Virtual patient design in undergraduate education
Background\ud Virtual patients (VPs) are computerised online representations of realistic clinical cases. Recent technology and software advances position VPs as a standardised, accessible, collaborative teaching tool. We do not know how they should be designed. My research question is: how do different VP design principles influence student experiences when completing VPs? The aim of this study is to provide qualitative and quantitative research evidence to support VP design and development.\ud \ud Methods\ud This research project uses qualitative and quantitative methods to evaluate how VP design influences medical student learning, based on groups of students from three UK medical schools (Warwick, Birmingham, Keele). The initial qualitative research component is a grounded theory (GT) focus group study evaluating VP design properties. The literature review and qualitative research identified the two most important VP properties to research were: (1) branching within the cases; and (2) structured clinical reasoning instruction (SR) intended to promote good clinical decision making in the VPs. The quantitative research component is a multi-centre randomised experimental 2x2 factorial study of undergraduate students at three UK medical schools, conducted to a published protocol. I investigate two most important independent VP design variables: (1) branching, present or absent; (2) SR, present or absent. Outcomes including: (a) VP scores; (b) VP student evaluations; (c) metrics collected from the VP environment; (d) student self-reported case preferences and (e) summative assessment results. The study has institution ethics approval.\ud \ud Results\ud In the qualitative study of six focus groups (n=46), I produced a model describing how VP design influences learning. In the quantitative research, 572 students completed 1773 VPs, and 1223 evaluations, with 296 (50.1%) students completing all four VPs (1184). Key findings were: student expressed preferred SR when present (70.5% of student, P<0.001); there were no significant differences in adjusted global VP scores or evaluation scores (all p>0.3 for the independent variables); institution factors played an important role with higher scores at one centre (p<0.001); and there were significant improvements in Bayesian reasoning with SR present (7% improvement, p<0.001).\ud \ud Discussion\ud This original research is the first GT study into VPs. The quantitative component is the largest study to date in the literature exploring VP design variables. It provides practical lessons for authors and institutions for design and delivery of VPs. All VPs used are available as open education resources.
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