# Training communication skills in a multiuser medical virtual reality simulation: a qualitative, observational study

## TL;DR

This study explores how virtual reality affects communication skills training for medical students, finding that VR impacts focus and flow during simulations.

## Contribution

The study provides insights into how VR influences communication behaviors and offers design recommendations for VR-based medical training.

## Key findings

- Students favored process communication skills like asking questions and thinking aloud in VR simulations.
- VR negatively affected attention focus and the flow of communication skills training.
- VR altered conversational turn-taking and increased cognitive load, potentially hindering communication goals.

## Abstract

Simulation-based education is a well-established training technique in medical curricula, also for communication skills. Virtual reality (VR) technology can enhance this form of experience-based learning. How VR interacts with training communication skills for interpersonal and interprofessional medical encounters is, however, unclear. This study investigates how VR influences communication skills and behaviors in patient-student and team encounters in medical undergraduate simulations, in order to make recommendations for VR simulation-based communication skills training (CST).

We conducted a study with 22 third-year medical students completing a dyadic VR simulation (Smart Collaboration Tutor software). We coded communication skills and behaviors for team and patient-student communication in videorecorded VR simulations. We then analyzed communication patterns and finally developed themes for VR-mediated CST.

Our findings revealed that students preferred the core communication skill of asking questions, informing, and thinking aloud as process communication skills in a VR simulation. Nonverbal and paraverbal behaviors were used with unclear intent. VR negatively impacted the focus of attention and flow of simulation-based communication skills training.

Dyadic VR simulations tend to emphasize team and task-oriented communication. Its value for patient-student and relation-oriented communication is unclear. VR influenced conversational turn-taking by altering visual and auditory perceptions. Cognitive load was enhanced, potentially diverting attention from communication goals and observational focus.

Multiuser VR simulation shows certain possibilities for CST in medical undergraduate simulations. Recommendations on the contextual design of VR simulations, however, need to be taken into account to safeguard the focus of attention and flow of CST.

The online version contains supplementary material available at 10.1186/s41077-025-00386-8.