Virtual Reality Soft Skills Training for Flu Vaccine Hesitancy

* Mouseover the image and click the start icon to launch windows media file or use the URL to launch the same video in YouTube.https://www.youtube.com/watch?feature=player_embedded&v=uCblgVoiz3Y

2. Teaching Resident Physicians

3. Empathic communication improves child health

• The challenge: Communication skills are important for effective counseling in cases of influenza vaccine hesitancy, a common occurrence in primary care practice. There are barriers to developing the communication skills of pediatric medical residents in busy outpatient settings on topics such as vaccine refusal.

• Our solution: Create an immersive virtual reality (VR) curriculum to teach best practice communication skills for counseling in cases of influenza vaccine hesitancy.

• The need to address this challenge

– Influenza infection can be a significant source of childhood morbidity and mortality that places a large burden on the healthcare system and is a burden disproportionately borne by minority populations.

– Effective empathic communication from physician to the child’s primary caregiver* is critical to understanding reasons for hesitancy and to provide appropriate recommendations that address the caregiver’s concerns.

– Research suggests that physicians especially trainees feel uneasy when addressing vaccine hesitant families.

• Solution specifics

– An immersive VR curriculum included three scenarios during which pediatric residents counseled a vaccine hesitant avatar.

– The virtual clinic space replicated an actual clinic room at Cincinnati Children’s Hospital Medical Center (CCHMC).

– Four avatars were created based on common demographics seen at CCHMC primary care clinics.

– Following the scenarios, residents received feedback regarding their use of best-practice communication skills including open-ended questioning, empathetic responses to caregiver comments and body language, and appropriate education without medical jargon.

• Results & implication

– We tested the VR intervention in an experiment in which only some residents underwent the VR experience; data on vaccinations for families seen by physicians in the VR and Non-VR groups was obtained from the electronic health records and compared. Individuals that had undergone the VR experience had a decreased rate of influenza vaccine refusal of nearly 10% when compared to the control group, a statistically significant difference.

– When more widely spread, a 10% increase in vaccinations could result in a significant decrease in the burden of illness in a large pediatric population.

* Caregiver refers to parent or other responsible adult accompanying the child to the clinic..

Resident: Bobby’s checkup looks good and he’s of the age we recommend giving him a flu shot

Parent: We’ll pass on the flu shot for today

Resident: Oh really? What is it about the flu shot that makes you nervous?

Parent: The Flu shot makes you sick

Resident: That’s a common misunderstanding – children are often sick but the flu shot does a very good job of preventing the flu.

Parent: His brother got the flu shot last year and he still got the flu

Resident: Because we give the flu shot during the fall and winter when lots of illnesses are going around, it is more likely that he got sick from a virus in the waiting room than the flu shot. The flu can get kids seriously ill so we give the flu shot to help keep kids out of the hospital.

Parent: I still don’t know

Resident: What else concerns you?

Parent: He had a rash with eggs once so he can’t get the flu shot.

Resident: That’s a good point, the current version of the flu shot is completely safe to give in kids who have had a rash with eggs. I know that it can seem scary, but I think it’s important to give your child the flu shot to help prevent them from getting sick from the flu.

Parent: You’re right, I don’t want him to become sick.

Parent: Thank you for listening to me, the flu shot does seem like a good idea.

Parent: Let’s give him the flu shot today

Avatars were created based on demographic

information for caregivers at our primary care clinic.

A common scenario is described below with a transcript of a typical Physician/Parent audio

exchange to the right…

Who are you: You are a pediatric physician counseling the caregiver of a child for whom an influenza vaccination is recommended.

Where are you: In the exam room of a busy pediatric primary care center at the conclusion of visit.

Why are you there: You have just completed a well-child visit, another caregiver has taken the child out of the room for a moment and as you are completing your conversation with the child’s mother. You recommend that the child receive a vaccination for influenza.

4. Immersion in the Simulation

5. Team Awesome*• Learning Sciences team

– Erika Cooksey, MSW: Voice artist for the avatars.

– Bradley Cruse, MFA: Development specialist responsible for backend programming and dashboard interface design.

– David Davis, MFA: Lead technology consultant with overall responsibility for design and development of the immersive experience.

– Daniel McLinden, EdD: Learning executive, team manager, and bricoleur.

– Matthew NeCamp: Programming specialist and integration with the vive platform.

• Medical Expertise– Francis (Joe) Real, MD: Project team leader, principal investigator, validation of

interactions in the scenarios, responsible for curriculum development, implementation, evaluation, and analysis of results

– Melissa Klein, MD, MEd: Documentation of the medical need, validate the interaction in the scenario, research design to evaluate impact.

– Dominick (Nick) DeBlasio, MD: Documentation of the medical need, validate the interaction in the scenario, research design to evaluate impact.

* This project was a collaboration between the Learning Sciences team in the Learning & Development department and the Education Section of the Division of General and Community Pediatrics at Cincinnati Children’s Hospital Medical Center. Collectively we considered our collaboration as awesome and dubbed our project team as “team awesome.”