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Cited by 570Simulation-Based Education in HealthcareInnovations in Medical EducationSurgical Simulation and Training

Computerized Virtual Patients in Health Professions Education: A Systematic Review and Meta-Analysis

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Cook, David A., Erwin, Patricia J., Triola, Marc M.·2010·Academic Medicine
DOI 10.1097/acm.0b013e3181edfe13
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Abstract

PURPOSE: Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design. METHOD: The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model. RESULTS: Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I²>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes. CONCLUSIONS: Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed.

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Authors
Cook, D. A., Erwin, P. J., & Triola, M. M.
Affiliations
Mayo Clinic (US)
Corresponding author
Cook, David A.
ORCID
Venue
Academic Medicine
Publisher
Oxford University Press (OUP)
Published
2010-10
Volume
85
Issue
10
Pages
1589-1602
ISSN
1040-2446 (ISSN-L)
DOI
10.1097/acm.0b013e3181edfe13
OpenAlex
W2009683697
Cited by
570
References
82
Citations by year
2026: 38 · 2025: 36 · 2024: 31 · 2023: 37 · 2022: 52 · 2021: 46 · 2020: 46 · 2019: 45 · 2018: 27 · 2017: 38 · 2016: 39 · 2015: 32 · 2014: 25 · 2013: 28 · 2012: 34
FWCI
2.44
Type
journal article
Language
en
Open access
Locations
  • Academic Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Health Sciences › Medicine › Surgery › Surgical Simulation and Training
Keywords
virtual patients, health professions education, computer-assisted instruction, clinical reasoning, knowledge outcomes, instructional design, feedback, advance organizers, contrasting cases, learning mastery, student satisfaction
MeSH terms
Clinical Competence, Computer-Assisted Instruction, Computer Simulation, Diagnostic Errors, Health Occupations, Humans, Teaching, User-Computer Interface

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