Virtual patient

The term virtual patient is used to describe interactive computer simulations used in health care education.[1] The special focus is targeted on the simulation of clinical processes with virtual patients. Virtual patients combine scientific excellence, modern technologies and the innovative concept of game-based learning. Virtual patients allow the learner to take the role of a health care professional and develop clinical skills such as making diagnoses and therapeutic decisions.[2] Virtual patients have also been considered computer-based simulations designed to complement clinical training.[3] The use of virtual patient programmes is increasing in healthcare, partly in response to increasing demands on health care professionals and education of students but also because they allow opportunity for students to practice in a safe environment.[2] There are many different formats a virtual patient may take. However the overarching principle is that of interactivity—a virtual patient will have mechanisms for the learner to interact with the case and material or information is made available to the learner as they complete a range of learning activities. Interactivity is often included with questions, specific decision-making tasks, text-composition etc. and is non-sequential. Most systems provide quantitative and qualitative feedback.[4]

Forms

Virtual patients may take a number of different forms:[5]

  • Case Presentation: review of patient related cases to reinforce and apply primary medical concepts to real world situations.
  • Interactive Patient Scenario: multimedia patient case designed to teach clinical reasoning skills such as diagnostic test ordering and interpretation.
  • Virtual Patient Game: interactive clinical scenarios that take place in an entirely virtual world designed to practice team training in high risk situations (e.g. avatars within a virtual health facility).    
  • Virtual Reality Scenarios: virtual reality based training exercises to teach procedural skills in situations of varying complexities. (e.g. virtual reality surgical simulation).
  • High Fidelity Software Simulation: computer programs designed to allow the mimicking of human physiological conditions for a variety of clinical scenarios.
  • High Fidelity Manikin: realistic, programmable manikins that are capable of simulating a wide range of clinical scenarios; including simulating cardiac arrest, seizure, etc. complete with simulated, real-time vitals. 
  • Virtual Standardized Patient: an artificially intelligent patient designed with natural language capabilities to assist in training provider-patient communication skills.

Types of interactions

A number of different modes of virtual patient delivery have been defined:[6]

  • Predetermined scenario [directed mode]
  • The learner may build up the patient or case data from observations and interactions [blank mode]
  • The learner may view and appraise or review an existing patient or scenario [critique mode or rehearsal mode]
  • The VP may be used as a mechanism to address particular topics [context mode]
  • The learner may use a scenario or patient to explore personal/professional dimensions [reflective mode]
  • Banks of patients or scenarios may collectively address broad issues of healthcare [pattern mode]

Possible benefits

Virtual patients have been shown to be a time-efficient and cost-effective method of developing clinical reasoning skills in students through independent and repeated practice of physician tasks in a safe environment without the risk of harm to the patient or learner, which can significantly increase the mental pool of learned cases in students.[7][8] Unlike simulated or real patients, virtual patients can be accessed on demand, and the user may monitor a case over several months while spending less than an hour in real-time.[9] Furthermore, virtual patients can be endlessly replayable and can be easily modified to allow the user to explore different clinical scenarios and patient outcomes.[8][10]  In comparison to simulated patients, virtual patients can also be used as a method of standardized assessment that minimizes variance.[11] Despite their efficacy, simulated patients are still a tangent and prosthesis to reality. They should be viewed as educational tools that augment existing modes and methods of clinical teaching.

Over-reliance on hypothetical "average" models has been criticized for not teaching medical students to identify the significant amount of normal variation seen in the real world.[12]

Data standards

The MedBiquitous consortium established a working group in 2005 to create a free and open data standard for expressing and exchanging virtual patients between different authoring and delivery systems. This was in part to address the problem of exchanging and reusing virtual patients and in part to encourage and support easier and wider use of virtual patients in general.

This standard has been very successful and is now widely adopted, e.g. in major projects like eViP.

In 2010, this standard attained status as an ANSI standard.

Notes and references
  1. JiSC (2009). "Repurposing existing virtual patients". Retrieved 2009-08-06.
  2. Imison M, Hughes C (2008). The virtual patient project: using low fidelity, student generated online case studies in medical education (PDF). Hello? Where are you in the landscape of educational technology? Proceedings ascilite Melbourne 2008.
  3. Huang, Grace (May 2007). "Virtual Patient Simulation at U.S. and Canadian Medical Schools". Educational Strategies. 82 (5): 446–51. doi:10.1097/ACM.0b013e31803e8a0a. PMID 17457063.
  4. Talbot, TB; Sagae, K; John, B; Rizzo, AA (2012). "Sorting out the Virtual Patient". International Journal of Gaming and Computer-Mediated Simulations. 4 (3): 707–716. doi:10.1373/clinchem.2011.176958. PMC 5742282. PMID 22266381.
  5. Kononowicz, Andrzej A.; Zary, Nabil; Edelbring, Samuel; Corral, Janet; Hege, Inga (2015-02-01). "Virtual patients - what are we talking about? A framework to classify the meanings of the term in healthcare education". BMC Medical Education. 15: 11. doi:10.1186/s12909-015-0296-3. ISSN 1472-6920. PMC 4318546. PMID 25638167.
  6. Rachel Ellaway (23 November 2004). "Modeling Virtual Patients and Virtual Cases" (PDF).
  7. Stevens, Amy; Hernandez, Jonathan; Johnsen, Kyle; Dickerson, Robert; Raij, Andrew; Harrison, Cyrus; DiPietro, Meredith; Allen, Bryan; Ferdig, Richard (June 2006). "The use of virtual patients to teach medical students history taking and communication skills". American Journal of Surgery. 191 (6): 806–811. doi:10.1016/j.amjsurg.2006.03.002. ISSN 0002-9610. PMID 16720154.
  8. Cook, David A.; Erwin, Patricia J.; Triola, Marc M. (October 2010). "Computerized virtual patients in health professions education: a systematic review and meta-analysis". Academic Medicine. 85 (10): 1589–1602. doi:10.1097/ACM.0b013e3181edfe13. ISSN 1938-808X. PMID 20703150.
  9. Orton, Eric; Mulhausen, Paul (2008). "E-learning virtual patients for geriatric education". Gerontology & Geriatrics Education. 28 (3): 73–88. doi:10.1300/J021v28n03_06. ISSN 0270-1960. PMID 18215989.
  10. Triola, Marc M.; Campion, Ned; McGee, James B.; Albright, Susan; Greene, Peter; Smothers, Valerie; Ellaway, Rachel (2007). "An XML Standard for Virtual Patients: Exchanging Case-Based Simulations in Medical Education". AMIA Annual Symposium Proceedings. 2007: 741–745. ISSN 1942-597X. PMC 2655833. PMID 18693935.
  11. Hubal, R. C.; Kizakevich, P. N.; Guinn, C. I.; Merino, K. D.; West, S. L. (2000). "The virtual standardized patient. Simulated patient-practitioner dialog for patient interview training". Studies in Health Technology and Informatics. 70: 133–138. ISSN 0926-9630. PMID 10977526.
  12. Jacobson, Ella (20 May 2019). "Too Human". Real Life. Retrieved 2019-05-27.
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