Veterans Affairs Medical Center, Miami, Florida 33125, USA.
J Palliat Med. 2010 Dec;13(12):1415-9. doi: 10.1089/jpm.2010.0108. Epub 2010 Nov 24.
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.
向患者传达坏消息是医生的一项重要沟通技能。教育者通常使用标准化患者（SP）的模拟场景来培训医生传达坏消息的技巧。由于旅行和日程安排等后勤原因，使用演员的成本很高，而且演员在教学场景中可以扮演的角色和条件有限。因此，我们研究了在虚拟世界中创建 SP 虚拟形象以培训医学实习生传达坏消息的可行性。SP 虚拟形象可以轻松针对不同场景进行定制，并且适合远程学习。
我们招募了 10 名医学实习生，让他们在三维模拟诊所中与标准女性虚拟形象进行互动，要求实习生告知虚拟形象她新诊断出的乳腺癌。实习生在互动前和互动后通过情感能力评分（ACS）评估自己传达坏消息的自我效能感。两位姑息治疗专家使用坏消息评估量表和表现 ACS 对每位实习生的表现进行评估。
实习生的自我效能感 ACS 评分总体上有所提高：互动前为 20±4，互动后为 24±3，p=0.001（最高得分为 30）。所有参与者都认为这种体验是积极的，并称赞了这种新颖的方法，尽管他们指出虚拟形象无法表现身体语言提示。
参与者认为虚拟形象介导的培训是学习如何传达坏消息的绝佳方法，但认为它不能替代与真实患者的互动。然而，参与者的自我效能感有所提高，这表明虚拟世界中的虚拟形象介导的培训是一种可行的技能培训方法，用于传达坏消息。
