Virtual reality helps students with informed consent
Students learned informed consent facts faster
Students who did practice sessions with a virtual reality "human subject" learned better informed consent skills than did those who only studied consent rules from written material, according to a recent study.
The results of the study, published in the Journal of Biomedical Informatics, hold promise for using virtual reality (VR) applications to help research staff learn to work better with participants, and even practice informed consent for specific studies.
The study was an outgrowth of virtual reality work previously done by Robert C. Hubal, PhD, a senior research engineer at RTI International, a nonprofit research institution in Research Triangle Park, NC.
Hubal says he had students interact with simulated characters to train them in interpersonal skills such as interviewing and negotiation. Wendy Visscher, PhD, director of RTI International's Office of Research Protection, notes that a previous project of Hubal's involved training interviewers to conduct household surveys.
"The first thing interviewers have to do is to see if they can get people to even talk to them," Visscher says. "There was a virtual reality simulation in which interviewers could practice going up to a door and interacting with the character at the door to talk to them about their concerns right up front, which is sort of the beginning of informed consent."
Developing 'subject's' questions
Visscher obtained a Human Subjects Research Enhancement Award from the National Institutes of Health, and asked Hubal to employ the same technology to train and assess informed consent skills.
The program developed by Hubal runs on a regular personal computer and creates a virtual environment on the screen as the setting for an informed consent discussion — a suburban kitchen, with a 30-something woman seated at a table.
"I come from the technology side, and so what I do is work with the experts to say, 'What would happen in this scenario?'" Hubal says. "What kind of questions would be asked? How would you respond appropriately to these questions? How would the person respond in response to that, and etc."
He set up a series of questions the subject would ask about a generic study: Do I have to participate? Will my answers be kept private? Will I get anything from the study?
The user answers, speaking into a microphone, and the subject asks another question. If a user gives an incorrect or incomplete answer, the virtual reality character replies "Please repeat that," or "I am not convinced." She might repeat a question.
"The questions come up in random order, which is very lifelike," Visscher says. "People aren't going to ask the questions in the same order every time."
Each interview would end with the character either agreeing to participate or declining.
Hubal tested the application on a group of Duke University undergraduates who were fulfilling a psychology research requirement. He says they were not experts in human subjects research.
The entire group was given training materials about informed consent, which they had eight minutes to review. Then, half the group went on to a virtual reality training program, while the others continued to study the written materials.
Those in the VR group were seated in front of a computer featuring the VR character and told to attempt to answer as many of her questions correctly as possible and "convince" her to participate. During the student's session he or she could run through the interview several times, with the order of the questions changing each time. VR participants averaged 6-7 interviews with the VR character during their 12-minute training phase.
Afterward, all of the students conducted another mock interview, this time with a real person. This interviewee asked all of the questions again, order to test how well students had learned the material.
In the end, those who had used the VR application did better in that final interview, answering questions more quickly and more accurately than the control group.
Enhancing lecture-style training
While the VR informed consent so far has not been used outside of this study, Visscher says that it could have real use in interviewer training.
"Generally, when you do an interviewer training session, you go over human subjects issues and, in particular, informed consent, but it's generally in a lecture setting," she says. "You go over the consent form, and then they will generally have some role-playing with each other."
But she notes that the role-playing encompasses the entire process, from gaining permission through the mechanics of the interview, rather than focusing on the informed consent portion.
"So there are a lot of things that they're practicing, and they don't generally have enough time to ask the sort of questions that this simulated character might ask about informed consent," Visscher says. "I think it's true that they don't get enough practice actually answering [informed consent] questions, and this helps them do that."
Hubal says that adapting the program to include more specific questions about a study is fairly easy, requiring only that the actress who recorded the initial dialogue be brought in to record more material.
Visscher says that other training programs that have included video have proven more expensive and difficult to amend later.
Hubal says that while he sees this program as being useful for helping students practice their skills, he doesn't anticipate that it would entirely replace a face-to-face interview with another human being to ensure that the student knows how to administer informed consent effectively.
"What we say is that there are stages of training, and along that continuum, you would use different sets of technologies," he says. "This virtual environment is particularly useful for acquiring and practicing these kind of skills. But I'm not sure we would ever suggest that for validation, before we sent somebody out in the field, we would want to use just a virtual environment."
Hubal says there currently are no plans to produce this program for sale as a training product. But he would like to take it further, if more grant money were available.
"We have some ideas of other populations and other areas where this type of technology might be really useful," he says. "There are some ideas in the works that we'll be pursuing."
Visscher agrees that the approach has real promise. "I think it's a neat application."
Source
Hubal RC, Day SD. Informed consent procedures: An experimental test using a virtual character in a dialog systems training application. Journal of Biomedical Informatics. 2006;39:532-540.
Students who did practice sessions with a virtual reality "human subject" learned better informed consent skills than did those who only studied consent rules from written material, according to a recent study.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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