Access to this full-text is provided by Springer Nature.
Content available from BMC Medical Education
This content is subject to copyright. Terms and conditions apply.
RESEARCH Open Access
© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and
the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included
in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Anderson et al. BMC Medical Education (2024) 24:1018
https://doi.org/10.1186/s12909-024-05990-2 BMC Medical Education
*Correspondence:
Dagmar Corry
dagmar.corry@qub.ac.uk
1School of Psychology, Queen’s University Belfast, Belfast, Northern
Ireland
Abstract
Introduction Myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) is a chronic condition which may be
characterised by debilitating fatigue, post-exertional malaise, unrefreshing sleep, and cognitive diculties. ME/CFS
has signicant negative impact on quality of life for those living with the condition. This may be exacerbated by a lack
of knowledge within healthcare regarding the condition. Previous research has found that immersive virtual reality
(VR) educational experiences within healthcare education can increase knowledge and empathy.
Methods The present study employed a quasi-experimental pre-test-post-test design to investigate the impact
of a short immersive VR educational experience on knowledge of ME/CFS and empathy for those living with the
condition. The VR experience placed participants into a virtual scene which told real life stories of the experience of
people living with ME/CFS and their families. 43 participants completed in this pilot study: 28 medical students and
15 primary care health professionals. Participants completed measures of knowledge of ME/CFS and empathy before
and after engagement with the experience.
Results A statistically signicant increase was found for levels of knowledge (p < .001, d = 0.74) and empathy (p < .001,
d = 1.56) from pre-VR experience levels to post-VR experience levels with a medium and large eect size, respectively.
Further analysis revealed no statistically signicant dierence between baseline levels of knowledge of ME/CFS
between healthcare professionals and medical students.
Discussion The present study is the rst to explore the use of this short immersive VR experience as an education
tool within healthcare to increase knowledge of ME/CFS, and empathy for those living with the condition. Findings
allude to the previously established lack of knowledge of ME/CFS within healthcare although promisingly the
increases in knowledge and empathy found suggest that this immersive VR experience has potential to address this.
Such changes found in this small-scale pilot study suggest that future research into the use of VR as an educational
tool within this setting may be benecial. Use of a control group, and larger sample size as well as investigation of
retention of these changes may also enhance future research.
Keywords Myalgic encephalomyelitis, Chronic fatigue syndrome, Medical education, Virtual reality, Immersive
experience
Virtual reality education on myalgic
encephalomyelitis for medical students
and healthcare professionals: a pilot study
TaraAnderson1, GraceDuy1 and DagmarCorry1*
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 2 of 8
Anderson et al. BMC Medical Education (2024) 24:1018
Background
Myalgic Encephalomyelitis is a chronic condition which
may be suspected from a presentation of debilitat-
ing fatigue, post-exertional malaise, unrefreshing sleep,
and cognitive difficulties [1]. e condition was first
described in the 1930s following an outbreak of similar
symptoms among the staff of Los Angeles County Gen-
eral Hospital in 1934 [2]. Although case definitions since
have differed and no one name for the condition has been
agreed upon [3, 4], the present paper will use the com-
posite term Myalgic Encephalomyelitis/ Chronic Fatigue
Syndrome (ME/CFS] as is most commonly used in the lit-
erature. An estimated three million people live with ME/
CFS in Europe [5]. However, prevalence estimates are
also challenging as there is currently no diagnostic test
nor effective treatment [6]. Recent research aims to bet-
ter understand the development of ME/CFS, for example
‘DecodeME’, a large scale genome-wide association study
[6]. Other research has suggested the condition is associ-
ated with viral infections [7–9].
ME/CFS has a significant impact on quality of life, with
48% of those living with ME/CFS reporting an inability
to engage in any productive activity [8]. ose living with
the condition scored significantly lower on health-related
quality of life than the population mean and the lowest
of 20 conditions, including multiple sclerosis and stroke,
with reports of fewer relationships and higher unemploy-
ment [10]. Additionally, people living with ME/CFS have
commonly reported experiences of minimisation of their
condition by health care professionals [11]. is may be
heightened by General Practitioners (GPs) lack of knowl-
edge, and in some cases, an unwillingness to recognise
ME/CFS as a genuine illness [12, 13]. For example, across
a range of countries many doctors and medical students
have reported that they are unsure that ME/CFS is real,
while patients have reported suspicion of their condition
by healthcare professionals [3, 12, 14–16].
Issues with diagnosis have been suggested to fuel the
stigmatisation of the condition, with stereotypes and
potential maltreatment of patients based on a lack of
knowledge and awareness [11]. Hospital doctors reported
a lack of formal teaching on ME/CFS, and knew little
about the clinical manifestations of the condition, the
appropriate management, and its impact on daily liv-
ing[16]. Further, in a survey of 811 UK GPs less than half
of respondents correctly identified all three key clinical
features of ME/CFS [3]. GP’s and hospital doctors have
also reported a lack of confidence in diagnosing and
managing ME/CFS patients[3, 16, 17] .
It is evident that health care professionals show a lack
of knowledge in regard to ME/CFS and research has
shown minimal, if any, training on the condition. For
example, an analysis of 119 medical textbooks found
information on the condition on only 0.09% of pages,
indicating that ME/CFS was vastly underrepresented
compared to other conditions[18]. Further, only 13 of
22 UK medical schools respondents taught about ME/
CFS, although no information was provided on what they
taught[19]. Encouragingly, medical schools and hospital
doctors are aware further training is required, and have
expressed a willingness to engage with such[16, 19].
A European wide study of 23 experts in the field
identified serious concerns among academics and
medical experts regarding the lack of knowledge and
understanding of ME/CFS among primary care physi-
cians[20]. ese experts expressed unanimous support
for increased teaching on ME/CFS within undergradu-
ate courses, postgraduate training, and specifically within
primary care. Little evidence exists for the incorpora-
tion of such education however, one case study found,
increases in medical students’ empathy for those living
with ME/CFS and their ability to better diagnose and
manage the condition were found following engagement
with a learning module[21].
Empathy is an important trait of health care profes-
sionals, with physician empathy linked to increased
patient satisfaction [22–24]. Virtual reality [VR] may help
to promote empathy and has shown promise as an edu-
cational tool within healthcare. For example, students
from various health care courses reported positive learn-
ing and increased empathy following an immersive VR
experience of a patient with vision and hearing loss[25].
Nursing and midwifery students also reported increased
engagement and motivation to learn following an immer-
sive VR experience of a baby’s life in the womb [26].
Students have shown satisfaction with VR learning
experiences, rating such experiences as highly valuable
and requesting their inclusion in curricula [27]. Further,
gains in understanding of disease processes, patients’
experience, the challenges faced by family members’, and
empathetic discourse have been found following VR edu-
cational experiences [27]. e immersive element of VR
education may facilitate constructivist learning experi-
ences [28]. Constructivism emerged from Piaget’s devel-
opmental perspective and emphasises the importance
of learners developing knowledge through experience
rather than passively absorbing information [29]. is
is in line with the effectiveness of interventions such as
VR, specifically within medical education, for increasing
knowledge, enthusiasm, and enjoyment [30].
Given the promise of VR as an educational tool cou-
pled with the discussed lack of existing knowledge and
stigmatisation regarding ME/CFS, the condition may
be amenable to an educational intervention such as VR.
the present study aims to evaluate the effectiveness of
an educational immersive VR experience in increas-
ing knowledge of ME/CFS and empathy for those living
with the condition. As primary care health professionals
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 3 of 8
Anderson et al. BMC Medical Education (2024) 24:1018
are likely the first point of contact for someone with
symptoms of ME/CFS, and medical students are likely
to encounter people living with ME/CFS in their future
career, this evaluation will be conducted these groups.
e objectives of this study were as follows:
1. To determine if engagement with the immersive VR
experience improved medical students and primary
care health professionals’ levels of knowledge of ME/
CFS.
2. To determine if engagement with the immersive VR
experience improved participants’ levels of empathy
for people living with ME/CFS.
Methods
Design and setting
is pilot study employed a quasi-experimental pre-test/
post-test design to compare participant knowledge and
empathy before and after engagement with the immersive
VR experience. It was conducted by undergraduate stu-
dent researchers under academic supervision and formed
the basis of their degree dissertation. Questionnaires
which measured knowledge and empathy were delivered
immediately prior to and following the VR experience.
Population
Recruitment was supported by Queen’s University Bel-
fast, School of Medicine, Dentistry and Biomedical Sci-
ences, Ulster University, School of Medicine, the Derry
GP Federation, Western Health and Social Care Trust,
and Western Rural Healthcare. Recruitment and test-
ing occurred in Northern Ireland between November
2022 and February 2023. A recruitment flyer was shared
by both UU and QUB Medical schools to their student
portals. is flyer contained a QR code at which poten-
tial participants could register their interest, and then
were contacted by a member of the research team. Pri-
mary care health professionals were recruited through
opportunistic sampling in a GP surgery local to a mem-
ber of the research team. Initial contact with the GP
surgery was made via a letter, a member of the research
team then attended the surgery to enable those working
there to participate. is also led to snowball sampling
of other primary care health professionals outside of this
GP surgery.
Intervention
e immersive VR experience, ‘Discover ME’, was com-
pleted using a VR headset provided by ‘Hope 4 ME and
Fibro NI’, a non-profit registered charity run by patients
and volunteers. e experience was created by Deepa
Mann-Kler along with the charity, who granted full per-
mission to use this for the purposes of this research. e
VR experience was created as part of the charity’s aware-
ness and education campaign. e experience lasted
just under seven minutes and placed participants into a
virtual scene which told real life stories consisting of an
animation accompanied by audio. e VR experience
enables users to hear the experiences of people living
with ME/CFS and their family members while looking
around a virtual scene portraying animations of the indi-
vidual’s story. e stories presented incorporate facts
about the condition, for example post-exertional malaise
as the defining feature of the disease.
Survey instrument
e pre- and post-measures were designed and adminis-
tered using Qualtrics. Two separate questionnaires were
administered: one for medical students and one for pri-
mary care health professionals. e medical student pre-
questionnaire recorded gender and year of study. Primary
care health professionals were asked to indicate gender,
role (e.g., GP, nurse, etc.) and their length of time work-
ing in primary care. Following these demographic ques-
tions, both questionnaires then included the 20-item
knowledge of ME/CFS scale developed by experts in
the field [16] (α = 0.71). is scale consisted of differ-
ent types of questions; 13 true/false (e.g. “ME resolves
within 6 months”), and seven multiple-choice questions
(e.g. “ME affects more… Men OR Women”). Finally, an
adapted version of six-item empathy scale developed
by Hannans et al. (2021) was completed [25]. is scale
had previously been validated by content experts [25]
and was adapted to reflect a patient living with ME/CFS
rather than the originally included vision impairment
(α = 0.44). Each item, (e.g. “I understand the perspective
of a patient living with ME”) consisted of a seven-point
Likert response scale ranging from 0 - strongly disagree,
to 6 - strongly agree. Both scales were adapted for health-
care professionals to ensure they reflected their current
career rather than their future careers.
Data collection
Participants attended a testing session where one
researcher present. Participants were welcomed and
assured that if, at any time, they became uncomfortable
or did not wish to continue, they could remove the head-
set and inform the researcher.
Participants first completed the pre-questionnaire on
Qualtrics which was accessed via a QR code presented by
the experimenter and completed on the participants own
device (e.g., mobile phone). A participant information
sheet outlining details of the study and an informed con-
sent form were embedded within this pre-questionnaire
and participants could not progress to the questionnaire
until informed consent had been obtained.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 4 of 8
Anderson et al. BMC Medical Education (2024) 24:1018
Once pre-measures had been completed a holding
screen was displayed which informed the participant to
let the researcher know they were ready for the VR expe-
rience. e researcher then assisted the participant to put
on the VR headset and ensured they could see the title
screen and hear the music. Once ready, the researcher
pressed ‘play’ to begin the immersive experience. e
experience did not require any movement or interaction
from participants, but they could look around the virtual
scene by moving their head. erefore, participants com-
pleted the VR experience sitting down, with a member of
the research team present at all times to assist the par-
ticipant if they wished to take the headset off or had any
difficulty with participation.
When the experience ended, participants removed
the headset and returned to the Qualtrics page to com-
plete the post-questionnaire. Finally, participants
were debriefed and thanked. e entire session took
15–20min.
Ethics
Queen’s University Belfast, Faculty of Engineering and
Physical Sciences Research Ethics Committee granted
ethical approval for this study on October 28th 2022
(Ref: EPS 22_349) after considering benefits and risks
and ensuring participants autonomy would be respected.
All participants provided informed consent via an online
form. All methods were performed in accordance with
the Declaration of Helsinki [31].
Data analysis
All analyses were conducted in SPSS version 28. Knowl-
edge scale data were coded as zero for incorrect answers
and one for correct answers; total knowledge scores rep-
resented the number of correct answers provided. Empa-
thy scale data was coded based on the Likert response
scale ranging from zero (strongly disagree) to six
(strongly agree). A number of items were reverse coded
to ensure higher scores reflected either more accurate
knowledge or higher empathy levels.
Descriptive statistics were performed to observe demo-
graphic details of the participant sample. Two paired
t-tests were then conducted to examine the change from
pre-test to post-test for both the knowledge and empa-
thy scales. Cohen’s d was calculated as a measure of effect
size by dividing the difference between the pre- and post-
test means by the pooled standard deviation.
Additionally, an independent samples t-test was con-
ducted to examine any difference between medical stu-
dents and primary care health professionals’ level of
baseline knowledge. Due to three t-test analyses in total,
a Bonferroni correction was applied to the alpha value
when determining the statistical significance of the
results of the analyses to reduce the risk of false positives
associated with multiple comparisons [32]. Alpha (0.05)
was divided by the total number of comparisons (3) to
give a value of α = 0.017. Results were therefore only con-
sidered to be statistically significant if their associated
p-value was 0.017 or below.
Results
In total, 43 participants (Table1) were recruited to evalu-
ate the impact of the immersive VR experience on knowl-
edge of ME/CFS and empathy for those living with ME/
CFS as assessed by pre- and post-questionnaires. 28 par-
ticipants were medical students while 15 were primary
care health professionals (three GPs, 11 first contact
physiotherapists, and one advance practice paramedic).
Most participants were female (67.4%), and medical stu-
dents represented the majority of the sample (65.1%).
Medical students’ level of study ranged from first to fifth
year with the majority in their third year of study (25.6%).
Most health professionals had worked in primary care for
less than five years (25.6%). Table1 provides participant
demographics.
Pre-test to post-test changes in knowledge and empathy
Knowledge
Due to non-normally distributed data, the non-para-
metric Wilcoxon signed-rank test was used to deter-
mine whether there was a statistically significant
difference between pre- and post-test levels of knowl-
edge of ME/CFS. Descriptive statistics (Table2) show
that post-test scores were higher than pre-test scores.
Participants showed increased scores on post-test mea-
sures (Mdn = 30) compared to their mean pre-test score
(Mdn = 26), a statistically significant increase of Mdn = 3,
Z = 4.86, p < .001, with medium effect size d = 0.74.
Table 1 Participant descriptive statistics
Descriptive Statistics N%
Gender Male 14 32.6
Female 29 67.4
Role Medical Student 28 65.1
General Practitioner 3 7.0
First Contact Physiotherapist 11 25.6
Advanced Practice Paramedic 1 2.3
Level of
Experience
First year medical student 5 11.6
Second year medical student 6 14.0
Third year medical student 11 25.6
Fourth year medical student 1 2.3
Working in primary care for less than 5
years
11 25.6
Working in primary care for 5–10 years 1 2.3
Working in primary care for more than 10
years
3 7.0
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 5 of 8
Anderson et al. BMC Medical Education (2024) 24:1018
Empathy
A paired-sample t-test was used to determine whether
there was a statistically significant difference between
pre- and post-test levels of empathy for those living
with ME/CFS. Descriptive statistics (Table3) show that
post-test scores were higher than pre-test scores. Par-
ticipants showed increased scores on post-test measures
(M = 30.02, SD = 2.89) compared to their mean pre-test
score (M = 24.37, SD = 3.80), a statistically significant
mean increase of 5.65, 95% CI [6.79, 4.51], t(42) = 10.01,
p < .001, with large effect size, d = 1.56.
Medical student baseline knowledge compared to primary
care health professionals
Post hoc analysis found no statistically significant differ-
ence on pre-questionnaire knowledge levels between the
two groups of participants: medical students and primary
care health professionals. Table 4 presents descriptive
statistics for baseline knowledge levels.
Summary of results
To summarise, 43 participants (28 medical students and
15 primary care health professionals) were recruited
to evaluate the impact of an immersive VR experience
on knowledge and empathy regarding ME/CFS. Pre-
and post-test analysis revealed statistically significant
(p < .001) median increases in both knowledge of ME/
CFS (with medium effect size) and empathy for those liv-
ing with the condition (with large effect size) following
engagement with the VR experience. ese results are
presented in graphical form in Fig. 1. No group differ-
ences were found on pre-test levels of knowledge.
Discussion
ME/CFS is a debilitating chronic condition [1] of
which healthcare professionals’ knowledge is lacking
[3, 11, 13, 16]. GP’s and hospital doctors have, however,
acknowledged their lack of confidence in the diagnosis
and management of ME/CFS and expressed a willing-
ness to engage with education initiatives [16, 17, 19]. To
the best of the authors’ knowledge this is first study to
investigate the utility of an immersive VR experience as
an educational intervention within this context. Follow-
ing engagement with the experience, participants showed
both increased knowledge of ME/CFS and improved
empathy for those living with the condition. ese
improvements highlight the potential of this experience
as an educational tool for medical students and health-
care professionals.
e portrayal of individual experience of ME/CFS has
been suggested to facilitate positive attitudes toward ME/
CFS [3]. VR represents an innovative method to facili-
tate this. Existing evidence has suggested that immersive
VR experiences can increase healthcare student knowl-
edge in other contexts such as disease processes, and the
experience of patients and family members[27, 30]. Tak-
ing these factors into account, the present study extends
this previous literature to the context of ME/CFS as par-
ticipants showed increased levels of knowledge of ME/
CFS following the VR experience. Given the discussed
lack of knowledge of the condition [3, 16, 17], this find-
ing is promising as this VR experience may have poten-
tial as an educational tool for current and future health
professionals.
Participants also showed increased empathy following
engagement with the VR experience, although interpreta-
tions of this finding are limited due to a lack of internal
validity within the scale used to measure empathy. How-
ever, increased empathy is in line with previous research
regarding the utility of VR for increasing healthcare stu-
dent empathy for patients with other conditions, such as
those with vision and hearing loss [25, 33]. Health care
professionals’ empathy has been linked to increased
patient satisfaction [22–24]. is may be of increased
Table 2 Descriptive statistics for pre-test and post-test total knowledge scores
NRange Minimum Maximum Mean Std. Deviation
Knowledge pre-test 43 18 17 35 25.93 4.35
Knowledge post-test 43 21 19 37 29.53 4.30
Valid N (listwise] 43
Table 3 Descriptive statistics for pre-test and post-test total empathy scores
NRange Minimum Maximum Mean Std. Deviation
Empathy pre-test 43 14 16 30 24.37 3.80
Empathy post-test 43 14 22 36 30.02 2.89
Valid N (listwise) 43
Table 4 Descriptive statistics for pre-test knowledge scores between groups
NRange Minimum Maximum Mean Std. Deviation
Medical student pre-knowledge score 28 15 17 32 25.61 4.10
Primary care health professional pre-knowledge score 15 15 20 35 26.53 4.87
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 6 of 8
Anderson et al. BMC Medical Education (2024) 24:1018
importance within the context of ME/CFS due to patient
reports of stigmatisation and suspicion from healthcare
professionals regarding their condition [11, 14].
Taken together, these findings suggest that the immer-
sive VR experience evaluated shows promise as an educa-
tional tool within medical education for medical students
and primary care health professionals. e convenience
of the experience, which lasts for less than seven minutes,
may be beneficial to incorporate into the busy schedules
of those working primary care. is may help to address
concerns regarding the need for increased teaching on
ME/CFS, specifically within primary care [20].
It is also interesting to note that no statistically signifi-
cant difference was found between levels of knowledge
measured prior to the VR experience (baseline knowl-
edge) between primary care health professionals and
medical students. Given that levels of knowledge may be
expected to increase with experience level, it is surprising
that those working in primary care did not show some-
what greater levels of knowledge than medical students.
is finding alludes to the lack of knowledge of ME/CFS
even in experienced practitioners [13, 17].
Strengths and limitations
Both knowledge and empathy were found to increase fol-
lowing engagement with this immersive VR experience.
is is a promising result of a short experience provid-
ing information, via real life patient stories, on ME/
CFS which suggests such an educational tool may be
beneficial in medical education regarding not only ME/
CFS but other chronic conditions of which knowledge
may currently be lacking.
Empathy was measured using an adapted version of
a questionnaire developed by experts in the field of VR
education [25] which was found to have a lack of internal
validity as assessed by Cronbach’s alpha. is may have
been a result of adapting the questionnaire to represent
empathy for those living with ME/CFS. Although this
questionnaire was designed specifically for pre- and post-
VR experiences, future research may benefit from use of
a more validated measure of empathy. Additionally, self-
report measures were used which may be influenced by
social desirability bias and interpretation, which has been
shown particularly in relation to empathy self-reports
[34, 35].
is was a small-scale pilot study, and although results
are promising, the study is limited by low statistical
power. is low sample size limits the generalisability of
the results, however the inclusion of both medical stu-
dents and health professionals working in primary care
may suggest the intervention’s potential within both
academic and professional medical settings. Addition-
ally, the generalisability of the results to other healthcare
professions and student groups is limited by the homo-
geneity of the sample. erefore, evaluation of the expe-
rience with an increased sample size, and inclusion of
more varied healthcare experiences and roles, within a
Fig. 1 Increases in knowledge and empathy from pre- to post-test levels
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 7 of 8
Anderson et al. BMC Medical Education (2024) 24:1018
randomised control trial (RCT) would facilitate more in-
depth conclusions.
Future directions
Although the increases in knowledge and empathy after
a short experience are promising, it is not possible to
draw conclusions on retention of this knowledge as post-
test data was obtained directly after engagement with
the experience. An additional questionnaire time-point
sometime after the experience may help to shed light on
any maintained impact of the resource on medical stu-
dents’ or health care professionals’ future practice. In
addition, future research may consider whether increased
knowledge and/or empathy, as a result of such interven-
tion, can positively impact patient outcomes.
e present study solely evaluated the VR experience as
a tool for increasing knowledge and empathy. Although
this is a convenient educational tool, it may be helpful to
incorporate the experience into a more in-depth training
session on ME/CFS which could lead to enhanced knowl-
edge of the condition. It may also be helpful to compare
the impact of the immersive VR experience with other
interventions. Although the pre- and post-test design of
the present study allowed evaluation to occur in a conve-
nient and cost-effective manner, this design does not have
a comparison or control group. Future research may ben-
efit from comparing the results of a VR group to other
interventions such as an information session, or a stand-
alone video. Although these may be more convenient
to incorporate within medical education, some of the
benefits of an immersive experience may be lost. Addi-
tionally, a control group may enable conclusions regard-
ing the causal effect of the VR experience on knowledge
and/or empathy as other confounding variables could be
accounted for.
Conclusion
e use of an immersive VR experience has demonstrated
increases in both knowledge of ME/CFS and empathy for
those living with the condition in a participant sample of
medical students and primary care health professionals
in this small-scale pilot study. is represents an innova-
tive and convenient method which may help to address
gaps within medical education and improve patient expe-
rience. However, future research is needed to test the
intervention with a larger population and within an RCT
to provide more reliable evidence regarding effectiveness.
Abbreviations
ME/CFS Myalgic encephalomyelitis/ chronic fatigue syndrome
NICE National Institute for Healthcare and Care Excellence
GP General practitioner
UK United Kingdom
VR Virtual reality
QUB Queen’s University Belfast
QR Quick Response
Ref Reference
SPSS Statistical Package for the Social Sciences
Mdn Median
M Mean
SD Standard deviation
RCT Randomised control trial
Acknowledgements
AcknowledgementsThe authors wish to thank ‘Hope 4 ME and Fibro NI’, in
particular: Joan McParland, Linda Campbell, and Deepa Mann-Kler, who
provided expertise, loaned equipment and materials and permitted the use
of the ‘Discover ME’ VR experience. We would also like to thank both Queen’s
and Ulster University medical schools as well as the Derry GP Federation,
the Western Trust, and Western Rural Healthcare for their support with
recruitment.
Author contributions
Authors and aliationsSchool of Psychology, Queen’s University Belfast,
Belfast, Northern Ireland Tara Anderson, Grace Duy, & Dr Dagmar
CorryContributionsAll authors have agreed the nal version of this paper and
agree to be accountable for the ndings. All authors have also met criteria
adapted from McNutt et al. Proceedings of the National Academy of Sciences,
Feb 2018, 201715374; https://doi.org/10.1073/pnas.1715374115; licensed
under CC BY 4.0. All authors been involved in substantial contributions to the
conception, design of the work, the acquisition, analysis, interpretation of data
and have drafted the work or substantively revised it. All of the authors read
and approved the nal manuscript.Corresponding authorCorrespondence to
Dr Dagmar Corry (dagmar.corry@qub.ac.uk).
Funding
The authors received no funding for this study.
Data availability
The datasets used and/ analysed during the current study is available here:
DOI: 10.17034/7b145be7-6412-4382-b93f-36fb86e497.
Declarations
Ethics approval and consent to participate
This study received ethical approval by Queen’s University Belfast, Faculty of
Engineering and Physical Sciences Research Ethics Committee in October
2022 (Ref: EPS 22_349). Online informed consent was obtained from all
participants. All methods were performed in accordance with the Declaration
of Helsinki [31].
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Received: 12 January 2024 / Accepted: 3 September 2024
References
1. National Institute for Health and Care Excellence (NICE). Myalgic encepha-
lomyelitis (or encephalopathy)/chronic fatigue syndrome: Diagnosis and
management [Internet]. 2021 Oct. https://www.nice.org.uk/guidance/ng206
2. Jason LA, Damrongvachiraphan D, Hunnell J, Bartgis L, Brown A, Evans M,
Brown M. Myalgic encephalomyelitis case denitions. Auton Control Physi-
ological State Function. 2012;1:1–14. https://doi.org/10.4303/acpsf/K110601.
3. Bowen J, Pheby D, Charlett A, McNulty C. Chronic fatigue syndrome: A survey
of GPs’ attitudes and k nowledge. Fam Pract. 2005;22(4):389–93. https://doi.
org/10.1093/fampra/cmi019.
4. Lim EJ, Son CG. Review of case denitions for myalgic encephalomyelitis/
chronic fatigue syndrome (ME/CFS). J Translational Med. 2020;18(1):289.
https://doi.org/10.1186/s12967-020-02455-0.
5. Nacul L, Authier FJ, Scheibenbogen C, Lorusso L, Helland IB, Martin JA,
Sirbu CA, Mengshoel AM, Polo O, Behrends U, Nielsen H. European network
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 8 of 8
Anderson et al. BMC Medical Education (2024) 24:1018
on myalgic encephalomyelitis/chronic fatigue syndrome (EUROMENE):
Expert consensus on the diagnosis, service provision, and care of people
with ME/CFS in Europe. Medicina. 2021;57(5):510. https://doi.org/10.3390/
medicina57050510.
6. Devereux-Cooke A, Leary S, McGrath SJ, Northwood E, Redshaw A, Shepherd
C, Stacey P, Tripp C, Wilson J, Mar M, Booyer D. DecodeME: Community
recruitment for a large genetics study of myalgic encephalomyelitis / chronic
fatigue syndrome. BMC Neurol. 2022;22(1):269. https://doi.org/10.1186/
s12883-022-02763-6.
7. Bansal AS, Kraneveld AD, Oltra E, Carding S, What Causes MECFS. The role of
the dysfunctional immune system and viral infections. J Immunol Allergy.
2022;3:1–4. https://doi.org/10.37191/Mapsci-2582-6549-3(2)-033.
8. Chu L, Valencia IJ, Garvert DW, Montoya JG. Onset patterns and course of
myalgic encephalomyelitis/chronic fatigue syndrome. Front Pead. 2019;7:12.
https://doi.org/10.3389/fped.2019.00012.
9. Lacerda EM, Geraghty K, Kingdon CC, Palla L, Nacul L. A logistic regression
analysis of risk factors in ME/CFS pathogenesis. BMC Neurol. 2019;19(275).
https://doi.org/10.1186/s12883-019-1468-2.
10. Falk Hvidberg M, Brinth LS, Olesen AV, Petersen KD, Ehlers L. The health-
related quality of life for patients with myalgic encephalomyelitis / chronic
fatigue syndrome (ME/CFS). PLoS ONE. 2015;10(7):e0132421. https://doi.
org/10.1371/journal.pone.0132421.
11. Anderson VR, Jason LA, Hlavaty LE, Porter N, Cudia J. A review and meta-
synthesis of qualitative studies on myalgic encephalomyelitis/chronic
fatigue syndrome. Patient Educ Counselling. 2012;86(2):147–55. https://doi.
org/10.1016/j.pec.2011.04.016.
12. Nacul LC, Lacerda EM, Pheby D, Campion P, Molokhia M, Fayyaz S, Leite JC,
Poland F, Howe A, Drachler ML. Prevalence of myalgic encephalomyelitis/
chronic fatigue syndrome (ME/CFS) in three regions of England: A repeated
cross-sectional study in primary care. BMC Med. 2011;9:1–2. https://doi.
org/10.1186/1741-7015-9-91.
13. Thomas MA, Smith AP. Primary healthcare provision and chronic fatigue
syndrome: A survey of patients’ and general practitioners’ beliefs. BMC Fam
Pract. 2005;6:1–6. https://doi.org/10.1186/1471-2296-6-49.
14. Blease C, Carel H, Geraghty K. Epistemic injustice in healthcare encounters:
Evidence from chronic fatigue syndrome. J Med Ethics. 2017;43(8):549–57.
https://doi.org/10.1136/medethics-2016-103691.
15. Pheby DF, Araja D, Berkis U, Brenna E, Cullinan J, de Korwin JD, Gitto L, Hughes
DA, Hunter RM, Trepel D, Wand-Steverding X. A literature review of GP
knowledge and understanding of ME/CFS: A report from the socioeconomic
working group of the European network on ME/CFS (EUROMENE). Medicina.
2020;57(1):7. https://doi.org/10.3390/medicina57010007.
16. Hng K, Geraghty K, Pheby D. An audit of UK hospital doctors’ knowledge and
experience of myalgic encephalomyelitis. Medicina. 2021;57(9):885. https://
doi.org/10.3390/medicina57090885.
17. Chew-Graham C, Dowrick C, Wearden A, Richardson V, Peters S. Mak-
ing the diagnosis of chronic fatigue syndrome/myalgic encephalitis in
primary care: A qualitative study. BMC Fam Pract. 2010;11(1):16. https://doi.
org/10.1186/1471-2296-11-16.
18. Jason LA, Paavola E, Porter N, Morello ML. Frequency and Content Analysis of
CFS in Medical Text Books. Aust J Prim Health. 2010. https://doi.org/10.1071/
PY09023.
19. Muirhead N, Muirhead J, Lavery G, Marsh B. Medical school education
on myalgic encephalomyelitis. Medicina. 2021;57(6):542. https://doi.
org/10.3390/medicina57060542.
20. Cullinan J, Pheby DFH, Araja D, Berkis U, Brenna E, de Korwin JD, Gitto L,
Hughes DA, Hunter RM, Trepel D, Wang-Steverding X. Perceptions of Euro-
pean ME/CFS experts concerning knowledge and understanding of ME/CFS
among primary care physicians in Europe: A report from the European ME/
CFS research network (EUROMENE). Medicina. 2021;57(3):208. https://doi.
org/10.3390/medicina57030208.
21. Brimmer DJ, Jones JF, Boneva R, Campbell C, Lin JMS, Unger ER. Assessment
of ME/CFS (myalgic Encephalomyelitis/Chronic fatigue syndrome): A case
study for health care providers. MedEdPORTAL. 2016;10527. https://doi.
org/10.15766/mep_2374-8265.10527.
22. Derksen F, Bensing J, Lagro-Janssen A. Eectiveness of empathy in general
practice: A systematic review. Br J Gen Pract. 2013;63(606):e76–84. https://doi.
org/10.3399/bjgp13X660814.
23. Kim SS, Kaplowitz S, Johnston MV. The eects of physician empathy on
patient satisfaction and compliance. Eval Health Prof. 2004;27(3):237–51.
https://doi.org/10.1177/0163278704267037.
24. Pollak KI, Alexander SC, Tulsky JA, Lyna P, Coman CJ, Dolor RJ, Gulbrandsen P,
Østbye T. Physician empathy and listening: Associations with patient satisfac-
tion and autonomy. J Am Board Family Med. 2011;24(6):665–72. https://doi.
org/10.3122/jabfm.2011.06.110025.
25. Hannans JA, Nevins CM, Jordan K. See it, hear it, feel it: Embodying a patient
experience through immersive virtual reality. Inf Learn Sci. 2021;122(7/8):565–
83. https://doi.org/10.1108/ILS-10-2020-0233.
26. Hardie P, Darley A, Carroll L, Redmond C, Campbell A, Jarvis S. Nursing &
Midwifery students’ experience of immersive virtual reality storytelling:
An evaluative study. BMC Nurs. 2020;19(1):78. https://doi.org/10.1186/
s12912-020-00471-5.
27. Elzie CA, Shaia J. Virtually walking in a patient’s shoes—the path to
empathy? Med Sci Educ. 2020;30(4):1737–9. https://doi.org/10.1007/
s40670-020-01101-0.
28. Marougkas A, Troussas C, Krouska A, Sgouropoulou C. Virtual reality in
education: A review of learning theories, approaches and methodologies
for the last decade. Electronics. 2023;12(13):2832. https://doi.org/10.3390/
electronics12132832.
29. Kaufman DM. Teaching and learning in medical education: How theory can
inform practice. Understanding Medical Education: Evidence, Theory, and
Practice. 2018;37–69. https://doi.org/10.1002/9781119373780.ch4
30. Barteit S, Lanfermann L, Bärnighausen T, Neuhann F, Beiersmann C, Aug-
mented. Mixed, and virtual reality-based head-mounted devices for medical
education: Systematic review. JMIR Serious Games. 2021;9(3):e29080. https://
doi.org/10.2196/29080.
31. World Medical Association. World medical association declaration of Helsinki.
Ethical principles for medical research involving human subjects. Bull World
Health Organ. 2001;79(4):373–4.
32. Bland JM, Altman DG. Statistics notes: Multiple signicance tests: The
bonferroni method. BMJ. 1995;310(6973):170–170. https://doi.org/10.1136/
bmj.310.6973.170.
33. Buchman S, Henderson D. Interprofessional empathy and communication
competency development in healthcare professions’ curriculum through
immersive virtual reality experiences. J Interprofessional Educ Pract.
2019;15:127–30. https://doi.org/10.1016/j.xjep.2019.03.010.
34. Colliver JA, Conlee MJ, Verhulst SJ, Dorsey JK. Reports of the decline of
empathy during medical education are greatly exaggerated: A reexamina-
tion of the research. Academic Medicine. 2010;85(4):588 – 93. doi: 10.1097/
ACM.0b013e3181d281dc.
35. Sassenrath C. Let me show you how nice I am: Impression management as
bias in empathic responses. Social Psychol Personality Sci. 2020;11(6):752–60.
https://doi.org/10.1177/1948550619884566.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional aliations.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
Content uploaded by Dagmar Anna Susanne Corry
Author content
All content in this area was uploaded by Dagmar Anna Susanne Corry on Sep 17, 2024
Content may be subject to copyright.
