• Adeline M Deladisma, Marc Cohen, Amy Stevens, Peggy Wagner, Benjamin Lok, Thomas Bernard, Christopher Oxendine, Lori Schumacher, Kyle Johnsen, Robert Dickerson, Andrew Raij, Rebecca Wells, Margaret Duerson, J Garrett Harper, D Scott Lind, and Association for Surgical Education.
• Department of Surgery, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA.
• Am. J. Surg. 2007 Jun 1;193(6):756-60.

BackgroundSignificant information exchange occurs between a doctor and patient through nonverbal communication such as gestures, body position, and eye gaze. In addition, empathy is an important trust-building element in a physician: patient relationship. Previous work validates the use of virtual patients (VP) to teach and assess content items related to history-taking and basic communication skills. The purpose of this study was to determine whether more complex communication skills, such as nonverbal behaviors and empathy, were similar when students interacted with a VP or standardized patient (SP).MethodsMedical students (n = 84) at the University of Florida (UF) and the Medical College of Georgia (MCG) underwent a videotaped interview with either a SP or a highly interactive VP with abdominal pain. In the scenario, a life-sized VP was projected on the wall of an exam room in SP teaching and testing centers at both institutions. VP and SP scripted responses to student questions were identical. To prompt an empathetic response (ie, acknowledging the patients' feelings), during the interview the VP or SP stated "I am scared; can you help me?" Clinicians (n = 4) rated student videotapes with respect to nonverbal communication skills and empathetic behaviors using a Likert-type scale with anchored descriptors.ResultsClinicians rated students interacting with SPs higher with respect to the nonverbal communication skills such as head nod (2.78 +/- .79 vs 1.94 +/- .44, P < .05), and body lean (2.97 +/- .94 vs 1.93 +/- .58, P < .05), level of immersion in the scenario (3.31 +/- .49 vs 2.26 +/- .52, P < .05), anxiety (1.16 +/- .31 vs 1.45 +/- .33, P < .05), attitude toward the patient (3.24 +/- .43 vs 2.89 +/- .36, P < .05), and asking clearer questions (3.06 +/- .32 vs 2.51 +/- .32, P < .05) compared to the VP group. The students in the SP group also had a higher empathy rating (2.75 +/- .86 vs 2.16 +/- .83, P < .05) and better overall rating (4.29 +/- 1.32 vs 3.24 +/- 1.06, P < .05) than the VP group. Empathy was positively correlated with the observed nonverbal communication behaviors. Eye contact was the most strongly correlated with empathy (r = .57, P < .001), followed by head nod (r = .55, P < .001) and body lean (r = .49, P < .001).ConclusionsMedical students demonstrate nonverbal communication behaviors and respond empathetically to a VP, although the quantity and quality of these behaviors were less than those exhibited in a similar SP scenario. Student empathy in response to the VP was less genuine and not as sincere as compared to the SP scenario. While we will never duplicate a real physician/patient interaction, virtual clinical scenarios could augment existing SP programs by providing a controllable, secure, and safe learning environment with the opportunity for repetitive practice.

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