Simulated communication skills training program effects using augmented reality with real-time feedback: A randomized control study

Background: While communication with dementia patients is challenging, known educational methods to improve communication skill for medical professionals are lacking. Our study aimed to assess the efficacy of simulated communication skills training for nursing students using augmented reality (AR) with real-time feedback. Methods: This is a randomized control study. Twenty-five nursing students enrolled and learned standardized multimodal comprehensive care communication skills through a self-learning material, which includes pathophysiology and clinical manifestations of dementia. Subsequently, participants were randomly assigned to one of the two learning systems—AR training or conventional nursing mannequin training. Each group had the training intervention to change the clothes of mannequins for one hour. The mannequin of the AR group was a superimposed computer graphic of an elderly woman’s face which reacted to participants' communication. Further, the communication skills of gaze and voice were evaluated by artificial intelligence (AI) and feedbacked to the participants’ head-mounted display in real-time. The conventional training group had the self-training with nursing mannequins. All participants performed basic nursing care, including changing clothes and bed bath, to simulated patients before and after the training intervention, which were video-recorded by an eye-tracking camera and a fixed camera, then the videos were analyzed the communication skills by AI. Additionally, participants' empathy to patients was evaluated by the Jefferson Scale of Empathy-Health Professions Students Version (JSPE-HSP). The primary outcome was the proportion of time spent in eye contact during the care to simulated patients. The secondary outcome was the empathy score of JSPE-HSP. Results: After the training intervention, the proportion of time spent in eye contact in the AR training group significantly increased than the conventional training group (eye contact 13.6% versus 4.4%, P<0.05). Moreover, the JSPE-HSP score increased from pre-training to post-training in the AR training group, whereas it decreased in the conventional training group [Mean (SD): 9.1 (6.6) versus -1.3 (3.8), P<0.01]. Conclusions: The simulated communication skills training for nursing students using augmented reality with real-time feedback was associated with increased interactive communication skills to simulated patients and the empathy to patients.