Virtual Patient Application Research Articles

Development and operationalisation of a mixed reality interactive virtual patient application for online nursing Objective Clinical Examinations

During the 2020 iteration of a Bachelor of Nursing Clinical Health Assessment skills course delivered in Singapore, the sudden cancellation of all face-to-face classes due to the COVID-19 pandemic resulted in innovative strategies being required and quickly created to enable students to successfully complete clinical skills laboratories and Objective Structured Clinical Examinations (OSCEs) online. However, the realism of the experience was rudimentary. At the end of the 2020 teaching semester, and the possibility that the next iteration of the course would also need to be online, it was decided to explore technologies to provide a more realistic and interactive user experience for the 2022 iteration of the Clinical Health Assessment skills course and particularly for the OSCEs. A research project was initiated in 2021, to develop and test the use of virtual or mixed reality applications for online simulated learning and clinical skills assessment. This paper discusses the development and operationalisation phases of a mixed reality interactive virtual patient application used for online OSCEs in a Clinical Health Assessment skills course.

The application of simulators in dental medicine students’ training

The simulation training of dental students has developed rapidly in recent years. The development of new technologies and virtual reality are an indispensable part of the education of dental students. The introduction of simulators in the education of dental students supports the harmonization and integration of knowledge from the pre-clinical and clinical education of the students. The opportunity to train on simulators in the field of dentistry helps future dentists to put their theoretical knowledge into practice and gain confidence to work with patients. Simulation operators are included in the students’ pre-clinical exercises. In recent years, computer-based simulation and virtual reality-based simulation have become an indispensable part of the pre-clinical training of dental students. Nowadays, there is a wide range of dental simulator models with different features and functions. Some of them are: DentSim, Haptic Technology, Moog Simodont Dental Trainer, HapTEL, the Geneva System, Robotic Patients for Virtual Dental Patient Simulation, Virtual Reality Dental Training System, PerioSim, the VirDenT system, the Forsslund System, DSE TM Expert Dental Simulation Units—KaVo Dental. In addition to student training, these simulators can also be used to assess learner performance or quality control various teaching methods. The development of new technologies marks successes in the development and improvement of the simulators applied in the training of dental medicine students. The virtual patient application provides many opportunities to recreate clinical situations in virtual reality and will make learning even more rewarding and interesting for dental students.

The Development and Application of Virtual Patient in Clinical Training: The New Horizon for Nursing Education

Clinical problem-solving training that involves hands-on practice with patients is regarded as an important yet challenging aspect of medical education. A majority of schools around the world have suspended face-to-face classes because of the COVID-19 pandemic. Although remote digital classes represent a widely adopted alternative approach to education, the format of these classes is poorly suited to clinical learning and examination. With advances in virtual technology using natural language processing and multimedia, virtual patients bring vivid clinical encounters with records and feedback and are able to facilitate learning in the realm of clinical problem-solving. Virtual patients may be used to replace paper cases, human patients, and standardized patients in clinical education. The related applications include virtual problem-based learning in group training, clinical skill examination, and cloud-based virtual training. Integrating online meeting systems with virtual patient systems effectively overcomes the barriers of learning related to distance and isolation. The cloud model is especially important in the pandemic period, as this model allows clinical team work training to continue outside of actual hospital settings. In conclusion, technology-assisted simulation has innovated clinical training and assessment. The success of technology-enhanced education relies on its alignment with students' level of training and targeted learning objectives, especially when coupled with observation and feedback. The success of clinical education will guarantee the improvement of students' clinical competency.

Effectiveness of virtual patients in teaching clinical decision‐making skills to dental students

The aim of this study was to investigate the effect of virtual patient-based training on the clinical decision-making ability of dental students. This quasi-experimental study with pretest and posttest design was conducted on 76 (2015 admitted) dental students of Shiraz Dental School in 2018-2019. The study samples were randomly divided into 2 groups: intervention (web-based virtual patient training=36) and control (face-to-face case-based training, n=40). The data collection tools in this study included a questionnaire consisting of 2 sections: demographic information and procedural knowledge. The key-feature test was used to measure procedural knowledge and problem-solving ability in students. Content validity was confirmed by 7 faculty members. Statistical analysis was carried out using SPSS Statistics version 23.0. Descriptive statistics were used to describe the samples, Independent-t test was used to compare the scores between the 2 groups, and repeated measures ANOVA was used to assess the effect of time on the training provided. P<0.05 was considered as the acceptable significance level. The mean clinical-decision-making score in the intervention group (11.3 ± 88.88) was more than the control group (8.2 ± 45.54) in Posttest 1 (1 week after intervention), and the difference was statistically significant (P<0.001). Besides, the scores in the control group (8.2 ± 45.54) rose more significantly than the intervention group (11.3 ± 0.86) in Posttest 2 (1 month after intervention) (P<0.001). The results of the present research showed that application of virtual patient (VP)-based training can improve learning and clinical decision-making ability of dental students. Moreover, group discussions in physical classrooms should be held alongside VP programs in order to ensure the maximum retention of the topics learned.

The application of virtual patient in gynecology and obstetrics clinical teaching

Gynecology and obstetrics is a theoretical and practical subject. It is an important goal for the medical students to develop the clinical thinking ability and operating skills and apply them in the diagnosis and treatment of disease. To overcome the limited teaching resources, the rare clinical skills opportunities caused by doctor-patient relationship tension, virtual patient (VP) combined with clinical teaching was applied in clinical teaching, which can reproduce the real, and bring the students to the role of the clinician, enrich the content of the obstetrics and Gynecology clinical teaching. Along with the reform the teaching faculty with high quality was established, their clinical teaching experiences and innovative thinking were improved significantly. The results were evaluated by means of clinical comprehensive ability test. The present study aimed to establish virtual patients of OBGYN (virtual patient, VP) learning to promote learning of basic knowledge, clinic skills, and thinking ability. Key words: Clinical teaching; Gynecology and obstetrics; Virtual patient

Resident Perceptions and Cost Analysis of a Virtual Patient Application for Anesthesia-Related Critical Incidents

Since there are limitations on the amount of time residents can spend in full-scale simulation sessions, we introduced a virtual patient application into our anesthesiology program to su pplement mannequin-based simulation sessions. Previous investigations have demonstrated a positive educational effect for virtual patients, but suggest that further research is needed to clarify how to effectively implement virtual patients in medical education. We present a description of the implementation of a virtual patient application in our residency training program, the residents' evaluation of their experience with the application, and a cost analysis of incorporation of the application into the residency program, in order to determine the residents' perceptions of the value and estimate the cost of using virtual patients in anesthesia residency training. For 20 years all anesthesia residents in our training program have been required to complete ten simulated cases using a virtual patient application prior to the end of their CA-1 year. Residents are given access to the anesthesia virtual patient application on departmental computers and also on their own personal computers. Residents complete 10 required cases on their own or in pairs and send printed case logs to an anesthesia attending for review and feedback. Participants anonymously completed surveys rating their perceptions of the virtual patient application's effectiveness. Cost to implement this program was estimated retrospectively. In total, 404 residents completed 3593 virtual patient cases in approximately 2800 hours. RESIDENT PERCEPTIONS: 252 residents completed the anonymous survey (62%). Almost all the respondents (97%) rated the virtual patient curriculum as worthwhile; 88% rated the application to be realistic; 97% felt better prepared to handle anesthesia-related critical incidents; 87% stated they had at least one event in a real operating room similar to an emergency presented in the virtual patient application, and 40% stated they experienced more than one such event. 93% were stimulated to read about management of anesthesia-related critical incidents after using the application. COST-ANALYSIS: The estimated cost to implement the screen-based curriculum for 20 years was $44,000 including the cost of software and faculty time. Therefore the cost for the 2800 hours of virtual patient simulation was about $16 per hour. The anesthesia virtual patient application was easily incorporated into our residency training program at the University of Washington. The application was well-received by anesthesia residents, helped them feel more prepared to manage critical incidents, and stimulated them to read more concerning the management of anesthesia-related critical incidents. The virtual patient application is far less expensive than mannequin-based simulation and much more available. Therefore, virtual patients should be considered an easily accessible supplement to mannequin-based simulation training.

As time goes by: Stakeholder opinions on the implementation and use of a virtual patient simulation system

Background: Stakeholder opinions on the implementation of a particular virtual patient application might prove important for decision-making and implementation efforts in general. This study aimed to capitalize on experiences originated from two post-implementation settings of Web-based Simulation of Patients (Web-SP).Method: We conducted a cross-sectional survey of stakeholder opinions (39 students, teachers, course directors, and university leaders) on the implementation and use of Web-SP in Colombia and Sweden, using a mixed method approach.Results: The respondents did not show equal preference in rating the ranking of the order of importance included in the variables (Friedman's Chi square: 26.5 to 115.1, df = 6, p < 0.001, Kendall's coefficient of concordance ranging from 0.11 to 0.50). The answers provided as free comments supported the statistical findings on the importance of end-user customization, need for authenticity in software design, and use of virtual patient simulations in a curricular context, for clinical reasoning development.Conclusions: Virtual Patient design should allow extensive editing, support case authenticity and enhance clinical reasoning abilities, in an effort for ensuring accountability and sustainable development of the field.

Virtual Patient Simulation at U.S. and Canadian Medical Schools

"Virtual patients" are computer-based simulations designed to complement clinical training. These applications possess numerous educational benefits but are costly to develop. Few medical schools can afford to create them. The purpose of this inventory was to gather information regarding in-house virtual patient development at U.S. and Canadian medical schools to promote the sharing of existing cases and future collaboration. From February to September 2005, the authors contacted 142 U.S. and Canadian medical schools and requested that they report on virtual patient simulation activities at their respective institutions. The inventory elicited information regarding the pedagogic and technical characteristics of each virtual patient application. The schools were also asked to report on their willingness to share virtual patients. Twenty-six out of 108 responding schools reported that they were producing virtual patients. Twelve schools provided additional data on 103 cases and 111 virtual patients. The vast majority of virtual patients were media rich and were associated with significant production costs and time. The reported virtual patient cases tended to focus on primary care disciplines and did not as a whole exhibit racial or ethnic diversity. Funding sources, production costs, and production duration influenced the extent of schools' willingness to share. Broader access to and cooperative development of these resources would allow medical schools to enhance their clinical curricula. Virtual patient development should include basic science objectives for more integrative learning, simulate the consequences of clinical decision making, and include additional cases in cultural competency. Together, these efforts can enhance medical education despite external constraints on clinical training.