Experiencing virtual patients in clinical learning: a phenomenological study

Abstract

Computerised virtual patients (VPs) are increasingly being used in medical education. With more use of this technology, there is a need to increase the knowledge of students' experiences with VPs. The aim of the study was to elicit the nature of virtual patients in a clinical setting, taking the students' experience as a point of departure. Thirty-one students used VPs as a mandatory part of an early clinical rotation in rheumatology. Using the qualitative approach of phenomenology, we interviewed these students and then analysed data regarding their experiences of VPs as a learning activity. The result shows that students perceived VP activities in relation to actual patients, the clinical context and other learning activities. The VPs represented typical clinical cases which encouraged clinical reasoning and allowed for decision making. The students experienced the activities as integrating biomedical knowledge and clinical experience, providing structure that prepared for the unstructured clinical environment and patient encounters under unstressful conditions. However, the VPs were experienced as lacking the emotional interactivity and complexity of actual patients. Theoretical frameworks of clinical reasoning and experiential learning are suggested as foundations for further educational integration of VPs in the clinical environment. VP activities during clinical rotations provide experiences of clinical reality and allow students to solve problems actively. These features are dependent on VP technology but are also contingent on the surrounding environment.

The use of virtual patients in medical education

“…• Studies regarding its place in the curriculum Studies have shown that designs that are associated with seminars, courses and corresponding tests [40], that are balanced [41] and appropriately integrated into the curriculum [42] all motivate students. Edelbring emphasized the importance of assessing VP-based activities not as separate phenomena but as an integrated whole together with other educational activities [42].…”

“…Edelbring emphasized the importance of assessing VP-based activities not as separate phenomena but as an integrated whole together with other educational activities [42].…”

Virtual patients: the influence of case design and teamwork on students’ perception and knowledge – a pilot study

“…In a study by Edelbring et al [14], students reported a perceived benefit to their clinical reasoning skills from working on VP cases with a partner and discussing their patient management approaches. Furthermore, motivation has been identified as being a dependent variable influenced by autonomy [15], which is also a necessary skill when working on VP cases.…”

Stories of becoming an emergency medicine physician

“…The use of phenomenology as both a method and theoretical framework within medical research broadly and post-graduate medical residency specifically, is modest at best. However, there do exist at least three instances of phenomenology being used specifically to investigate topics related to medical education, including conceptions of being a health advocate (Dharamsi et al, 2010;Edelbring, Dastmalchi, Hult, Lundberg, & Owe Dahlgren, 2011;Tavakol, Dennick, & Tavakol, 2012), and with palliative medicine (Mak & Elwyn, 2003). Since this study is grounded within a hermeneutic phenomenological tradition, it will be a novel addition to a number of areas of literature, including qualitative health research, emergency medicine, post-graduate medical education and workplace learning.…”

“…There are opportunities where further training could incorporate Lowenstein's (1994) research on the 'curiosity gap' whereby Residents participate in simulations prior to the didactic sessions such that they are more engaged with the material presented. Nevertheless, given the increased use of simulation training within the context of PGME, this area warrants further research, especially when related to increasing the fidelity of simulations (Edelbring et al, 2011;Teteris, Fraser, Wright & McLaughlin, 2012). This would benefit both the learners, but also by extension the patients.…”