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Journal of Medical Internet Research






e15459 (11 pg.)


Background: Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)–based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial.

Objective: This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication.

Methods: We employed a mixed methods intervention design, involving a comparison of 2 quantitative measures—MPathic-VR–calculated scores and the objective structured clinical exam (OSCE) scores—with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis.

Results: OSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; F1,414=6.09; P=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers.

Conclusions: VHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills.


©Timothy C Guetterman, Rae Sakakibara, Srikar Baireddy, Frederick W Kron, Mark W Scerbo, James F Cleary, Michael D Fetters. Originally published in the Journal of Medical Internet Research (, 25.11.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

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Original Publication Citation

Guetterman, T. C., Sakakibara, R., Baireddy, S., Kron, F. W., Scerbo, M. W., Cleary, J. F., & Fetters, M. D. (2019). Medical students' experiences and outcomes using a virtual human simulation to improve communication skills: Mixed methods study. Journal of Medical Internet Research, 21(11), e15459. doi:10.2196/15459