It's hard to teach empathy in the classroom, yet it's one of the foundations of the doctor-patient relationship. How well physicians can put themselves in their patients' shoes is directly linked with patient satisfaction.

"When I was in med school, no one told me how to do that," said Dennis Novack, professor of medicine and associate dean of medical education at Drexel University College of Medicine. "You could watch your mentors, if you were lucky. Or make mistakes."

Numerous studies have shown patients with empathetic caregivers are more likely to stick to their doctor's treatment plan, leading to better health results. Doctors who can better understand their patients also are more satisfied with their work. And hospitals know how important patient satisfaction is to their bottom line, now that it is a factor Medicare considers in reimbursement.

Medical educators at Drexel have designed a tool for Internet-based training for medical students using actors - or "standardized patients," as they're called in this context. Students get to practice what have been deemed the most effective communication techniques in a simulated setting before they face real patients.

The patented program develops "more advanced skills, such as giving bad news, or counseling a mom who is reluctant to give immunizations to a child. These are dicey, difficult conversations," said Novack, who codeveloped the program. During medical care, you're "dealing with strong emotions. How do you manage when a patients' family is mad at you? What do you do?"

The program fills the need for this kind of training by allowing students to interact with trained actors through a webcam. It's like a Skype session on educational steroids.

During training, students are evaluated on their performance by the "patient" and receive immediate feedback on strengths and weaknesses from the actors, who have been rigorously trained in what to look for. The program also lets students see a recorded clip of their performance, as well as prepared scenes of an expert breaking bad news to a patient.

"Learning in clinical medicine is always multimodal," said program cocreator Christof Daetwyler, associate professor in the department of family, community, and preventive medicine at Drexel. To fully understand the skills, he said, it helps to see a master do it first.

"I think that this is very novel," said Amy Windover, director of communication skills training for the Center for Excellence in Healthcare Communication at the Cleveland Clinic. "I think a lot of people are working on developing something like this."

Today's medical students are especially receptive to this type of e-learning technology, because they've grown up with it. "We need to get with the times, because this is the language they speak and we need to adapt," she said.

Communication skills and empathy training are "taught universally at medical schools," said Maryellen Gusic, chief medical education officer for the Association of American Medical Colleges. "People are doing it in many different ways."

Still, she said, the Drexel program is innovative because it's taking what many schools are doing in the classroom, but making it available through the web-based platform. Additionally, a program like this could be used as a uniform format across all medical schools.

In 2013, out of 140 schools that reported their methods, 84 were using computer-assisted instruction to teach clinical skills, such as empathy training.

Windover notes, however, that such programs have limits.

"How much of a true relationship can you have between a student and a standardized patient? And even more so with an standardized patient who is just Skyping in?" she asked.

In collaboration with DecisionSim, Inc., Drexel's technology is being licensed, although neither side would say what Drexel will be paid. The technology is being unveiled under the new name, CommSim, short for communication simulation.

Drexel's technology "has been piloted in health systems," said Bob Yayac, CEO of DecisionSim, Inc. "That was a big reason why we decided the purchase it."

Communication training needs to be repeated throughout a physician's career, not just in medical school. That's why Yayac says he thinks this product has potential to reach many health care systems.

The Cleveland Clinic's Windover agreed that such e-learning programs are useful for refresher training.

"It's like a booster shot for communication skills training," she said. "It's not just one and done."

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