Effectiveness of AI-enhanced virtual patients for psychiatric interview training in health professions education: a meta-analysis

BackgroundVirtual 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.ObjectiveThe 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.MethodsWe 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.ResultsA 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, I2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=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.ConclusionsLow 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.

The field of health professions continues to struggle with the impact of increasing practitioner and educator shortages. Health professions education is also faced with the issues of limited clinical placements and an increasing demand for online education. To address these issues, health professions educators have increasingly turned to simulations to provide experiential learning in safe, controlled environments. One of the newest simulation technology innovations to emerge is that of virtual patient simulations. This chapter reviews the context in which virtual patients have emerged, the range of virtual patient technologies available, and the ways in which health professions educators currently use virtual patient simulations.

Virtual patient (VP) simulations can offer educational benefits in healthcare disciplines by supplementing traditional training approaches and enabling the acquisition of clinically relevant skills and knowledge. Although the existing body of literature covers VP usage in healthcare professions such as medicine and nursing, there are no current reviews highlighting the use of VP simulations in the field of psychology. The aim of this scoping review was to examine the educational impact of VP simulations on learning and user experience outcomes among psychology students and clinicians. Cochrane Library, PsycINFO, PubMed, Scopus, ERIC, IEEE Xplore and SAGE journals databases were searched up to June 2023. Studies of all designs and comparator groups were included if they appraised the effectiveness and user experience of any VP simulation aimed at addressing learning outcomes among psychology students and clinicians. A total of nine studies met the inclusion criteria. Overall, VP simulations hold promise in facilitating improvements in skill acquisition, clinical competence and knowledge. Although user impressions were largely positive, there were notable technical challenges that hampered their usability and learning effectiveness. Further research and standardisation of VP simulations are needed to draw definite conclusions about the effectiveness of these simulations in psychology education. Implications for practice or policy: Educators could incorporate VP simulations into psychology curricula to enhance the learning experience of students and impact skill and knowledge acquisition and clinical competence. Higher education policymakers could advocate for further research and standardisation of VP simulations in psychology education to establish evidence-based guidelines, fostering a more comprehensive and consistent educational environment for psychology students and clinicians. Course developers or coordinators could establish a standardised approach to assess core professional competencies required for practice.

Background:Virtual patient simulations are interactive, computer-based cases. We designed scenarios based on the McGill Simulation Complexity Score (MSCS), a previously described objective complexity score. We aimed to establish validity of the MSCS and introduce a novel learning tool in trauma education at our institution.Methods:After design of an easy and difficult patient scenario, we randomized medical students and residents to each perform 1 of the 2 scenarios. We conducted a 2-way analysis of variance of training level (medical student, resident) and scenario complexity (easy, difficult) to assess their effects on virtual time, the number of steps taken in the scenario, beneficial and harmful actions, and the ratio of beneficial over harmful actions.Results:Virtual patient scenarios were successfully designed using the MSCS. Twenty-four medical students and 12 residents participated in the easy scenario (MSCS = 3), and 27 medical students and 12 residents did the difficult scenario (MSCS = 18). Though beneficial actions were similar between students and residents, sudents performed more harmful actions, particularly when the scenario was difficult. One virtual patient died in the easy scenario and 3 died in the difficult one (all medical students). Performance varied with level of complexity and there was significant interaction between level of training and number of steps, as well as with number of harmful actions. Decreasing performance with increasing level of complexity, as defined by the MSCS, suggests this score can accurately quantify difficulty.Conclusion:We established validity of the MSCS and showed its successful application on virtual patient scenario design.

The aim of the work is to evaluate the efficiency of theoretical knowledge and practical skills acquisition by intern doctors using the body interact virtual patient simulator in distance (offline) and traditional (online) form of education. Materials and methods. The study involved 22 interns in the second year of study of the specialty “Internal Diseases”. 17 of them studied in offline format, 5 – in distance (online) format. The efficiency of theoretical knowledge acquisition was evaluated based on the results of the Integrated License exam “KROK 3. General Medical Training”. The efficiency of practical skills acquisition was determined by passing scenarios of providing medical care using the virtual patient simulator “Body Interact”. Results. It has been established that the effectiveness of traditional (offline) and distance (online) learning is comparable in terms of theoretical knowledge acquisition which is evidenced by the comparative results of passing the Integrated License exam “KROK 3. General Medical Training”. The results of passing the state license integrated exam “KROK 3. General medical training” and the virtual patient “Body Interact” had no correlation, which indicates the insufficient representativeness of the test assessment regarding the practical skills acquisition. Traditional (offline) learning is more effective in practical skills acquisition, which is confirmed by the better results of passing scenarios of providing medical care using the virtual patient program “Body Interact” in the group of traditional form of education compared to the group of online learning. Conclusions. Utilizing virtual patient simulation technology such as “Body Interact” in the training of intern doctors not only enhances the acquisition of theoretical educational material but also offers an opportunity to practice practical skills. This is particularly valuable in light of resource constraints resulting from COVID-19 and martial law. Implementing the “Body Interact” virtual patient technology into daily educational practices, especially in the context of distance learning, is advisable.

Virtual and human patient simulation methods offer an effective way to increase patient safety, reduce the incidence of errors, and improve clinical decision-making skills. The study was conducted to compare the effects of virtual and human patient simulation methods on performance, simulation-based learning, anxiety, and self-confidence with clinical decision-making scores of nursing students. A quasi-experimental, stratified, randomized controlled study was conducted with third-year nursing students. The students (n = 166) were divided into experimental and control groups. The difference between the pretest-posttest scores of intragroup nursing anxiety and self-confidence with clinical decision-making and total and sub-scale scores of in-group simulation-based learning were statistically significant ( P < .05). Performance scores were found to be statistically significantly high in the virtual patient simulation group ( P < .001). It was determined that virtual patient simulation was superior to other methods in terms of nursing anxiety and self-confidence with clinical decision-making, simulation-based learning, and performance scores.

Research Training in Psychiatry Residency: Strategies for Reform

Virtual patients are an active learning pedagogical tool which simulate clinical scenarios in a three-dimensional environment. Their use in pharmacy education is under-researched in comparison to other healthcare professions. In the United Kingdom, pre-registration training refers to a year of workplace based training which pharmacy graduates must complete prior to professional registration as pharmacists. This study aimed to evaluate pre-registration pharmacists' perceptions on the integration, usefulness and enjoyment of completing virtual patient simulations or non-interactive case studies as part of their training. Pre-registration trainees completed three virtual patient simulations or three non-interactive case studies on the topics of: emergency hormonal contraception, renal function and childhood illnesses. Telephone interviews were conducted with twenty pre-registration pharmacists, exploring their perspectives on the use of the virtual patient or non-interactive case studies. Data was analysed using the five-stage framework approach. Four main themes emerged from the data: case study design; usefulness of the case studies as a training tool; support in pre-registration training; utility of the learning tools. Trainees also identified technical issues they had experienced while completing the virtual patient simulations, specifically with keyword recognition. Pre-registration trainees who used the virtual patients provided comments relating to the novelty, realism and enjoyment in completing them. Trainees in both groups reported developing knowledge and skills from completing the case studies; those who used the virtual patient commented on the development of communication skills and an increase in confidence for practice and those who used the non-interactive cases focused on knowledge acquisition and numeracy. Participants were enthusiastic about virtual patients as a novel training tool which provided an opportunity for learners to practice realistic scenarios in a safe environment. Virtual patients offer the potential to 'bridge the gap' in pharmacist pre-registration sector-related training variation, promote learning through reflection on doing and increase overall preparedness for practice.

Virtual patients are an active learning pedagogical tool which simulate clinical scenarios in a three-dimensional environment. Their use in pharmacy education is under-researched in comparison to other healthcare professions. In the United Kingdom, pre-registration training refers to a year of workplace based training which pharmacy graduates must complete prior to professional registration as pharmacists. This study aimed to evaluate pre-registration pharmacists’ perceptions on the integration, usefulness and enjoyment of completing virtual patient simulations or non-interactive case studies as part of their training. Pre-registration trainees completed three virtual patient simulations or three non-interactive case studies on the topics of: emergency hormonal contraception, renal function and childhood illnesses. Telephone interviews were conducted with twenty pre-registration pharmacists, exploring their perspectives on the use of the virtual patient or non-interactive case studies. Data was analysed using the five-stage framework approach. Four main themes emerged from the data: case study design; usefulness of the case studies as a training tool; support in pre-registration training; utility of the learning tools. Trainees also identified technical issues they had experienced while completing the virtual patient simulations, specifically with keyword recognition. Pre-registration trainees who used the virtual patients provided comments relating to the novelty, realism and enjoyment in completing them. Trainees in both groups reported developing knowledge and skills from completing the case studies; those who used the virtual patient commented on the development of communication skills and an increase in confidence for practice and those who used the non-interactive cases focused on knowledge acquisition and numeracy. Participants were enthusiastic about virtual patients as a novel training tool which provided an opportunity for learners to practice realistic scenarios in a safe environment. Virtual patients offer the potential to ‘bridge the gap’ in pharmacist pre-registration sector-related training variation, promote learning through reflection on doing and increase overall preparedness for practice.

“Ready to Practice?”(R2P) is a virtual patient simulation designed for undergraduate medical and pharmacy students. After initial prototyping, R2P developed into a screen-based virtual patient (VP) simulation with an intuitive interface using photorealistic images of people and places with speech bubbles and decision menus. We describe the design of the VP, findings from student experiences with the software, and the potential of VPs for interprofessional learning. We used a mixed methods study to assess students’ perceptions of the VP as a learning tool. Qualitative data were gathered using semi-structured interviews and observations, and quantitative data through the Readiness for Interprofessional Learning Scale (RIPLS) and an evaluation questionnaire. Overall, participants showed significantly improved RIPLS scores after participation in the simulation (78.78 to 82.25, p &lt; 0.0001), including in the Positive Professional Identify domain (p &lt; 0.001). Students also showed significant improvement in RIPLS scores in the Teamwork and Collaboration domain when pharmacy and medical students were working together in interprofessional pairs (40.75 to 43.00, p &lt; 0.006) but not when working alone (n.s.). Five themes emerged from interviews where participants identified specific interprofessional insights into each other’s roles and skills. Students found the VP engaging and valuable for their learning and their understanding of teamwork.

Psychiatric Resident Perceptions of Competency in the Management of Social Isolation and Grief in Geriatric Patients

Intimate partner violence (IPV) is a major public health concern, and healthcare staff must be competent in identifying and responding to IPV. However, training opportunities to handle such cases remain limited. This study examined whether integrating a virtual patient (VP) simulation into nursing education improves confidence, self-efficacy, and knowledge in addressing IPV. In this randomized controlled trial (RCT), fifty-four nursing students (87% female) were randomly assigned to an intervention group (n = 29) receiving a VP module in addition to standard training, or a control group (n = 25) receiving standard training only. Students were assessed at baseline and after each educational activity: (1) a web-based module (both groups) (2), VP training for the intervention group while the control group had no corresponding module, and (3) a teacher-led seminar (both groups). Primary outcomes were confidence in asking about IPV, general self-efficacy, self-assessed knowledge, and objective knowledge. Linear mixed-effects models were used to analyse changes over time. The VP group showed a significantly greater improvement in confidence in asking about IPV (between-group difference + 1.26, 95% CI 0.40–2.15; p = 0.010). Objective knowledge scores were consistently higher in the VP group, although the group × time interaction was not significant. General self-efficacy and self-assessed knowledge improved similarly in both groups. Integrating an interactive VP simulation into a nursing curriculum enhances learners’ confidence in addressing IPV and is associated with higher levels of factual knowledge. VP simulations may represent a scalable complement to conventional teaching for complex and sensitive clinical topics. ClinicalTrials.gov ID: NCT06706011.

Evaluation of a virtual agent to train medical students conducting psychiatric interviews for diagnosing major depressive disorders

Research Training in Psychiatry Residency: Strategies for Reform

Medical simulation has become an integral part of medical student education. There is a limited body of literature comparing virtual and high-fidelity simulation in terms of effectiveness and student perception. A total of 130 medical students at the University of Rzeszów participated in this cross-sectional study. The respondents were divided into two groups: students who completed a selected scenario using a virtual patient (Body Interact) and students who completed a scenario using traditional high-fidelity (manikin-based) simulation (HFS). After completing the scenario, students filled in the following questionnaires: the Simulation Design Scale (SDS), the Educational Practices Questionnaire (EPQ), the Student Satisfaction and Self-Confidence in Learning Scale (SSCL) and a customized survey questionnaire. The study found no significant difference in the effectiveness of HFS between students exposed to either type of simulation. Detailed analysis within specific categories - problem-solving, teamwork, and active learning - also showed no significant differences between virtual and traditional HFS. Furthermore, there were no notable differences between virtual and traditional simulations regarding specific aspects such as satisfaction with learning, self-confidence in learning, and expectations. However, within the virtual simulation group, females rated active learning significantly higher. Students aged 24-33 rated satisfaction with learning, self-confidence, overall effectiveness and perception of HFS, problem-solving, and active learning more favorably. Additionally, the levels of perceived effectiveness and satisfaction of higher years students with HFS increased. Virtual patient simulation and traditional HFS foster the development of practical skills, as well as soft skills of medical students in challenging situations.