Virtual patient design and curricular integration evaluation toolkit

Abstract

Context and setting Virtual patients (VPs) are used increasingly in medical education, especially to teach clinical reasoning. Under the electronic virtual patients (eVIP) Project (http://www.virtualpatients. eu), which is co-funded by the European Union, 320 VPs will be developed and repurposed to different cultures, languages and educational settings. Both the design and the curricular integration of VPs (blended learning) seem to be essential for their success. Why the idea was necessary To date, no standardised instruments to evaluate the design and curricular integration of VPs have been published. Extensive translational research at the practitioner level could add substantially to the limited knowledge we have about the affordances and limitations of VP design and curricular integration with regard to the teaching of clinical reasoning. What was done In order to enable adequate comparisons between the designs and curricular integration of VPs in different institutions, we developed four instruments with a special focus on clinical reasoning: (i) a checklist enabling reviewers such as teachers and authors to characterise the design of a VP in detail; (ii) a questionnaire assessing students’ experiences with VPs for learning clinical reasoning skills; (iii) a checklist enabling reviewers to characterise the curricular integration of VPs in detail, and (iv) a questionnaire assessing students’ experiences with the curricular integration of VPs in relation to clinical reasoning skills. The following sources informed the development of the VP design instruments: (i) literature on strategies to teach clinical reasoning; (ii) literature on the design of teaching cases, and (iii) the results of a focus group study exploring students’ opinions on the ideal design of VPs for learning clinical reasoning skills. The resulting student questionnaire consists of 14 questions clustered into the following five main categories: (i) authenticity of patient encounter and consultation; (ii) professional approach in the consultation; (iii) coaching during consultation; (iv) learning effect; (v) overall judgement. The following sources informed the development of the VP integration instruments: (i) literature on a community of inquiry model; (ii) a blended learning framework; (iii) criteria for categorising didactic scenarios; (iv) results of a focus group study exploring students’ opinions on the ideal curricular integration of VPs for learning clinical reasoning skills, and (v) literature concerning educational strategies to teach clinical diagnostic reasoning. The resulting student VP integration questionnaire consists of 20 questions, clustered in five main categories: (i) teaching presence; (ii) cognitive presence; (iii) social presence; (iv) learning effect, and (v) overall judgement. The comments resulting from the review of the instruments by the eVIP Project partners were used to refine them. The instruments were then tested on the target groups, further refined and again tested and refined. Responses are given on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Each instrument also includes open-ended questions. The multilingual instruments are available via the eVIP website (http://www.virtualpatients.eu/resources/ evaluation-tool-kit/). Evaluation of results and impact The first studies using the above-mentioned instruments indicate that the instruments are suitable for comparing and improving the design and curricular integration of VPs across national borders. We are looking forward to receiving feedback from others who have used the instruments.