A mile in the patient’s shoes

By Helle Gjønnes Møller

Self-driving cars, genetically modified foods, wearable health devices. Technology is continually making our lives safer, more efficient, and more convenient. But can tech teach humans to be more humane? Can artificial intelligence help people be more person-centered?

In São Paulo, a team of dedicated academics believe so. They’re working on an ambitious initiative to help students at the University of São Paulo, Bauru Campus (FOB/USP) develop person-centered skills using virtual reality (VR). By creating a 3D experience and adding physical stimuli like touch, smell, and sound, the project — dubbed the ImPACT Lab — aims to mimic clinical scenarios, allowing students to virtually put themselves in the patient's or practitioner’s shoes.

The illusion of being another 

The ImPACT Lab is a transdisciplinary project that promotes immersive, deep, affective, and competency-based learning, supported by digital technologies. A key aspect of the project is based on embodied virtual reality (EVR), which combines immersive VR and multisensory elements to create the illusion of being in someone else’s body.

The virtual environment is developed in collaboration with Philippe Bertrand — a pioneer artist in virtual reality. Bertrand has done extensive work to explore the possibilities of using VR for learning empathy-related abilities — his technology is already widely used to explore issues like mutual respect, gender identity, physical limitations, and immigration. “Empathy enables us to learn from others’ pain and to know when to offer support,” says Bertrand in the article Learning Empathy Through Virtual Reality. “Similarly, virtual reality appears to allow individuals to step into someone else’s shoes, through a perceptual illusion called embodiment, or the body ownership illusion.”

The Proteus effect

In virtual environments, users are known to be influenced by their avatars — a reaction referred to as the Proteus effect. For instance, studies have shown that game avatars resembling members of the Ku Klux Klan generate a high level of aggression in the user. Conversely, the characteristics of an avatar nurse or a humanitarian worker could activate sentiments associated with these roles, e.g., empathy and compassion. And this is exactly the effect they are aiming to nurture at FOB/USP, as they prepare a new generation of healthcare professionals.

Deborah Ferrari and Dagma Abramides are Associate Professors at the Speech-Language Pathology and Audiology Department at FOB/USP and key drivers behind the ImPACT Lab. Ferrari says, “A lot of people don’t really understand what it means to be person-centered, but the ImPACT Lab can actually show them what a person-centered and empathetic interaction looks like. With this project, we will help our students develop a professional identity, communication skills, self-knowledge, empathy — and creativity and sensitivity to improve the patient-professional relationship.”

A changing landscape

The ImPACT Lab was sparked by a number of near-concurrent events. The pandemic had accelerated tech developments, pushing hearing care professionals to consider digital, remote telecare. This caused frustration and concern for many and raised the question of how to be person-centered in an online interaction.

Around the same time, a number of prominent reports were published, stressing and substantiating the importance of person-centered care (PCC): the WHO Rehabilitation Competency Framework, the WHO World Hearing Report, and ISO 21388 for hearing aid fitting management.

In parallel, the Ida Institute launched the Future Hearing Journeys report, exploring the future characteristics and dynamics of hearing care. In the report, PCC was estimated to be the decisive, differentiating factor for hearing care professionals in a tech-dominated future, where they’ll compete with new delivery models, like over-the-counter offerings.

Abramides says, “The scenarios presented in the Future Hearing Journeys report were aligned with discussions that were already occurring in our group — for example, the impact of megatrends and, more recently, the COVID-19 pandemic in the context of a health system that, in our country, is already weakened. The challenges are countless and require a paradigm shift — particularly concerning the performance of the health professional.”

To prepare for this changing landscape, the report identified a need for academia to rethink audiology programs. Educators should help students enhance their counseling expertise and see PCC as an avenue for new generations of hearing care professionals to create value for their patients.

No going back to the blackboard

The ImPACT Lab aims to address these points by embracing technology and applying the aspects of it that can help the students be more human-centric. “There’s no doubt that digital technology, virtual reality, and e-learning make more sense for this generation of students,” says Ferrari. “We don’t want to go back to the blackboard because that doesn’t appeal to them. We need to embrace technology and make it our friend. It’s not the technology per se that interests us; it’s how it can help us become more humane.

“As academic educators, it’s our job to prepare the future generation for what they’re going to face in their daily professional lives. We can’t just apply the same methods and rationale with students today because the context is completely different. There are many unknowns, but there’s one thing we do know: that the future practitioners will need to prioritize their human skills.”

From dentistry to medical

At FOB/USP, they are keen to integrate PCC across disciplines. As Ferrari puts it, “people are people.” Beyond audiology and speech-language pathology, the ImPACT Lab involves colleagues from the dentistry and medical faculties as well, including professors Mariana Zangrando and Linda Wang from the Departments of Periodontics and Dentistics respectively. Zangrando explains, “Dentistry is one of the health areas that, unfortunately, still has a technicist character. This scenario has been slowly changing thanks to the efforts of groups with a deeper knowledge in the development of skills and competencies. In the discipline of periodontics, the importance of evaluating the patient as a whole becomes even more evident for the achievement of positive outcomes. If, during the periodontal treatment, we don’t achieve the so-called ‘adherence’, i.e., the patient's cooperation in relation to the therapy employed, we certainly will not achieve success.”

Wang agrees, “A person's oral health condition is an important indicator of his/her health habits. In recent years, this premise has pushed for a more comprehensive approach, which considers the relevance of treating the person and allowing them to become conscious and active about their own health, going beyond the disease. In this scenario, when approaching a patient in need of dental treatment, the principles of person-centered care have enabled greater patient compliance by including them in the process. To achieve such a goal, appropriate communication skills are very relevant. Thus, dental professionals must achieve levels of technical professional excellence without this prevailing over the center of care, which is the human being.”

The student at the center

As much as the ImPACT Lab leans on technology, its real strength comes through inclusion of the students and patients in its development. By including their perspectives throughout the development and testing phases, the project team aims to ensure relevancy and usability for all parties. Abramides explains, “An important point of the project is the UX design — the creation of products that provide meaningful and relevant experiences to users. To achieve this, the student is more actively involved, from the conceptualization to the analysis of the solutions, addressed through workshops, focus groups, and consensus meetings with teachers and patients.”

Ferrari adds, “We need to be student- and patient-centered to be person-centered. By co-creating innovative educational resources, we enable new forms of interaction between students, teachers, and patients in the construction of knowledge.”

The ImPACT Lab is currently in the scoping phase with the first prototype expected to launch in late 2022.