Conversations that count: Teaching empathy the immersive way at Stanford Children’s Hospital

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It’s a conversation every physician dreads. How do you tell a parent that their ill child is not going to get better?

The average pediatric oncologist is inspired by the idea of helping sick children recover and one day live a healthy life. But the reality doesn’t always play out this way. Difficult conversations are an unfortunate, unavoidable aspect of the job, and physicians are often drastically unprepared for them.

“As a physician, I can think of no interaction that is more emotionally charged than the delivery of bad news to a mother or father,” says Dr. Loren Sacks, a specialist in pediatric cardiovascular critical care at Lucile Packard Children’s Hospital of Stanford. “Parents remember every aspect of the discussion, while medical providers are often not prepared to guide such a daunting conversation.”

With this in mind, Sacks and his colleagues, Drs. Anne Dubin and Lauren Schneider, began development on an Immersive Learning program using Virtual Reality (VR) to train physicians how to better communicate and navigate difficult conversations with families. Collaborating with Strivr, the team created an Immersive Learning module and began to test it out.

Teaching the art of empathy

Immersive Learning is an experiential training methodology that combines VR with advanced learning theory, data science, and spatial design to improve effectiveness and user engagement. VR captures the undivided attention of the user and places them in realistic scenarios that effectively require the user to do as opposed to just understand. The approach is founded in decades of neuroscience research, which indicates that the brain treats VR experiences just like it would treat real life.

The science behind VR’s transformative impact

In particular, ample research has demonstrated the heightened ability of Immersive Learning to facilitate preparedness when it comes to soft skills — such as the ability to navigate difficult conversations under intense conditions and find the just-right balance of empathy and clinical delivery. VR enables participants to experience real emotional response to a situation, unlike with paper testing or conventional role-playing.

For the team at the helm of this particular project, a sample of pediatric cardiology fellows from around the country were outfitted with VR headsets and underwent an immersive training experience that allowed them to practice end-of-life conversations with parents of a terminally ill child on life support. In-headset coaching helped guide the conversations as scenarios played out. 

The immersive training offered by VR allows physicians to simulate repeatable, real-world scenarios to ensure they are prepared when they need it most.

Dr. Loren Sacks, MD, Lucile Packard Children’s Hospital of Stanford

During the VR experience, 70% of the participants reported “real discomfort” — ideally, close to the same level of discomfort they’d experience in a real conversation. Because Immersive Learning enables learners to repeat the experience multiple times, they could repeat the experience until they felt they’d reached an appropriate level of comfort in the conversation. Now, when they must deliver bad news in real life, they have both a calmer demeanor and a stronger empathetic connection with the patient and the family. 

The balance of clinical demeanor

Empathy is key in such conversations, of course, but so is the ability to deliver news in a calm, straightforward manner. As Sacks recently told The New Yorker, “I’m not trying to teach people to be emotive. I’m giving people tips about how to communicate effectively, and how to convey the sense that they are invested in you. I want to give people a sort of armamentarium of techniques.” 

In this particular experiment, the percentage of doctors who felt moderately or mostly prepared to have difficult conversations grew from 16 to 37% after just one VR training session. The percentage who felt not at all prepared to engage in such conversations before the training fell from 14% percent to zero after the simulation.

If we can teach providers to overcome their own discomfort and to feel relaxed in these demanding situations, then we have managed to impact not only medical education but also the experiences of parents faced with the impossibility of a critically ill child.

Dr. Loren Sacks, MD, Lucile Packard Children’s Hospital of Stanford

“I was ecstatic to see such strong results from the pilot testing of the program,” said Sacks. “If trainees report a real benefit from the training after a single session with one scenario, that benefit can only multiply with additional scenarios and the ability to repeat the experience.”

An improved experience all around

The Stanford Fellows believe this type of training will help them do their jobs better, with 95% of participants indicating they would do the VR training again. This collaboration with Lucile Packard Children’s Hospital is a great example of how Immersive Learning can be used to ingrain critical soft skills into the repertoires of medical providers, and how that progress ultimately and ideally improves the experience for families.

But this example is just one way in which VR-based training is being used to teach interpersonal skills like communication, listening, and empathy. Using Immersive Learning for soft skills provides a transformative training experience for many types of roles from physician to call center representative to sales manager. It immerses learners into real-world situations and allows them to practice and self-assess in a safe environment, while allowing organizations to provide engaging, effective, and consistent training at scale.

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