Abstract
Virtual patients are computer-based simulators of patient encounters for the purposes of instruction, practice, and assessment. Although virtual patients have been around for some time they have yet to become part of mainstream medical education. A major reason for this would seem to be a lack of clarity as to what educational value virtual patients actually have. This paper argues that virtual patients should be seen as activities rather than artifacts and that activity theory can be used to generate different ways to frame scholarship in and around virtual patients. Drawing on the work of Leont’ev and Engeström this paper describes a range of perspectives based on the operations, actions, and objectives in and around virtual patients; the use of virtual patients to mediate activities; and the sociocultural context and the participants in virtual patient activities. This approach allows us to move beyond the ‘does or does not work’ discourse of much of the existing scholarship around virtual patients and, to an extent, around educational technologies as a whole. Activity perspectives, and activity theory in particular, offer new horizons for research and evaluation that address many of the limitations of intervention-based paradigms of inquiry.
Highlights
Computer-based simulations of patient encounters have been a focus of interest in the medical education literature for some time [1, 2], often but not always under the label of ‘virtual patients’ [3, 4]
It would be unusual for an experienced medical educator to mistake a problem-based learning (PBL) case for a PBL activity, so it may be a particular quirk of virtual patients that they are so often mistaken for the activities in which they are used
Activity theory is much larger and complex than I have been able to represent in this paper and it could be further explored to inform the scholarship of virtual patients
Summary
Computer-based simulations of patient encounters have been a focus of interest in the medical education literature for some time [1, 2], often but not always under the label of ‘virtual patients’ [3, 4]. Virtual mediation of the virtual patient activity objectives: how virtual patients align to a curriculum or program actions:what teachers and learners do with and around virtual patients operations: the clicks and key presses needed to make virtual patients run sociocultural context for a virtual patient activity: culture, community, rules, participants. Key questions from an objectives perspective should focus on the kinds of objectives, outcomes, and competencies that participation in virtual patient activities can afford, their efficacy and effectiveness in realizing them, and how they compare with the available alternatives This domain is concerned with how activities can be (and are) mediated by using virtual patients, primarily focusing on the ways in which they elicit or trigger learning. Research that draws on these domains (individually or in combination) may explore ‘what worked in this situation?’ or it could take a more design-based approach by asking ‘how should we design or change this situation to optimize its efficacy and efficiency?’
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