Simulation of a virtual patient with cranial nerve injury augments physician-learner concern for patient safety

We have created the Neurological Exam Rehearsal Virtual Environment (NERVE), a virtual patient based simulation targeted to train medical students in the diagnosis of abnormal findings in the neurological examination. In NERVE, a learner communicates with and performs a physical examination of a life-sized virtual character experiencing double vision as a result of a cranial nerve palsy. NERVE affords verbal communication through natural speech and gestures, and affords physical interaction through manipulation of virtual tools such as an ophthalmoscope. Creation of NERVE is motivated by the limited quantity and depth of current medical education and simulation approaches to providing learners with exposure to abnormal physical findings in the context of a doctor-patient interaction. NERVE not only provides an immersive and on-demand learning opportunity, but provides students with the opportunity to experience the patient’s double vision in the first person in a “Patient Vision Feedback” (PVF) session. PVF allows the learner to experience how the world looks to the virtual patient, providing an opportunity for enhanced perspective taking and empathy. Thirty-two medical students have examined a virtual patient in NERVE. Twenty-nine of these students were able to correctly diagnose the virtual patient’s cranial nerve palsy, demonstrating content validity of NERVE. A subset of eight medical students experienced Patient Vision and, as a result, demonstrated improved concern for the patient’s wellbeing. NERVE is able to augment a neurology curriculum by providing increased exposure to abnormal findings and providing students with a unique insight into how the disease affects the patient’s wellbeing.