Improving student learning through virtual means

Virtual Patients are used in medical education but research evidence to guide their use is still modest. This research was designed to test the hypothesis that the use of Virtual Patients does not significantly improve the development of clinical knowledge, professional identity and reflective skills in undergraduate medical students. The research questions addressed were: (i) Based on an evaluation of current undergraduate training, is there a need to supplement the traditional paediatric curriculum to ensure that all students receive equivalent educational experiences?: (ii) Are Virtual Patients an effective learning tool in undergraduate education? Following an evaluation of the current curriculum, an online Virtual Patient model, and an instrument for assessing it, were developed and assessed in 181 undergraduate medical students and 25 postgraduate trainees. A multi-level mixed method approach (logbook reviews, focus groups, questionnaires, MCQs, problem-based questions, professional dilemma cases and semi-structured observer ratings) was used to assess the impact on clinical knowledge, professional identity and reflective capacity. The current curriculum did not provide adequate exposure to essential infrequent cases in clinical practice and students were not receiving equivalent educational exposure. Virtual Patients provided an acceptable learning tool and the measure developed for evaluating their impact was practical, reliable and valid. Compared to the traditional curriculum alone, exposure to Virtual Patients significantly improved short-term learning and long-term knowledge retention. Providing students with written feedback during the module improved their learning about professional norms and their ability to apply such norms to clinical scenarios. A semi-structured, observer-rated instrument was shown to have acceptable psychometric properties as a measure of students’ responses to videos designed to evoke reflection. Female, postgraduate and academically higher performing students were significantly more likely to engage in deeper reflection. Guided reflection improved students’ ability to reflect, but may not encourage students who do not have a natural tendency to reflect, to engage in the process. In conclusion, Virtual Patients are acceptable learning tools for improving clinical learning while simultaneously promoting the development of professionalism and reflective abilities in undergraduate medical students.