Social presence, or the feeling of being there with a “real” person, is a crucial component of interactions that take place in virtual reality. This paper reviews the concept, antecedents, and implications of social presence, with a focus on the literature regarding the predictors of social presence. The article begins by exploring the concept of social presence, distinguishing it from two other dimensions of presence—telepresence and self-presence. After establishing the definition of social presence, the article offers a systematic review of 222 separate findings identified from 150 studies that investigate the factors (i.e., immersive qualities, contextual differences, and individual psychological traits) that predict social presence. Finally, the paper discusses the implications of heightened social presence and when it does and does not enhance one’s experience in a virtual environment.

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A Systematic Review of Social Presence: Definition, Antecedents, and Implications.

Background: Blended learning, which combines face-to-face learning and e-learning, has grown rapidly to be commonly used in education. Nevertheless, the effectiveness of this learning approach has not been completely quantitatively synthesized and evaluated using knowledge outcomes in health education.
Objective: The aim of this study was to assess the effectiveness of blended learning compared to that of traditional learning in health education.
Methods: We performed a systematic review of blended learning in health education in MEDLINE from January 1990 to July 2019. We independently selected studies, extracted data, assessed risk of bias, and compared overall blended learning versus traditional learning, offline blended learning versus traditional learning, online blended learning versus traditional learning, digital blended learning versus traditional learning, computer-aided instruction blended learning versus traditional learning, and virtual patient blended learning versus traditional learning. All pooled analyses were based on random-effect models, and the I2 statistic was used to quantify heterogeneity across studies.
Results: A total of 56 studies (N=9943 participants) assessing several types of learning support in blended learning met our inclusion criteria; 3 studies investigated offline support, 7 studies investigated digital support, 34 studies investigated online support, 8 studies investigated computer-assisted instruction support, and 5 studies used virtual patient support for blended learning. The pooled analysis comparing all blended learning to traditional learning showed significantly better knowledge outcomes for blended learning (standardized mean difference 1.07, 95% CI 0.85 to 1.28, I2=94.3%). Similar results were observed for online (standardized mean difference 0.73, 95% CI 0.60 to 0.86, I2=94.9%), computer-assisted instruction (standardized mean difference 1.13, 95% CI 0.47 to 1.79, I2=78.0%), and virtual patient (standardized mean difference 0.62, 95% CI 0.18 to 1.06, I2=78.4%) learning support, but results for offline learning support (standardized mean difference 0.08, 95% CI –0.63 to 0.79, I2=87.9%) and digital learning support (standardized mean difference 0.04, 95% CI –0.45 to 0.52, I2=93.4%) were not significant.
Conclusions: From this review, blended learning demonstrated consistently better effects on knowledge outcomes when compared with traditional learning in health education. Further studies are needed to confirm these results and to explore the utility of different design variants of blended learning.

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Blended Learning Compared to Traditional Learning in Medical Education: Systematic Review and Meta-Analysis.

This article surveys the area of computational empathy, analysing different ways by which artificial agents can simulate and trigger empathy in their interactions with humans. Empathic agents can be seen as agents that have the capacity to place themselves into the position of a user’s or another agent’s emotional situation and respond appropriately. We also survey artificial agents that, by their design and behaviour, can lead users to respond emotionally as if they were experiencing the agent’s situation. In the course of this survey, we present the research conducted to date on empathic agents in light of the principles and mechanisms of empathy found in humans. We end by discussing some of the main challenges that this exciting area will be facing in the future.

Empathy in Virtual Agents and Robots: A Survey

Background: Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of ...

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Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background Empathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective. Methods We searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. Study inclusion criteria were: (1) intervention arm in which subjects underwent an educational curriculum aimed at enhancing empathy and/or compassion; (2) clearly defined control arm in which subjects did not receive the curriculum; (3) curriculum was tested on physicians (or physicians-in-training); and (4) outcome measure assessing the effect of the curriculum on physician empathy and/or compassion. We performed a qualitative analysis to collate and tabulate effects of tested curricula according to recommended methodology from the Cochrane Handbook. We used the Cochrane Collaboration’s tool for assessing risk of bias. Results Fifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients’ non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion. Conclusion Evidence suggests that training can enhance physician empathy and compassion. Training curricula should incorporate the specific behaviors identified in this report.

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Curricula for empathy and compassion training in medical education: A systematic review

This research explores the extent to which humans behave realistically during conflict with a virtual human occupying a position of authority. To this end, we created a virtual team to train nurses how to manage conflict in the operating room; the team’s virtual surgeon engages in reckless behavior that could endanger the safety of the team’s patient, requiring nurses to intervene and correct the virtual surgeon’s behavior. Results from post-hoc behavioral analysis and semi-structured interviews indicate that participants behaved realistically during conflict, as compared against existing behavioral frameworks. However, some participants reported perceiving their virtual teammates as strangers, which they felt may have caused them to behave differently than they would with their normal teammates.

A Qualitative Evaluation of Behavior during Conflict with an Authoritative Virtual Human

In a group setting, it is possible for attributes of one group member to indirectly affect how other group members are perceived. In this paper, we explore whether one group member's agency (e.g. if they are real or virtual) can indirectly affect behavior with other group members. We also consider whether variations in the agency of a group member directly affects behavior with that group member. To do so, we examined gaze behavior during a team training exercise, in which sixty-nine nurses worked with a surgeon and an anesthesiologist to prepare a simulated patient for surgery. The agency of the surgeon and the anesthesiologist were varied between conditions. Nurses' gaze behavior was coded using videos of their interactions. Agency was observed to directly affect behavior, such that participants spent more time gazing at virtual teammates than human teammates. However, participants continued to obey polite gaze norms with virtual teammates. In contrast, agency was not observed to indirectly affect gaze behavior. The presence of a second human did not affect participants' gaze behavior with virtual teammates.

Do Variations in Agency Indirectly Affect Behavior with Others? An Analysis of Gaze Behavior

Introduction The virtual patient (VP) program “Denise” was designed to present a clinical scenario that may not be encountered during a short psychiatry clinical rotation in medical school

Denise: A Virtual Patient

We present a novel methodology to process hurricane data to be ready for display in Microsoft Live Labs Pivot. We describe the complexity of hurricane data files, which makes gleaning information out of them difficult. Hurricane data files contain a significant amount of information pertaining to hurricanes, however it is a poor representation of data. We present an algorithm for a parser to extract information out of data files and generate a CXML formatted file compatible with Microsoft Live Labs Pivot for a more appealing and therefore more useful statistical representation. We show how historical data from past hurricanes can be modified for representation.

Interactive Visualization and Analysis of Hurricane Data

Interpersonal skills training is a key concept in medical education. Unfortunately, components like empathy are dicult to measure. In many cases, experts analyze

Andrew Cordar

Papers

A Qualitative Evaluation of Behavior during Conflict with an Authoritative Virtual Human

Do Variations in Agency Indirectly Affect Behavior with Others? An Analysis of Gaze Behavior

Denise: A Virtual Patient

Interactive Visualization and Analysis of Hurricane Data

Leveraging the Crowd to Evaluate Empathy with Virtual Humans