Design and implementation of virtual patients for learning of clinical reasoning

Introduction: Virtual Patients (VP) are electronic interactive patient cases. The aim of this PhD project was to explore how to improve the design and implementation of VPs to foster learning of clinical reasoning. Methods: This PhD report is based on five consecutive studies. Using focus groups among clerkship students, we explored design features of VP. A modified Delphi study among VP experts was used to establish a VP design typology. Validity evidence was established for a questionnaire to evaluate VP design from the student perspective. In student focus groups, we explored features on how to implement VP into a clerkship. Further, we explored students’ perception of different exam formats, in an assessment of a clerkship which includes learning with VP, by focus groups, and examined whether their psychometric properties differ. Results: Aspects to improve VP design: 1. using instructional design criteria such as ensuring an appropriate level of difficulty, authenticity, interactivity, feedback, and focusing on relevant learning points, ; 2. implementing virtual coaching on clinical reasoning into the VP, such as asking for discriminating and confirming features, and 3. providing theory-guided instruments for systematic improvements such as the developed VP typology and VP design questionnaire. . Aspects to improve VP implementation: 1. sequencing VP and other educational activities according to complexity, and aligning ; 2. instruction and 3. assessment with the use of VP. . Conclusion: Our results are in line with insights outside of VP research. Our studies demonstrate how VP can be designed, systematically further improved, and implemented to foster learning of clinical reasoning.