Interactive Clinical Avatar Use in Pharmacist Preregistration Training: Design and Review

Examining the Impact of Digital Human Gaze Expressions on Engagement Induction

With advancements in technology, digital humans are becoming increasingly sophisticated, with their application scope widening to include interactions with real people. However, research on expressions that facilitate natural engagement in interactions between real people and digital humans is scarce. With this study, we aimed to examine the differences in user engagement as measured by subjective evaluations, eye tracking, and electroencephalogram (EEG) responses relative to different gaze expressions in various conversational contexts. Conversational situations were categorized as face-to-face, face-to-video, and digital human interactions, with gaze expressions segmented into eye contact and gaze avoidance. Story stimuli incorporating twelve sentences verified to elicit positive and negative emotional responses were employed in the experiments after validation. A total of 45 participants (31 females and 14 males) underwent stimulation through positive and negative stories while exhibiting eye contact or gaze avoidance under each of the three conversational conditions. Engagement was assessed using subjective evaluation metrics in conjunction with measures of the subjects' gaze and brainwave activity. The findings revealed engagement disparities between the face-to-face and digital-human conversation conditions. Notably, only positive stimuli elicited variations in engagement based on gaze expression across different conversation conditions. Gaze analysis corroborated the engagement differences, aligning with prior research on social sensitivity, but only in response to positive stimuli. This research departs from traditional studies of un-natural interactions with digital humans, focusing instead on interactions with digital humans designed to mimic the appearance of real humans. This study demonstrates the potential for gaze expression to induce engagement, regardless of the human or digital nature of the conversational dyads.

A systematic review on the use of virtual patient and computer-based simulation for experiential pharmacy education

Background

Simulation use is rapidly expanding, with technologies like virtual patients (VPs) and computer-based simulation (CBS) allowing for educators to equip pharmacy students with the necessary skills that are aligned with the demands and expectations of a practicing pharmacy professional. These technologies enable pharmacy students to be exposed to challenging or infrequent patient case scenarios in an authentic pharmacy setting. This allows for the reinforcing of care processes and for techniques and crucial skills to be applied.

Aim of the study

To consolidate the existing evidence regarding the utilization of VPs and CBS in preparing and supporting students in pharmacy experiential education and evaluate the effectiveness of these approaches in enhancing student pharmacists' learning outcomes, including knowledge, skills, confidence, enjoyment, and engagement.

Methods

Five electronic databases were searched using combined keyword and indexing terms (when available) with Boolean operators for the literature search. Studies that reported or investigated the use of VPs and CBS in pharmacy experiential education were included. Data on study design, demographics of participants, information on the interventions, course/skills, primary and secondary outcomes, and qualitative findings were extracted.

Results

A total of 911 unique articles were initially identified and filtered down to 19 articles fitting within the inclusion criteria. The selected 19 articles involved student pharmacists (Y1-Y5) and pre-registered pharmacists from ten countries. Simulation tools were used in various pharmacy courses, including Advanced Pharmacy Practice Experience (APPE), Advanced Pharmaceutical Care II, and Medication Management. Implementing these tools in pharmacy experiential education demonstrated a statistically significant improvement in student knowledge (p < 0.05). Most students agreed/strongly agreed that practicing with virtual patient cases enhanced their clinical reasoning, counseling skills, confidence in communication, and attitudes toward the courses.

Conclusions

This systematic review supports the use of VPs and CBS in pharmacy experiential education and provides practical recommendations for educators including selecting suitable tools, implementing them strategically within courses, integrating them with existing activities, and considering financial and IT support.

The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China

BACKGROUND

The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC.

OBJECTIVE

This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement.

METHODS

Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement.

RESULTS

Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, -0.03 (95% CI -0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place.

CONCLUSIONS

There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the "know-do" gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.