Beyond 'Simulated Patients': Examining social virtual reality to augment healthcare training

Background. Realplay with simulated patients (SP) is an effective educational tool, particularly for interpersonal patient-provider interactions (PPIs); however, it requires learner/actor physical and temporal co-presence and is therefore not highly scalable. Emerging technologies offer the potential to overcome this hurdle. Purpose. To examine whether social virtual reality (SVR) can enhance SP scalability in the context of SBIRT training. PPIs are central to SBIRT, which has been shown effective in addressing substance abuse during short-duration PPIs; however, training providers to implement SBIRT remains a dissemination challenge for which SP is particularly applicable. Results. Using a multistage, provider-centered development methodology, subject-matter expert/end-user content validation, and mixed-methods formative and summative evaluation among subject-matter experts and practitioners, the effort generated a design document and patient cases, selected Second Life as the testing platform, and created a virtual environment, patients, and providers. Methods for conducting and recording interactions, including comparison of voice versus text interaction, were investigated and simulated patient cases were generated. Participants found the SVR usable and innovative, noting the technology's potential; however, numerous interface and cognitive overhead issues were also identified. Discussion. The effort demonstrated that SVR can make simulated patient education more scalable and cost-effective by allowing learners, patients (actors), and experts to be co-present without being in the same physical space. Recording interactions, and other strategies including automating simulated patients, can remove “same time” scalability limitations. The research supports the feasibility of using SVR to augment provider education while pointing to significant challenges, barriers, and important questions for further research.