to suspend reality owing to the highly immersive oculus rift headset.

Aside from exploring the potential of virtual reality technology as a training tool, the specific purposes of Pan et al.’s study were twofold: first, fernandochagasimoveis.com.br to investigate whether medical doctors would take the virtual situation seriously, and, second, whether experienced GPs would be more resistant to patient demands than GP trainees. A short video demonstrating the work can be seen at https://www.youtube.com/watch? Experienced GPs were more able to say no to patients and uphold the principles of antibiotic stewardship, with trainees more likely to demonstrate poor prescribing behavior: eight of the nine trainees prescribed antibiotics, compared with seven of the twelve qualified GPs (1). Despite being only 15-min long, the scenario was very taxing and quite uncomfortable, as demonstrated by the facial expressions and body language of the participants and audience. v=C8Hs6NxtXB8. Results showed participants found it a useful and interesting experience.

Pan et al.’s study focuses on the technical details of the virtual reality technology used, with some analysis of its success. We decided it was important to gather opinions and reflect further on how valuable the scenario was and the wider applications of virtual reality in medical education. However, the article was lacking in information regarding how useful the scenario was as a tool for medical education and antibiotic stewardship.

Methodology

The content of this paper is a culmination of findings and feedback from the panel discussion at the Center for Behavior Change 3rd Annual Conference at University College London (UCL) on February 22, 2017. We held the panel discussion to consider how the short immersive virtual reality scenario might help change doctors’ prescribing behavior, what the limitations are and to discuss potential applications and implementations of virtual reality in medical education more broadly.

We selected a panel of experts from the following backgrounds: virtual reality, general practice, medicines management, medical education, and ethics. The aim of the panel was to invite questions and views from the audience and encourage balanced discussion of the issue from all of these angles. Attendees were asked to watch the video then each panel member (all of whom are authors) gave a brief dialog about one aspect of the issue:

(1) CS (general practitioner): antibiotic prescribing in general practice

(2) A-NL (pharmacist): antimicrobial stewardship

(3) CF (pediatrician): training tools in communication skills and the ethical considerations of virtual reality as a training tool

(4) XP (virtual reality lecturer): the technical details of the scenario with a focus on how avatars could be used in training

(5) SL (Clinical Leadership Fellow at NHS England): the benefits and potential negative implications for virtual reality as a training tool

The audience consisted of a range of healthcare professionals, commercial healthcare company representatives, public health professionals, behavioral science researchers, healthcare communication company representatives, and journalists. The panel members reflected on the views offered during the panel discussion and compared them with their own. By culminating the attendees’ contributions with our thoughts, this article provides a critical analysis of the use of virtual reality in medical education from a variety of perspectives. Unsurprisingly, there was a fair amount of dialog and disagreement as to the use of virtual reality in training medical professionals.

Communication Skills in Medical Education

Communication skills training is now a core aspect of medical education, generally introduced early and continued throughout medical school. In this way, they are able to mold the consultation to ensure the patient’s satisfaction while remaining efficient. Medical students can modify the basic model depending on what they have observed in role models and what they feel most comfortable with. Many courses use the Cambridge-Calgary guide to the medical consultation as a useful framework for use in communication skills teaching (6). It can be broken down and its constituent parts used sequentially during both learning and examining. We believe that this is a skill that can be learned, practiced, honed and assessed.

Throughout training and in continuing professional development, medical students and doctors use roleplay with real and simulated patients to practice communication skills. They are often videoed and watched contemporaneously by a group, then kept for personal use to watch in a private space for deeper reflection and understanding. This allows for both self-reflection and for an expert to analyze the consultation at a later time. Another tool is to video real patient consultations with consent. One current training tool involves consultations with a patient actor followed by immediate feedback by experienced staff and the actor.

Communication skills training is also undertaken on the job, for example, in the form of work based assessments with senior colleagues or as part of a summative assessment for a specialist exit examination. Learning to communicate in complex or emotionally charged situations is challenging: it may occur by reflecting on things that could have gone better or, in worst case scenarios, when having to deal with a complaint, a claim or in court.

Often conflicts arise because we make assumptions about others we come into contact with, not least patients. It is important to reflexively consider how culture affects patient care. Aspects of culture such as race, religion, gender, sexuality, age, experience, background, language, and so on, undoubtedly affect the views medical professionals hold, and the way in which situations are handled. The use of virtual reality, where the appearance of avatars can be easily altered, may allow clinicians to gain a deeper understanding of their own values and how these affect their clinical practice. There are often stereotypes that must be abandoned while working with other professionals to be able to honestly and fruitfully work together.

Currently there is very little literature published comparing the use of virtual reality in consultation training compared with the current methods and this is something we plan to investigate in the future.

Discussion and Emerging Themes

The workshop began by audience participants watching the avatar-doctor consultation video mentioned in the background section. The responses were wide-ranging and highlighted some of the various themes that can affect an individual’s expectations and approach to a consultation with a doctor. They were then asked to reflect on their most recent experience of visiting a doctor for antibiotics and their impressions when the doctor decided to either give or refuse the prescription.

First, geographical and cultural factors were found to influence an individual’s level of engagement and involvement in treatment decisions, and their attitudes toward antibiotics. People of different nationalities were generally aware that antibiotics must be used prudently. German participants were more likely to anticipate that the doctors would decide whether or not they needed antibiotics (” this is what I think you need” ). A Danish student said she was accustomed to doctors asking her for her viewpoint on what kind of remedy she needed, including antibiotics.” What would you like?\ Usage of online fact in a random controlled test to shorten cognitive palsy’s effect period Dev Neurorehabil ( 2017 ) 1: 1-6. doi: 10.1080/17518423.2017

5. Van Bennekom MJ, De Koning PP, and Denys D. A poetry assessment that objectifies the examination of clinical diseases. Front Psychiatry ( 2017 ) 8: 163. doi: 10.3389/fpsyt. 2017.00163

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6. Silverman J, Kruse S, Teaching and Learning Communication Techniques in Medicine. Oxford: CRC Press ( 1998 ).