By Roland Piquepaille
Medical students often learn to ask questions such as "Tell me where it hurts" with live actors who are following prepared scripts. But this is expensive and the University of Florida (UF) has developed a new way to teach the subtle art of the patient-doctor interview. This news release, "UF's Virtual Reality 'Patient' Teaches Bedside Manners to Medical Students," tells us more about DIANA, which stands for "DIgital ANimated Avatar" and is a life-sized image of a young woman. Her image, completed by a simulation of a doctor's office, is projected in front of a student who can interview her. So far, the method has only been used by two dozens students, but results are promising. Read more...Let's start with the introduction of DIANA.
"DIANA," which stands for DIgital ANimated Avatar, is a life-sized image of a 19-year-old Caucasian female with a passing resemblance to video game hero Lara Croft. Her image, complete with simulated doctor's office in the background, is projected onto a wall. Through their interviews with her, medical students can practice not only the right questions to ask to come to an accurate diagnosis but also the less straightforward aspects of human interaction such as gestures and eye contact.
"We want to focus on communication," said Benjamin Lok, an assistant professor in UF's Computer and Information Science and Engineering (CISE) department and the lead researcher on the project. "Part of (the interview training) is to get the right answer, but part of it is to learn communication skills."
The images below show how the whole system works.
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On this image, a student is diagnosing DIANA, a 'virtual' patient with acute abdominal pain, while the instructor watches. The colored headset is for head tracking (Credit: CISE, University of Florida). |
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This screenshot shows a close-up of DIANA, the virtual patient, complaining of acute abdominal pain (Credit: CISE, University of Florida). This image, and the other one below, comes from the Virtual Objective Structured Clinical Examination (VOSCE) project webpage |
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"Head tracking data shows where the medical student is looking during the interview. This student looked mostly at DIANA's head and thus maintained adequate eye-contact for the scenario." (Credit: CISE, University of Florida) |
Now, here is the current status of this project -- and its promising results.
Currently, medical students can practice interviewing skills with "standardized patients," live actors who are given a script to follow for the interview. However, training the actors can be expensive, and it can be difficult to find sufficiently diverse populations of actors, a factor that can make a subtle difference in the interview process, Lok said. The system, which costs less than $10,000, would help students train for the standardized patient interviews, making those sessions more effective, Lok said.
Seven medical students tested DIANA in August, and another 20 interviewed her in December. After each test, the students rated the realism and usefulness of the interviews on a one-to-10 scale. By December, DIANA's average rating of 7.2 was nearly identical to the 7.4 average for the live actors.
Of course, this system is not perfect and researchers are working on some of its limitations.
Though those results are promising, DIANA isn't ready to replace live actors yet, Lok said. She can look up when she is spoken to, look down during pauses, reach out to receive a handshake. But there are many other physical cues in human conversations that can provide information to a doctor and also reassure a patient that the doctor is paying attention, he added.
"There are so many things that you and I do when we talk -- I can tell whether your eyes are focusing on me, whether you're listening, hand gestures, facial gestures, body posture. These are things that the computer can't do -- but we're working on that," he said.
For more information about this new computer interface for medical students, you can read this document, "Experiences in Using Immersive Virtual Characters to Educate Medical Communication Skills" (PDF format, 8 pages, 959 KB). The top illustration above comes from this document.
Sources: University of Florida news release, March 12, 2005; and various websites
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