Virtual patients for education, assessment and research : A webbased approach

Abstract: Virtual simulations of patient encounters have been an increasingly important complement in the development of healthcare competence. Virtual patients (VPs) are interactive computer programs that simulate real-life clinical scenarios, provide an effective way for healthcare professionals and students to not only learn about a wide range of clinical topics, but also to practice in a virtual and therefore safe environment. The purpose of this thesis is to systematically design and develop a virtual patient system (Web-SP), evaluate its usability, acceptance and applicability in health-sciences education. Then as a subsequent step, use the newly-developed Web-SP system as a research tool to produce evidence for best practices regarding the authoring and implementation of VPs in health-sciences curricula and their use for learning and assessment. Four studies were undertaken. Study I focused on the design and development of the Web-SP system with the aim to enable the authoring of VPs by faculty. Study II aimed at evaluating the usability, acceptance and applicability of Web-SP when integrated in medicine, dentistry and pharmacy courses. Study III explored the importance of the feedback module and its influence on the utilization of virtual patients by students. Study IV was a randomized controlled trial (RCT) that investigated the impact of the clinical vignette component using history taking reasoning and therapeutic decisions as outcome measures. The evaluation of the usability and the acceptance of the Web-SP system, as well as the built-in authoring environment, were positive. The students found the VPs created by the teachers to be engaging, realistic, fun to use, instructive and relevant to their courses. The applicability of Web-SP was demonstrated when integrated in three different healthcare science courses and applied in pre-clinical and clinical settings. The results of the experimental studies showed that the students clearly favoured VPs with feedback compared to VPs without feedback. Furthermore, the availability of feedback fostered a deeper mode of engagement with the VPs. Furthermore, an RCT showed that variations in the amount of clinical data presented in the introductory clinical vignette component did not have an impact on the history-taking reasoning, nor the therapeutic decisions, an important finding when VPs are used to assess the students performances. The increasing adoption and implementation of Web-SP at several universities opens up opportunities for joint efforts in planning and conducting interventions to produce conclusive evidence, and also enables scientific procedures such as multi-centre RCT and systematic reviews.