Evaluation of a Virtual Counseling Application for Communication Skills Training in Nursing Education

Study Overview
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Brief Summary
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The Alice Lee Centre for Nursing Studies under the National University of Singapore offers a three-years (four years for honors students), full-time Bachelor of Science (Nursing) program that is accredited by the Singapore Nursing Board. The course covers core modules such as, anatomy, physiology and physical assessment, pathophysiology, pharmacology and nursing practice, communication and cultural diversity, and includes clinical practicums at tertiary hospitals that range from two weeks to three months. This project will be carried out with nursing undergraduates of National University of Singapore who had completed the core module NUR1110 (Effective Communication for Health Professionals) in their year 1 of nursing courses. The 2-year study will follow these students in year 2 and year 3 consecutively by introducing Virtual Patients (VP) depicting real-life case scenarios at gradual difficulty levels before their end-of-semester clinical posting. Four VP case scenarios were developed for each semester on the following topics: 1) interview a pregnant woman with pain to solicit holistic history taking (year 2 semester 1); 2) history taking from a depressed patient (year 2 semester 2); 3) use of a standardized approach such as Situation, Background, Assessment, and Recommendation (SBAR) to hand off interdisciplinary communications (year 3 semester 1); and 4) showing empathy to the fellow nursing student (year 3 semester 2). Overall, the aim of this project is to develop and evaluate the use of VPs in better preparing nursing undergraduates in communicating with real-life patients, family members, and other healthcare professionals during their clinical posting. The specific research questions the investigators plan to answer in this project are as follows: What is the effect of using VPs in enhancing nursing undergraduates' self-efficacy and attitude toward learning communication skills? Do the students receiving additional training using VPs perform better in their communication skills during the clinical posting compared with students receiving standard training? What are the levels of outcomes of students' self-efficacy and attitude toward learning communication skills at pretest (semester 1, year 2 before receiving the VP training), posttest 1 (last day of clinical posting year 2 semester 1), posttest 2 (last day of clinical posting year 2 semester 2), posttest 3 (last day of clinical posting year 3 semester 1), and posttest 4 (last day of clinical posting year 3 semester 2)? What are the changes in self-efficacy and attitude toward communication skills scores over time (pretest, posttests 1-4)? What are the students' experiences in receiving additional training using VPs before their clinical posting? The aim of this paper is therefore to provide a detailed breakdown on the development process of the Virtual Counseling Application using Artificial Intelligence (VCAAI) for communication skills training in nursing education and to highlight challenges faced and recommended resolutions to inform future research.

Official Title
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Evaluation of a Virtual Counseling Application for Communication Skills Training in Nursing Education

Conditions
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Communication

Intervention / Treatment
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* Other: Virtual Counselling Application using Artificial Intelligence


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Year two nursing undergraduates Enrolled for Bachelor of Science (Nursing) course for Academic years 2017/2018 at Alice Lee Center for Nursing Studies, NUS. Completed the core module Effective Communication for Health Professionals in Year 1 Able to read and speak English fluently Exclusion Criteria: Medical or mental illness that may hinder the use of Virtual Patients

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: virtual patients group<br>Only nursing undergraduates from AY2017/2018 cohort, who have completed the redesigned NUR1110 (Effective Communication for Health-Professionals) core module will receive additional training using Virtual Patients in each semester (2 semesters per year) of year 2 and year 3 before they go for the clinical posting. Students will have unlimited access to the Virtual Patients (available scenarios depend on which semester the student is in) by logging in through the school portal. | Other: Virtual Counselling Application using Artificial Intelligence<br>* Intervention comprises of four Virtual Patients scenarios that aimed to improve nursing undergraduates communication skills in a clinical setting. These scenarios are based on authentic clinical cases (adapted from the real-life clinical case studies) focusing mainly on the communication aspects. Scenarios included 1) a middle-aged pregnant woman in her third trimester experiencing pain, 2) a middle-aged lorry driver who self-admitted to the hospital due to relapse of depressive symptoms, 3) changing a bloody dressing of a middle-aged male patient who had an operation 3 days ago, and 4) communicating with a fellow stressed student during their final preregistration clinical posting period.<br>|
| No Intervention: Blended learning group<br>Nursing undergraduates from AY2016/2017 cohort who who have completed the redesigned NUR1110 (Effective Communication for Health-Professionals) core module that comprised of weekly online e-lectures and face-to-face tutorials. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean score of students' attitude towards learning communication skills | Measured using a self-report, 26-items Communication Skills Attitude Scale (CSAS) that uses a 5-point Likert scale (1=strongly disagree, 5=strongly agree), and has a total score of 130. A higher score indicate more positive attitude towards learning communication skills. Within cohort comparison. | at 4 months | 
| Mean score of students' attitude towards learning communication skills | Measured using a self-report, 26-items Communication Skills Attitude Scale (CSAS) that uses a 5-point Likert scale (1=strongly disagree, 5=strongly agree), and has a total score of 130. A higher score indicate more positive attitude towards learning communication skills. Within cohort comparison. | at 12 months | 
| Mean score of students' attitude towards learning communication skills | Measured using a self-report, 26-items Communication Skills Attitude Scale (CSAS) that uses a 5-point Likert scale (1=strongly disagree, 5=strongly agree), and has a total score of 130. A higher score indicate more positive attitude towards learning communication skills. Within cohort comparison. | at 16 months | 
| Mean score of students' attitude towards learning communication skills | Measured using a self-report, 26-items Communication Skills Attitude Scale (CSAS) that uses a 5-point Likert scale (1=strongly disagree, 5=strongly agree), and has a total score of 130. A higher score indicate more positive attitude towards learning communication skills. Within cohort comparison. | at 24 months | 
| Mean score of students' perceived self-efficacy | Communication skills sub-scale of the Nursing students self-efficacy scale. 8-items using a 5-point likert scale (0=not at all confident, 5= completely confident) with a total score of 40. A higher score indicates a higher perceived communication self-efficacy. Within cohort comparison. | at 4 months | 
| Mean score of students' perceived self-efficacy | Communication skills sub-scale of the Nursing students self-efficacy scale. 8-items using a 5-point likert scale (0=not at all confident, 5= completely confident) with a total score of 40. A higher score indicates a higher perceived communication self-efficacy. Within cohort comparison. | at 12 months | 
| Mean score of students' perceived self-efficacy | Communication skills sub-scale of the Nursing students self-efficacy scale. 8-items using a 5-point likert scale (0=not at all confident, 5= completely confident) with a total score of 40. A higher score indicates a higher perceived communication self-efficacy. Within cohort comparison. | at 16 months | 
| Mean score of students' perceived self-efficacy | Communication skills sub-scale of the Nursing students self-efficacy scale. 8-items using a 5-point likert scale (0=not at all confident, 5= completely confident) with a total score of 40. A higher score indicates a higher perceived communication self-efficacy. Within cohort comparison. | at 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| clinical communication skills mean scores | Clinical assessment scores by clinical instructors obtained through the online clinical management system. Performance scores will be compared with the previous cohort that did not have virtual patient training. The Entrustable Professional Activities (EPA) assessment scale comprises of 7-items, each with a score of 1 to 5, and a total score of 35. The higher the score the better the communication performance. | 4 months (after completion of Year 2 semester 1 clinical posting) | 
| clinical communication skills mean scores | Clinical assessment scores by clinical instructors obtained through the online clinical management system. Performance scores will be compared with the previous cohort that did not have virtual patient training. The Entrustable Professional Activities (EPA) assessment scale comprises of 7-items, each with a score of 1 to 5, and a total score of 35. The higher the score the better the communication performance. | 12 months (after completion of Year 2 semester 2 clinical posting) | 
| clinical communication skills scores | Clinical assessment scores by clinical instructors obtained through the online clinical management system. Performance scores will be compared with the previous cohort that did not have virtual patient training. The Entrustable Professional Activities (EPA) assessment scale comprises of 7-items, each with a score of 1 to 5, and a total score of 35. The higher the score the better the communication performance. | 16 months (after completion of Year 3 semester 1 clinical posting) | 
| clinical communication skills scores | Clinical assessment scores by clinical instructors obtained through the online clinical management system. Performance scores will be compared with the previous cohort that did not have virtual patient training. The Entrustable Professional Activities (EPA) assessment scale comprises of 7-items, each with a score of 1 to 5, and a total score of 35. The higher the score the better the communication performance. | 24 months (after completion of Year 3 semester 2 clinical posting) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Virtual reality, Learning, Technology, Patients