Virtual Client Applications in Psychological Interview Training : A Systematic Review
Gamze Gültekin, Orçun YorulmazVirtual client applications created with technology are seen to have been used in recent years in various health disciplines as an alternative to traditional practice and training methods. Even more recently, they have become a topic in the field of mental health. This study aims to systematically examine the empirical studies in the literature to get a clearer picture of the virtual client applications that are specific to the mental health field but have yet to become widespread. To broaden the scope of the search, the Web of Science and Scopus databases were scanned according to the search terms created using the relevant keywords. The study has systematically reviewed 16 empirical studies on virtual simulations in the field of psychology and psychiatry education in line with the inclusion criteria. The findings have been evaluated within the scope of the scientific studies’ aims, the characteristics of the virtual applications used in these studies, the measurement tools used for evaluating the studies, and finally the results from these studies. As a result of the findings from this review, virtual client applications were seen to have been developed with various designs and technical features. When examining the measurement methods used according to the aims of the studies, the methods were found to differ from one another. When considering the findings from these studies, studies measuring users’ experiences with virtual client applications indicated the participants to have predominantly evaluated the virtual client applications positively. In addition, these studies indicated the virtual client applications to have improved various aspects of the participants, such as their psychopathological assessment skills, empathic communication skills, and interviewer selfefficacies. However, some problems were experienced during the applications, and feedback was found on how to improve the applications. In this context, the use of virtual client applications as a safe and supportive tool for gaining experience in psychological interview training can be concluded as promising. Still, when considering the limitations of the current studies, more experimental studies are needed that take different methods into account in terms of both virtual client design and research design in order to be able to use technology for psychological interview training more effectively and successfully and for understanding the effectiveness of the proposed applications more comprehensively.
Psikolojik Görüşme Eğitiminde Sanal Danışan Uygulamaları: Sistematik Bir Derleme
Gamze Gültekin, Orçun YorulmazSon yıllarda teknoloji aracılığı ile oluşturulan sanal danışan uygulamalarının geleneksel uygulama ve eğitim yöntemlerine alternatif olarak çeşitli sağlık disiplinlerinde kullanıldığı, ancak psikolojik sağlık alanında görece yeni gündeme geldiği görülmektedir. Bu çalışmada, henüz kullanımı yaygınlaşmamış olan psikolojik sağlık alanına özgü sanal danışan uygulamalarına yakından bakabilme amacı ile alanyazındaki bilimsel araştırma desenlerinin temel alındığı çalışmaların sistematik olarak incelenmesi hedeflenmiştir. Tarama kapsamını geniş tutmak üzere ilgili anahtar kelimeler ile oluşturulmuş arama terimleri aracılığıyla Web of Science ve Scopus veritabanları taranmıştır. Dahil etme kriterleri doğrultusunda psikoloji ve psikiyatri eğitimi kapsamındaki sanal danışan uygulamalarını içeren 16 araştırma sistematik olarak incelenmiştir. Bulgular, bilimsel çalışmaların amaçları, bu çalışmalarda kullanılan sanal uygulamaların özellikleri, çalışmaların değerlendirme amaçlı kullandığı ölçüm araçları ve son olarak çalışmaların ulaştığı sonuçlar kapsamında değerlendirilmiştir. Bu derleme çalışmasının bulguları sonucunda çeşitli tasarım ve teknik özelliklere sahip sanal danışan uygulamalarının geliştirildiği görülmüştür. Araştırmaların amaçlarına göre kullanılan ölçüm yöntemleri incelendiğinde ölçümlerin birbirinden farklılaştığı bulunmuştur. Araştırmaların bulgularına bakıldığında, sanal danışan uygulamalarına ilişkin kullanıcı deneyimini ölçen çalışmalar bu uygulamaların katılımcılar tarafından ağırlıklı olarak olumlu yönde değerlendirildiğini göstermektedir. Ayrıca bu uygulamaların psikolojik sorunları değerlendirme becerisi başta olmak üzere, empatik iletişim becerisi, görüşmeye ilişkin özyeterlik gibi çeşitli açılara yönelik katılımcıları geliştirdiği görülmüştür. Yine de uygulamalar esnasında yaşanılan bazı aksaklıklar ve uygulamaların geliştirilmesine yönelik sunulan geribildirimler de mevcuttur. Bu bağlamda sanal danışan uygulamalarının güvenli ve destekleyici bir deneyimleme aracı olarak, psikolojik görüşme eğitiminde kullanımının ümit vadettiği çıkarımı yapılabilir. Yine de mevcut araştırmalardaki kısıtlılıklar göz önünde bulundurulduğunda, psikolojik görüşme eğitimine yönelik teknolojinin daha etkin ve başarılı şekilde kullanılabilmesi ve önerilen uygulamaların etkinliğinin kapsamlı bir şekilde anlaşılabilmesi için hem sanal danışan tasarımı hem araştırma deseni açısından farklı yöntemlerin hesaba katıldığı daha fazla sayıda deneysel çalışmaya ihtiyaç duyulmaktadır.
Virtual client applications can be defined as interactive computer simulations of real clinical situations for purposes such as practice and training (Ellaway et al., 2006). Virtual client applications are used for medical, dentistry, nursing, pharmacy (Cook et al., 2010), and social work students (Washburn & Zhou, 2018). However, these applications are relatively new in mental health education. Virtual contexts may have benefits in mental health education, such as providing experiential learning, visualizations, and simulations of difficult situations and being able to tailor them according to what is needed (Mantovani et al., 2003). As far as is known, no systematic review of virtual client applications has yet to occur regarding psychological interview training. Therefore, a systematic review has been conducted to obtain a general picture of the status of the literature regarding virtual client applications, particularly in the field of psychological interview training. The framework was arrived at by categorizing the findings in psychology- and psychiatry-related studies under the following subheadings: virtual client applications’ objectives, design characteristics, measurement methods, and findings.
Method
The Web of Science and Scopus databases were searched using relevant keywords. The keywords of virtual patient, virtual human, clinical interview, interview skills, psychology, psychiatry, and other related terms were searched within studies’ titles, abstracts, and keywords. The search was conducted in August 2020. Journal articles and conference proceedings were selected from among the search results, and all dates up to August 2020 were included. As a result, 16 studies were included in the systematic review by following the criteria of preferred reporting items for systematic reviews and meta-analyses (PRISMA).
Results
The objectives of the virtual client applications were categorized as assessing usability, learning diagnostic skills, learning interview skills, developing psychological factors (i.e., self-efficacy, self-confidence), and comparing methods. The majority of the studies focused on the objectives of assessing usability and learning diagnostic skills in psychopathology. The design characteristics of the virtual clients varied among the studies in terms of the information provided about the virtual clients and the technical features of the applications. Some studies presented only psychopathological information about the virtual clients, while other studies had psychopathological information be accompanied by additional information about the virtual clients (e.g., epicrisis). The most preferred visual appearance was a moving avatar. Other preferred visual appearances were videos of real persons and photos of avatars. In addition, the virtual client applications had different technical features in terms of how to communicate with the virtual clients. One commonly preferred method was to send responses and ask questions using a multiple-choice format on the computer screen. Among the measurement methods, self-assessment scales were mostly used. Other forms of assessment were software-based assessment and standardized patient assessment.
In terms of assessing usability, the majority of participants were seen to have assessed the virtual client applications quite positively. In addition to these positive evaluations, participants reported some drawbacks such as poor animation quality, lack of spontaneity, and irrelevant responses from the virtual client. Lastly, the majority of the studies indicated the virtual client simulations to have improved participants’ diagnostic, interview skills, and psychological factors (i.e., self-efficacy, self-confidence).
Discussion
Virtual client applications offer promising results for improving students’ skills (Calinici et al., 2017; Dupuy et al., 2019, 2020; Foster et al., 2016; Gutiérrez-Maldonado et al., 2014, 2015; Matsumura et al., 2018; Pantziaras et al., 2015a; Washburn et al., 2020) and self-efficacy levels (Calinici et al., 2017; Pantziaras et al., 2015b; Washburn et al., 2020) in psychological interview training. These applications have also predominantly been perceived as userfriendly by students (e.g., Dupuy et al., 2019; Matsumura et al., 2018; Penaloza-Salazar et al., 2011). Despite some of the positive indicators from the studies, other points may also be mentioned that need improvement. The majority of the studies focused on assessing usability assessment and developing diagnostic skills; therefore, other skills or psychological factors (e.g., Washburn et al., 2020) came after these aims. The design of the virtual clients was mostly based on a psychopathological disorder, and further studies may consider enhancing the characteristics of these virtual clients (e.g., demographics, history). The technological medium (e.g., head-mounted display compared to a computer screen) did not appear to influence skill development (Gutiérrez-Maldonado et al., 2015). However, individual characteristics (e.g., the sense of presence [of being in a virtual environment], openness to technology) may play a role regarding the usability of virtual client applications (Kenny et al., 2009) and should be considered in further studies. The measurement methods varied across the studies (e.g., Dupuy et al., 2019; Foster et al., 2015), and this variability made comparing the studies’ outcomes difficult. Also, the difficulty levels of the skill measurements may plausibly have differed in relation to the nature of the virtual client application. Further studies may consider a format in which difficulty levels are adaptable according to the participant. Lastly, the research designs of the studies were mostly based on a single group, pretest-posttest design; only one study was found to implement a follow-up measure (Pantziaras et al., 2015a). In addition to weak research designs, most studies had a pilot structure which made drawing inferences challenging. In conclusion, virtual clients appear to be an alternative tool for supporting students in psychology- and psychiatry-related mental health fields. Although the present framework promises hope for the future, more randomized, controlled, and follow-up studies are needed in order to better understand the effectiveness of the proposed approaches.
