The term virtual patient is used to describe interactive computer simulations used in health careeducation. The special focus is targeted on the simulation of clinical processes with virtual patients. Virtual patients combine scientific excellence, modern technologies and the innovative concept of game-based learning. Virtual patients allow the learner to take the role of a health care professional and develop clinical skills such as making diagnoses and therapeutic decisions. Virtual patients have also been considered computer-based simulations designed to complement clinical training. The use of virtual patient programmes is increasing in healthcare, partly in response to increasing demands on health care professionals and education of students but also because they allow opportunity for students to practice in a safe environment. There are many different formats a virtual patient may take. However the overarching principle is that of interactivity—a virtual patient will have mechanisms for the learner to interact with the case and material or information is made available to the learner as they complete a range of learning activities. Interactivity is often included with questions, specific decision-making tasks, text-composition etc. and is non-sequential. Most systems provide quantitative and qualitative feedback.
Forms
Virtual patients may take a number of different forms:
Case Presentation: review of patient related cases to reinforce and apply primary medical concepts to real world situations.
Interactive Patient Scenario: multimedia patient case designed to teach clinical reasoning skills such as diagnostic test ordering and interpretation.
Virtual Patient Game: interactive clinical scenarios that take place in an entirely virtual world designed to practice team training in high risk situations.
Virtual Reality Scenarios: virtual reality based training exercises to teach procedural skills in situations of varying complexities..
High Fidelity Software Simulation: computer programs designed to allow the mimicking of human physiological conditions for a variety of clinical scenarios.
High Fidelity Manikin: realistic, programmable manikins that are capable of simulating a wide range of clinical scenarios; including simulating cardiac arrest, seizure, etc. complete with simulated, real-time vitals.
A number of different modes of virtual patient delivery have been defined:
Predetermined scenario
The learner may build up the patient or case data from observations and interactions
The learner may view and appraise or review an existing patient or scenario
The VP may be used as a mechanism to address particular topics
The learner may use a scenario or patient to explore personal/professional dimensions
Banks of patients or scenarios may collectively address broad issues of healthcare
Possible benefits
Virtual patients have been shown to be a time-efficient and cost-effective method of developing clinical reasoning skills in students through independent and repeated practice of physician tasks in a safe environment without the risk of harm to the patient or learner, which can significantly increase the mental pool of learned cases in students. Unlike simulated or real patients, virtual patients can be accessed on demand, and the user may monitor a case over several months while spending less than an hour in real-time. Furthermore, virtual patients can be endlessly replayable and can be easily modified to allow the user to explore different clinical scenarios and patient outcomes. In comparison to simulated patients, virtual patients can also be used as a method of standardized assessment that minimizes variance. Despite their efficacy, simulated patients are still a tangent and prosthesis to reality. They should be viewed as educational tools that augment existing modes and methods of clinical teaching. Over-reliance on hypothetical "average" models has been criticized for not teaching medical students to identify the significant amount of normal variation seen in the real world.
Data standards
The MedBiquitous consortium established a working group in 2005 to create a free and open data standard for expressing and exchanging virtual patients between different authoring and delivery systems. This was in part to address the problem of exchanging and reusing virtual patients and in part to encourage and support easier and wider use of virtual patients in general. This standard has been very successful and is now widely adopted, e.g. in major projects like eViP. In 2010, this standard attained status as an ANSI standard.
