Medical education experts have grappled with the difficulties of providing learners with authentic and flexible opportunities to manage complex clinical situations in a controlled learning environment for years, but recent collaborations with eLearning experts may hold the key to a new wave of interactive courses focused on building clinical decision-making skills. The innovation that spawned from this partnership between medical experts and eLearning professionals is known as the Virtual Patient (VP) simulation model.

What is a VP simulation? Simply put, the VP model is an interactive computer simulation of real-life clinical scenarios for the purpose of medical training, education, or assessment. Pedagogical frameworks come alive for learners through the use of a narrative format embedded with decision-making scenarios and interactive multimedia components.

VP simulations are attractive to medical educators for a variety of reasons. The flexibility and interactivity of eLearning platforms allow for complex clinical cases to develop organically in the mind of the learner through dynamic conversations and exploratory decision branching. Information can be presented in an intuitive, conversational format that mimics real-life clinical encounters with patients.  The use of VP simulations online also has promise to assist with CE requirements that require evidence of performance improvement (PICME).  That is only the tip of the iceberg.

VP sims also provide individual learners with the power to make active diagnostic choices in a safe and risk-free virtual environment. These complex pedagogical encounters used to only be possible using mock patients or static textbook examples, but the ability to integrate interactive items like X-Ray images, audio heart sounds, patient charts and test results in VP sims means that core experience is now accessible to learners anytime and anywhere. Likewise, educators and examiners gain the ability to “sit in” on every experience thanks to decision-tracking and unique feedback methods available in the eLearning environment. In an interesting twist, eLearning can bring educators and learners even closer than they were before while using traditional methods.

The upsurge of eLearning has prompted the Medical Teacher, a journal that concentrates on the needs of both teachers and administrators that are engaged in training for health professions, to publish an article on guidelines for facilitating the development of virtual patient cases.  I recently came across this article, “12 Tips: Guidelines for authoring virtual patient cases” by Nancy Possel, David Fleiszer and Bruce M. Shore, and it highlights not only the many challenges that exist while creating these cases, but also attempts to provide guidelines that will hopefully remove most problems that may arise during the facilitation process.

Here is a brief overview of each guideline:

“Tip 1: Determine case content and choose a design model”: It is important that the content of the virtual patient case captures the interest of the learner while also including an ample amount of information “to encourage the learner to truly identify with people, their problems and situation” (Posel et al. 702).  The article explores the pros and cons of three different designs: linear cases, exploratory cases, and branching cases; it decides that while linear cases guarantee that all learners review the same material and should be used for beginning students, the most advanced case type, branching cases, are most realistic.

“Tip 2: Organize and storyboard your case before you start”: It is necessary that beyond organizing the content of cases, one must determine the developmental processes that will be used, along with available instructor resources.  Instructors have to target whether or not the course will be used in further teachings or will be specific to one group of individuals, and if medical teachers can be the course authors, or, instead, if an administrator needs to direct a group of designers, illustrators, technicians, and writers.

“Tip 3: Manage case complexity and match it to the case objectives”: Because virtual patient cases can provide a powerful way to teach students to obtain meaningful information from realistic situations, it is necessary to determine the level of case complexity.  Four details can help determine this case complexity: the level of the target learner, the content or story of the patient case, the knowledge area that is required in order to find the resolution, and the cognitive load that is associated with case.

“Tip 4: Include assessment and feedback from the start”: Self-assessment has proven to be a successful method in both memory recall and memory retention.  Virtual patient cases that provide a self-assessment for the student, allows the learner to view a summary of their activities.  This assessment furthers to help the teachers as monitoring of student progress, common tendencies of student treatments and rationales, and time and resources used become available information—include assessment to your virtual patient cases.

“Tip 5: Support an individualized approach to learning”: Because this individualized approach to learning leaves room for different responses from students, authors should support and recognize that each leaner approaches the case from a different perspective.  The article suggests that authors encourage learners to provide self explanations as opposed to a multiple-choice option, etc.  It is noted, however, that this type of answer is more suitable for advanced learners.

“Tip 6: Use your virtual patient case to encourage collaboration and collaborative learning”: Interoperability is key.  Ensure that virtual patient cases can be exported, shared, and available to students no matter their location.  Furthermore, collaboration amongst faculty is also emphasized.

“Tip 7: Tackle interactivity”: Interactivity should be integrated as much as possible.  Successful virtual patient cases should effectively use media, while also permitting learners to choose the questions they would like to ask the “patient”, to determine a “diagnosis” and a “treatment plan”, and if possible, to predict the outcome.  This branching design, which determines a greater amount of possible outcomes, allows for the greatest level of interactivity, though, again, this is the hardest case to successfully create.

“Tip 8: Anticipate and navigate”: Keep the interface simple.  Virtual patient cases that have richly layered and compelling information can be disengaging if the interface is confusing.  Use templates and keep the cases as visually alike as possible.  Navigation aids that position the learner in the lesson are very helpful.

“Tip 9: Ensure privacy and confidentiality of data”: It is important to respect the privacy and confidentiality of both a patient whose case details may be used in the creation of the patient case study, as well as the personal information and detailed report of the answers given by the learner.  It is the law to obtain written patient consent if details are from a specific and real case.  It is also good to provide, in writing, if any third party company will have access to student’s grade information.

“Tip 10: Integrate evaluation”: It is important to continuously develop and improve virtual patient cases.  Whatever methodology is used should provide information to teachers and administrators about common answers, and whether or not the intended information is being relayed.

“Tip 11: Recognize the potential of expert traces and the use of script concordance”: Beyond using the virtual patient cases to teach students in the health professions, administrators and health experts should recognize the potential that the virtual patient case brings.  Traces of unique cases have the possibility to demonstrate rare cases along with common diagnoses from health professionals.  These can be used to form good practice models as well as be used in different research opportunities.

“Tip 12: Choose the right authoring application for your case”: With the growing number of eLearning software producers (Full Disclosure: Web Coursework’s markets a branching authoring template within its CourseCreate produce), there is a large amount of accessible applications to choose from; some are open source or “free”.  It is important to research each authoring tool and software company, learn of its resources and skills, as well as its willingness to support the teachers through the process.

I believe that following the basic guidelines of this article will help to create a good basic plan for what you want to accomplish through the use of virtual patient case development.  I do, however, want to stress “Tip 12” and the importance of choosing an eLearning development company who has the resources and experience in this type of learning tool.  I am looking forward to the influx of virtual patient cases from the clients of Web Courseworks Ltd. and plan to integrate these tips into our planning process.

Managing eLearning is written by the Blog team at Web Courseworks which includes Jon Aleckson, Steve Van Horn and Jillian Bichanich.  Ideas and concepts are originated and final copy reviewed by Jon Aleckson.