ENGAGE: Analyzing the Value of Virtual Reality in a Patient-Centric Immersive Learning Program in Myasthenia Gravis for Healthcare Professionals

Ina Weisshardt^1*Cornelia Reyes Acosta¹Trishna Chauhan²Kaloyan Haralampiev³Andrijana Mušura Gabor⁴Alexis Rodriguez⁵Allison Foss⁵Ashwin Pinto⁶Channa Hewamadduma^7,8John Vissing⁹Nicholas J. Silvestri¹⁰Sophie Lehnerer¹¹Marc De Backer¹²Natasha Monin¹³Sophie Barry¹⁴Ivo Vlaev¹⁵

• ¹LLH Concepts GbR, Haimhausen, Germany
• ²University of Liverpool, Liverpool, United Kingdom
• ³Sofia University, Sofia, Bulgaria
• ⁴Behavioral and Experimental Economics Lab, Zagreb School of Economics and Management, Zagreb, Croatia
• ⁵MG Georgia, Atlanta, GA, United States
• ⁶Division of Clinical Neuroscience, University of Southampton, Southampton, United Kingdom
• ⁷Academic Neuromuscular Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
• ⁸Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
• ⁹Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
• ¹⁰Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
• ¹¹Department of Neurology with Experimental Neurology, Charite – Universitätsmedizin Berlin, Berlin, Germany
• ¹²UCB, Brussels, Belgium
• ¹³UCB, Malvern, Australia
• ¹⁴UCB, Dublin, Ireland
• ¹⁵Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Abstract Word count: 348/350 Background: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease characterized by muscle weakness that can significantly impact patients' lives. Recent patient-led research highlighted a disconnect between healthcare professionals (HCPs) and patients, emphasizing the need for effective and empathetic patient–HCP dialogue and shared decision-making (SDM). The power of virtual reality (VR) to increase empathy and provide impactful learning experiences has been established. This outcome evaluation assessed the ability of VR to improve HCPs' knowledge, attitudes and empathy in MG, aiming to strengthen patient–HCP communication and facilitate SDM. Methods: The ENGAGE educational pilot program comprised a needs assessment, a VR-based intervention and an outcome evaluation. Content for the VR intervention was developed using a patient-centric approach integrating patient and HCP voices. The VR module simulated "a day in the life of Julia", a virtual patient with MG, allowing HCPs to experience MG symptoms and their impact on a patient's life. The experience was implemented in hospital-based workshops. The outcome evaluation included surveys assessing Moore's Levels 2–4, the Theoretical Domains Framework (TDF), and SDM, and was supplemented by semi-structured interviews. Quantitative and qualitative data were analyzed using SPSS Statistics and thematic analysis, respectively. Results: Eighty-seven HCPs completed the VR experience across twelve workshops. Sixty HCPs participated in the outcome evaluation survey, and ten participated in interviews. HCPs reported high satisfaction with the immersive learning, citing its relevance and ease of use. Based on survey responses, HCPs' most important learnings were a "better understanding of the impact of MG on patients' lives" (n/N=46/60) and "developing empathy for how a patient with MG might feel" (n/N=37/60). HCPs expressed commitment to changing their practice. Quantitative analysis revealed significant improvements in most TDF domains and SDM post-intervention, with the TDF domain "beliefs about capabilities" emerging as the strongest predictor of SDM. Conclusion: Our study found that the immersive VR intervention effectively increased HCP empathy, knowledge and attitudes in MG care. The program's patient-centric design ensured content relevance. These findings suggest that VR-based learning is a valuable tool for medical education and the improvement of SDM, particularly in rare diseases like MG.