Our Blog | IKONA Health

Meet Jerome.

Jerome is a 29 year old Registered Nurse who lives and works in the Heartland of America. Jerome received his R.N. in early 2019 and immediately found employment in a nearby hospital in St. Louis. He was excited to put his knowledge and skills to work in the interest of patient health and well-being. As with so many newly-minted RNs he found the job exhilarating, but he also felt like there were some significant gaps in his training. In particular, he noticed very quickly that interpersonal skills are central to providing high-quality healthcare, yet this was almost completely absent from his formal training.

When he expressed this concern to his more seasoned colleagues they all nodded their head in agreement and assured him that effective communication skills training would be learned on-the-job. It was unspoken, though clear, they all agreed more training on these critical skills ought to be available in school.

VR and Empathy Building in Healthcare

Healthcare professionals must be well-trained and have competence and expertise in their chosen field. Even so, what sets the best healthcare systems apart from the rest are those whose staff show high levels of emotional intelligence. A critical feature of emotional intelligence is empathy.

Empathy encompasses the ability to understand and vicariously experience the feelings and thoughts of another. It requires much more than a cognitive understanding. Empathy is about an emotional, experiential and visceral understanding, as if you have “walked a mile in someone else’s shoes” and have shared their experiences. Empathy is also about behavior. Empathy is something that you can see in another’s action.

In this report, we show that traditional approaches to empathy training that rely on text or PowerPoint are ineffective because they target a cognitive, as opposed to an experiential, emotional and behavioral understanding of empathy. Although role-playing and simulation are better because they do target an experiential, emotional, and behavioral understanding of empathy, we show that this is not time-  or cost-effective, and is not scalable. Instead, we argue that interactive storytelling with VR provides an effective empathy building solution that is time- and cost-effective, and is scalable in ways that role-play and simulation are not.

To train empathy in a person, we must understand the psychology and neuroscience of learning so that we can effectively engage the parts of the brain that matter. The human brain is comprised of at least four distinct learning systems. 

The experiential learning system has evolved to represent the sensory aspects of an experience, whether visual, auditory, tactile or olfactory. Critical brain regions include the occipital, temporal, and parietal lobes. Every experience is unique, adds rich context to the learning and is immersive. Experience is at the heart of empathy training. The more one can vicariously experience the feelings, thoughts, and experiences of another, the more empathetic they will become.

The cognitive system is our information system. The critical brain region here is the prefrontal cortex. The cognitive system processes and stores knowledge and facts using working memory and attention. Critically, these are limited resources and form a bottleneck that slows learning with more information coming in than can be processed. A cognitive understanding of empathy is important, but not nearly as important as the experiential, emotional or behavioral components.

The behavioral system in the brain has evolved to learn motor skills. The critical structure is the striatum whose processing is optimized when behavior is interactive and is followed in real-time (literally within milliseconds) by corrective feedback. This system builds the “muscle memory” that drives empathetic behaviors. This system links rich experiential contexts (represented by the experiential learning system) and emotions with the appropriate behavioral responses. It is one thing to know the definition of empathy, to know that eye contact is important, and to know that you need to show understanding, but it is completely different (and mediated by different systems in the brain) to know how to show empathy with eye contact and behaviors that demonstrate true understanding.

More than anything, it is the emotional learning system in the brain that builds the interpersonal understanding, awareness, and sensitivity that are at the heart of empathy and an understanding of our and others’ behaviors. If one can “walk a mile in someone else’s shoes” and gain that vicarious understanding, awareness and sensitivity of another, they can build empathy. The critical brain regions are the amygdala and other limbic structures. Emotional learning, when combined with context rich experiences, builds rich repertoires of empathetic understanding and behavior.

Text and Powerpoint are ineffective methods for training empathy because they engage only cognitive systems. Role play and simulation are better because they are interactive, involve emotion-laden situations and behavior, but even here it is often difficult to suspend the reality of who you are and who your role-playing partner might be. In addition, people differ in their willingness and ability to role play. Finally, simulation and role play are time-consuming, costly, and not scalable.

Interactive storytelling with virtual reality, on the other hand, can address the shortcomings of traditional approaches to patient education and empathy building. With interactive storytelling in virtual reality you “learn through experience”. Experiential learning with VR is far superior to information learning with text because VR broadly engages multiple learning and memory systems in the brain in synchrony.

For example, as a nurse-in-training might don a VR headset and “walk a mile in the shoes of a patient”. They can obtain a first-person virtual experience of the stress and anxiety that a patient feels when someone is explaining a procedure to them and they don’t understand all of the jargon and terminology. They can experience what it is like to be a patient interacting and communicating with an empathetic nurse and with a nurse who shows little empathy. These “walk a mile in my shoes” experiences are visceral.

Analogously, a nurse-in-training might be transported into the middle of a busy emergency room and shadow a seasoned nurse explaining a patient’s condition to their distraught spouse. Using voice-over, the seasoned nurse might explain how they are showing empathy to soothe the concerns of the spouse. The nurse-in-training is in the situation and can feel the emotions. They can combine the information provided by the seasoned nurse with the behaviors they are observing, all within an emotion-laden, realistic experience. This engages multiple learning systems in synchrony and will build empathy quickly and effectively.

With emotion-laden, experiential empathy training via interactive storytelling with VR, a healthcare system can differentiate itself from the rest, but providing the top medical, but also emotional support for their patients. With VR training for healthcare professionals you can achieve this goal—one experience at a time.

The SOAP Note: how to gather the information and create a note. 

The SOAP note is an acronym for Subjective, Objective, Assessment and Plan.

The US is currently experiencing a shortage of nurses and this will only continue to grow with the aging population of the baby boomers.