University of Florida's virtual reality patient teaches bedside manners to medical students

Gainesville 02 March 2005"Tell me where it hurts" is the classic opening to many a doctor's examination, and University of Florida researchers have given it a digital twist. The scientists have created a virtual reality "patient" that can help medical students master the subtle art of the patient-doctor interview. "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 practise 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.


University of Florida doctoral student Kyle Johnson interviews virtual reality patient DIANA, supervised by University of Florida computer and information science professor Benjamin Lok and virtual reality "doctor" VIC on February 25, 2004. DIANA is holding her hands to her side to indicate where she feels pain. The student interacts with DIANA using speech and gestures, communicated via infrared LEDs contained in his hat and glove, and takes notes on a small TabletPC. VIC, for Virtual Interactive Character, appears in some interview scenarios as exam proctor and instructor, instructing students on how to interact with the system and giving them post-interview feedback on their performance. (AP Photo/University of Florida/Ray Carson).

"We want to focus on communication", stated Benjamin Lok, an assistant professor in University of Florida's computer and information science and engineering 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." A member of Benjamin Lok's team, University of Florida doctoral student Kyle Johnson, will present the group's research in mid-March at the Institute of Electrical and Electronics Engineers' Virtual Reality 2005 Conference, the largest virtual reality conference in the world.

For Benjamin Lok and his team, the question was whether naturally interacting with a simulated patient, with no keyboard or mouse in sight, would better help students to develop their interviewing skills. "We wondered, would people respond to virtual people?" Benjamin Lok explained. "Does it help to make the interaction between a virtual patient and the doctor as realistic as possible?"

During testing of the system, the scientists found that doctors treated DIANA differently than they would a regular computer programme. In fact, their behaviour was similar to how people interact with sitcom characters or movie celebrities, according to Benjamin Lok. "We believe there is something different about walking into a room, seeing the patient life-sized and interacting with her naturally", he stated. "We see somebody that looks like a person and we start attributing humanity to them. People are willing to buy into it."

For their interviews with DIANA, the students wear headsets to communicate with her, take notes on a digital notepad and wear gloves with built-in LED pointers so the system can track gestures. The conversations are highly structured, with the system trained to respond to keywords and phrases. However, that structure is necessary in a medical interview, as Benjamin Lok explained. "If you're a medical educator and you need to educate 100 students on how to do something, you're going to give them a very structured path to follow: ask a set of questions in this order, the location of the pain, and its duration", he stated.

Currently, medical students can practise 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, as Benjamin Lok noted. The system, which costs less than $10.000, would help students train for the standardized patient interviews, making those sessions more effective, as Benjamin Lok believes.

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.

Though those results are promising, DIANA isn't ready to replace live actors yet, as Benjamin Lok emphasised. 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 stated.

However, virtual reality patients eventually will allow students to try a nearly limitless variety of interview scenarios - different medical conditions as well as different ages, races and genders. And a virtual patient also can serve as a kind of quality control in medical education, as Benjamin Lok stated. "If you have 50 students, how do you guarantee that they all experience the same thing?" he asked. "And how do you know that somebody who graduated from the University of Florida experienced the same thing as somebody from Harvard Medical School? That's where we'd like to go, long term."

Integrating computer science with human communication is a challenge, noted Larry Hodges, professor and chairman of the department of computer science at the University of North Carolina at Charlotte. Benjamin Lok was a postdoctoral researcher in Professor Hodges' Virtual Environments Group before arriving at the University of Florida. "This is interdisciplinary research by its nature. You can't do this with just computer scientists or medical professionals. Bringing these things together is something that Ben does very well."

The project includes University of Florida doctoral students Johnson and Andrew Raij and University of Florida undergraduate Robert Dickerson, as well as Dr. D. Scott Lind of University of Florida's College of Medicine and Dr. Amy Stevens of the Malcom Randall Veterans Affairs Medical Center.

While computer-based programmes for medical students to practise their diagnostic ability exist, they lack a certain "human" element, Benjamin Lok stated. "There are systems where you talk to a computer, you watch graphics on the monitor, you click on different things", he noted. "We look at our system as going down a different road. We're trying to look at interaction itself."

Leslie Versweyveld

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