Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Abstract

Background Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. Objective The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. Methods We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. Results A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI −0.17 to 0.39, I 2 =74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I 2 =88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. Conclusions Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.

Digital Learning Designs in Physiotherapy Education: A Systematic Review and Meta-Analysis.

“…Five of these twelve studies (26,38,(43)(44)(45) showed results equal to the control group. One of these twelve studies showed results in favour to traditional classroom teaching (30).This leaves a somewhat mixed impression of the effects of different learning designs and is in line with another review regarding different learning designs (3,21).…”

“…For example, using virtual patients in the learning design, evidence shows that when compared with traditional teaching, virtual patients can more effectively improve students' skills, and at least as effectively improve students' knowledge (20). To our knowledge, there is only one systematic review from 2015 that summarizes studies on effects of digital learning technology in physiotherapy education (21). The results showed that online technology (e.g.…”

Constraints Lead to Opportunities for Medical Education in Times of COVID-19 Pandemic

“…The implementation of virtual patient cases is helping to develop clinical reasoning skills but makes it harder for students to develop physical examination skills, and this will be one of the greatest difficulties that students from the clinical years will face. 3 Even with online classes, not all in-person course units can be replaced by digital tools. It Is widely recognized that, on its own, providing formal knowledge is not enough to train a clinical expert.…”

Learning clinical reasoning with virtual patients

“…Teaching medical decision making should target not only the diagnosis itself, but also the reasoning process, which involves the application of medical knowledge, knowledge structure and problem‐solving strategies. However, the clinical thinking process involves unconscious cognitive capacities, which makes teaching and learning in this field challenging 1 . The traditional pedagogies of clinical reasoning are lectures, group discussions, bedside and ambulatory encounters, and case studies.…”