Marilyn Gugliucci, a researcher from the University of New England in Maine, is placing young medical students in the shoes of older adult patients because she wants to provide them with experiential learning in empathy. 

Gugliucci believes empathy is a skill many health care professionals lack in their practice, especially regarding older adult patients with age-related diseases. 

Medical students, and students in other healthcare fields, are put into the shoes of older patients through virtual reality labs run by Gugliucci and her team.

I spoke with Gugliucci about the research project to gain a deeper understanding of how it began, its outcome, and the likelihood of introducing virtual reality technology to all medical school curriculums.

Marilyn Gugliucci is professor and director of geriatrics research at the University of New England and College of Osteopathic Medicine. As an expert in the field of aging, Gugliucci is teaching medical and health care profession students how to empathize with older adults through experiential learning. PHOTO: Supplied by Marilyn Gugliucci

Julie Patton: How did your research project, Using virtual reality in medical education to teach empathy, begin?

Marilyn Gugliucci: To give context for you, in 2005 I started a project called the Learning by Living Nursing Home Immersion Project. Medical students were admitted into nursing homes for two weeks to live the life of an elderly resident. They received standard procedures of care and as soon as they walked through the door they were put in a wheelchair. They were being bathed, eating pureed food, the whole 9 yards.

We are the only medical school in the world that did this project and we had to stop due to COVID-19. I also couldn’t get a whole lot of students into it because it was two weeks in a nursing home, and it cost over US$600 a day to have a student stay there for that length of time. But the learning was amazing.

The next project I started was the 48 Hour Hospice Home Immersion Project in 2014. Two students are paired together, and they go into what’s called the ICU of Hospice. They go in as providers of care working with a professional team. They share a room, live there for 48 hours, and they provide patient care, family support, and postmortem care. They’re going to get between five and 10 deaths in 48 hours on average, so this is a remarkable hands-on learning experience for medical students.

Now onto what grabbed me about virtual reality. You know with the nursing home immersion, I might be able to get two or three students in, within a year, and in that same amount of time I can get up to 36 students with the hospice home immersion. But, virtual reality provides these opportunities to all of our health profession students, including nursing, physical therapy, and occupational therapy. Everybody is able to do virtual reality and that makes all the difference.

We did pre-test and post-test research where we devised questions while working with Embodied Labs. They posted those questions in the virtual reality labs for us, and when students got on to do them, they answered the questions that applied, and then at the end of the experience, they visited those questions and answered again. The outcome from pre to post was remarkable.

Learning from the virtual reality session definitely changed their attitudes and views, the significance was off the chart. These virtual reality experiences were something that we could get out to a lot more students, and although they didn’t have the hands-on experience, they had a virtual experience at least. 

Embodied Labs is the creator of the University of New England’s VR lab. Their labs place students in the shoes of older adults, teaching them valuable lessons in empathy through first hand experience. PHOTO: Supplied by Marilyn Gugliucci Credit: Marilyn Gugliucci

What made virtual reality the best option to promote empathy in medical students and health care professionals?

I could get more students.

The bottom line for health professions is education. Adding that experiential component to their learning, and you can’t do that all the time, but to actually be in that environment and embody that person that has an issue, that augments learning beyond anything you can ever teach in a classroom. There’s even a lab on different people of the LGBTQ2+ community.

What previous research about the relationship between medical professionals and older patients prompted this program and your previous programs?

In the field of aging, we are now at a point where we are trying to reframe the concept of aging. If I asked you how eager you are to turn 70, 80, 90, or 100, as compared to how anxious you are, would you be eager or anxious?

In many of the classes I teach, I put that question out to the students. They typically say they’re anxious because aging gets such a bad rep in our society.

The first theory of functional and successful aging is called the disengagement theory. This theory from 1961 states that it is mutually beneficial for the elderly to disengage from society and vice versa. It’s gradual and inevitable, and death is the ultimate disengagement. Essentially the theory is saying that you should die in order to be aging functionally.

That theory was debunked many years ago, but it is still found in textbooks today. There’s so many negative attitudes about aging and if older adults are believing it then they’re not living life to its fullest extent because of their fear or anxiety. So many people have issues, but they can still have incredibly functional and successful lives.

Virtual reality at least augments empathy because the student then understands what it’s like to have macular degeneration, hallucinations, or whatever the lab is. I’m not sure if it changes attitudes around aging, but I think it does augment empathy, and we have been able to prove that in our pretests and posttests.

What is the most surprising result you’ve found through this program?

I couldn’t believe that we were going to have the significance that we had across the board for each of the labs that we tested. 

Thinking of one anecdotal comment, one of the students who came to me had previously worked in an optometry office. She was testing the eyesight of people coming in and she kept blowing up the sight test for a patient in the chair. Later she found out that the patient had macular degeneration. The student couldn’t understand why the person couldn’t see. Why couldn’t they read these letters or see which way they’re going?

The student then did the lab focusing on macular degeneration and hearing loss. She was blown away by finally understanding what that person was going through while she was testing their eyesight. 

There’ve been thousands of those kinds of comments from students over the years since we’ve had virtual reality. That’s huge learning, right? We can explain how it works and what to do with it, but until you actually experience it, you really have no idea.

What is the probability of this type of experiential empathy training becoming mandatory in all schools for health care professions?

Because Embodied Labs was a venture capitalist startup company, everybody wanted their money back at the end, so the price went up. It made it unattainable for us, so we had to negotiate with the company to get to a price that we could afford to do the 2D at the least. It’s just a computer version of the lab that anybody could access from their own laptops.

I think virtual reality, virtual learning, and virtual simulation for people doing surgeries and the like, it’s an amazing learning environment. The key is accessibility and cost.

Do you have any plans to follow up on the students who took part in the VR lab to see if higher empathy levels are maintained throughout their careers?

A weakness of our research is that we only did pre-test and post-test. Even in our articles that we wrote, we said we did not do the longitudinal research to test how it carries over in the field. Personally, I’ve checked in with our medical students during third and fourth year, but not in a research capacity.

I’ve asked ‘Have you thought about this? Has this had any impact on you? Is there anything from this lab that came back for you while you were in your clerkship years?’ Anecdotally, students have remembered the experience and said it was powerful for them, but there’s no publishable data.

With 2D, I don’t know if it’s going to be as powerful. I think it was more enduring for students that used the virtual reality headset, and were actually maneuvering through it. We did some research and found that there was an increase in empathy, but in terms of watching it in 2D, I don’t think it’s going to be as lasting.

Editor’s note: This interview has been edited for length and clarity. If you have tips or insights about VR use in the medical field, contact Julie Patton, who is researching a larger project on the subject.

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Julie Patton is a fourth year journalism student at MRU and newsletter editor at the Calgary Journal. She is also the news editor at The Reflector.