Web-based virtual patients in nursing education: development and validation of theory-anchored design and activity models

Integrating virtual patients into undergraduate health professions curricula: a framework synthesis of stakeholders' opinions based on a systematic literature review

BACKGROUND

Virtual patients (VPs) are widely used in health professions education. When they are well integrated into curricula, they are considered to be more effective than loosely coupled add-ons. However, it is unclear what constitutes their successful integration. The aim of this study was to identify and synthesise the themes found in the literature that stakeholders perceive as important for successful implementation of VPs in curricula.

METHODS

We searched five databases from 2000 to September 25, 2023. We included qualitative, quantitative, mixed-methods and descriptive case studies that defined, identified, explored, or evaluated a set of factors that, in the perception of students, teachers, course directors and researchers, were crucial for VP implementation. We excluded effectiveness studies that did not consider implementation characteristics, and studies that focused on VP design factors. We included English-language full-text reports and excluded conference abstracts, short opinion papers and editorials. Synthesis of results was performed using the framework synthesis method with Kern's six-step model as the initial framework. We appraised the quality of the studies using the QuADS tool.

RESULTS

Our search yielded a total of 4808 items, from which 21 studies met the inclusion criteria. We identified 14 themes that formed an integration framework. The themes were: goal in the curriculum; phase of the curriculum when to implement VPs; effective use of resources; VP alignment with curricular learning objectives; prioritisation of use; relation to other learning modalities; learning activities around VPs; time allocation; group setting; presence mode; VPs orientation for students and faculty; technical infrastructure; quality assurance, maintenance, and sustainability; assessment of VP learning outcomes and learning analytics. We investigated the occurrence of themes across studies to demonstrate the relevance of the framework. The quality of the studies did not influence the coverage of the themes.

CONCLUSIONS

The resulting framework can be used to structure plans and discussions around implementation of VPs in curricula. It has already been used to organise the curriculum implementation guidelines of a European project. We expect it will direct further research to deepen our knowledge on individual integration themes.

Application of Anchored Instructional Method in Cardiac Surgery ICU Nursing Education

BACKGROUND

This study investigated the impact of applying the anchored teaching mode with nursing interns on the cardiac surgery intensive care unit (CSICU).

METHOD

A total of 110 interns were divided into a control group (taught through traditional methods) and an experimental group (taught using the anchored teaching mode). The anchored mode, emphasizing student-centered learning, included creating scenarios, identifying problems, using self-directed and collaborative learning, and evaluating outcomes.

RESULTS

Our study found that the experimental group showed significantly higher scores in emergency response ability, nursing skills, and teaching effectiveness compared with the control group at graduation.

CONCLUSION

The findings suggest that implementing the anchored teaching mode can effectively enhance the education of nursing interns on the CSICU, emphasizing the need for further research across different departments and types of hospitals. [J Contin Educ Nurs. 2024;55(7):359-364.].

Acceptance of virtual patients as a continuous professional development approach among practicing nurses in primary health care settings in a low-income country: a quasi-experimental posttest setup design

BACKGROUND

Virtual patients are an educational technological approach used in healthcare education. Its distinctive features have rendered virtual patient technology appealing for the training of medical and healthcare students, particularly in the enhancement of clinical reasoning. Virtual patients are less often applied for continuous professional development for practicing healthcare providers, and there is a scarcity of studies exploring this possibility. This study aimed to assess the acceptability of nurses for using virtual patients as a continuous professional development approach.

METHOD

The study used a quasi-experimental posttest setup design. The study was conducted in ten primary healthcare settings in Rwanda. Among 76 nurses who consented to participate in the study, 56 completed the intervention and responded to the study questionnaire. Following a one-week program of continuous professional development on four non-communicable diseases, the study used a self-administered questionnaire based on the Technology Acceptance Model 3 to collect data. Descriptive analysis served as the primary method for analyzing participants' responses. The study also used a correlation test to assess the relationship of variables.

RESULTS

Across all items in the questionnaire, the median response tended towards either agree or strongly agree, with only a minority number of participants expressing strong disagreement, disagreement, or neutrality. The results indicated a significant positive correlation between perceived usefulness and behavior intention (p < 0.001).

CONCLUSION

The findings indicate an acceptability and behavioral intention of adopting virtual patients as an alternative continuous professional development approach among nurses working at health centers in Rwanda or other locations with similar contexts.

Psychometric properties of the persian version of the nursing clinical reasoning scale

AIM

The aim of this study was to translate the Nursing Clinical Reasoning Scale (NCRS) into Persian and evaluate its psychometric properties.

DESIGN

This study was a methodological and cross-sectional study.

METHODS

This methodological study was conducted in 2020 in a teaching hospital. After obtaining necessary permission from its developers, NCRS was translated into Persian through the method proposed by the World Health Organization. Then, its face, content, and construct validity and reliability were assessed. For construct validity assessment through exploratory and confirmatory factor analyses, 300 nurses (two 150-nurse samples), who had randomly been selected, completed the instrument. Reliability also assessed through the internal consistency and the stability methods. Data were analysed using the SPSS (v. 20.0) and the AMOS (v. 5.0) software.

RESULTS

The content validity indices of NCRS and its items were 0.97 and more than 0.79, respectively. Exploratory factor analysis revealed an assessment and confirmation factor and an implementation and reflection factor for the scale which together explained 57.30% of the total variance. Confirmatory factor analysis also confirmed this two-factor structure (χ2 /df = 2.11, NNFI = 0.952, RMSEA = 0.053, CFI = 0.91, GFI = 0.94, IFI = 0.95, and NFI = 0.96). The Cronbach's alpha and the intraclass correlation coefficient values of the scale were 0.96 and 0.94, respectively.

PUBLIC CONTRIBUTION

The Persian NCRS can help nursing policy makers and mentors identify the need for developing nurses' and nursing students' CR skills and implement need-based educational courses to improve these skills. Moreover, it helps determine whether the educational programmes are effective in improving nurses' CR skills and clinical competence.

Theories informing technology enhanced learning in nursing and midwifery education: A systematic review and typological classification

BACKGROUND

Learning is a complex process involving internal cognitive processes and external stimuli from curricula, pedagogical strategies, and the learning environment. Theories are used extensively in higher education to understand the intricacies of adult learning and improve student outcomes. Nursing and midwifery education uses a range of technology enhanced learning (e-learning) approaches, some of which are underpinned by theoretical frameworks.

OBJECTIVE

Synthesise literature on theories that inform technology enhanced learning in nursing and midwifery education.

DESIGN

A systematic review.

DATA SOURCE

CINAHL, ERIC, MEDLINE and PubMed were searched for relevant studies (2000-2021). Reference lists of related literature reviews were hand searched.

REVIEW METHODS

Title and abstract, followed by full texts were screened by two reviewers independently using predefined eligibility criteria. Quality appraisal was not undertaken. Data were extracted and Merriam and Bierema's typology of adult learning theories used to categorise theories in each study.

RESULTS

Thirty-three studies were included, incorporating twenty-nine distinct learning theories from the behaviourist, cognitivist, constructivist, and social cognitivist domains, with constructivist being the most widely used. Kolb's Experiential Learning Theory and Driscoll's Constructivist Learning Theory were the most commonly reported theories. The population of learners were mainly undergraduate nursing students who used a range of online, mobile, blended or computerised learning, virtual reality, or digital forms of simulation, primarily in university settings. Theories were employed to inform the technology enhanced learning intervention or to help explain how these could improve student learning.

CONCLUSION

This review highlighted a range of theories, particularly constructivist approaches, that underpin research on technology enhanced learning in nursing education, by informing or explaining how these digital interventions support learning. More rigorous research that examines the myriad of theoretical frameworks and their effectiveness in informing and explaining technology enhanced learning is needed to justify this approach to pedagogical nursing research and practice.

Written and computer simulation on the moral sensitivity of nurses

Background: Moral sensitivity is the first step towards ethical decision-making. This sensitivity should form a basic attitude in healthcare team members, particularly nurses, toward providing effective and ethical care. This is highlighted in intensive care units (ICUs) where close attention should be paid to patient rights and moral or ethical decision-making.Objective: The present study aimed at determining and comparing the effect of written simulation and computer simulation of a virtual patient on the development of moral sensitivity of ICU nurses.Research design: Randomized controlled trial with one control arm and two experimental arms.Participants and content: This study involved 204 ICU nurses working in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran, from 2019 to 2021 using a random allocation method. The participants were allocated to three groups comprising virtual patient computer simulation, written simulation, and the no simulation control group. After training based on a Patient Rights Charter, five scenarios, with themes reflecting the clauses of the Patient's Rights Charter, were written as a computer program and text for the computer simulation and written simulation groups, respectively. Finally, nurses' moral sensitivity was assessed using the Lützén moral sensitivity questionnaire as pre- and post-tests (immediately and 2 months after the intervention).Ethical considerations: Ethical permission was obtained for the study. All the participants signed the informed consent before the study onset.Results: The study results showed a significant difference in moral sensitivity among the three groups before the intervention (p = 0.003). Immediately after the intervention compared to pre-intervention, the three groups showed no significant differences in this regard (p = 0.056), however a significant difference among the three groups was found 2 months post-intervention (p < 0.001).

The value of a redesigned clinical course during COVID-19 pandemic: an explorative convergent mixed-methods study

Background

The COVID-19 lockdown in March 2020 had a significant consequence for nursing students worldwide including limited access to learning situations in clinical rotation. Therefore, this study aims to explore how an innovative redesign of a clinical course in a time of pandemic supported nursing students in learning the fundamentals of care in their first year. The redesign involved the transformation of a traditional hands-on clinical course into a technology-enhanced learning environment.

Design

This was an explorative convergent mixed-methods study using both quantitative and qualitative methods.

Methods

Twenty-four first-year nursing students responded to an online questionnaire with open-ended questions. Two nursing students and one faculty member participated in individual online interviews, and three faculty members participated in an online focus group interview. All the data were collected in June 2020. The quantitative data were analyzed using descriptive statistics and the qualitative data using content analysis. The GRAMMS guideline was applied.

Results

The students achieved the learning outcomes regarding fundamental care, basic physical assessment skills, and clinical reasoning with the help of academic assignments, multimedia learning resources, and virtual patients. Further, six central aspects of the facilitator role in the virtual simulation were identified. The aspect that was considered most valuable involved uncovering the “red thread” between different areas of knowledge in the first year of nursing education; this supported the students to better understand how to think and talk like a nurse.

Conclusion

This study offers insight into how a technology-enhanced clinical course can foster the learning of fundamental nursing care, basic physical assessment skills, and clinical reasoning skills; enhancing students’ preparedness for clinical hours. Virtual patients’ scenarios contributed to integrating different types of knowledge and skills that are important when providing nursing care for patients in clinical practice. This study also highlighted a gap in pedagogical competence among faculty members with regards to facilitating learning in a technology-enhanced learning environment. Study findings suggest promising pedagogical strategies that should be further developed post-pandemic, in response to the call for a renewal of nursing education using more technologically supported learning designs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00872-8.

Effect of educational intervention on clinical reasoning skills in nursing: A quasi-experimental study

This study evaluated the effect of an educational intervention based on virtual clinical simulation and problem-based learning using a mobile application in a clinical nursing education context as a tool to improve clinical reasoning skills of students on the second year of nursing graduation. A prospective quasi-experimental study was conducted in the year 2018, and assessments were performed before and after the educational intervention. A random convenience sample (n = 32) of nursing students in the second year of a public university in Brazil was divided equally into experimental and control groups. The experimental group underwent educational intervention about clinical reasoning skills and measured the quality of the Diagnostician Nurse software by LORI 2.0 instrument. The control group experienced the conventional class on clinical reasoning skills. Four clinical cases were used to assess reasoning skills before and after the educational intervention. The data were analyzed using descriptive and inferential statistics. The experimental group showed a statistically significant difference regarding the prioritization of nursing diagnoses (p = 0.014) and a higher final score. There was a statistically significant difference in performance between the pre- and post-test in the grades of the students who participated in the intervention (p = 0.003). The control group also showed statistical significance in the score attributed to the clinical reasoning process (p = 0.015). In addition, the Diagnostician Nurse software had excellent usability and quality evaluations (SUS 87.81 and LORI 4.66, respectively). It is concluded that educational intervention based on virtual clinical simulation and learning problems using the Diagnostician Nurse software is effective as a tool to improve clinical reasoning skills and can support early detection of patients. The educational intervention developed was of high quality and attractive and improved students' motivation for the teaching-learning process.

Case-based learning: Facilitating nurse practitioner clinical learning with virtual patient cases

ABSTRACT

Through unfolding patient case studies, case-based learning has the potential to facilitate nurse practitioner (NP) student application of didactic knowledge to clinical practice, thus narrowing the theory-practice gap. The purpose of this study was to investigate NP student experience using virtual patient cases to supplement clinical learning. Bloom's cognitive taxonomy served as the framework. Seven students enrolled in the final semester of a distance family NP program completed 45 virtual patient cases over an 8-week period. Case topics covered a variety of primary care problems. Usability of the virtual learning platform was measured by the System Usability Scale. Clinical learning value was measured by the Student Satisfaction and Self-Confidence in Learning Scale. Students rated their perceived ability to manage common primary care problems at the start and end of the 8-week period. Students found the virtual learning platform highly usable and were satisfied and self-confident with their learning. Student perceived ability to manage common primary care problems increased for all virtual case topics from start to end of course. This study provides further evidence that well-designed virtual patient cases have the potential to effectively supplement NP student clinical learning. These results are important as NP faculty look for alternative forms of clinical learning to supplement direct care clinical experiences.

A virtual patient model for students' interprofessional learning in primary healthcare

Objectives

Interprofessional education is important for increasing the quality of patient care, but organising it in primary healthcare is still challenging. The aim of this study was to develop and assess a virtual patient model for primary healthcare and to investigate students' perceptions of learning with this interprofessional virtual patient model.

Methods

The virtual patient case described a patient with several medical conditions who had returned home after surgery. The virtual patient included text files, short videos, and links to illustrate different health professions' roles in home care. Ten interprofessional groups with 39 students assessed the virtual patient from four different study programmes: nursing, physiotherapy, medicine, and occupational therapy. The students answered a questionnaire about how they perceived the usability of the virtual patient and participated in group interviews. Qualitative content analysis was used to analyse the data from the semi-structured group interviews.

Results

The analysis of the interviews resulted in four main categories: The virtual patient model facilitated the learning process; It was beneficial to have students from different programmes in the group when working with the virtual patient; Working with the virtual patient helped the students to understand the roles and competencies of their own and other professions and All professions are needed in clinical work in order to help the patient. The students perceived that the mixture of text and multimedia made the virtual patient seem authentic and stimulated their group discussions, which they valued most. The students gave generally high points for usability in the questionnaire, but they also gave input for improvement of the program in their comments.

Conclusions

The interprofessional virtual patient model facilitated interactions and discussions between students and may be a useful complement for interprofessional education in clinical contexts and might be a suitable tool in preparing students for future teamwork.

Exploring the application of mixed reality in Nurse education

The aim of this study was to explore the contemporary application, inclusive of advantages and challenges, of mixed reality (MR) technology in the education of nursing students and, its contribution to enhanced learning. A descriptive evaluation design was undertaken to explore the learning experience of second year students enrolled in a 3 year Bachelor of Nursing programme. One hundred per cent of the students stated that the experience assisted them in their learning. The key themes of engagement in learning, and developing clinical judgement emerged from students' responses, and demonstrated ways in which students felt MR enhanced their learning. This emerging technology has the potential to assist in enhancing clinical judgement and developing skills in noticing physical cues in patients. The implementation of MR may also enhance student motivation and engagement with learning.

Virtual patient technology to educate pharmacists and pharmacy students on patient communication: a systematic review

Background

Virtual patients (VPs) are a sub-type of healthcare simulation that have been underutilised in health education. Their use is increasing, but applications are varied, as are designs, definitions and evaluations. Previous reviews have been broad, spanning multiple professions not accounting for design differences.

Objectives

The objective was to undertake a systematic narrative review to establish and evaluate VP use in pharmacy. This included VPs that were used to develop or contribute to communication or counselling skills in pharmacy undergraduates, pre-registration pharmacists and qualified pharmacists.

Study selection

Eight studies were identified using EBSCO and were quality assessed. The eligibility criteria did not discriminate between study design or outcomes but focused on the design and purpose of the VP. All the included studies used different VP applications and outcomes.

Findings

Four themes were identified from the studies: knowledge and skills, confidence, engagement with learning, and satisfaction. Results favoured the VPs but not all studies demonstrated this statistically due to the methods. VP potential and usability are advantageous, but technological problems can limit use. VPs can help transition knowledge to practice.

Conclusions

VPs are an additional valuable resource to develop communication and counselling skills for pharmacy students; use in other pharmacy populations could not be established. Individual applications require evaluation to demonstrate value due to different designs and technologies; quality standards may help to contribute to standardised development and implementation in varied professions. Many studies are small scale without robust findings; consequently, further quality research is required. This should focus on implementation and user perspectives.

What Can Be Achieved With Motivation-Based Teaching of Medical Students? A Monocentric Retrospective Audit of Retention Among Highly Motivated Graduates Who Underwent the Learning-by-Doing Concept in Anesthesiology and Intensive Care Medicine

Background

Medical education, in general, is undergoing a significant shift from traditional methods. It becomes very difficult to discover effective teaching methods within the limited possibilities in patient hands-on education, especially as seen in anesthesiology and intensive care medicine (AIM) teaching. Motivation-based teaching is very popular in all other aspects of education, but it has received scant attention in medical education literature, even though it can make a real difference for both students and physicians.

Objective

The primary aim of this retrospective audit was to find out if proper motivation-based teaching of students via the development of AKUTNE.CZ’s serious games can help retain graduates of the Faculty of Medicine of Masaryk University (FMMU) for the AIM specialty.

Methods

Motivation-based teaching and the learning-by-doing concept were applied to a subject called Individual Project. Our topic, The Development of the Multimedia Educational Portal, AKUTNE.CZ, has been offered since 2010. The objective has been the development of supportive material in the form of interactive algorithms, serious games, and virtual patients for problem-based learning or team-based learning lectures aimed at acute medicine. We performed a retrospective questionnaire evaluation of all participants from the 2010-2017 period, focusing on their choice of medical specialty in 2017. The data were reported descriptively.

Results

We evaluated 142 students who passed Individual Project with topic The Development of the Multimedia Educational Portal, AKUTNE.CZ during 2010 to 2017. In this period, they developed up to 77 electronic serious games in the form of interactive multimedia algorithms. Out of 139 students in general medicine, 108 students (77.7%) had already graduated and 37 graduates (34.3%) worked in the AIM specialty. Furthermore, 57 graduates (52.8%) chose the same specialty after graduation, matching the topic of their algorithm, and 37 (65%) of these graduates decided to pursue AIM.

Conclusions

Motivation-based teaching and the concept of learning-by-doing by the algorithm/serious game development led to the significant retention of FMMU graduates in the AIM specialty. This concept could be considered successful, and as the concept itself can also be well integrated into the teaching of other medical specialties, the potential of motivation-based teaching should be used more broadly within medical education.

Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial

Background

In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students’ intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed.

Nowadays, professors play the role of learning facilitators rather than simple “lecturers” and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time.

Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings.

Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy.

However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning.

Objective

This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students.

Methods

A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers.

We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students’ levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention.

Results

The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054).

Conclusions

The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.

An Integrative Review of Clinical Reasoning Teaching Strategies and Outcome Evaluation in Nursing Education

BACKGROUND

This study explored teaching strategies used to promote clinical reasoning in nursing education and identify outcomes used to evaluate effectiveness.

METHOD

The integrative review framework by Whittemore and Knafl (2005) was used in this study.

RESULTS

Strategies included simulation (n = 10); active learning strategies such as case studies, reflection, journaling, and collaborative learning (n = 13); teaching strategies such as think aloud or case studies with simulation (n = 12); and experiential or clinical experiences (n = 2). Although most studies used exams, worksheets (n = 19), or observations by clinical instructors (n = 2) to measure effectiveness, some studies (n = 8) also used surveys to measure student satisfaction, engagement, or perception; three studies measured the student's ability to use the instrument.

CONCLUSION

Improving clinical thinking requires development of innovative, effective teaching strategies. Instruments that can accurately evaluate teaching and learning strategies are needed to advance this educational initiative and improve quality of care.

Nursing students' perceptions of a video-based serious game's educational value: A pilot study

BACKGROUND

Despite an increasing number of serious games (SGs) in nursing education, few evaluation studies specifically address their educational value in terms of face, content, and construct validity.

OBJECTIVES

To assess nursing students' perceptions of a video-based SG in terms of face, content, and construct validity. In addition, the study assessed perceptions of usability, individual factors, and preferences regarding future use.

DESIGN

A pilot study was conducted.

SETTING AND PARTICIPANTS

An SG prototype was implemented as part of two simulation courses in nursing education: one for home health care and one for hospital medical-surgical wards. The SG aimed to teach clinical reasoning and decision-making skills to nursing students caring for patients with chronic obstructive pulmonary disease. A total of 249second-year nursing students participated in pilot testing of the SG.

METHOD

A paper-based survey was used to assess students' perceptions of the SG's educational value.

RESULTS

Overall, students from both simulation courses perceived the SG as educationally valuable and easy to use. No significant differences were found in perceptions of educational value between nursing students with previous healthcare experience versus those with none. However, significantly more students in the home healthcare simulation course indicated that the SG tested their clinical reasoning and decision-making skills. Students from both the medical-surgical and home healthcare simulation courses suggested that more video-based SGs should be developed and used in nursing education.

CONCLUSIONS

Overall, the survey results indicate that the participants perceived the SG as educationally valuable, and that the SG has potential as an educational tool in nursing education, especially in caring for patients with chronic diseases and in home healthcare simulation. Showing a SG's educational value and user acceptance among nursing students may justify the development and application of more SGs in nursing education.

Transforming Health Care One Team at a Time: Ten Observations and the Trail Ahead

The present review synthesizes existing evidence and theory on the science of health care teams and health care team training. Ten observations are presented that capture the current state of the science, with applications to both researchers and practitioners. The observations are drawn from a variety of salient sources, including meta-analytic evidence, reviews of health care team training, primary investigations, and the authors’ collective expertise in developing and implementing medical team training. These observations provide insight into the team (e.g., psychological safety) and organizational-level (e.g., culture for teamwork) factors that drive effective health care teamwork, as well as advancements and best practices for designing and implementing team training initiatives (e.g., multilevel measurement). We highlight areas where new knowledge has emerged, and offer directions for future research that will continue to improve our understanding of health care teams in the future.

Appraising the role of the virtual patient for therapeutics health education

BACKGROUND

Face-to-face instruction, paper-based case-studies and clinical placements remain the most commonly used teaching methods for therapeutics curricula. Presenting clinical content in a didactic manner presents challenges in engaging learners and developing their clinical reasoning skills which may be overcome by inclusion of the virtual patient (VP). Currently there is limited literature examining the use of the VP in therapeutics teaching and learning. This review aimed to determine the role of VPs in therapeutics education, specifically the impact on student experiences, performance, and clinical skills.

METHODS

A search of primary literature was conducted with search terms including virtual patient, education, health, AND learning. Boolean operators were applied to include studies from health relevant fields with article titles and abstracts vetted.

RESULTS

Nine of the 21 included studies were control-matched, and all but one compared VPs to traditional teaching. VPs enhanced the learning experience in all 17 studies that measured this outcome. Fourteen studies measured performance and clinical skills and 12 found VPs were beneficial, while two did not. The VP was not superior to traditional teaching in all studies, but the VP appeared beneficial to the student learning experience. Discrepancy was found between the impact of VPs on short- and long-term knowledge.

IMPLICATIONS

The VP appears to enhance the student learning experience and has a role in therapeutics education, however a blended-learning (BL) approach may be required to account for individual learning styles. Additional investigation is required to clarify the efficacy of the VP, particularly as a component of BL, on longer-term knowledge retention.

Evaluation of the Use of a Virtual Patient on Student Competence and Confidence in Performing Simulated Clinic Visits

Objective. To assess the effect of incorporating virtual patient activities in a pharmacy skills lab on student competence and confidence when conducting real-time comprehensive clinic visits with mock patients. Methods. Students were randomly assigned to a control or intervention group. The control group completed the clinic visit prior to completing virtual patient activities. The intervention group completed the virtual patient activities prior to the clinic visit. Student proficiency was evaluated in the mock lab. All students completed additional exercises with the virtual patient and were subsequently assessed. Student impressions were assessed via a pre- and post-experience survey. Results. Student performance conducting clinic visits was higher in the intervention group compared to the control group. Overall student performance continued to improve in the subsequent module. There was no change in student confidence from pre- to post-experience. Student rating of the ease of use and realistic simulation of the virtual patient increased; however, student rating of the helpfulness of the virtual patient decreased. Despite student rating of the helpfulness of the virtual patient program, student performance improved. Conclusion. Virtual patient activities enhanced student performance during mock clinic visits. Students felt the virtual patient realistically simulated a real patient. Virtual patients may provide additional learning opportunities for students.

Using Foreign Virtual Patients With Medical Students in Germany: Are Cultural Differences Evident and Do They Impede Learning?

Background

Learning with virtual patients (VPs) is considered useful in medical education for fostering clinical reasoning. As the authoring of VPs is highly demanding, an international exchange of cases might be desirable. However, cultural differences in foreign VPs might hamper learning success.

Objective

We investigated the need for support for using VPs from the United States at a German university, with respect to language and cultural differences. Our goal was to better understand potential implementation barriers of a intercultural VP exchange.

Methods

Two VPs were presented to 30 German medical students featuring a cultural background different from German standards with respect to diagnostic and therapeutic procedures, ethical aspects, role models, and language (as identified by a cultural adaptation framework). Participants were assigned to two groups: 14 students were advised to complete the cases without further instructions (basic group), and 16 students received written explanatory supplemental information specifically with regard to cultural differences (supplement group). Using a 6-point scale (6=strongly agree), we analyzed the results of an integrated assessment of learning success as well as an evaluation of cases by the students on usefulness for learning and potential issues regarding the language and cultural background.

Results

The German students found it motivating to work with cases written in English (6-point scale, 4.5 points). The clinical relevance of the VPs was clearly recognized (6 points), and the foreign language was considered a minor problem in this context (3 points). The results of the integrated learning assessment were similar in both groups (basic 53% [SD 4] vs supplement 52% [SD 4] correct answers, P=.32). However, students using the supplemental material more readily realized culturally different diagnostic and therapeutic strategies (basic 4 vs supplement 5 points, P=.39) and were less affirmative when asked about the transferability of cases to a German context (basic 5 vs supplement 3 points, P=.048).

Conclusions

German students found English VPs to be highly clinically relevant, and they rated language problems much lower than they rated motivation to work on cases in English. This should encourage the intercultural exchange of VPs. The provision of supplemental explanatory material facilitates the recognition of cultural differences and might help prevent unexpected learning effects.

Online Tobacco Cessation Training and Competency Assessment for Complementary and Alternative Medicine (CAM) Practitioners: Protocol for the CAM Reach Web Study

Background

Complementary and alternative medicine (CAM) practitioners, such as chiropractors, acupuncturists, and massage therapists, are a growing presence in the US health care landscape and already provide health and wellness care to significant numbers of patients who use tobacco. For decades, conventional biomedical practitioners have received training to provide evidence-based tobacco cessation brief interventions (BIs) and referrals to cessation services as part of routine clinical care, whereas CAM practitioners have been largely overlooked for BI training. Web-based training has clear potential to meet large-scale training dissemination needs. However, despite the exploding use of Web-based training for health professionals, Web-based evaluation of clinical skills competency remains underdeveloped.

Objective

In pursuit of a long-term goal of helping CAM practitioners integrate evidence-based practices from US Public Health Service Tobacco Dependence Treatment Guideline into routine clinical care, this pilot protocol aims to develop and test a Web-based tobacco cessation training program tailored for CAM practitioners.

Methods

In preparation for a larger trial to examine the effect of training on CAM practitioner clinical practice behaviors around tobacco cessation, this developmental study will (1) adapt an existing in-person tobacco cessation BI training program that is specifically tailored for CAM therapists for delivery via the Internet; (2) develop a novel, Web-based tool to assess CAM practitioner competence in tobacco cessation BI skills, and conduct a pilot validation study comparing the competency assessment tool to live video role plays with a standardized patient; (3) pilot test the Web-based training with 120 CAM practitioners (40 acupuncturists, 40 chiropractors, 40 massage therapists) for usability, accessibility, acceptability, and effects on practitioner knowledge, self-efficacy, and competency with tobacco cessation; and (4) conduct qualitative and quantitative formative research on factors influencing practitioner tobacco cessation clinical behaviors (eg, practice environment, peer social influence, and insurance reimbursement).

Results

Web-training and competency assessment tool development and study enrollment and training activities are complete (N=203 practitioners enrolled). Training completion rates were lower than expected (36.9%, 75/203), necessitating over enrollment to ensure a sufficient number of training completers. Follow-up data collection is in progress. Data analysis will begin immediately after data collection is complete.

Conclusions

To realize CAM practitioners’ potential to promote tobacco cessation and use of evidence-based treatments, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors (eg, social influence and insurance reimbursement). Given marked differences between conventional and CAM practitioners, extant knowledge about factors influencing conventional practitioner adoption of tobacco cessation behaviors cannot be confidently extrapolated to CAM practitioners. The potential impact of this study is to expand tobacco cessation and health promotion infrastructure in a new group of health practitioners who can help combat the continuing epidemic of tobacco use.

Medical Student and Tutor Perceptions of Video Versus Text in an Interactive Online Virtual Patient for Problem-Based Learning: A Pilot Study

Background

The impact of the use of video resources in primarily paper-based problem-based learning (PBL) settings has been widely explored. Although it can provide many benefits, the use of video can also hamper the critical thinking of learners in contexts where learners are developing clinical reasoning. However, the use of video has not been explored in the context of interactive virtual patients for PBL.

Objective

A pilot study was conducted to explore how undergraduate medical students interpreted and evaluated information from video- and text-based materials presented in the context of a branched interactive online virtual patient designed for PBL. The goal was to inform the development and use of virtual patients for PBL and to inform future research in this area.

Methods

An existing virtual patient for PBL was adapted for use in video and provided as an intervention to students in the transition year of the undergraduate medicine course at St George’s, University of London. Survey instruments were used to capture student and PBL tutor experiences and perceptions of the intervention, and a formative review meeting was run with PBL tutors. Descriptive statistics were generated for the structured responses and a thematic analysis was used to identify emergent themes in the unstructured responses.

Results

Analysis of student responses (n=119) and tutor comments (n=18) yielded 8 distinct themes relating to the perceived educational efficacy of information presented in video and text formats in a PBL context. Although some students found some characteristics of the videos beneficial, when asked to express a preference for video or text the majority of those that responded to the question (65%, 65/100) expressed a preference for text. Student responses indicated that the use of video slowed the pace of PBL and impeded students’ ability to review and critically appraise the presented information.

Conclusions

Our findings suggest that text was perceived to be a better source of information than video in virtual patients for PBL. More specifically, the use of video was perceived as beneficial for providing details, visual information, and context where text was unable to do so. However, learner acceptance of text was higher in the context of PBL, particularly when targeting clinical reasoning skills. This pilot study has provided the foundation for further research into the effectiveness of different virtual patient designs for PBL.

Training with virtual patients in transcultural psychiatry: do the learners actually learn?

BACKGROUND

The rapid increase in the number of patients with diverse ethnic backgrounds and previous exposure to severe mental trauma dictates the need for improvement in the quality of transcultural psychiatric health care through the development of relevant and effective training tools.

OBJECTIVE

This study aimed to evaluate the impact of training with a virtual patient on the learner's knowledge of posttraumatic stress disorder symptoms, clinical management, and basic communication skills.

METHODS

The authors constructed an interactive educational tool based on virtual patient methodology that portrayed a refugee with severe symptoms of posttraumatic stress disorder and depression. A total of 32 resident psychiatrists tested the tool and completed a pre-interaction and post-interaction knowledge test, including skills, at the time and several weeks later.

RESULTS

All of the participants (N=32) completed the pre-interaction and post-interaction test, and 26 (81%) of them completed the online follow-up test. The mean pre-interaction score was 7.44 (male: 7.08, female: 7.65, no statistical significance). The mean post-interaction score was 8.47, which was significantly higher (P<.001) than the pre-interaction score (mean score 7.44). The mean score for the follow-up test several weeks later was 8.38, higher than the pre-interaction score by 0.69 points but not statistically significant.

CONCLUSIONS

Our results suggest that virtual patients can successfully facilitate the acquisition of core knowledge in the field of psychiatry, in addition to developing skills such as clinical reasoning, decision making, and history taking. Repeated training sessions with virtual patients are proposed in order to achieve sustainable educational effects.

Designing and evaluating an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care: randomized controlled trial

Background

Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice.

Objective

This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses’ competencies in acute nursing care.

Methods

Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants’ clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool.

Results

The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving.

Conclusions

Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses’ competencies in acute care. Web-based simulations provide a promising educational tool in institutions where large groups of nurses need to be trained in acute nursing care and accessibility to repetitive training is essential for achieving long-term retention of clinical competency.