The Emotional and Behavioral Impact of Delivering Bad News to Virtual versus Real Standardized Patients: A Pilot Study.

Virtual standardized patients (SPs) are becoming increasingly common in medical education, though one limitation of SPs is the artificiality of computer-based simulators. Past research on the use of SPs has not clearly established whether learners have different emotional responses to real SPs (SPs) compared with SPs; however, understanding learners' emotional responses to SPs is important in providing realistic learning experiences and establishing the validity of this teaching and assessment tool. This study compared the emotional experiences of individuals who interacted with SPs and SPs. Sixty medical students at a medical school in the southeastern United States participated in the study. Participants were randomly assigned to deliver bad news to an SP or SP. The SP for this study used a hybrid intelligence model that allowed a person to "inhabit" the SP. Salivary cortisol and a self-report measure of mood-the Profile of Mood States, Second Edition (POMS 2)-were gathered before and after delivering the bad news. The SP and 2 independent evaluators rated the behavioral performance of each participant in real and virtual conditions. Participants also rated the performance of the SP. Participants in both conditions reported increased negative emotionality on the POMS 2 following the SP interaction. There were no significant between-group differences on the POMS 2 or salivary cortisol concentration following the SP interaction. Ratings by the SP and independent evaluators indicated that participants performed similarly on most interpersonal dimensions, except tone of voice. Participants perceived the SP as less realistic than the SP. These results suggest that medical students may have similar emotional and behavioral responses when delivering bad news to a SP when compared to an SP. These findings provide support for the continued use of SPs in training learners to deliver bad news and other communication-based skills and to assess their performance on these tasks.