Exploring undergraduate nursing student interactions with virtual patients to develop ‘non-technical skills’ through case study methodology

BACKGROUND: Virtual patients are a recent addition to the educational arsenal to develop non-technical skills in undergraduate health professionals. The Virtual Simulated Patient Resource (www.vspr.net.au) is a web-based resource that uses branching, narrative virtual patients to develop knowledge, attitude and practice of all categories of non-technical skills in undergraduate health professionals. However, there is limited literature exploring how the interaction with a virtual patient influences the development of knowledge, attitude and practice of non-technical skills in undergraduate nursing students. METHODS: An intrinsic case study method, using focus groups and individual interviews, enabled exploration of the experience of undergraduate nursing students when interacting with a virtual patient to develop non-technical skills. Purposive sampling identified participants to address the research question. Framework analysis supported by a codebook enabled deductive and inductive data analysis. RESULTS: Forty-five first-year and 31 third-year students consented to participate. Findings indicated that the different years interacted differently with the virtual patients. Four themes were recognised in the data: how the virtual patients enabled learning non-technical skills, learning surrounding the virtual patient encounter, changing the way students perceive practice and potential limitations to learning. CONCLUSIONS: Interactions with virtual patients influence learning knowledge, attitudes and practice of non-technical skills in undergraduate nursing students via authenticity in the virtual patient interaction, socialisation to the professional role, vicarious learning and learning by making mistakes. Potential limitations to learning from virtual patient interactions include fear, overconfidence, groupthink and confusion. To manage limitations to learning, facilitation approaches, opportunities for reflection, constructive feedback and debriefing may be key. This study demonstrates learning non-technical skills via interactions with virtual patients can change the way students perceive practice, with learning transferable to the clinical setting to support safe and competent patient care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s41077-019-0088-7) contains supplementary material, which is available to authorized users.